Low transscrotal orchidopexy is a safe and effective approach for undescended testes distal to the external inguinal ring.

OBJECTIVES: To review the results of a low transscrotal orchidopexy in patients with palpable undescended testes located distal to the external inguinal ring. METHODS: Between July 1998 and June 2005, transscrotal orchidopexy with a single low scrotal incision was performed in 32 patients for 49 undescended testes. The indication was an undescended testis that lay distal to the external ring and could be pulled down manually into the scrotum under general anesthesia. RESULTS: All testes that were treated with the low transscrotal approach were successfully fixed in the middle or lower portion of the scrotum. The mean operative time was significantly shorter for the low transscrotal orchidopexy (45.2 min) than for the inguinal orchidopexy (66.6 min) for 107 undescended testes at similar locations. The median follow-up duration was 39.1 months; all testes except 1 (97.7%) were located in a good position within the scrotum and had a good consistency; 1 testis ascended postoperatively and required inguinal orchidopexy. No inguinal hernias or hydroceles occurred after the surgery. CONCLUSIONS: Low transscrotal orchidopexy appears to be an excellent alternative to the standard inguinal orchidopexy for undescended testes located distal to the external inguinal ring.

Bilateral male breast cancer with male potential hypogonadism.

BACKGROUND: Male breast cancer is a comparatively rare disease, and simultaneous bilateral male breast cancer is considered to be an extremely rare event. Risk factors are said to be genetic factors and hormonal abnormalities due to obesity or testicular diseases. CASE PRESENTATION: The patient was a 47-year-old Japanese male. His family had no history of female breast cancer. This patient also had hypospadias and hormonal examination indicated the presence of primary testicular potential hypogonadism, and these hormonal abnormalities seemed to be present since childhood or the fetal period. The bilateral breast cancer developed in this man at a comparatively young age, and histopathological studies of multiple sections showed that there was almost no normal epithelial cell in the ducts, while the ducts were almost completely filled with breast cancer cells. CONCLUSION: It is thought that male breast cancer is caused by an imbalance between estrogen and testosterone. We cannot rule out the possibility that the breast cancer developed due to the effect of the slight elevation of estrogen over a long period of time, but the actual causative factors in this patient were unable to be definitively identified. In the future, we hope to further elucidate the causes of male breast cancer.

[A pediatric case of ammonium acid urate lithiasis with ulcerative colitis].

A 13-year-old boy with ulcerative colitis was admitted to our hospital for the purpose of controlling diarrhea. He had received total colectomy and had been managed by intravenous hyper alimentation because of severe diarrhea (10 times/day). Oral intake had been prohibited except for fluid. Abdominal CT scan incidentally revealed two small calculi in the left kidney, which were left untreated. Two months later, one of them descended and was impacted into the urethra. Transurethral cystolitholapaxy showed the stone composition to be pure ammonium acid urate. Although ammonium acid urate lithiasis is rare in Japan, it should be reminded as a complication of chronic diarrhea secondary to inflammatory bowel disease in children.

Laparoscopic findings of transverse testicular ectopia.

Transverse testicular ectopia (TTE) is an extremely rare congenital anomaly in which both testes descend through the same inguinal canal. We report an 8-month-old male with TTE and hypospadias. To help manage the patient, we conducted laparoscopy to elucidate the anatomy of the spermatic cord of the ectopic testis. On laparoscopy, we clearly identified the spermatic cord of the right ectopic testis. In addition, the laparoscopic guide was helpful when doing the trans-septal orchidopexy, in that the ectopic testis could be precisely discriminated without confusion as to the laterality of the testes. Long-term follow-up at 32 months confirmed that both testes were properly positioned in the scrotum and had a good consistency.

Ruptured internal carotid artery anterior wall aneurysm identified during vasospasm: case report.

OBJECTIVE AND IMPORTANCE: Aneurysms of the paraclinoid segment arising from the anterolateral wall of the proximal internal carotid artery (ICA) are usually located in the intradural space, and the proximal neck of the aneurysm is closely adjacent to the dural ring. Although most of these aneurysms can be identified by cerebral angiography, the top of the aneurysm can be flattened because of its relationship to the undersurface of the clinoid process. We report a rare case of a ruptured ICA anterolateral wall aneurysm that was not identified by initial angiography but was clearly observed at the time of vasospasm. CLINICAL PRESENTATION: A 59-year-old female patient was transferred to our hospital because of sudden loss of consciousness. Initial angiography failed to disclose any aneurysm except for one projecting to the right at the C3-C4 portion of the left ICA. A left frontotemporal craniotomy with drilling of the anterior clinoid process was performed 1 day after the onset of subarachnoid hemorrhage. Within the operative field, however, no hemorrhage was detected near the C3-C4 portion of the left ICA. Subsequent angiography performed during vasospasm clearly demonstrated a ruptured aneurysm in the anterior paraclinoid segment of the right ICA. INTERVENTION: After drilling the anterior clinoid process and cutting the dural ring, we successfully clipped the aneurysm. The aneurysm was saccular, with a broad neck that extended below the dural ring. Intraoperative inspection demonstrated that the dome of the aneurysm was in a subclinoid location, suggesting that most of the aneurysm might have been flattened by the dural ring at the time of initial angiography but before the onset of vasospasm. CONCLUSION: The presented case suggests that this type of aneurysm may be missed by routine angiography performed before and after vasospasm. If initial angiography fails to reveal the origin of the subarachnoid hemorrhage but computed tomography still discloses hemorrhage from an ICA aneurysm, repeated angiography should be considered within 14 days after the onset of subarachnoid hemorrhage to confirm whether the aneurysm has arisen from the anterior clinoid segment of the ICA.

