Testicular Temperature and the Effects of Orchiopexy in Infants with Cryptorchidism.

PURPOSE: Testicular temperature should remain low to maintain optimal function of germ cells; however, information regarding testicular temperature in infants and the effect of cryptorchidism and its correction, including laparoscopic staged Fowler-Stephens orchiopexy (LSFSO), is limited. MATERIALS AND METHODS: A total of 82 infants with unilateral palpable cryptorchidism, 24 with nonpalpable testes who underwent unilateral LSFSO and 20 with scrotal hydrocele were included. Ultrasonographic determination of testicular volume and measurement of testicular temperature but not scrotal surface temperature using a Coretemp CTM204® (Terumo, Tokyo) were performed before and 12 months after orchiopexy. The effects of the route of testicular delivery, conventionally through a new hiatus medial to the inferior epigastric vessels or through the transinguinal approach, were investigated in the LSFSO cases. RESULTS: Undescended testicular volume was significantly increased after orchiopexy (0.80 ml to 0.92 ml, p <0.0001). The preoperative testicular temperature (35.1C) was significantly higher than that of the control (34.4C, p <0.0001), and significant decreases in testicular temperature occurred after orchiopexy (34.3C, p <0.0001). A multivariate analysis showed that a decrease in testicular temperature was a factor associated with postoperative testicular development. Twelve months after LSFSO, transinguinal approach was shown to be more effective in decreasing the testicular temperature than the conventional approach (34.4 and 35.3C, respectively, p <0.05). CONCLUSIONS: Orchiopexy is effective in correcting the high-temperature environment caused by cryptorchidism. In the case of nonpalpable testes treated by LSFSO, transinguinal fixation is more effective than the conventional approach in reducing testicular temperature, but a longer followup period is necessary to draw a final conclusion.

Frequent and mild scrotal heat stress in mice epigenetically alters glucose metabolism in the male offspring.

Several studies have reported that health problems occur in assisted reproductive technology (ART)-conceived offspring. Recently, investigations have demonstrated that paternal environmental conditions influence offspring health. However, it is unclear whether the factors that cause male infertility per se affect offspring health and contribute to health problems in ART-born children. Scrotal heat stress represents a common cause for oligoasthenozoospermia, and in these cases, in vitro fertilization-embryo transfer (IVF-ET) is typically recommended for those individuals trying to conceive. We exposed C57BL/6J male mice to frequent and mild scrotal heat stress (fmSHS) (39°C for 30 min once weekly for 5 consecutive wk). Sperm was subjected to IVF-ET with oocytes of untreated C57BL/6J females to produce offspring mice. Glucose intolerance and insulin resistance was observed in the male offspring mice derived from fmSHS-exposed fathers. Islets, after evaluation, remained unchanged. Genes involved in glucose metabolism, especially, those in insulin signaling pathways, showed dysregulation in the liver of the fmSHS-derived male offspring. Differentially methylated regions were found in the sperm of fmSHS-exposed mice by whole genome bisulfite sequencing. Interestingly, abnormal methylation of some genes with altered expression in offspring was observed in both the sperm of fmSHS fathers and the liver of their male offspring. Our results suggest that the factors that cause male infertility can affect male offspring health by an epigenetic mechanism.

[Clinical effect of a scrotal rapid recovery dressing device in the treatment of acute epididymitis].

OBJECTIVE: To study the protective effect of a scrotal rapid recovery dressing device, scrotal girdle, on the scrotum of the patient with acute epididymitis, so as to improve the prognosis and the patient's satisfaction. METHODS: A total of 120 patients with acute epididymitis were treated in our hospital from December 2018 to November 2019, 60 with the scrotal girdle plus local cold compress in addition to antibiotics administration (the scrotal girdle group) and the other 60 with antibiotics only (the control group), all for 6 days. Then, comparisons were made between the two groups of patients in the improvement of scrotal swelling, total effectiveness rate and the patients' satisfaction with therapeutic outcomes. RESULTS: After 6 days of treatment, the patients in the scrotal girdle group, compared with the controls, showed significantly lower scrotal swelling scores (1.01 ± 0.34 vs 1.38 ± 0.20, P < 0.05), a higher total effectiveness rate (83.33% vs 65%, P < 0.05) and higher satisfaction with the therapeutic outcomes (86.67% vs 56.67%, P < 0.05). CONCLUSIONS: For the treatment of acute epididymitis, the application of the scrotal girdle for protection can significantly relieve scrotal pain and discomfort, improve the therapeutic effect and patients' satisfaction, and enhance the patients' recovery and quality of life.

