Do prune-belly syndrome and neural tube defects change testicular growth? A study on human fetuses.

BACKGROUND: There are no reports comparing testicular volume between normal fetuses, fetuses with prune-belly syndrome (PBS), and fetuses with anencephaly. The study hypothesis was that PBS and especially anencephaly alter the testicular volume during the human fetal period. AIM: The objective of the study was to compare the testicular growth in fetuses with anencephaly, with PBS, and without anomalies. STUDY DESIGN: This is a morphometric study of human fetuses. Seventy testes from fetuses without anomalies aged 11-22 weeks post-conception (WPC), 30 testes from fetuses with anencephaly aged 13-19 WPC, and eight testes from fetuses with PBS aged 13-16 WPC were studied. Testicular length, width, and thickness were evaluated with the aid of computer programs (Image Pro and ImageJ) (Figure). The fetal testicular volume was calculated using the ellipsoid formula: Testicular volume (TV) = [length × thickness × width] × 0.523. The Shapiro-Wilk test was used to ascertain the normality of the data and to compare quantitative data between normal fetuses vs. fetuses with anencephaly, while the Kruskal-Wallis test was used to assess gender and laterality differences. Simple linear correlations (LCs) were calculated for testicular volume according to fetal age, weight, and crown-rump length. RESULTS: All 108 testes studied were abdominal. The right (p = 0.0310) and left (0.0470) testicular volumes were significantly smaller in fetuses with anencephaly than those in the control group. The linear regression analysis indicated that the right and the left testis volume in the control group (right: r2 = 0.6665; left: r2 = 0.6707) and PBS group (right: r2 = 0.9937; left: r2 = 0.9757) increased with fetal age (p < 0.0001). This analysis also indicated that the testicular volume in fetuses with anencephaly did not increase with fetal age (right: r2 = 009816; left: r2 = 0.07643). DISCUSSION: This article is the first to report testicular volume correlations with fetal parameters in fetuses with anencephalic and fetuses with PBS. Significant alterations were observed in testicular growth in the anencephalic group compared with the control group, and it was also observed that the bilateral cryptorchidism in PBS does not alter the testicular development and growth during the fetal period. The unequal WPC distribution between fetuses with PBS, fetuses with anencephaly, and controls and the small sample size are limitations of this study. Further studies should be performed to confirm this study's findings. CONCLUSIONS: Testicular growth is slower and does not show significant correlations with fetal parameters in fetuses with anencephalic. Significant differences in testicular development in fetuses with PBS was not observed.

Primary urethral reconstruction results in penile fracture.

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

Relationship between sexual position and severity of penile fracture.

The objective of the study was to evaluate the relationship between the sexual position and severity of penile fracture (PF). We studied 90 patients with PF. The mechanism of injury and the sexual position was assessed. We divided our sample by the etiology of the fracture in six groups: (a) masturbation or penile manipulation; (b) 'man-on-top' position; (c) 'doggy style' position; (d) 'woman-on-top' position; (d) blunt trauma; and (e) 'rolling over' fracture. We used the χ2-test for contingency analysis of the populations under study (P<0.05). The patient's age ranged from 18 to 66 years (mean 39 years). Investigation of the injury mechanism identified sexual trauma as the main etiological factor, involved in 69 cases (76.5%). The sexual position at the time of injury varied, with 23 cases (25.5%) occurring in the 'man-on-top', 37cases (41%) in the 'doggy style' and 9 cases (10%) in the 'woman-on-top'. We do not observe differences between the severity of the PF between the 'doggy style' and 'man-on-top' (P=0.9595), but the 'doggy style' had more severity of PF when compared with 'woman-on-top' (P=0.0396) and penile manipulation (P=0.0026). The 'man-on-top' and 'doggy style' positions showed more associations with bilateral fractures of the corpus cavernosum and urethral lesions.

Morphology of the fetal bladder during the second trimester: comparing genders.