Functional evaluation of one-stage urethroplasty with parameatal foreskin flaps repair of hypospadias using uroflowmetry.

BACKGROUND: Uroflowmetry is a simple, accurate and non-invasive test. In the present study, we aimed to determine the role of uroflowmetry in the evaluation of the functional results of one-stage urethroplasty with parameatal foreskin flaps (OUPF) technique. METHODS: Twenty-one children who had undergone OUPF repair at our clinic were selected. Selection criteria were that patients were toilet trained and had no fistula. Uroflowmetry was performed using a rotating disk sensor. The maximum flow rate (Qmax) and average flow rate (Qave) were plotted against body surface related flow rate nomograms. The upper 95% tolerance limits for the 5th, 10th, 15th, 20th and 25th percentiles of the normal population were used for comparison. The flow pattern was classified as bell ring, plateau or intermittent. RESULTS: The median age at the first uroflowmetry was 4.7 years (range 2.5-8.6) and the mean postoperative follow-up period was 25 months (range 1-58). Twelve children had Qmax above the 25th, six between the 5th and 25th and three less than the 5th percentiles of the normal population. A normal bell-shaped flow curve was obtained in 17 (80.6%) of the children. Of the three children with Qmax below the 5th percentile, two children had a plateau flow pattern and were found to have a urethal stricture. Dilation was performed successfully, after which the Qmax returned to the normal range and the symptoms disappeared. CONCLUSION: The OUPF technique provided satisfactory functional results for hypospadias repair. We advocate the use of uroflowmetry for routine postoperative follow-up.

Intra-abdominal testis with loop-like epididymis and intra-canalicular vas and vessels.

A case of intra-abdominal testis with loop-like epididymis and intra-canalicular vas and vessels is presented. A 3-year-old male with left impalpable testis since birth was admitted to our department. Physical examination and ultrasonography were inconclusive. Laparoscopy revealed a small left abdominal testis with surrounding adhesions close to the left-obliterated umbilical artery. The vas deferens and spermatic vessels were entering into the internal inguinal ring. The processus vaginalis was patent. At inguinal exploration the testis was atrophic and the epididymis was loop-like, joining the vas deferens in the inguinal canal. The spermatic vessels continued to the atrophic testis in a loop-like manner. The testis, epididymis and the vas deferens were removed. Histopathological examination of the testis revealed Sertoli cells only. If inguinal exploration had been performed without laparoscopy, the presence of the vas deferens and spermatic vessels in the inguinal canal with the absence of the testis could have been misdiagnosed as vanishing testis. Abdominal testis would thus have been missed, with increased risk of complications, particularly malignancy.

Laparoscopic nephroureterectomy for dysplastic kidney in children: an initial experience.

BACKGROUND: Laparoscopic nephroureterectomy for dysplastic kidney is now becoming a widely accepted procedure. We report here our initial experience with laparoscopic nephroureterectomy in four girls. METHODS: Between 1993 and 1999, laparoscopic nephroureterectomy was performed in four girls (mean age 5.3 years). Three patients had an ectopic dysplastic kidney with ectopic ureter, and one patient had hydronephrosis with megaureter due to distal ureteral atresia of the upper moiety in a duplicated dysplastic kidney. The transperitoneal approach was used in all cases. RESULTS: Mean operative time was 195 min (range 150-266). Blood loss was minimal. All operations were completed successfully and there were no intraoperative or postoperative complications except for subcutaneous emphysema in one patient (case 4). Postoperative analgesia was used in three patients and administered in the form of diclofenac sodium suppositories 12.5 mg (cases 1 and 2) or acetaminophen suppositories 50 mg (case 3) for 1-2 days. One patient did not require any analgesia (case 4). Oral fluid intake was resumed on the first postoperative day and ambulation began within 1-3 days (mean 1.6, cases 1, 2 and 3) and 6 days (case 4). All children returned to normal activity within 3-6 days of surgery. Mean postoperative hospital stay was 7.3 days. All cases had uneventful courses after discharge. CONCLUSION: Laparoscopic nephroureterectomy can be performed safely, with minimal postoperative pain, excellent cosmetic results and early ambulation. We advocate the use of laparoscopy for the diagnosis and treatment of dysplastic kidney with ectopic ureter.

Prostatic carcinosarcoma: a case report and review of literature.

A unique case of carcinosarcoma of the prostate detected in a 71-year-old man is presented. Pelvic exenteration was performed, and the resected prostatic mass was found to consist of two histologically distinct elements; adenocarcinoma and sarcoma with focal osteosarcomatous element. The patient is still alive with neither metastasis nor recurrence. This is the 42nd case of carcinosarcoma of the prostate to be reported in the literature.