Novel truncating variants expand the phenotypic spectrum of KAT6B-related disorders.

Say-Barber-Biesecker-Young-Simpson syndrome (SBBYSS) and Genitopatellar syndrome (GTPTS) are very rare conditions caused by KAT6B truncating variants. Because of both syndromes often share common features the associated phenotypes are usually grouped under the term "KAT6B-related disorders." However, particular signs of each syndrome have been reported and their appearance seems to be dependent on where the KAT6B variant is located. Thus, whereas truncating variants associated with SBBYSS have their highest density in the distal part of exon 18, those resulting in GTPTS are distributed between the end of exon 17 and beginning of exon 18. Here, we reported two de novo heterozygous KAT6B truncating variants. The first variant (c.5802delA; p.A1935Pfs*16), identified in a boy with SSBYSS phenotype, resulting in the most distal KAT6B truncating variant reported up-to-date in the scientific literature. The second variant (c.3152delG; p.S1051Tfs*63), located in a region hitherto defined as specific of SBBYSS, seems to cause an overlapping SBBYSS/GTPTS phenotype. The clinical and genetic characterization of these patients could contribute to the understanding of the KAT6B-related disorders.

A novel truncating variant within exon 7 of KAT6B associated with features of both Say-Barber-Bieseker-Young-Simpson syndrome and genitopatellar syndrome: Further evidence of a continuum in the clinical spectrum of KAT6B-related disorders.

KAT6B sequence variants have been identified in both patients with the Say-Barber-Biesecker-Young-Simpson syndrome (SBBYSS) and in the genitopatellar syndrome (GPS). In SBBYSS, they were reported to affect mostly exons 16-18 of KAT6B, and the predicted mechanism of pathogenesis was haploinsufficiency or a partial loss of protein function. Truncating variants in KAT6B leading to GPS appear to cluster within the proximal portion of exon 18, associated with a dominant-negative effect of the mutated protein, most likely. Although SBBYSS and GPS have been initially considered allelic disorders with distinctive genetic and clinical features, there is evidence that they represent two ends of a spectrum of conditions referable as KAT6B-related disorders. We detected a de novo truncating variant within exon 7 of KAT6B in a 8-year-old female who presented with mild intellectual disability, facial dysmorphisms highly consistent with SBBYSS, and skeletal anomalies including exostosis, that are usually considered component manifestations of GPS. Following the clinical diagnosis driven by the striking facial phenotype, we analyzed the KAT6B gene by NGS techniques. The present report highlights the pivotal role of clinical genetics in avoiding clear-cut genotype-phenotype categories in syndromic forms of intellectual disability. In addition, it further supports the evidence that a continuum exists within the clinical spectrum of KAT6B-associated disorders.

Scrotal insulation and sperm production in the boar.

Seasonal infertility is a limiting factor in boar fertility, and is increasingly important as climate changes. Spermatogenesis in the boar produces 256 spermatozoa per type A1 spermatogonium, but the process is inefficient such that only 10-30% of these potential spermatozoa are actually produced. Heat further impacts spermatogenesis by reducing the number of specific germ cells produced while increasing the fraction of abnormal sperm. Early studies used whole-animal exposure to simulate seasonal exposure to heat under production settings, but this approach is associated with many confounding factors that make assessment of the mechanisms of heat-induced damage to spermatogenesis difficult. Scrotal insulation provides a better model to investigate the mechanisms and potential mitigation strategies of heat-induce damage. For example, scrotal insulation helped identify a link between short-term heat stress and damage to meiotic germ cells. This outcome is likely due to changes in the integrity of the blood-testis barrier, which induce apoptosis, autophagy and DNA damage in the germ cells. Further understanding how heat damages spermatogenesis, and whether or not this can be repaired, are crucial to mitigating heat effects on boars in production settings.

Physical therapy for chronic scrotal content pain with associated pelvic floor pain on digital rectal exam.

