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INTRODUCTION: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. MATERIAL AND METHODS: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. RESULTS: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. CONCLUSIONS: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.
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Edad Gestacional , Pene , Humanos , Masculino , Pene/irrigación sanguínea , Pene/embriología , Pene/inervación , Feto/irrigación sanguínea , Feto/embriología , Inmunohistoquímica , Desarrollo Fetal/fisiologíaRESUMEN
PURPOSE: The gubernaculum seems to be the most important anatomical structure in the testicular migration process. The objective of this paper is to review current literature regarding the role of gubernaculum testis nerves in testicular migration. We conducted a comprehensive literature review about the gubernaculum testis innervation. A PubMed database search was performed in April 2024, focusing on gubernaculum testis and cryptorchidism and genitofemoral nerve (GFN) and calcitonin gene-related peptide (CGRP) gene. The gubernaculum has its own nerve supply, the GFN, descending on the anteromedial surface of the psoas muscle from L1-L2 segments. The second phase of testicular descent is regulated by androgens and CGRP, released from the sensory nucleus of the GFN. The GFN doesn't directly play a role in testicular migration but there is a theory that shows a regulatory function of this nerve in hormonal action during this process. The gubernaculum testis has important structural alterations during the testicular migration and the genitofemoral nerve and CGRP gene are of great importance in this process. The genitofemoral nerve provides motor innervation to the cremaster muscle and gubernaculum, which helps regulate the position of the testes within the scrotum.
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Criptorquidismo , Gubernáculo , Testículo , Humanos , Masculino , Testículo/fisiología , Testículo/embriología , Gubernáculo/fisiología , Gubernáculo/embriología , Péptido Relacionado con Gen de Calcitonina/fisiología , Feto/fisiologíaRESUMEN
ABSTRACT Objective: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. Material and Methods: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. Results: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. Conclusion: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.
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OBJECTIVE: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. MATERIAL AND METHODS: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. RESULTS: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. CONCLUSION: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.
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Cálculos Renales , Riñón , Humanos , Riñón/diagnóstico por imagen , Riñón/cirugía , Cálices Renales/diagnóstico por imagen , Cálices Renales/cirugía , Pelvis Renal/diagnóstico por imagen , Pelvis Renal/cirugía , Cálculos Renales/diagnóstico por imagen , Cálculos Renales/cirugía , Bases de Datos FactualesRESUMEN
Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and determine the laterality pattern of the testicular and epididymal hydatids and evaluate the correlations between the length and width of the testicular and epididymal hydatids with testicular measurements. We analyzed 60 fixed cadavers and 16 patients with prostate cancer without previous hormonal treatment undergoing bilateral orchiectomy, totalizing 76 units and 152 testicles. In relation to the testicular appendices, we analyzed the following situations: absence of testicular and epididymis appendages, presence of a testicular appendix, presence of epididymis appendix, and presence of testicular and epididymis appendix. We measured the length, width and thickness of the testis and classified the appendages as sessile or pedicled. Chi-square test was used to verify associations between categorical variables. McNemar Test was used to verify differences between the percentages of right and left appendages. Correlations between quantitative measures were evaluated using the Pearson Correlation Coefficient (p < 0.05). In 50 cases (65.78%) we observed the presence of some type of appendices, in 34 cases (44.72%) we observed the presence of testicular appendices and in 19 cases (25%) the presence of epididymal appendices. We observed the presence of pedicled appendices in 39 cases (51.32%), with 25 of the cases (32.89%) of pedicled testicular appendices and 14 of the cases (18.42%) of pedicled epididymal appendages, with a significant association between the occurrence of appendices on the right and left sides (p < 0.001). Testicular hydatids were present in around two thirds of our sample being pedunculated in almost half of the cases with bilateral similarity. There is a significant chance in cases of twisted appendices that the same anatomical characteristics are present on the opposite side, which is a factor that tends to indicate the need for contralateral surgical exploration in cases of torsion, however studies with larger samples are needed to confirm these findings.