OBJECTIVES: The aim of the present study was to determine, by histological and stereological analysis, whether there are between-gender structural differences in the bladder in the second gestational trimester in human fetuses. MATERIAL AND METHODS: Forty bladders, which were obtained from 40 human fetuses (20 males and 20 females) ranging in age from 13 to 23 weeks post-conception (WPC), were studied. The fetuses were macroscopically well preserved, without anomalies of the urinary and genital systems; the cases with syndromes were abandoned. The bladders were dissected and embedded in paraffin, from which 5-µm thick sections were obtained and stained with: Masson's trichrome, to quantify connective and smooth muscle tissue; Weigert's resorcin fuchsin, to observe elastic fibers; picrosirius red with polarization, to observe collagen; and anti-beta III tubulin antibody, to observe the bladder nerves. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was performed with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using simple linear regression and the paired t-test (P<0.05). RESULTS: The fetuses weighed between 60 and 490 g, and had crown-rump lengths between 9.5 and 20.4 cm. No elastic system fibers were observed in any bladders. Quantitative analysis indicated no differences in the Vv of the smooth muscle cells in the male bladders (26.19-50.16%; mean=35.66%) compared to the female ones (30.60-45.63%; mean=38.73%) (P=0.740) and there were also no differences in the Vv of the connective tissue in females (40.52-60.40%; mean=50.69%) and males (38.84-70.16%; mean=57.04%) (P=0.0506). There were no differences observed in the distribution of the nerves and collagen between the genders. CONCLUSION: The histological analysis of the smooth muscle, collagen, nerves and connective tissue of the developing bladders revealed that there are no gender differences during weeks 13-23 of gestation.

Unilateral Renal Haemangiopericytoma: Report of a Rare Tumour

RESUMEN: Los pericitos son células musculares lisas modificadas de los tubos capilares circundantes los cuales cambian el diámetro del lumen vascular. En este artículo relatamos un caso dehemangiopericitoma renal presente en una mujer de 78 años, quien manifestaba dolor abdominal. La ultrasonografía determinó una lesión sólida en la tercera porción del riñón izquierdo. La exploración abdominal de CT reveló una masa tumoral. Debido a la alta sospecha de neoplasia maligna, la paciente fue sometida a nefrectomía radical izquierda. La evaluación histopatológica confirmó el hemangiopericitoma, a través de inmunohistoquímica. La paciente sobrevive cinco años después de la nefrectomía radical.

Rare variation in course and affluence of internal iliac vein due to its anatomical and surgical significance.

During regular dissection of the retroperitoneal region, three uncommon anatomical variations of the internal iliac veins were found on dissected specimens: in the first case, the internal iliac veins converge forming a common trunk draining into the left external iliac vein. In the other two cases, the internal iliac vein crosses the median plane and flows into the contralateral common iliac vein. These anomalies result from a persistence of the embryonic inferior branch of the cardinal vein and are important to be known for they may be undetected or may not appear in imaging. These data have implications for both pelvic surgeons and anatomists who manipulated this anatomical area.

Triple Right Renal Vein: An Uncommon Variation / Vena Renal Derecha Triple: Una Variación Rara

We report an unilateral three renal veins the right kidney in an elderly male cadaver. They were three calibrous veins having independent courses up to the inferior vena cava. No other vascular anomalies were noted in this specimen. This anatomical curiosity should be kept in mind by clinicians and academics that may manipulate this anatomical area.

Presentamos una variación anatómica consistente en tres venas renales unilaterales presentes en el riñón derecho de un cadáver de un individuo adulto de sexo masculino. Las tres venas eran de calibre considerable, las cuales tenían cursos independientes hasta la vena cava inferior. No se observó ninguna otra variación vascular en este individuo. Tanto los clínicos como los académicos deben tener presente esta variación anatómica cuando se acceda a esta área anatómica.

Variaciones anatómicas entre el nervio isquiático y el músculo piriforme durante el período fetal humano / Anatomical variations between sciatic nerve and periform muscle during fetal period in human

El nervio isquiático, ramo del plexo sacro, abandona la pelvis pasando, generalmente, por debajo del músculo piriforme. Este nervio puede presentar variaciones en su relación con el músculo piriforme, entre ellas, las referidas a la división alta. Sin embargo, son pocos los trabajos que correlacionan esta división con variaciones anatómicas y su relación con el músculo piriforme, en fetos humanos. Con el propósito de verificar una posible asociación entre el trayecto y relaciones de ramos del nervio isquiático, fueron disecadas 100 regiones glúteas de fetos humanos. Se encontraron 3 tipos de variaciones entre el nervio isquiático y el músculo piriforme: en 8 casos (16,0 por ciento) el nervio fibular común pasó a través del músculo y el nervio tibial transcurrió por debajo de su margen inferior (Tipo I). En estos mismos casos se observó que 5 (62,5 por ciento) estaban a la izquierda y 3 a la derecha. En un caso (2,0 por ciento), el nervio fibular común hizo su trayecto por sobre el margen superior del músculo piriforme y el nervio tibial pasó por debajo de su margen inferior (Tipo II). Fue observado en el Tipo III,que el nervio isquiático perfora el músculo piriforme, no presentando ninguna división. El músculo piriforme mostró variaciones de fusión con el músculo glúteo mediano (lado derecho =2,0 por ciento) y con el músculo gemelo superior (lado derecho =24,0 por ciento e izquierdo =32,0 por ciento). Estos datos muestran que existe una equivalencia de variacion entre los trayectos y relaciones del nervio isquiático con el músculo piriforme en fetos y adultos. Las variaciones en el músculo piriforme no están asociadas con alteraciones funcionales en la biomecánica de la pelvis.