INTRODUCTION: Chronic scrotal content pain (CSCP) is a common condition that can be challenging to manage definitively. A cohort of patients with CSCP have referred pain from myofascial abnormalities of the pelvic floor and therefore require treatment modalities that specifically address the pelvic floor such as pelvic floor physical therapy (PFPT). MATERIALS AND METHODS: Retrospective chart review of all men with a pelvic floor component of CSCP presenting to our tertiary care medical center and undergoing PFPT from 2011-2014. Patients with CSCP and pain/tightness on pelvic floor evaluation with 360° digital rectal exam (DRE) were referred to a physiotherapist for PFPT. CSCP was defined as primary unilateral or bilateral pain of the testicle, epididymis and/or spermatic cord that was constant or intermittent, lasted greater than 3 months, and significantly interfered with daily activities. Long term follow up was conducted by office visit and physical therapy chart review. RESULTS: Thirty patients, mean age of 42 years (range 18-75), were followed for a median of 13 months (range 3-48). Median pre-PFPT pain score was 6/10 (range 2-10). After a mean of 12 PFPT sessions (IQR 6-16), pain improved in 50.0% of patients, median decrease in pain was 4.5/10 (range 1-10). Complete resolution of pain occurred in 13.3%, 44.0% had none to minor residual pain. Following PFPT, fewer subjects required pain medication compared with prior to PFPT (44.0% versus 73.3%, p = 0.03). CONCLUSIONS: For men with CSCP and a positive pelvic floor exam with DRE, we recommend a trial of PFPT as an effective and non-operative treatment modality.

Management of acute scrotum in children: a 25-year single center experience on 558 pediatric patients.

INTRODUCTION: The aim of this study was to analyze management and outcomes of treatment in patients with acute scrotum. MATERIAL AND METHODS: From January 1990 until January 2015 case records of 558 patients who underwent surgery for acute scrotum were retrospectively reviewed. Mean age was 12 years old. Each patient was analyzed for following parameters: history data, localization of pain, physical examination, operating results and the results of follow up, age, etiology, and the time from initial symptoms to surgery. RESULTS: Scrotal explorations revealed 142 cases (25%) of spermatic cord torsion, 344 (62%) torsion of the testicular appendage, 54 (10%) epididymitis, 10 (2%) testicular trauma and 8 cases (1%) of other conditions. Two peaks of incidence of spermatic cord torsion were found, the first during first year of life and the second between 13 and 15 years of life. In patients with spermatic cord torsion, median duration of symptoms in the group of salvaged testes was 6 hours; while in the group of patients who underwent orchiectomy was 46 hours. Of the total number of patients with spermatic cord torsion 40 patients (28%) underwent orchiectomy while 102 testicles (72%) were saved. There were no major complications. Acute scrotum is significantly more common in the winter. Torsion of the testis has the highest incidence in January and August. CONCLUSION: Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. It is of great importance that the patient seeks immediate medical attention. If the patient arrived within 6 hours the testicle can be saved.

Multiple Scrotal Ulcers in an Infant Due to a Traditional Child Care Practice: Salting.

Application of salt to the newborn's skin is a common traditional child care custom in Turkey. We present an infant with multiple ulcerating scrotal lesions due to prolonged salt exposure in the diaper area. Scrotal ulcers associated with salting have not been described previously.

Liposarcoma scroti: a rare paratesticular tumor.

Paratesticular liposarcoma is a rare condition characterized by a growing, painless inguinal, or scrotal mass. To our knowledge, less than 200 cases worldwide are reported thus far. It is characterized by slow growth and can reach large dimensions at diagnosis. Paratesticular well-differentiated liposarcoma has a prolonged clinical course with recurrences in more than half the cases, sometimes late. Regardless of tumor size, radical orchidectomy with free surgical margins is recommended in order to avoid recurrence. When there is tumor recurrence, reoperation is the treatment of choice because radio- and chemotherapy have yet to be well established in these cases. There is a low risk of metastasis. Overall prognosis is good. Adjuvant therapies, represented by radio- and chemotherapy, have a controversial role in the literature due to the rarity of the disease. In this article, we present review of the literature and case discussion of paratesticular liposarcoma with focus on diagnosis, treatment and follow-up.

A patient with a unique frameshift mutation in GPC3, causing Simpson-Golabi-Behmel syndrome, presenting with craniosynostosis, penoscrotal hypospadias, and a large prostatic utricle.