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Torsión del Cordón Espermático , Testículo , Masculino , Humanos , Testículo/cirugía , Epidídimo/cirugía , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/cirugía , Pelvis , OrquiectomíaRESUMEN
ABSTRACT Purpose: To analyze the histology and distribution of abdominal testicular vessels in human fetuses Patients and Methods: We studied 19 fetuses (34 testes) ranging in age from 12 to 19 weeks post-conception. The fetuses were evaluated regarding crown-rump length (CRL), total length (TL) and body weight immediately before dissection. Each testis was dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson's trichrome and Anti-CD31 antibody to quantify the vessels. The stereological analysis was carried out with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the unpaired T-test (p<0.05). Results: The fetuses presented mean weight of 222.5g, mean CRL of 15.3 cm and mean TL of 23.2 cm. All testes were in the abdominal position. The mean percentage of vessels (Vv) in the upper portion of the testis was 7.6% (4.6 to 15%) and in the lower portion the mean was 5.11% (2.3 to 9.8%), with a significant difference (p=0.0001). In the analysis between the upper portion of the right and left testes (p=0.99) and in the analysis of the lower portion of the right and left testes (p=0.83), we did not observe significant differences. Conclusion: The upper portion of the abdominal testis in human fetuses had a higher concentration of vessels than the lower portion. These results suggest that manipulation of the lower end of the testis during Fowler-Stephens surgery should be avoided in order to preserve the collateral circulation.
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PURPOSE: To analyze the histology and distribution of abdominal testicular vessels in human fetuses Patients and Methods: We studied 19 fetuses (34 testes) ranging in age from 12 to 19 weeks post-conception. The fetuses were evaluated regarding crown-rump length (CRL), total length (TL) and body weight immediately before dissection. Each testis was dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson's trichrome and Anti-CD31 antibody to quantify the vessels. The stereological analysis was carried out with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the unpaired T-test (p<0.05). RESULTS: The fetuses presented mean weight of 222.5g, mean CRL of 15.3 cm and mean TL of 23.2 cm. All testes were in the abdominal position. The mean percentage of vessels (Vv) in the upper portion of the testis was 7.6% (4.6 to 15%) and in the lower portion the mean was 5.11% (2.3 to 9.8%), with a significant difference (p=0.0001). In the analysis between the upper portion of the right and left testes (p=0.99) and in the analysis of the lower portion of the right and left testes (p=0.83), we did not observe significant differences. CONCLUSION: The upper portion of the abdominal testis in human fetuses had a higher concentration of vessels than the lower portion. These results suggest that manipulation of the lower end of the testis during Fowler-Stephens surgery should be avoided in order to preserve the collateral circulation.
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Criptorquidismo , Testículo , Masculino , Humanos , Lactante , Testículo/cirugía , Criptorquidismo/cirugía , Feto/cirugía , FertilizaciónRESUMEN
ABSTRACT Purpose To evaluate the penile morphology after the isolated and combined administration of dutasteride and tamsulosin in a rodent model. Materials and Methods Forty male rats were assigned into the following groups: Control group (C, receiving distilled water, n=10); Dutasteride group (D, receiving 0.5 mg/Kg/day of dutasteride, n=10); Tamsulosin group (T, receiving 0.4 mg/Kg/day of tamsulosin, n=10); and Dutasteride associated with Tamsulosin group (DT, receiving both drugs n = 10). All drugs were administered via oral gavage. After 40 days, the animals were submitted to euthanasia and their penises were collected for histomorphometric analyses. Data were compared using one-way ANOVA followed by Bonferroni's post-test, considering p<0.05 as significant. Results The sinusoidal space and smooth muscle fiber surface densities (Sv), and the cross-sectional penile areas of rats in groups D, T and DT were reduced in comparison to controls with the most notable reductions in the combined therapy group. The connective tissue and elastic system fibers Sv were augmented in groups D, T and DT in comparison with the control group, again with the most pronounced changes observed in animals receiving the combined therapy. Conclusion Both treatments with dutasteride or tamsulosin promoted penile morphometric modifications in a rodent model. The combination therapy resulted in more notable modifications. The results of this study may help to explain the erectile dysfunction observed in some men using these drugs.
