Testicular torsion in undescended testis:A persistent challenge

Objective:To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature.Methods:The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed.The medical records included age at presentation,medical history,physical examination,operative findings and the results of follow-up.The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration.Results:In six cases the testis was preserved and orchiopexy was performed,while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case.Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h.From six patients treated by orchiopexy,two patients suffered from testicular atrophy at a mean of 24 months.Conclusion:Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage.The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.

Presentation of Undescended Testis to a Paediatric Referal Centre in Jos

Background: Undescended testis is the commonest disorder affecting the male urogenital tract. Late presentation has significant socio-medical impact on the individual’s quality of life. Aim: To evaluate the presentation of undescended testis and age at surgery in our centre. Methods: A 9-year retrospective analysis of the clinical records of patients < 18 years managed for undescended testis in our centre. Results: A total of 73 records were analysed, 58 (79.5%) presented > 1 year. Median age at presentation was 4 years, range 1 day - 16 years. Males 73 (100%), only 17 (23.3%) were referred by health personnel, while 56 (76.7%) self-referred. Commonest site involved was the left 33 (45.2%), 29 (39.7%) right and 11 (15.1%) bilateral. There were 13 (17.4%) who had associated congenital malformations. Hypospadias 7 (53.8%), isolated micropenis 4 (30.8%) and 1 each (7.7%) had myelomeningocele and hernia. Median age at presentation for bilateral involvement was 30 days, with associated hypospadias was 12 days, while those with isolated micropenis was 7.5 years. Median age at surgery for bilateral involvement was 2 years, overall median age at surgery was 4 years. Surgery Findings: Supra-scrotal testis 47, canalicular 25 (34.2%), and bilateral abdominal 1 (1.4%). Outcome: Wound infections 4 (5.5%), scrotal wound breakdown 1, Recurrence 3 and testicular atrophy 1. Conclusion: Our patients presented very late beyond the recommended age for surgery, evaluating for DSD also contributed to delay in intervention even when these patients presented early. We advocate for early screening at birth, during routine child immunization and school enrollment, with prompt referral.

Laparoscopic Management of Undescended Testis: Results and Outcomes in a Pediatric Population

Aim: This study aimed to evaluate the results of the laparoscopic treatment of high and intra-abdominal undescended testes. Methods: A retrospective study was carried out from 2014 to 2021 at the Centre medico-chirugicale d’urologie in Douala. We consulted the clinical records of 27 patients aged 6 - 15 years who underwent laparoscopic orchiopexy at our hospital. We included patients with unilateral or bilateral undescended testes as detected by palpation and excluded patients with incomplete clinical records. The data collected were entered into Microsoft Excel 2016 and exported to Epi info 7 for analysis. Continuous variables were presented as mean values and standard deviations while categorical variables were presented as frequencies and percentages. The threshold for statistical significance was set at p Results: The ages of the 27 participants ranged from 6 years to 15 years, with a mean age of 10.22 ± 2.68 years. Hypospadias was an associated abnormality in 7.41% of participants. The mean duration of the surgical procedure was 80.56 ± 30.30 minutes. The overall success rate of the laparoscopic procedure was 95.83%. The mean duration of postoperative hospital stay was 26.67 ± 7.69 hours. The only postoperative complication we encountered was testicular atrophy, which occurred in 7.41% of participants. All our patients underwent single-stage laparoscopic procedures. Conclusion: Laparoscopy, which is the technique of choice for the diagnosis and management of undescended testis, is more rapid, more effective, and characterized by a shorter hospital stay and fewer postoperative complications compared to open surgery. Single-stage procedures are as effective and safe as two-stage procedures.

Splenogonadal fusion-limb deformity syndrome: a rare but important cause of undescended testis

Background: Splenogonadal fusion is a rare congenitalanomaly which is characterized by fusion formationbetween the spleen and gonad.Methods: We report a case of a 14-month boy withspleongonadal fusion-limb deformity syndrome focusingon the importance of awareness of this syndrome.Results: The patient was admitted to our clinic becauseof a left undescended testis, and preoperative diagnosiswas not made. During the operation, "spleen-like" tissueattached to the gonad induced splenogonadal fusion, whichwas confi rmed by laparoscopy. The patient also had a shortright femur, hip dysplasia and a syndromic face.Conclusion: Splenogonadal fusion anomaly shouldbe considered in the evaluation of undescended testis,especially in patients with facial and limb deformities.