RESUMEN
BACKGROUND: This case describes a Reeves' muntjac deer (Muntiacus reevesi) with a suspected undescended testicle or cryptorchidism. The cryptorchid testicle could not be palpated or visualized with sonography. Contrast-enhanced computed tomography (CT) imaging was performed to avoid an exploratory surgical operation, but no cryptorchid testicle was discovered. The final diagnosis was a singular testicular anorchia. DISCUSSION: Cryptorchidism and hypogonadism affect a relatively small population of male infants but are the most common male genitourinary anomalies. Identifying the location of the undescended testicle is paramount because surgical intervention should occur before the individual's first birthday. Although sonography and magnetic resonance imaging can help identify the location of undescended testicles, when the testicle is intra-abdominal, surgical intervention often is required to identify or confirm the location. CONCLUSION: Although CT is not a first-line imaging modality in human infants with suspected cryptorchidism because of the associated radiation exposure, this case serves as evidence that it might be useful.
Asunto(s)
Criptorquidismo , Tomografía Computarizada por Rayos X , Masculino , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Tomografía Computarizada por Rayos X/métodos , Animales , Ciervo Muntjac , Diagnóstico Diferencial , Medios de Contraste , Testículo/diagnóstico por imagen , Testículo/anomalíasRESUMEN
INTRODUCTION: The American Urological Association guidelines recommend against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism before expert consultation. We aimed to examine our institutional experience with cryptorchidism and measure adherence to currently available guidelines. METHODS: An institutional review board-approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2019, at a single tertiary level pediatric hospital. RESULTS: We identified 1796 patients evaluated in surgical clinics for cryptorchidism. Surgical intervention was performed in 75.2% (n = 1351) of the entire cohort. Ultrasound was performed in 42% (n = 754), most of which were ordered by referring physicians (91% n = 686). Of those who received an ultrasound, surgical intervention was performed in 78% (n = 588). Those 166 patients (22%) who did not undergo surgical intervention were referred with ultrasounds suggesting inguinal testes; however, all had normal physical examinations or mildly retractile testes at the time of consultation and were discharged from the outpatient clinic. There were 597 patients referred without an ultrasound, 81% (n = 483) were confirmed to have cryptorchidism at the time of specialist physical examination and underwent definitive surgical intervention, the remainder (19%, n = 114) were discharged from the outpatient clinics. CONCLUSIONS: Ultrasound evaluation of cryptorchidism continues despite high-quality evidence-based guidelines that recommend otherwise, as they should have little to no bearing on the surgeon's decision to operate or the type of operation. Instead, physical examination findings should guide surgical planning.
Asunto(s)
Criptorquidismo , Adhesión a Directriz , Ultrasonografía , Humanos , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Masculino , Estudios Retrospectivos , Ultrasonografía/normas , Preescolar , Lactante , Adhesión a Directriz/estadística & datos numéricos , Niño , Guías de Práctica Clínica como Asunto , Testículo/diagnóstico por imagen , Testículo/cirugía , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , AdolescenteRESUMEN
AIM: To assess testicular volume at puberty for boys who underwent orchidopexy at 9 or at 36 months compared to boys with spontaneous postnatal descent. METHODS: At age 6 months, boys with congenital unilateral cryptorchidism were randomised to surgery at 9 or 39 months of age and followed to 16 years in parallel with boys with spontaneous postnatal descent. Ultrasound was done at 11 and 16 years to determine testicular volume. The ratio of the initially undescended testis to its scrotal counterpart was used to assess testicular growth. RESULTS: At age 16, the ratio was lower (p < 0.00) in the late group compared to the early group. At 16 years, the spontaneously descended testes were significantly smaller than their scrotal counterparts but larger than the operated groups (early p < 0.01 and late p < 0.00). CONCLUSION: Our data at 16 years show that orchidopexy at 9 months results in better testicular growth compared to 3 years but did not reach the corresponding volumes of their scrotal counterparts. This indicates that earlier surgery is beneficial to testicular growth. At age 16, the postnatally descended testes were not only larger than the surgically treated testes but also exhibited impaired testicular growth.