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PURPOSE: To evaluate the penile morphology after the isolated and combined administration of dutasteride and tamsulosin in a rodent model. MATERIALS AND METHODS: Forty male rats were assigned into the following groups: Control group (C, receiving distilled water, n=10); Dutasteride group (D, receiving 0.5 mg/Kg/day of dutasteride, n=10); Tamsulosin group (T, receiving 0.4 mg/Kg/day of tamsulosin, n=10); and Dutasteride associated with Tamsulosin group (DT, receiving both drugs n = 10). All drugs were administered via oral gavage. After 40 days, the animals were submitted to euthanasia and their penises were collected for histomorphometric analyses. Data were compared using one-way ANOVA followed by Bonferroni's post-test, considering p<0.05 as significant. RESULTS: The sinusoidal space and smooth muscle fiber surface densities (Sv), and the cross-sectional penile areas of rats in groups D, T and DT were reduced in comparison to controls with the most notable reductions in the combined therapy group. The connective tissue and elastic system fibers Sv were augmented in groups D, T and DT in comparison with the control group, again with the most pronounced changes observed in animals receiving the combined therapy. CONCLUSION: Both treatments with dutasteride or tamsulosin promoted penile morphometric modifications in a rodent model. The combination therapy resulted in more notable modifications. The results of this study may help to explain the erectile dysfunction observed in some men using these drugs.
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Inhibidores de 5-alfa-Reductasa , Hiperplasia Prostática , Humanos , Masculino , Ratas , Animales , Dutasterida/farmacología , Dutasterida/uso terapéutico , Tamsulosina/uso terapéutico , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Hiperplasia Prostática/tratamiento farmacológico , Roedores , Estudios Transversales , Quimioterapia CombinadaRESUMEN
ABSTRACT Objective: To evaluate the anatomical aspects of the kidney surface in human fetuses during the second gestational trimester. Material and Methods: We studied 108 kidneys obtained from 54 human fetuses (29 males and 25 females). The kidney was dissected and the number of clefts was counted. The renal volume was also assessed. To compare the quantitative data in both sexes, the Students-t-test was used (p < 0.05). Simple linear correlations were calculated for all kidney measurements, according to fetal age. Statistical analysis was performed with the R program (Version 3.5.1). Results: The fetuses ranged in age between 11.4 to 23 weeks post-conception. The renal volume of the right kidney ranged from 0.09 to 2.397 cm (mean=0.8479) and the renal volume of the left kidney ranged from 0.07 to 2.416 cm (mean=0.8036). The mean number of renal clefts in fetuses studied was 15.25 (7 to 28). There was no statistical significant difference in renal clefts between the sides either in males (p = 0.646) or in females (p = 0.698). Also, there was no significant difference in the mean number of renal clefts between male and female fetuses in right kidney (p = 0.948) and in left kidney (p = 0.939). Conclusions: The number of renal clefts has a great variation, weak correlation and no tendency to decrease during the 2nd gestational trimester. The number of clefts in right kidney of total sample and female fetuses has a significant development with age.
