A Rare Case Report of Undescended Testis: Both on One Side.

Undescended Testis is a medical term that uses for any testis which is not in its normal place (bottom of the scrotum). UDT can be classified as unilateral and bilateral. Unilateral UDT is more common than bilateral UDT. There is a very rare condition in which both testicles are on the same side and have not descended.We report in this article a 3 years old boy by a chief complaint of bilateral testicular mass absence. Diagnostic evaluation has been done but testes was abcent in scrota.  Exploring laparoscopy has been done and rare cases of UDT diagnosed, in which both testicles was on left side of the pelvis by two separate spermatic cord. The shorter spermatic cord fixed in the left scrotum and the longer one fixed on the right side. The testis was normal in follow up examinations.

The prevalence of bell clapper anomaly in the solitary testis in cases of prior perinatal torsion.

PURPOSE: Bell clapper anomaly is associated with an increased risk of intravaginal testicular torsion. However, perinatal torsion is thought to be secondary to an extravaginal process. We quantified the contralateral prevalence of bell clapper anomaly in children found to have atrophic testicular nubbins secondary to presumed torsion during gestation to better define the subsequent risk of metachronous testicular torsion. MATERIALS AND METHODS: Inspection results for the presence of contralateral bell clapper anomaly was recorded by a single surgeon in 50 consecutive cases in which exploration for nonpalpable testes revealed a testicular nubbin. For comparison data were collected in 27 consecutive cases of acute testicular torsion. Anatomy of the normal contralateral testis was compared between the 2 groups. RESULTS: Average age at surgery in the perinatal torsion group was 15 months vs 12.7 years in the acute torsion group. One case of partial contralateral bell clapper anomaly was discovered in the perinatal torsion group but no complete anomaly was found. In contrast, in older boys with acute testicular torsion complete bell clapper anomaly was found in 21 of the 27 contralateral testes (78%). CONCLUSIONS: In older boys with acute testicular torsion contralateral bell clapper anomaly is highly prevalent, supporting the standard practice of contralateral testicular fixation in this clinical situation. However, the prevalence of contralateral bell clapper anomaly is exceedingly small in cases of monorchism after perinatal torsion, substantiating an insufficient risk of subsequent torsion to justify routine fixation of the solitary testis.

Scrotal nubbins associated with blind-ending spermatic vessels and a normal vas deferens on laparoscopy.

OBJECTIVES: To determine whether a scrotal nubbin is present in children with unilateral non-palpable testis when diagnostic laparoscopy demonstrates blind-ending vessels and a normal vas deferens entering a closed internal ring. METHODS: Eighty consecutive patients with a unilateral nonpalpable testis were retrospectively reviewed. Patients underwent initial diagnostic laparoscopy, and, if needed, subsequent inguinal exploration was performed. On inguinal exploration, any testicular remnant or nubbin-like tissue was removed and evaluated histologically. Patients with a patent processus vaginalis were excluded from this analysis. RESULTS: Overall, 60 of the 80 patients had neither an abdominal testis nor a patent processus vaginalis. Of these 60, 34 patients had both a vas deferens and spermatic vessels entering a closed internal ring, and all of these underwent inguinal exploration. A total of 17 patients had both a blind-ending vas deferens and blind-ending spermatic vessels; no inguinal exploration was attempted. In nine patients, laparoscopy revealed blind-ending vessels with a normal vas deferens entering the closed internal ring. Of these nine, six underwent inguinal exploration, and a scrotal nubbins was found in three. At histological examination, hemosiderin deposit and calcification were seen in the nubbin tissue. No viable germ cell was detected in these specimens. CONCLUSIONS: A laparoscopic finding of blind-ending vessels above the closed internal ring does not mean intra-abdominal vanished testis, regardless of the appearance of the vas deferens.

[Polyorchidism: a case report and review of the literature]. / Poliorquidismo: aportación de un caso y revisión de la literatura actual.

Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.

Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis.