Asunto(s)
Criptorquidismo , Orquidopexia , Pubertad , Testículo , Humanos , Masculino , Criptorquidismo/cirugía , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/patología , Testículo/crecimiento & desarrollo , Testículo/diagnóstico por imagen , Adolescente , Lactante , Niño , Preescolar , Pubertad/fisiología , Tamaño de los Órganos , Ultrasonografía , Factores de Edad , Estudios de SeguimientoRESUMEN
PURPOSE: We assessed the stiffness of unilateral undescended testes after orchiopexy, examining its value in tracking histopathological changes and fertility potential during postoperative follow-up. Additionally, we explored the optimal timing for surgery based on testicular stiffness. PATIENTS AND METHODS: Thirty-six boys who had been diagnosed with unilateral undescended testis and treated with orchiopexy were included in the study. Testicular stiffness was evaluated several times over respective follow-up periods by ultrasound strain elastography after orchiopexy. The strain ratios were measured as the ratios of the elasticities of the descended testis to those of the operated testes. The patients were divided into two groups based on the age at which they underwent orchiopexy:under < 2 years (Group A) and ≥ 2 years (Group B). RESULTS: The mean strain ratios were 0.90 ± 0.32 and 0.92 ± 0.20 in Groups A and B, respectively. In Group A, the strain ratio was constant regardless of postoperative months (r = 0.01, p = 0.99); however, in Group B, it tended to increase with postoperative months (r = 0.42, p = 0.07). CONCLUSIONS: Evaluation of testicular stiffness may be useful for the estimation of histopathological changes and fertility potential in boys with unilateral undescended testes at follow-up appointments after orchiopexy. Our data indicate that performing orchiopexy as early as possible may be recommended to avoid testicular damage.
Asunto(s)
Criptorquidismo , Diagnóstico por Imagen de Elasticidad , Orquidopexia , Testículo , Humanos , Masculino , Criptorquidismo/cirugía , Criptorquidismo/diagnóstico por imagen , Lactante , Preescolar , Testículo/diagnóstico por imagen , NiñoRESUMEN
INTRODUCTION: AUA Guidelines do not support the routine use of ultrasound (US) in evaluation of boys with an undescended testicle (UDT) prior to urology referral. Multiple studies have demonstrated that real time US is inferior to a physical examination by a pediatric urologist in detecting an UDT. However, improved US technology, which now permits detection of the non-palpable testis located just proximal to the internal ring, may aid in guiding the surgical approach to the non-palpable testis. We evaluated US findings of boys deemed to have a non-palpable UDT and compared them to surgical findings. OBJECTIVE: To assess the role of pre-operative ultrasonography in guiding surgical management in boys deemed to have a non-palpable testis by a pediatric urologist. STUDY DESIGN: US of boys with a non-palpable UDT, as reported by a pediatric urologist on physical exam, during a 3-year period, were reviewed. All US were performed jointly by a technician and pediatric radiologist. Patient demographics, laterality, and intra-operative findings were assessed. RESULTS: Thirty-one boys with a non-palpable testicle on physical exam underwent scrotal/inguinal/pelvis US at a median age of 7.5 months (IQR 2.5-12.3 months). Two patients had bilateral non-palpable testicles, 21 had a non-palpable left sided testicle and 8 had a non-palpable right sided testicle. Of the 33 non-palpable testes, 5 (15.2%) were identified in the inguinal canal. Sixteen (48.5%) were visualized in the lower pelvis just proximal to the internal ring and graded as intra-abdominal. Four (12.1%) nubbins or very atrophic testes were identified in the inguinal region or scrotum and 5 (15.2%) testes were not identified on US. Three (9.1%) testes were observed to be mobile between the lower pelvis just proximal to the internal ring and the inguinal canal. Of the 8 patients with testes that were identified in the inguinal canal, or mobile between the lower pelvis and inguinal canal, 7 avoided a diagnostic laparoscopy and underwent an inguinal orchiopexy. Of the 16 testicles located in the lower pelvis proximal to the internal ring, only 2 underwent laparoscopy/laparoscopic orchiopexy. DISCUSSION: In cases of a non-palpable testicle following a physical examination by a urologist, an ultrasound can impact the operative plan, and allow for patients to avoid laparoscopy. In our cohort, 87.5% of non-palpable testes avoided laparoscopic surgery after ultrasound identification of a viable testis. CONCLUSIONS: US in the evaluation of cryptorchidism can guide surgical management in select cases in which a testis is non-palpable following careful examination by a urologist.
