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.

Laparoscopic Management for Non-Palpable Testis

Purpose: To present our experience with laparoscopic management of the non-palpable undescended testis. Patients and Methods: Between Nov. 2010 and Oct. 2012, 47 non-palpable testes in 41 patients were evaluated prospectively by laparoscopy. The age of the patients at the time of surgery varied from 1 to 9 years with a mean age of 2.85 years. Testicular viability and location were evaluated by physical examination and Doppler ultrasonography after 1 and 3 months. Results: Out of 49 testicular units, 47 (95.9%) were successfully treated by laparoscopic orchiopexy. 45 testicular units (91.8%) were treated by one-stage laparoscopic orchiopexy, 2 (4.1%) were treated by two-stage laparoscopic orchiopexy and 2 (4.1%) diagnosed as vanishing testis with detection of blind end spermatic vessels and vas deferens during laparoscopy. Physical examination and Doppler study demonstrated that 46 of 47 testes (97.9%) were viable and 45 of 47 (95.7%) were located in the lower scrotum and 2 of 47 (4.3%) in the upper scrotum at the end of follow-up. Conclusion: The laparoscopy is a reliable technique for diagnosis and treatment of the non-palpable intra-abdominal testis with high success and survival rates of the testes.

Undescended Testis in Adult: Epidemiology and Therapeutic Aspects. About 23 Cases in HKM University Teaching Hospital of Cotonou

Introduction: Undescended testis is a genital pathology of pediatric age. But it is not rare that the diagnosis of this pathology is made in adults, especially in low income countries with management problems as Benin Republic. The purpose of this study was to describe the epidemiology and therapeutic aspects of this congenital malformation in adults, in HKM University Teaching Hospital of Cotonou. Material and Method: It was a retrospective, cross-sectional and descriptive study, conducted from January 1, 2007 to December 31, 2016. Patient files served as data collecting support. All the patients aged 16 years and older were included in this study, treated and followed in the urology clinic department for undescended testis. Results: Twenty-three files were selected. The most represented age group was 16 to 20 years of age. The average consultation time from the observation of the anomaly was 213.6 months. The vacuity of the scrotum was the main reason for consultation. The absence of an intra-scrotal testis was the most clinical finding. The testis was found in the inguinal canal in 15 patients. Surgical re-positioning testis in scrotal location had been conducted for all patients and the open surgery was the only modality. Orchiectomy was performed in presence of atrophic testis. Any complication was reported in postoperative time. Later, two retractions of the testis and two testicular hypotrophies were seen. Semen control (spermograms) revealed persistence of azoospermia in three patients and astheno-zoospermia in another. Conclusion: Cryptorchidism is a pathology of the child but can still be seen in adults in our context. The main reason for consultation is the vacuity of scrotum but also paternity desire. Surgical lowering is the rule. In adults, its main purpose is the surveillance for the easy and early detection of a testicular tumor.

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.

经脐单一切口腹腔镜联合2mm trocar治疗腹腔型隐睾

目的探讨经脐单一切口腹腔镜联合2 mm trocar治疗腹腔型隐睾的应用价值。方法 2009年11月～2011年1月,采用经脐单一切口腹腔镜联合2 mm trocar治疗11例腹腔型隐睾。脐下缘1.5 cm弧形切口,置入自制多通道trocar,置入5 mm腹腔镜和操作器械1把,脐与耻骨联合连线中点处直接穿刺置入2 mm trocar,置入2 mm腹腔镜抓钳,进行手术。结果 10例11侧成功将隐睾下降固定于阴囊;1例1侧行隐睾切除术。手术时间30～70 min,平均45 min。无手术并发症发生。10例随访3～14个月,平均8.8月,未发现下降的睾丸萎缩。结论经脐单一切口腹腔镜联合2 mm trocar治疗操作不复杂的腹腔型隐睾可行。