PURPOSE: We reviewed the histological findings of cord structures excised at inguinal exploration after diagnostic laparoscopy in patients with a nonpalpable testis with the vas deferens and spermatic vessels exiting the internal inguinal ring in the absence of a patent processus vaginalis. MATERIALS AND METHODS: A retrospective review of 809 laparoscopic explorations for nonpalpable testes between 1981 and 2003 was conducted. The histological findings of the excised remnants of those patients with a closed processus vaginalis were reviewed. RESULTS: A total of 110 patients underwent excision of a testicular remnant at inguinal exploration in association with a closed processus vaginalis. Of the specimens 31 (28%) were on the right side and 79 (72%) were on the left side. The incidence of viable germ cell elements was 8 of 110 (7%). The presence of hemosiderin, calcification and fibrosis was identified in all 8 remnants with viable germ cell elements. CONCLUSIONS: The incidence of viable germ cell elements in the excised remnant when the vas deferens and spermatic vessels are identified exiting a closed internal ring in patients with a nonpalpable testis is 7%. To our knowledge no prior study has evaluated the incidence of viable germ cell elements in remnants associated with a closed internal inguinal ring. Based on these findings, we advocate inguinal exploration and excision of testicular remnants in these patients.

[Laparoscopic intervention in pediatric urology]. / Laparoszkópos beavatkozások a gyermekurológiában.

The authors summarise the short history of the laparoscopy, and main steps of its use in international and Hungarian practice of urological surgery. They evaluate the possibility of laparoscopy in paediatric urological practice. Finally, they present their experience with this minimally invasive technique from 1995. Between October 1995 and September 1998, 83 laparoscopic procedures were performed. In 59 patients the vena testicularis were ligated by laparoscopy and in 22 patients 24 non palpable testes were diagnosed and operated. In 9 of the cases laparoscopic orchidopexy was performed. The authors demonstrate their operative technique. All laparoscopic interventions were tolerated well by children and they were treated without any complication. Postoperative pain medication were given for 5 children. The operative time for varix ligation ranged from 15 and 20 minutes, and for laparoscopic orchidopexy from 30 and 40 minutes. The recurrence rate of varicocele was found to be 1.5%, and postoperative hydrocele developed in one patient (1.5%).

[The advantage of the laparoscopic method of examining patients with nonpalpable testes]. / Preimushchestvo laparoskopicheskoi metodiki obsledovaniia bol'nykh s nepal'piruemymi iaichkami.

The authors compared the diagnostical value of traditional operations with the inguinal access and a new method using laparoscopy for treatment of patients with testis aplasia. The laparoscopic method of examination was found to be preferable since it allows the correct diagnosis to be made in 96% of children with cryptorchism.

Incomplete disappearance of the processus vaginalis as a cause of ascending testis.

PURPOSE: Recently evidence has been accumulating that some undescended testes present later in childhood after apparent normalcy in infancy. These ascending testes appear to explain why a significant number of orchiopexies are performed later in childhood despite the recommendation that surgery for cryptorchidism be performed in infancy. We aimed to determine whether the cause of these ascending testes was persistence of the processus vaginalis. MATERIALS AND METHODS: A total of 25 boys 4 to 13 years old with no history of testicular maldescent at birth underwent transscrotal orchiopexy in a 2-year period. A total of 33 orchiopexies was performed (8 bilateral). The spermatic cord was carefully dissected and operative findings of the nature of the spermatic cord were noted. RESULTS: In all cases dissection within the spermatic cord revealed a similar finding, namely a fibrous string situated deep to the cremasteric muscle and spermatic fasciae. Transection of this string allowed adequate elongation of the vas deferens and gonadal vessels to permit scrotal placement of the testis. Histological examination revealed characteristic processus vaginalis tissue in which the peritoneal derived mesothelial lining cells were present within a partially obliterated processus vaginalis. CONCLUSIONS: Cryptorchidism presenting later in childhood may be an acquired abnormality caused by failure of natural growth of the spermatic cord when the processus vaginalis leaves a fibrous remnant, which prevents normal elongation. These observations suggest that the ascending testis is acquired postnatally and the cause may be related to inguinal hernia.

Hydrocele of the spermatic cord: embryology and ultrasonographic appearance.

Five cases of hydrocele of the spermatic cord are presented. All five patients had a firm inguinal mass, and ultrasonography, performed to exclude adenopathy, incarcerated hernia, and paratesticular tumor, showed an avascular cystic mass superior to and separate from the testicle. A testicular hydrocele did not coexist. This typical appearance should lead to a confident diagnosis of this benign but rare anomaly. Elective surgery may prevent the development of an acquired indirect hernia.