Asunto(s)
Criptorquidismo , Laparoscopía , Masculino , Humanos , Niño , Lactante , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Ultrasonografía , OrquidopexiaRESUMEN
BACKGROUND: Testicular volume in neonates is a potential indicator of testicular development during the fetal period, particularly the masculinization programming window. Reliable measurements of testicular volume provide an opportunity for early detection of testicular abnormalities. This study aimed to assess the testicular volume in neonates and evaluate its relationship with gestational week and birth weight in Hainan Province, China. METHODS: Data on 458 neonates who underwent ultrasonography examinations at our institution from 2018 to 2022 were collected. The neonates were categorized by gestational week, birth weight, and presence of cryptorchidism. We evaluated the testicular volume among different groups and its relationship to gestational week and birth weight. RESULTS: There was no significant difference between the right and left testicular volume in neonates without cryptorchidism. However, a significant difference was observed between normal birth weight and low birth weight neonates in terms of testicular volume. Similarly, there was a significant difference between premature and full-term neonates in testicular volume. Bilateral testicular volume showed positive and significant correlations with gestational week and birth weight. Additionally, a significant difference was noted in testicular volume between the affected side in neonates with cryptorchidism and the same side in normal birth weight full-term neonates. CONCLUSIONS: We established the normal range of testicular volume for neonates in Hainan Province and demonstrated that testicular volume is positively correlated with both birth weight and gestational week. Cryptorchidism also affects testicular volume during the neonatal period, likely due to reduced androgenic exposure in utero, particularly during the masculinization programming window. The findings of this study have significant implications for assessing testis development during fetal development.
Asunto(s)
Criptorquidismo , Masculino , Recién Nacido , Humanos , Peso al Nacer , Criptorquidismo/diagnóstico por imagen , China , Desarrollo Fetal , Instituciones de SaludRESUMEN
PURPOSE: Children with undescended testes (UDTs) undergoing orchiopexy at a later age reportedly experience more negative effects on post-orchiopexy testicular volume (TV). This study aimed to investigate the effect of orchiopexy according to the age at operation. METHODS: We included 93 patients (127 testes) who underwent orchiopexy between 2008 and 2020. According to their age at orchiopexy, they were divided into Group 1 (< 24 months; n = 36, median follow-up: 17 [14-39] months) and Group 2 (≥ 24 months; n = 57, median follow-up: 16 [13-34] months). TV was measured with ultrasonography preoperatively and postoperatively. In unilateral UDTs, the testicular volume rates (TVR) were calculated as diseased-side TV/intact-side TV × 100%. A TVR < 50% indicated preoperative testicular atrophy (pre-op TA), whereas volume loss ≥ 50% from baseline indicated postoperative testicular atrophy (post-op TA). RESULTS: Only seven patients experienced pre-op TA. The TV of these 14 atrophic testes improved after orchiopexy (TVR: 100% (7/7) in Group 1 and 85% (6/7) in Group 2). Furthermore, the median TVR significantly improved after orchiectomy, from 27 to 58% (p < 0.01) and from 32 to 61% in Groups 1 and 2 (p < 0.05), respectively. Post-op TA was found in four testes (8%) in Group 1 and three testes (4%) in Group 2. Multivariate analysis showed that only preoperative testicular location predicted post-op TA. CONCLUSION: Post-orchiopexy TA may occur regardless of the patient's age at orchiopexy, and orchiopexy is recommended irrespective of age at diagnosis.
Asunto(s)
Criptorquidismo , Niño , Masculino , Humanos , Lactante , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Orquidopexia , Estudios Retrospectivos , Testículo/diagnóstico por imagen , Testículo/cirugía , Testículo/patología , Atrofia/patología , Resultado del TratamientoRESUMEN
Here, we report an adult case of intra-abdominal testicular cancer after surgical treatment of an undescended testis in infancy. A 36-year-old male patient was accidentally diagnosed with a tumor in the pelvic cavity by ultrasonographic examination. He had hematuria and the human chorionic gonadotropin beta subunit level was slightly elevated. T2-weighedmagnetic resonance imaging revealed a well-defined and highly intense mass. Since these findings suggested intra-abdominal testicular cancer, laparoscopic surgery was performed to remove the mass. Laparoscopy revealed an intra-abdominal tumor accompanied by a looping vas deferens entering the left inguinal canal. The distal part of the looping vas had already been removed from the external inguinal ring. The pathological findings revealed a pT1 seminoma. The patient has been recurrence-free for 12 months. The present case implies the importance of careful investigation and treatment for intra-abdominal testicular cancer, since intra-abdominal testis might have been overlooked at the time of surgery for undescended testis.