腹腔内型未降睾丸精原细胞瘤的螺旋CT诊断价值

目的探讨螺旋CT对腹腔内型未降睾丸精原细胞瘤的诊断与分期价值。方法回顾性分析经手术病理证实的8例腹内未降睾丸精原细胞瘤的螺旋CT表现和临床资料。结果8例肿块长轴均与正常睾丸腹内下降路径一致。供血动脉为同侧睾丸动脉,7例显示睾丸静脉引流。同侧睾丸及精索缺如。肿块呈囊实混合型,近中线侧坏死明显,其内可见条状纤维血管分隔,实性部分轻度强化。所有肿块内未见钙化或脂肪。CT分期均与手术病理符合。结论螺旋CT可以显示腹腔内型未降睾丸精原细胞瘤的多种特征性征象,有助于术前的定位、定性及分期。

Fowler-Stephens手术治疗高位隐睾12例报告

目的：探讨Fowler-stephens手术方法治疗高位隐睾的效果。方法：报告12例高位隐睾患者的临床资料。12例均患侧阴囊空虚，并在腹股沟不能扪及隐睾，其中9例通过B超及CT明确定位了高位隐睾位置，3例不能明确定位。手术先找到隐睾，在输精管汇入精索以上位置行Fowler-stephens试验，明确手术方法可行后在该处离断精索，将隐睾下降固定于阴囊，术中注意避免对精索进行广泛游离。结果：12例患者经6个月～3年的随访，10例睾丸的大小、质地及多普勒彩超结果满意，2例发生睾丸萎缩。结论：Fowler-Stephens手术是治疗高位隐睾的有效方法。提高手术成功率关键在于：选择好手术适应证；术中避免对精索的广泛游离，不要破坏精索血管与输精管间的系膜，以保全侧枝循环对睾丸的血供。

小儿隐睾提睾肌自主神经支配缺陷的超微结构研究

目的了解小儿先天性隐睾提睾肌的超微结构与腹股沟斜疝患儿提睾肌之间的差异,希望能阐明小儿隐睾的发病机制。方法分别于手术时取研究组(小儿隐睾8例)及对照组(腹股沟斜疝患儿8例,年龄与研究组相似)提睾肌各一小块,编号后常规送电子显微镜检查。结果与对照组相比,研究组中的提睾肌可见:无髓鞘纤维减少,有髓鞘纤维的数量多于无髓鞘纤维、肌纤维排列紊乱、肌膜过多、基底层空虚、肌原纤维排列散乱、肌丝厚实、Z线缺失、肌质网扩大、线粒体形状不规则、卫星细胞不活动等。结论无髓鞘纤维数量的减少代表自主神经纤维的减少,肌纤维的改变提示其自主神经支配的缺陷,这可能导致隐睾的发生。

扩散加权成像联合常规MRI检查在未降睾丸诊断价值

目的探讨常规MRI检查联合扩散加权成像序列在未降睾丸的诊断价值。方法回顾性分析18例经临床手术证实未降睾丸患者的完整影像资料,所有患者均行常规MRI检查(T1WI、T2WI-FS、增强)及DWI检查。采用双盲法评估并计算MR常规检查、DWI联合常规MRI检查对于隐睾诊断的敏感性、特异性、准确性。结果隐睾表现为边缘清晰的椭圆形长T1、长T2信号,DWI上呈高信号。联合应用T1WI、T2WI-FS、增强检查及DWI的敏感性、准确性分别为94%与94%,高于常规MRI检查。结论联合应用T1WI、T2Wl-FS、增强检查与DWI序列有助于提高不可触及隐睾的准确定位和诊断。

高位隐睾应用“长袢输精管”睾丸固定术12例报告

对于高位隐睾不能Ⅰ期手术降入阴囊者采用了“长袢输精管”固定术,共治疗12例17侧隐睾,16侧效果满意。随访中对睾丸部位、大小、弹性作了估价。认为手术成功的关键在于高位切断精索、保留输精管血管及睾丸引带侧支。