Proximal insertion of gubernaculum testis in normal human fetuses and in boys with cryptorchidism.

PURPOSE: We determine how the proximal gubernaculum testis is attached to the testis and epididymis in human fetuses, and compare these data with findings in boys who had undergone surgery for cryptorchidism. MATERIALS AND METHODS: We analyzed 280 testes and epididymides with the gubernacula of 140 well preserved, fresh human fetuses ranging from 10 to 35 weeks after conception with no detectable congenital malformations and 36 undescended testes of 28 boys 2 to 15 years old (mean age 6.8) who had undergone surgery for cryptorchidism. In both groups the different conformations of the relationship among the proximal gubernaculum, testis and epididymis were classified according to a system used for patients with cryptorchidism. In group A the gubernaculum is attached to the testis and epididymis, in group B the gubernaculum is attached only to the testis with a tail disjunction epididymal anomaly, in group C the gubernaculum is attached only to the testis with total disjunction of the epididymis, in group D the gubernaculum is attached only to the epididymal tail and in group E there are no attachments among gubernaculum, testis and epididymis. RESULTS: Of the 280 fetal testes studied 194 (69.2%) were in the abdomen, 38 (13. 57%) in the inguinal canal and 48 (17.14%) in the scrotum. There were 277 cases (98.9%) in group A and 3 (1.1%) in group B. Of the 36 undescended testes analyzed 2 (5.6%) were abdominal and 34 (94.4%) were inguinal. There were 26 cases (72.2%) in group A, 8 (22.2%) in group B and 2 in group D. CONCLUSIONS: In fetuses without congenital malformations or epididymal alterations, such as tail disjunction or elongated epididymis, the proximal portion of the gubernaculum was attached to the testis and epididymis in all cases. In undescended testes there was an increased incidence of paratesticular structure malformations accompanied by gubernacular attachment anomalies compared to the testes in normal fetuses.

Arterial supply of the human fetal testis during its migration.

PURPOSE: Irrespective of the surgical technique chosen to treat high undescended testis, preservation of an adequate arterial supply for the testis is crucial for successful orchiopexy with maintenance of normal testicular size and texture. To provide an anatomical background for such a procedure, we performed a systematic study on the number and origin of arteries supplying the fetal testis during its migration from the abdomen to the scrotum. MATERIALS AND METHODS: We studied bilaterally 64 testes from 32 fresh human fetuses 13 to 33 weeks after conception. The fetuses were injected through the thoracic aorta with a microvascular silicone rubber red resin to fill in the arterial tree, thereby enabling identification and dissection of all arteries supplying the testes. RESULTS: Of the 64 testes 3 arteries (testicular, deferential and cremasteric) were found in 46 (71.9%), 2 (testicular and deferential) in 15 (23.4%) and 4 in 3 (4.7%). CONCLUSIONS: The fetal testis is always supplied by at least 2 arteries (testicular and deferential arteries) and by 3 or 4 arteries in nearly 80% of the cases.

Analysis of testicular migration during the fetal period in humans.

PURPOSE: We present an analysis concerning the testicular migration and its position correlated to body weight, crown-rump length and gestational age during the fetal period in humans without congenital abnormalities. MATERIALS AND METHODS: We studied bilaterally 142 testes taken from 71 fresh human fetuses between 10 and 35 weeks after conception. The fetuses were also evaluated in regard to crown-rump length and body weight. The position of the testes was correlated to the fetal parameters. RESULTS: In 37 fetuses (74 testes) at 10 to 23 weeks after conception only 7 testes (9.45%) had migrated from the abdomen and were situated in the inguinal canal, in 19 fetuses (38 testes) at 24 to 26 weeks after conception 22 testes (57.9%) had migrated from the abdomen and in 9 fetuses (18 testes) at 27 to 29 weeks after conception only 3 testes (16.7%) had not descended to the scrotum. The testes had not descended into the scrotum in any fetus weighing 990 gm. or less and with a crown-rump length of 24.5 cm. or less. On the other hand, in all fetuses weighing more than 1,220 gm. and with a crown-rump length of more than 27.5 cm. the testis was in the scrotum. CONCLUSIONS: Until 23 weeks after conception the majority of testes remain in the abdomen. The more intense migration of the testes through the inguinal canal occurred between 21 and 25 weeks after conception. After 30 weeks after conception all testes were descended to the scrotum in all fetuses.