Asunto(s)
Neoplasias Abdominales , Criptorquidismo , Laparoscopía , Neoplasias Testiculares , Masculino , Adulto , Humanos , Testículo/patología , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/cirugía , Criptorquidismo/complicaciones , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Neoplasias Abdominales/complicaciones , Neoplasias Abdominales/cirugíaRESUMEN
BACKGROUND: Crossed testicular ectopia or transverse testicular ectopia is an extremely rare urogenital anomaly. In this condition, on average at 4 years of age the testes migrate through the inguinal canal and one or both testes may turn up in the abdomen, inguinal region, or in the hemiscrotum, with an empty contralateral hemiscrotum. Our case report documents transverse testicular ectopia in a 5-year-old boy who presented with right inguinal hernia and nonpalpable left testis. He underwent previous right herniorrhaphy at the age of 1 year. CASE PRESENTATION: A 5-year-old Iranian boy was diagnosed with a right inguinal hernia. He underwent right inguinal herniorrhaphy at the age of 1 year. For this case report, the hernia symptoms had returned. Both testicles were palpated in the right scrotum, an ultrasound examination also revealed both testicles to be present in the right scrotum, and a hernia sac located in the right inguinal region with an internal ring. The patient was recommended to undergo a surgical reconstruction. Surgical reconstruction was performed by crossing the left testis in the transseptal orchiopexy technique. CONCLUSION: In patients with cryptorchidism on one side and an inguinal hernia on the other side, the surgeon must consider a rare condition known as transverse testicular ectopia. Sonography can be helpful for diagnosing cases where transverse testicular ectopia is suspected, evaluating other anomalies, and selecting the most appropriate treatment.
Asunto(s)
Criptorquidismo , Hernia Inguinal , Masculino , Humanos , Preescolar , Hernia Inguinal/complicaciones , Hernia Inguinal/diagnóstico por imagen , Hernia Inguinal/cirugía , Irán , Testículo/diagnóstico por imagen , Testículo/cirugía , Testículo/anomalías , Criptorquidismo/complicaciones , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Orquidopexia/métodosAsunto(s)
Criptorquidismo , Seminoma , Neoplasias Testiculares , Masculino , Humanos , Adulto Joven , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Seminoma/diagnóstico por imagen , Seminoma/cirugía , Ultrasonografía , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/cirugía , Neoplasias Testiculares/patologíaRESUMEN
BACKGROUND AND OBJECTIVE: The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020. STUDY DESIGN: We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org). RESULTS: A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p = 0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17 mm (16-19.2)) as compared to patients with a viable testis (median length 15 mm (14-17), p = 0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p < 0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p = 0.007]. CONCLUSION: Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.
Asunto(s)
Criptorquidismo , Testículo , Masculino , Humanos , Niño , Lactante , Testículo/diagnóstico por imagen , Testículo/cirugía , Incidencia , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/epidemiología , Criptorquidismo/cirugía , Ultrasonografía , HipertrofiaRESUMEN
PURPOSE: One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT. METHODS: The data of 215 patients aged < 15 years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded. RESULTS: TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy. CONCLUSION: Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.
Asunto(s)
Criptorquidismo , Niño , Masculino , Humanos , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Estudios Retrospectivos , AtrofiaRESUMEN
Transverse testicular ectopia is a rare anomaly characterized by both testes descending through a single inguinal canal. The objective of this study was to investigate the pathogenesis, diagnosis, and treatment of transverse testicular ectopia (TTE) with persistent Mullerian duct syndrome (PMDS), and to deepen the understanding of the disease in clinical. A retrospective analysis of the clinical manifestation, diagnosis, and treatment of two children suffering from TTE with PMDS was conducted. Previous studies on the characteristics, diagnosis, and treatment of this disease were reviewed. The two patients were treated with laparoscopy-assisted transseptal orchidopexy-inguinal evaluation. After the surgery, the two patients recovered well. The follow-up visits were done 3 months after the operation. An ultrasound examination confirmed that the two patients had testes in the orthotopic position and normal size. TTE with PMDS is an exceedingly rare disease. The patients manifested cryptorchidism on one side; contralateral inguinal hernia was suspected. Detailed physical and ultrasound examinations before the operation are the key to the early diagnosis of TTE. Laparoscopic evaluation is helpful for the diagnosis and finding of other abnormalities. Surgical treatment is the only method to cure the disease; long-term follow-up is needed after TTE operation.