睾丸横过异位畸形的诊断和治疗:附1例报告并文献复习

目的结合1例睾丸横过异位患者的诊治过程,复习有关文献探讨其病因学、诊断方法和治疗措施。方法本院收治1例青年男性患者存在左侧睾丸横过异位伴同侧精索鞘膜积液,右侧腹股沟斜疝,右侧附睾囊肿,手术证实右侧腹股沟2根输精管和2根精索,右侧阴囊内2个睾丸。将异位的左侧睾丸通过阴囊纵隔复位固定于对侧阴囊肉膜下,并行左侧精索鞘膜大部切除,右侧腹股沟疝修补术,右侧附睾囊肿切除术。根据该患者的临床表现、诊断和治疗过程,结合相关文献对该病的整体临床特征进行分析。结果本例患者术后诊断为:①左侧睾丸横过异位;②左侧精索鞘膜积液;③右侧腹股沟复发疝;④右侧附睾囊肿;⑤弱精症。术后患者病情恢复顺利,术后随访3个月,复查见患者双侧睾丸位置良好,形态大小和血供正常。其他伴随异常均消失。结论睾丸横过异位作为一种罕见的生殖系发育畸形,常伴有腹股沟疝、精索鞘膜积液甚至苗勒氏管持续存在综合征等多种异常,宜及早采取手术治疗并同时纠正伴随病变。为避免伴随的胚胎发育残迹的远期癌变,术后需长期随访。

腹腔镜诊治未触及隐睾39例(44侧)

目的探讨腹腔镜技术诊断和治疗未触及隐睾的疗效。方法2004年2月～2007年2月利用腹腔镜技术对39例44侧未触及隐睾进行诊断和治疗。结果39例均得到明确诊断。38侧腹腔内隐睾中31侧行一期睾丸固定术,7侧行分期Fowler-Stephesn睾丸固定;6侧为睾丸缺如。39例随访0.5～1.0年,1侧分期Fowler-Stephesn睾丸萎缩。结论腹腔镜对小儿未触及隐睾的诊断和治疗具有创伤小、恢复快、治疗效果好等优点,可作为未触及隐睾患儿的首选诊治方法。如条件许可,一期睾丸固定术也能取得满意的临床疗效。

保留鞘膜睾丸下降固定术

目的 介绍保留鞘膜睾丸下降固定术 ,探讨其优越性及注意事项。方法 采用保留鞘膜睾丸下降固定术治疗 6 2例隐睾。结果 6 2例中 6 1例完整保留鞘膜在无张力情况下 ,把睾丸固定在阴囊最低位 ,1例至阴囊上方 ,随诊 41例 ,期限 1～ 4年 ,没有 1例发生睾丸回缩或睾丸萎缩 ,且睾丸在阴囊内滑动良好。

腹腔镜诊治未触及隐睾29例(34侧)

目的探讨腹腔镜技术诊断和治疗未触及隐睾的疗效。方法2002年7月～2005年3月对29例34侧未触及隐睾利用腹腔镜技术进行诊断和治疗。结果29例均得到明确诊断。21侧腹腔内隐睾中16侧行一期睾丸固定术，5侧行分期Fowler-Stephens睾丸固定；13侧为睾丸缺如。29例随访0，5～1年，睾丸无回缩或萎缩。结论腹腔镜对小儿未触及隐睾的诊断和治疗具有创伤小、恢复快、治疗效果好等优点，可作为未触及隐睾患儿的首选诊治方法，如条件许可，一期睾丸固定术也能取得满意的临床疗效。