We present a Hispanic male with the clinical and molecular diagnosis of Simpson-Golabi-Behmel syndrome (SGBS). The patient was born with multiple anomalies not entirely typical of SGBS patients, including penoscrotal hypospadias, a large prostatic utricle, and left coronal craniosynostosis. In addition, he demonstrated endocrine anomalies including a low random cortisol level suspicious for adrenal insufficiency and low testosterone level. To our knowledge, this is the first report of a prostatic utricle in SGBS and the second report of craniosynostosis. The unique disease-causing mutation likely arose de novo in the mother. It is a deletion-insertion that leads to a frameshift at the p.p. S359 [corrected] residue of GPC3 and a premature stop codon after five more amino acids. p. S359 [corrected] is the same residue that is normally cleaved by the Furin convertase, although the significance of this novel mutation with respect to the patient's multiple anomalies is unknown. We present this case as the perinatal course of a patient with unique features of SGBS and a confirmed molecular diagnosis.

Necrotising fasciitis in the central part of the body: diagnosis, management and review of the literature.

Necrotising fasciitis (NF) is characterised by rapidly spreading necrosis of the soft tissue and fascia. It is rare but can be fatal when not managed properly. The aim of this study is to evaluate the diagnosis, treatment and results such as mortality, morbidity and reconstructive options of NF localised in the central part of the body. The main goal is to emphasise upon the clinical symptoms for early diagnosis which is the most important factor in saving the lives of these patients. Between January 2000 and December 2010, 30 patients with NF localised in central parts of the body were treated. Six of the patients were female (20%) and the others were male (80%). The mean age was 54·03 years (ranged between 26 and 83 years). The average time from the onset of symptoms to diagnosis was 6 days, ranging from 2 to 11 days. The localisation of NF was perineum in 24 patients (80%); inguinal and thigh region in 5 patients (16·7); and back in 1 patient (3·3%). The hospitalisation time was varying between 17 and 32 days (mean 23 days). Six patients (20%) died and 24 patients (80%) survived. All non-survivors had risk factors and secondary comorbidities such as immunosuppression, chronic cardiac failure, and diabetes with high glucose level. Survivors also underwent repeated debridement operation 2-4 times. Reconstructive procedures were split-thickness skin graft (STSG) in eight patients (33·3%), fasciocutaneous flaps in four patients (16·6%), fasciocutaneous flap + STSG in six patients (25%), scrotal flap + STSG in two patients (6·6%), scrotal flap in two patients (6·6%) and musculocutaneous flap + STSG in one patient (3·3%). There was no major complication such as flap and graft loss, after reconstructive procedures. Early diagnosis of NF may be the lifesaving factor. Amuputation can save the patient's life in the case of NF in the extremities; however, this is not an option for NF in central parts of the body. In these cases, when NF is suspected, early debridement of necrotic tissues should be performed. As soon as the infection and the spread of the necrosis are controlled, reconstruction should be considered.

[Balanoplasty in accordance with the normal anatomy--the key to successful correction of hypospadias].

The features of the normal anatomy of the balanus and distal urethra were evaluated. It was found that there is a physiological mechanism of stretching of distal urethra during urination owing to the scaphoid fossa, bridle and hippocrepiform-located corpus spongiosum of balanus. Based on these data, modified balanoplasty was proposed, which consisted in mobilization and increase the length of corpus spongiosum of wings of balanus by longitudinal incisions, followed by suturing wings of balanus with separate inside sutures on a short distance not above 3-5 mm and their dipping at a depth not above 1-2 mm. Between 2005 and 2010, 410 patients aged 1 to 18 years underwent surgeries. 90 (22%) patients underwent reoperation. Boys with glandular and coronal hypospadias (n = 69) underwent MAGPI surgery. Patients with penile hypospadias (n = 243) underwent TIP-Snodgrass (n = 72), onlay (n = 23), Mathuie (n = 123), and GTIP (n = 25) surgeries. In children with scrotal and perineal hypospadias (n = 98), method of transverse tubularized foreskin flap was used. All patients were arbitrarily divided into two groups. The study group consisted of patients (n = 210) who underwent modified balanoplasty. The comparison group consisted of 200 patients who underwent conventional balanoplasty. Complication rate after hypospadias correction was reduced from 18 to 12% in penile hypospadias, and from 28 to 18% in scrotal and perineal hypospadias. It is shown that modified balanoplasty excludes formation of obstructive ring of corpus spongiosum in the distal urethra. The results of urodynamic examinations in follow-up period showed improvement of mean urinary flow rates.

Scrotal infrared digital thermography in assessment of varicocele--pilot study to assess diagnostic criteria.