Asunto(s)
Criptorquidismo , Trastorno del Desarrollo Sexual 46,XY , Masculino , Niño , Humanos , Estudios Retrospectivos , Trastorno del Desarrollo Sexual 46,XY/diagnóstico , Trastorno del Desarrollo Sexual 46,XY/cirugía , Orquidopexia/efectos adversos , Criptorquidismo/diagnóstico , Criptorquidismo/diagnóstico por imagen , Testículo/diagnóstico por imagen , Testículo/cirugía , Testículo/anomalíasRESUMEN
Cryptorchidism is defined as the failure of the testis to descend into the scrotal position. Bulls with cryptorchidism have problems in both meat quality and husbandry management; thus, it is greatly important to accurately identify the retained testis and remove it during the early stage. Abdominal computed tomography (CT) was performed under general anesthesia in 34 bulls aged 3-9 months with cryptorchidism. All bulls underwent laparoscopic or incision approach for cryptorchidectomy, and 40 testes were dissected. The detection rates of retained testes were 64.5% in the abdominal cavity and 100% in the subcutaneous inguinal region, and the total detection rate was 72.5%. Furthermore, all cases in this study were suspected to have intra-abdominal cryptorchidism in primary care, but CT revealed that 22.5% of cases had cryptorchidism in the subcutaneous inguinal region. The CT value (mean ± standard deviation) of the retained testes was 20.96 ± 7.54 Hounsfield Unit, and the CT value and size of the retained testes showed a positive weak correlation with bovine age. Therefore, there is the demerit that general anesthesia and a huge device are necessary; nevertheless, CT is suggested to be useful in identifying the location of retained testes and selecting an appropriate surgical approach in bulls with cryptorchidism. Moreover, CT findings suggested that the maturation of the retained testes might depend not on the descending process but on age.
Asunto(s)
Enfermedades de los Bovinos , Criptorquidismo , Laparoscopía , Animales , Bovinos , Enfermedades de los Bovinos/diagnóstico por imagen , Enfermedades de los Bovinos/cirugía , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Criptorquidismo/veterinaria , Laparoscopía/métodos , Laparoscopía/veterinaria , Masculino , Escroto/diagnóstico por imagen , Escroto/cirugía , Testículo/diagnóstico por imagen , Testículo/cirugía , Tomografía , Tomografía Computarizada por Rayos X/veterinariaRESUMEN
To explore the value of ultrasound in the preoperative diagnosis of nonpalpable testis (NPT) in children. A retrospective study of 254 cases with NPT from May 2017 to December 2021. The preoperative ultrasound examination results were compared with the surgical exploration and pathological results. There were 254 cases (312 testes) NPT has got surgery in our centre. The surgical age were from 6 month to 12 years old, the median age was 2.33 years. There were 103 cases (136 testes) diagnosed as intra-abdominal testis (IAT) by preoperative ultrasound, and 80 cases (103 testes) of extra-abdominal testis (EAT), 71 cases (73 testes) of non-viable testis (NVT). There were 102 cases (135 testes) consistented as IAT by the diagnostic laparoscopy, the preoperative ultrasound's coincidence of IAT was 99.02%. There were 80 cases (103 testes) consistented as EAT by the diagnostic laparoscopy, the preoperative ultrasound's coincidence rate was100%. There were 62 cases (62 testes) consistented as NVT by the diagnostic laparoscopy, there were 9 cases (11 testes) misdiagnosed, the preoperative ultrasound's coincidence rate was 84.9%. Ultrasound can provide valuable information for the preoperative diagnosis of children with nonpalpable testicles, and especially good at identifying the EAT and IAT with normal testicular morphology.
Asunto(s)
Criptorquidismo , Laparoscopía , Niño , Preescolar , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/patología , Humanos , Lactante , Laparoscopía/métodos , Masculino , Estudios Retrospectivos , Testículo/patología , UltrasonografíaRESUMEN
A 14-week-old male unilaterally cryptorchid Clumber spaniel was presented for acute lethargy. Physical examination revealed abdominal pain, and a single testis was palpated in the scrotum. Abdominal ultrasound and computed tomography (CT) revealed a poorly vascularized, ovoid structure immediately caudal to the left kidney with scant regional peritoneal effusion. Left intra-abdominal testicular torsion was confirmed at surgery, and routine cryptorchidectomy was performed. The patient recovered uneventfully from anesthesia and surgery. Key clinical message: The most common CT characteristics of testicular torsion were present in this case and correlated well with sonographic findings to allow for rapid, accurate diagnosis and surgical planning of unilateral, non-neoplastic, intra-abdominal cryptorchid testicular torsion in a juvenile dog. Contrast enhanced CT facilitated accurate localization of the undescended testis and evaluation of testicular perfusion and may be a useful alternative to ultrasound for diagnosing testicular torsion, especially in indeterminate cases.