隐睾并发睾丸网腺癌1例报告并文献复习

目的:探讨1例隐睾并发睾丸网腺癌的临床病理学特征及诊治要点。方法:收集1例隐睾并发睾丸网腺癌患者的临床及影像学、观察期病理学形态及免疫表型,并复习相关文献,探讨其病理诊断和诊治要点。结果:患者老年男性,因右侧腹股沟肿痛一周入院。查体右侧腹股沟区触及实性肿块,压痛、质地较硬,右侧阴囊空虚。CT显示右侧腹股沟睾丸样肿块合并积液、腹膜转移增厚、腹水形成。病理组织学检查显示有乳头状结构,伴有腺体和小管,基质富含胶原,以实性病变为主。肿瘤细胞呈中度核异型性和频繁的核分裂。显微镜下可见曲细精管、精原细胞减少,基底膜增厚。肿瘤细胞免疫组化CEA^+、CA199^+、HBME-1^-、EMA^+、Calectin^-、CK5/6^-。结论:睾丸网腺癌临床罕见,病因不明,临床表现无特异性,确诊易延误。基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术,转移性睾丸网腺癌予以化疗,放疗效果不佳。

未降睾丸并精原细胞瘤的MRI诊断

目的 探讨未降睾丸并精原细胞瘤的MRI特点 ,以期提高对本病的认识。材料与方法 3例经病理证实的未降睾丸精原细胞瘤 ,采用Shimadzu 5 0X/H型磁共振仪 ,0 .5T ,超导型。术前行MRI平扫及增强扫描。结果 3例均为单侧腹腔内精原细胞瘤 ,直径分别为 8cm、9cm及 2cm ,其MRI特点包括 :(1)阴囊内单侧或双侧睾丸缺如并腹内肿块 ;(2 )肿块常较大 ;(3)信号强度不均 ,常有出血、钙化及坏死 ;(4)恶变的未降睾丸可有完整包膜 (睾丸白膜 ) ,如肿瘤边缘不清则提示有局部侵犯。结论 MRI为显示未降睾丸精原细胞瘤的最好方法 ,它能精确显示恶变隐睾的部位、内部结构和侵犯范围。

Bilateral Impalpable Testes: A Special Entity of Cryptorchidism

Background: Cryptorchidism is one of the most common genitourinary disorders in young boys. About 1% - 2% of boys at age of 1 year have an undescended testis (UDT);this disorder is unilateral in about 90% of individuals and bilateral in about 10%. However, bilateral impalpable testes represent a special category that should be differentiated from anorchidism as well as male pseudohermaphroditism. We investigated whether bilateral impalpable testes with its inherent hormonal and genetic factors has different outcomes in terms of success of orchiopexies compared to unilateral impalpable testes. Methods: We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6 month outcomes, in patients diagnosed with bilateral impalpable undescended testes between 2006 and 2010. Findings were reported after a minimum of 6 months from the last surgical intervention. Results: Nine patients underwent laparoscopy for bilateral impalpable testes, 7 of whom had testes in the region of the internal inguinal ring. The success rate after laparoscopic exploration and open orchiopexy was 60% while the success rate with unilateral impalpable testes was 63.3% in the same study. Conclusion: Although laparoscopy is extremely useful in both the diagnosis and treatment of patients with bilateral impalpable testes, laparoscopy should be preceded by careful cytogenetic and hormonal workup for this particular group of patients. We found that the success rates of laparoscopic management of bilateral and unilateral impalpable testes were similar, as shown by testicular size clinically sassed during serial postoperative outpatient visits.

腹内未降睾丸精原细胞瘤10例MSCT分析

目的分析腹内未降睾丸精原细胞瘤的MSCT表现,以提高对该肿瘤的认识。方法回顾性分析经病理证实的10例腹内未降睾丸精原细胞瘤患者的影像学资料。结果10例腹内未降睾丸精原细胞瘤的MSCT表现均为腹腔内孤立性实质性肿块样病变,边缘光滑,密度不均匀,其中9例病变内可见星芒状低密度区,增强后病变呈渐进性轻度强化,病灶周围于动脉期可清楚显示血管蒂,其内星芒状低密度区无明显强化,MIP、CTA及CTV可见肿瘤供血动脉来自睾丸动脉,引流静脉为睾丸静脉。结论腹内未降睾丸精原细胞瘤是一种少见肿瘤,MSCT检查能为临床诊断提供有价值的信息。