The aim of this study was to assess scrotal thermography in diagnostics of varicocele and suggest potential diagnostic criteria. Twelve patients with clinically diagnosed varicocele were examined with scrotal infrared digital thermography, physical examination and ultrasound/doppler. The main outcome measure was evaluation of thermography diagnostic criteria for varicocele. Mean temperature at left pampiniform plexus was ≥ 34 °C in 83%, and at right pampiniform plexus in all cases was ≤ 34 °C. In 92% of patients, temperature at the left testicle was ≥ 32 °C, whereas at the right testicle it was >32 °C in 50% patients. Temperatures between left and right pampiniform plexus and between left and right testicle were significantly different with P < 0.0001 and P < 0.006 respectively. In all patients, temperature difference between pampiniform plexuses was ≥ 0.6 °C. In 92% of patients, temperature at left pampiniform plexus was equal or higher to thigh temperature with the mean temperature difference of 1.1 ± 1.1 °C. Temperature at right pampiniform plexus was colder than the thigh in 92% of patients. This study suggests diagnostic criteria of five thermographic signs to easily diagnose varicocele. Scrotal thermography presents feasible, short and low cost diagnostic method for varicocele. Further study on a larger number of patients and healthy participants is needed to evaluate sensitivity and specificity of this method.

Primary lymphedema complicated by weeping chylous vesicles in the leg and scrotum: report of a case.

We report a case of primary lymphedema complicated by leaking chylous vesicles in the toe and scrotum, caused by lymphangiectasia, which was eventually managed with lymphaticovenular anastomoses after conservative treatments proved ineffective. The patient was a 25-year-old man with a 5-year history of massive swelling with chylous weeping of his right leg and scrotum. Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph reflux. Although he was instructed in standard methods of complex therapy, it did not alleviate his symptoms. Because of the increasing frequency of cellulitis, lymphatic surgery was finally indicated. The operation consisted of lymphaticovenous anastomoses (LVA) in the ankle and groin, using a super-micro-surgical technique. After surgery, his symptoms resolved and have been controlled by self-care. Thus, early LAS to confirm the dilated iliac lymph trunks causing lymph reflux, followed by LVA might be beneficial for the management of this disease.

[Effectiveness of cycloferon in complex treatment of brucellosis patients with lesions of the scrotum].

The article presents the results of urological examination (spermograms and data of ultrasound examination) of 22 patients with chronic brucellosis and diseases of the scrotum (6 patients with orchitis, 16 with orchiepididymitis) before and after conventional therapy (10 patients) and combined treatment with the inclusion of cycloferon (2 courses of 5 intramuscular injection [0.25 g] with an interval of 10 days)--12 patients. It is shown that the administration of cycloferon leads to more effective relief of intoxication symptoms and inflammation in the testes and appendages (reduction of scrotal wall thickness, size of testes and/or adjuncts, and the incidence and severity of hydrocele), and has a positive effect on spermatogenesis (reduction of semen viscosity, the number of white blood cells in semen, sperm agglutination associated with the formation of sperm antibodies in most patients after treatment), as well as reduces the number of exacerbations of chronic orchitis/orchiepididymitis by 2.4 times.

Evaluation of sexual function in men with orchialgia.

This study examined the effect of chronic scrotal pain on sexual function using the International Index of Erectile Function (IIEF). We enrolled 50 patients with symptoms consistent with orchialgia and 50 control subjects without orchialgia, who were healthy, sexually active, married, and age-matched. Both groups were evaluated using the IIEF questions for sexual function, and quality of life was investigated using the abbreviated version of the World Health Organization Quality of Life Questionnaire. A significant difference was found in the values of orgasmic function, intercourse satisfaction, sexual desire, overall sexual satisfaction, and total IIEF scores between the patient and control groups; however, there were no significant group differences in the IIEF scores related to erectile function. In the patient group, 39 of 50 subjects reported decreased sexual desire and satisfaction due to a decrease in frequency of sexual activities. Thus, investigation of sexual function was essential for these patients in order to determine the adequate management and treatment of chronic orchialgia.

Ruptured abdominal aortic aneurysm presenting as painless testicular ecchymosis: the scrotal sign of Bryant revisited.

The diagnosis of ruptured abdominal aortic aneurysm (AAA) is often missed as a result of an atypical presentation, resulting in increased mortality. Here we present an unusual case of painless scrotal ecchymosis as a presentation of ruptured AAA. We review the origin of the scrotal sign of Bryant and emphasize the importance of this uncommon finding as a diagnostic aid in atypical cases of ruptured AAA.