Tomodensitométrie d'une torsion testiculaire chez un chien juvénile atteint de cryptorchidie unilatérale. Un épagneul Clumber avec une cryptorchidie unilatérale âgé de 14 semaines a été présenté pour une léthargie aiguë. L'examen physique a révélé des douleurs abdominales et un seul testicule a été palpé dans le scrotum. L'échographie abdominale et la tomodensitométrie ont révélé une structure ovoïde mal vascularisée immédiatement caudale au rein gauche avec peu d'épanchement péritonéal régional. Une torsion testiculaire intra-abdominale gauche a été confirmée lors de la chirurgie et une cryptorchidectomie de routine a été réalisée. Le patient s'est remis sans incident de l'anesthésie et de la chirurgie.Message clinique clé:Les caractéristiques tomodensitométriques les plus courantes de la torsion testiculaire étaient présentes dans ce cas et bien corrélées avec les résultats échographiques pour permettre un diagnostic rapide et précis et une planification chirurgicale de la torsion testiculaire avec cryptorchidie unilatérale, non néoplasique et intra-abdominale chez un chien juvénile. La tomodensitométrie avec contraste a facilité la localisation précise du testicule non descendu et l'évaluation de la perfusion testiculaire et peut être une alternative utile à l'échographie pour diagnostiquer la torsion testiculaire, en particulier dans les cas indéterminés.(Traduit par Dr Serge Messier).
Asunto(s)
Criptorquidismo , Enfermedades de los Perros , Torsión del Cordón Espermático , Animales , Criptorquidismo/diagnóstico por imagen , Criptorquidismo/cirugía , Criptorquidismo/veterinaria , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/cirugía , Perros , Masculino , Torsión del Cordón Espermático/diagnóstico por imagen , Torsión del Cordón Espermático/cirugía , Torsión del Cordón Espermático/veterinaria , Tomografía Computarizada por Rayos X , Ultrasonografía/veterinariaRESUMEN
AIM: Scrotal ultrasounds are utilised in some primary care settings for suspected cryptorchidism, despite inaccuracies. We aim to identify the correlation between ultrasound and primary care provider (PCP) findings of undescended testicles (UDTs) as a potential source of confirmation bias. METHODS: Males referred for suspected UDT by PCPs who underwent scrotal ultrasound and paediatric urologist examination from 2014 to 2019 were included. Correlation between PCP and ultrasound findings and diagnostic accuracy were evaluated. Logistic regression was utilised to determine associations between patient factors and UDT misdiagnosis. RESULTS: Out of 145 testes, ultrasound corroborated PCPs' UDT diagnoses 87.6% of the time, 49.6% of which were confirmed as UDT by paediatric urologists. Ultrasound had a false positivity rate of 81.0% and specificity of 19.0%. Ultrasound versus paediatric urologist findings regarding testicle location were significantly different (P < 0.0001). Patients aged ≥8 years old had 5.2 times greater odds of being misdiagnosed with UDT than patients <8 years old (95% confidence interval: 1.6-16.7; P < 0.002) by PCP and ultrasound. CONCLUSION: Scrotal ultrasound highly corroborated PCPs' UDT diagnoses. Older patients were more likely to be misdiagnosed with UDT by PCP and ultrasound. As ultrasounds rarely refute PCP examinations for suspected UDTs and are highly inaccurate, confirmation bias may explain the use of ultrasound in the workup of UDT.
Asunto(s)
Criptorquidismo , Niño , Criptorquidismo/diagnóstico por imagen , Humanos , Masculino , Examen Físico , Derivación y Consulta , Escroto/diagnóstico por imagen , UltrasonografíaRESUMEN
ABSTRACT: Doppler ultrasonography and testicular scintigraphy are sensitive techniques to detect the adequacy of blood flow to testicular tissue. Because Doppler ultrasonography is an operator-dependent imaging modality, it can result in equivocal findings. Testicular scintigraphy proves to be more accurate in such cases, but it may be inconclusive on occasion. The authors report the case of a young man with a left undescended testis where testicular scintigraphy was inconclusive for viability and 18F-FDG PET/CT provided important diagnostic information.