Embarazo con espermatozoides testiculares / Pregnacy with testicular spermatozoa

En un paciente con diagnóstico de agenesia de vías espermáticas se propuso afectuar una aspiración epididimaria asociada a FIV (fertilización in vitro). En la exploración excrotal no se encontró epidídimo (debido probablemente a antecedente quirúrgico de biopsia epididimaria) por lo que se efectuó una biopsia testicular. Este material fue procesado obteniéndose escasos espermatozoides (algunos cientos). Estos espermatozoides fueron inyectados en el citoplasma de los ovocitos de la esposa (técnica de ICSI).De los 18 ovocitos inyectados, 3 se dañaron durante el procedimiento y a las 16 horas se observaron signos de fertilización normal en 6 de ellos, prosiguiendo el desarrollo 4 de embriones que fueron transferidos al útero por vía transcervical, 3 en estado de 8 células y uno de 6 células, habiéndosele efectuado previamnete en la zona pelúcida de cada uno de los embriones un orificio de 20 micrones con solución ácida de Tyrode. A los 15 días de la transferencia (2-1-95) el resultado de la subunidad beta de HCG fue positiva, detectándose al mes (2-2-95) por ecografía un embrión de 19 mm, cursando un embarazo normal

[Spleno-gonadal fusion. Apropos of 3 case reports]. / Fusion spléno-gonadique. A propos de 3 observations.

Splenogonadal fusion is a very rare congenital anomaly, usually diagnosed during operation for other surgical conditions as inguinal during operation for other surgical conditions as inguinal hernia, testicular tumor, cryptorchism or epididymitis and discontinuous. In first form exists a link of splenic and connective-fibrous tissue between spleen and testicle. This string runs above the bowels, then through an inguinal canal and joins the testicle or surrounds the gonad. Surgical treatment consists of cutting of the cord from spleen and separating from albugineals coat of testicle. In discontinuous form numerous tubercles of splenic tissue situated near gonad are confirmed. Three own cases are presented. First case concerns a 4 year-old boy with diagnosis: tumor of testicle and left inguinal hernia. Splenic tissue surrounded testicle and separated it from epididymis. An attempt of separation of these masses from the testicle was unsuccessful and hemicastration was performed and removed 17 cm long cord attached to the spleen. There was no union between testicle and epididymis on micro- and macroscopic examination. Second case refers to a 8 year-old boy with left-sides cryptorchidism. During an operation 7 cm long string like rosary was removed. Last case: 12 year-old boy was treated with diagnosis of tumor of spermatic cord and suspicion of spleno-gonadal fusion. A 15 cm long string connecting upper pole of testicle and spleen was amputated. The embryology, the diagnosis and the treatment are discussed in both cases.

Ultrasonography of the undescended testis.

Sixty prospective sonographic preoperative examinations were performed on 57 boys, 3 to 12 years of age (mean 6 2/3), in order to investigate the accuracy of the method for localizing undescended or non-palpable testes in the anteperitoneal region, i.e. the inguinal canal. Sonographic results agreed with the findings at surgical exploration in 53 (88%) of the 60 examinations performed which was regarded as a satisfactory result. The method is convenient and valuable for the planning of surgery. Sonograms of patients earlier operated upon were difficult to interpret and accounted for some misinterpretations as did examinations in some patients with divergent anatomy.

Congenital mesonephric defects in male infants with mucoviscidosis.

Reports that men with mucoviscidosis were sterile and that portions of their genital tracts were atretic prompted us to investigate the genital tracts of 15 male infants with mucoviscidosis who died within the first year of life and came to necropsy. The genital tracts of all of these infants were abnormal, the abnormalities being confined to mesonephric derivatives. Hypoplastic or absent ducti efferentia, ducti epididymides, or ducti deferentia were found in all 28 specimens of epididymides, and the ducti deferentia were missing from 25 of 27 examples of spermatic cord. The seminal vesicles and the ejaculatory ducts were less frequently hypoplastic or absent. Because these abnormalities of mesonephric derivatives were present so early in life and inflammatory and obstructive changes were absent we believe that they resulted from a failure of development.