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OBJECTIVE: To evaluate the anatomical aspects of the kidney surface in human fetuses during the second gestational trimester. MATERIAL AND METHODS: We studied 108 kidneys obtained from 54 human fetuses (29 males and 25 females). The kidney was dissected and the number of clefts was counted. The renal volume was also assessed. To compare the quantitative data in both sexes, the Students-t-test was used (p < 0.05). Simple linear correlations were calculated for all kidney measurements, according to fetal age. Statistical analysis was performed with the R program (Version 3.5.1). RESULTS: The fetuses ranged in age between 11.4 to 23 weeks post-conception. The renal volume of the right kidney ranged from 0.09 to 2.397 cm (mean=0.8479) and the renal volume of the left kidney ranged from 0.07 to 2.416 cm (mean=0.8036). The mean number of renal clefts in fetuses studied was 15.25 (7 to 28). There was no statistical significant difference in renal clefts between the sides either in males (p = 0.646) or in females (p = 0.698). Also, there was no significant difference in the mean number of renal clefts between male and female fetuses in right kidney (p = 0.948) and in left kidney (p = 0.939). CONCLUSIONS: The number of renal clefts has a great variation, weak correlation and no tendency to decrease during the 2nd gestational trimester. The number of clefts in right kidney of total sample and female fetuses has a significant development with age.
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Feto , Riñón , Femenino , Feto/diagnóstico por imagen , Edad Gestacional , Humanos , Lactante , Riñón/diagnóstico por imagen , Masculino , Embarazo , Segundo Trimestre del EmbarazoRESUMEN
One of the most common malformations of the central nervous system is related to embryonic neural tube alterations. We hypothesized that anencephaly affects the development of the uterus during the human second trimester of pregnancy. The objective of this study was to study the biometric parameters of the uterus in fetuses with anencephaly and compare them with normocephalic fetuses at that important. In our study, 34 female fetuses were analyzed, 22 normal and 12 anencephalic, aged between 12 and 22 weeks post-conception (WPC). After dissection of the pelvis and individualization of the genital tract, we evaluated the length and width of the uterus using the Image J software. We compared the means statistically using the Wilcoxon-Mann-Whitney test and performed linear regression. We identify significant differences between the uterus length (mm)/weight (g) × 100 (p = 0.0046) and uterus width (mm)/weight (g) × 100 (p = 0.0013) when we compared the control with the anencephalic group. The linear regression analysis indicated that 80% significance was found in the correlations in normocephalic fetuses (12.9 to 22.6 WPC) and 40% significance in anencephalic fetuses (12.3 to 18.6 WPC). The measurements of the uterus were greater in anencephalic group but there are no difference in the uterine width and length growth curves during the period studied. Further studies are required to support the hypothesis suggesting that anencephaly may affect uterine development during the human fetal period.
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Anencefalia , Craneosinostosis , Defectos del Tubo Neural , Femenino , Feto , Humanos , Lactante , Embarazo , ÚteroRESUMEN
ABSTRACT Purpose: To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan). Materials and Methods: We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics. Results: There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference. Conclusions: The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.
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ABSTRACT Background: To analyze the incidence of epididymal anomalies (EAs) associated to spermatic obstruction in patients with undescended testis (UT) according to testicular position and age. Materials and Methods: We studied 87 patients (110 testis) with cryptorchidism and analyzed the presence of EAs correlated with the testicular position, age and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis we considered three situations: (a) Normal pattern: the epididymis was attached to the testis at the head and tail and epididymis totally attached to the testis; (b) EAs: when the epididymis was attached to the testis only at the head (Figure-1A) and (c) EAs associated to spermatic obstruction: epididymis was attached to the testis only at the tail (Figure-1B) and when there are no visible connection between testis and epididymis (Figure-1C). We used the Wilcoxon-Mann-Whitney test and the Chi-square test for contingency analysis (p <0.05). Results: The mean age of the patients was 5.18 years (SD=2.867). Of 110 testes analyzed, 14 were abdominal (12.72%); 83 inguinal (75.45%) and 13 suprascrotal (11.81%). Normal relationships between testis and epididymis were observed in 54 patients (62.1%) with no significant differences in relation to the patient's age (p=0.666). Epididymal tail disjunction was observed in 23 patients (26.44%), with no significant differences in relation to age (p=0.59). EAs associated to spermatic obstruction were observed in 16 patients (18.4%), also with no significant differences in relation to age (p=0.684). We did not observe significant correlation between the testis position and the incidence of EAs (p=0.119). We did not observe significant correlations between patency of the PV (64.7%) and incidence of EAs (p=0.742). Conclusions: Epididymal anomalies associated with spermatic obstruction are present in almost 20% of undescended testes, without significant correlation with age, testicular position and patency of the PV. This information needs to be correlated to the infertility risk of this congenital anomaly.