The pig kidney as an endourologic model: anatomic contribution.

We present detailed anatomic findings on collecting system anatomy and renal morphometry in the pig and compare these findings with previous findings in humans. We studied three-dimensional polyester resin corrosion endocasts of the pelviocaliceal system obtained from 100 kidneys (50 pigs). Eighty kidneys were evaluated morphometrically, considering length, cranial pole width, caudal pole width, thickness, and weight. The pig collecting system was classified into two major groups (A and B). Group A (40%) was composed of kidneys in which the mid-zone is drained by calices dependent on the cranial or the caudal caliceal group or both. Group B (60%) kidneys have the mid-zone drained by calices independent of the polar groups. Group B includes two subtypes (B-I and B-II). The pig collecting system showed only angles smaller than 90 degrees between the caudal (lower) infundibulum and the renal pelvis. Renal morphometric measurements revealed the following means: length 11.8 cm, cranial pole width 5.64 cm, caudal pole width 5.35 cm, thickness 2.76 cm, and weight 98 g. As in human kidneys, one may group the pig collecting system into two groups. Nevertheless, in pigs, we did not find a subdivision of Group A. The incidence of collecting systems in Groups A and B and the subtypes of Group B in pigs are different from those in humans. Also different from humans, in pigs, we found only angles smaller than 90 degrees between the caudal (lower) infundibulum and the renal pelvis. Except for the length, the means of the other morphometric measurements of the pig kidney are smaller than those of humans. From an anatomic standpoint, despite the differences pointed out, we conclude that the pig kidney is a good animal model for endourologic research and training.

Anatomical relationships between testis and epididymis during the fetal period in humans (10-36 weeks postconception).

OBJECTIVE: To determine the anatomy of the epididymis and its relationship with the testis during the fetal period in normal individuals. METHODS: We studied bilaterally 146 testes and epididymides taken from 73 normal fresh human fetuses ranging in age from 10 to 36 weeks postconception. The epididymal anatomy was classified in six types: type I: the epididymis is connected to the testis by its head and tail and the epididymal body is separated from the testis; type II: the epididymis is completely attached to the testis; type III: the epididymis is attached to the testis only by its head; type IV: the epididymis is attached to the testis only by its tail; type V: the epididymis is completely detached from the testis; type VI: segmental atresia of the epididymis. RESULTS: Normal epididymal anatomy, considered type I and type II, was found in 89.72% and in 7.53% of the cases, respectively. Type III and type IV epididymal anatomy was found in only 2.05% and 0.68% of the cases, respectively. We did not find types V and VI epididymal abnormalities. CONCLUSIONS: Our results show that irrespective of testicular position during the fetal period, the incidence of epididymal abnormalities in normal fetuses is very low (2.75%) when compared with previous reports in patients with cryptorchidism and/or with a patent processus vaginalis (36-79%).

[The renal arterial pedicle in the human fetus]. / Pédicule artériel du rein chez le foetus humain.

To analyze the incidence of renal arteries variations during the fetal period and compare these findings with previous findings in adults, we studied the renal arterial pedicle in 70 human fetuses ranging in age from 13 to 36 weeks postconception. The fetuses were injected through the right common carotid artery with a red polyester resin to fill in the arterial tree enabling the identification and dissection of the small fetal arteries. The renal arteries were analyzed considering their number, origin, direction and site of penetration. Among the 70 fetuses studied, 30 (42.8%) presented at least one kidney with renal artery variations. In 6 fetuses the variation was bilateral. Among the total of 140 renal pedicles studied, 36 presented arterial variations (25.7%). We did not find statistically significant difference between right and left kidneys and between male and female fetuses. In the present study we did find kidneys with more than 2 arteries, probably because we did not study kidneys with any kind of development anomaly. Even kidneys with malrotations of the vertical axis were removed from the study.

Ureteropelvic junction stenosis: vascular anatomical background for endopyelotomy.