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Humanos , Masculino , Preescolar , Criptorquidismo/complicaciones , Testículo/anomalías , Incidencia , Epidídimo/anomalías , Conducto InguinalRESUMEN
PURPOSE: To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan). MATERIALS AND METHODS: We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics. RESULTS: There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference. CONCLUSIONS: The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.
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Riñón Fusionado , Cálculos Renales , Adulto , Riñón Fusionado/diagnóstico por imagen , Humanos , Riñón/anatomía & histología , Riñón/diagnóstico por imagen , Cálices Renales/diagnóstico por imagen , Pelvis Renal/diagnóstico por imagenRESUMEN
BACKGROUND: To analyze the incidence of epididymal anomalies (EAs) associated to spermatic obstruction in patients with undescended testis (UT) according to testicular position and age. MATERIALS AND METHODS: We studied 87 patients (110 testis) with cryptorchidism and analyzed the presence of EAs correlated with the testicular position, age and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis we considered three situations: (a) Normal pattern: the epididymis was attached to the testis at the head and tail and epididymis totally attached to the testis; (b) EAs: when the epididymis was attached to the testis only at the head (Figure-1A) and (c) EAs associated to spermatic obstruction: epididymis was attached to the testis only at the tail (Figure-1B) and when there are no visible connection between testis and epididymis (Figure-1C). We used the Wilcoxon-Mann-Whitney test and the Chi-square test for contingency analysis (p <0.05). RESULTS: The mean age of the patients was 5.18 years (SD=2.867). Of 110 testes analyzed, 14 were abdominal (12.72%); 83 inguinal (75.45%) and 13 suprascrotal (11.81%). Normal relationships between testis and epididymis were observed in 54 patients (62.1%) with no significant differences in relation to the patient's age (p=0.666). Epididymal tail disjunction was observed in 23 patients (26.44%), with no significant differences in relation to age (p=0.59). EAs associated to spermatic obstruction were observed in 16 patients (18.4%), also with no significant differences in relation to age (p=0.684). We did not observe significant correlation between the testis position and the incidence of EAs (p=0.119). We did not observe significant correlations between patency of the PV (64.7%) and incidence of EAs (p=0.742). CONCLUSIONS: Epididymal anomalies associated with spermatic obstruction are present in almost 20% of undescended testes, without significant correlation with age, testicular position and patency of the PV. This information needs to be correlated to the infertility risk of this congenital anomaly.
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Criptorquidismo , Preescolar , Criptorquidismo/complicaciones , Epidídimo/anomalías , Humanos , Incidencia , Conducto Inguinal , Masculino , Testículo/anomalíasRESUMEN
ABSTRACT Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.
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Humanos , Masculino , Cordón Espermático/cirugía , Laparoscopía , Criptorquidismo/cirugía , Arterias/cirugía , Testículo/cirugía , OrquidopexiaRESUMEN
OBJECTIVES: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. MATERIAL AND METHODS: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. RESULTS: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. CONCLUSIONS: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.
Asunto(s)
Criptorquidismo , Laparoscopía , Cordón Espermático , Arterias/cirugía , Criptorquidismo/cirugía , Humanos , Masculino , Orquidopexia , Cordón Espermático/cirugía , Testículo/cirugíaRESUMEN
ABSTRACT Purpose: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction. Material and methods: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p <0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). Results: Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. Conclusion: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Adulto Joven , Torsión del Cordón Espermático/cirugía , Prótesis e Implantes , Testículo/cirugía , Orquiectomía , Estudios Retrospectivos , Implantación de PrótesisRESUMEN
PURPOSE: The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction. MATERIAL AND METHODS: We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p<0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05). RESULTS: Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again. CONCLUSION: There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.