To help endourologists perform endopyelotomy safely and efficiently with a reduced risk of vascular complications, we analyzed the vascular relationships to the ureteropelvic junction in 146, 3-dimensional endocasts of the kidney collecting system together with the intrarenal arteries and veins. There was a close relationship between a prominent vessel (artery and/or vein) and the anterior surface of the ureteropelvic junction in 65.1% of the cases, including the inferior segmental artery with a tributary of the renal vein in 45.2% and an artery or vein in 19.9%. In the remaining 34.9% of the cases the anterior surface of the ureteropelvic junction was free of vessels. There was a direct relationship between a prominent vessel (artery and/or vein) and the posterior surface of the ureteropelvic junction in 6.2% of the cases, including an artery and vein in 2.1%, and just an artery in 1.4%. In all cases (3.5%) of an artery crossing at the posterior surface of the ureteropelvic junction, this vessel was the posterior segmental artery (retropelvic artery). In 2.7% of the cases the relationship of the prominent vessel was just with a posterior tributary of the renal vein, and in 20.5% a vessel crossed lower than 1.5 cm. above the posterior surface of the ureteropelvic junction. Among these latter cases the vessel was an artery (posterior segmental artery) in 6.8%. In the remaining 73.3% of the cases the posterior surface was free of vessels up to 1.5 cm. above the ureteropelvic junction. Due to the anatomical findings, we advise that posterior and posterolateral incisions at the ureteropelvic junction be avoided, and that deep incision alongside the ureteropelvic junction stenotic wall be done only laterally.

Proportional analysis of the kidney arterial segments.

The proportional area of each renal arterial segment was analyzed in 49 polyester resin corrosion endocasts of the renal vasculature. We defined a segmental artery as a primary or secondary branch of the renal artery that could be isolated outside the hilum. We found kidneys with five arterial segments in 30 of 49 casts (61.2% of cases) and kidneys with four arterial segments in 19 of 49 casts (38.8%). To enable the evaluation of the proportional areas of the autonomous segments (by using the "point-counting planimetry method"), each arterial segmental branch was injected with different-colored resin. The superior segment (apical) was present in 36 of 49 casts (73.5% of cases) and had a median proportional area of 13.02%. The anterosuperior and anteroinferior segments were present in 30 of 40 casts (61.2% of cases) and had median proportional areas of 21.36% and 17.18%, respectively. The anterior segment was present in 19 of 49 casts (38.8% of cases; when the mid-kidney anterior surface received only one segmental artery) and had a median proportional area of 28.44%. The inferior segment was present in 100% of cases and had a median proportional area of 22.65%. The posterior segment was also present in 100% of cases and was the segment with the greatest median proportional area (33.76%).

Intrarenal access: 3-dimensional anatomical study.

In an attempt to determine the best route to puncture and access the kidney collecting system we studied 62, 3-dimensional polyester resin endocasts of the pelvicaliceal system together with the intrarenal vessels. A retrograde pyelogram was obtained, and the arterial and venous trees were injected with red and blue resins, respectively. When the resin was still in the gel state, the kidneys were positioned at 30 to 45 degrees and the collecting system was punctured under radioscopy. Since the resin is not opaque to x-ray the operator was not able to visualize the vessels while puncturing. After puncture, the needle was maintained in place, the contrast medium was removed and the pelvicaliceal system was filled with yellow resin. After the resin had set, the renal organic matter was corroded in acid and the endocast was obtained (with the needle in the original position). This type of preparation allowed us to examine the needle tract and the vessels damaged during the puncture. In the same kidney we punctured the superior pole, mid kidney and inferior pole. In some cases we also punctured the renal pelvis. We performed 104 punctures through an infundibulum, 39 through a fornix of a calix and 12 through the renal pelvis. Due to a high percentage of vascular lesions, intrarenal access through an infundibulum should be avoided. Also, renal pelvis puncture should be avoided. Regardless of the kidney region, puncture through a fornix of a calix was safe.

[Endopyelotomy. Anatomical study of the vascular relationships to ureteropelvic junction]. / Endopyélotomie. Etude anatomique des rapports vasculaires de la jonction pyélo-urétérale (JPU).

In order to assist endourologists in performing endopyelotomy safely and efficiently, we have made an anatomical study on the vascular relationships to ureteropelvic junction (UPJ). Our material consisted of 82 3-dimensional polyester resin corrosion endocasts of pelviocaliceal system together with intrarenal arteries and 52 casts of pelviocaliceal system together with intrarenal veins. Relationships to renal arteries: in 53.6% of the cases (44/82 casts) we found a close relationship between the inferior segmental artery and the anterior surface of the UPJ (among these, in 1 case, there was 1 artery anterior and 1 artery posterior to UPJ). In the other cases (38/82 casts), the UPJ was not related to arteries. Relationships to renal veins: in 40.4% of the cases (21/52 casts) we found a close relationship between an important tributary of the renal vein and the anterior aspect of the UPJ (among these, in 1 one case, existed 1 vein anterior and 1 vein posterior to UPJ). In the other cases (31/52 casts), the UPJ was not related to veins. Due to our findings, we can advise that UPJ must be incised just laterally, avoiding arteries and veins.