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1.
BMC Surg ; 19(1): 167, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711457

RESUMO

BACKGROUND: Abdominal cocoon is a rare peritoneal lesion and is difficult to diagnose because of its lack of special clinical manifestations. Until now, there is no case report of abdominal cocoon combined with cryptorchidism and seminoma. CASE PRESENTATION: A case of abdominal cocoon with cryptorchidism and seminoma was diagnosed and treated in our hospital. The patient had no symptoms except occasional abdominal pain. He underwent laparoscopy because of bilateral cryptorchidism and seminoma in the right testis. During the surgery, he was diagnosed with abdominal cocoon due to the thick fibrous tissues which was tightly adhered and encased part of intestine like a cocoon. Enterolysis and bilateral cryptochiectomy were performed after the diagnosis and nutritional and symptomatic support was provided after the surgery. The patient recovered well and was discharged soon. The postoperative pathological examination confirmed the presence of bilateral cryptorchidism and seminoma in the patient's right testis. CONCLUSION: There are only a handful of cases where a patient has both abdominal cocoon and cryptorchidism. Since the etiologies of both diseases remain unknown, further research is required to investigate effective diagnosis and treatment for the diseases and explore the potential connection between the two diseases.


Assuntos
Criptorquidismo/diagnóstico , Seminoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Criptorquidismo/complicações , Criptorquidismo/cirurgia , Diagnóstico Diferencial , Humanos , Laparoscopia/métodos , Imagem por Ressonância Magnética , Masculino , Escroto , Seminoma/complicações , Seminoma/cirurgia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/cirurgia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
2.
Rev. esp. anestesiol. reanim ; 66(7): 381-384, ago.-sept. 2019.
Artigo em Espanhol | IBECS | ID: ibc-187551

RESUMO

El síndrome de Steinert congénito es una forma severa de distrofia miotónica, caracterizada por hipotonía generalizada, diplejía facial, dificultad respiratoria y anomalías en la succión y deglución presentes desde el nacimiento. Este síndrome tiene una incidencia de 1 caso por cada 10.000 recién nacidos y una mortalidad del 50% en el período neonatal. Se considera un reto para el anestesiólogo debido a la gran variedad de complicaciones que se pueden presentar en el intraoperatorio y postoperatorio, tanto por la evolución de la enfermedad como por la susceptibilidad a la gran mayoría de los anestésicos. Describimos el caso de un niño de 3 años con distrofia miotónica congénita, en el que se realiza una orquidopexia bilateral por laparoscopia con anestesia general sin relajación muscular, combinada con un bloqueo TAP bilateral ecoguiado


Congenital Steinert syndrome is a severe form of myotonic dystrophy, characterized by general hypotonia, facial diplegia, respiratory difficulty and sucking and swallowing problems presented since birth. This syndrome has an estimated incidence of 1 per 10.000 births. Mortality is close to 50% during the neonatal period. It represents a challenge for the anesthesiologist due to the great variety of intraoperative and postoperative adverse events, given by both the evolution of the disease and the susceptibility to the vast majority of the anesthetic agents. A report of a 3-year-old boy with congenital myotonic dystrophy is presented, scheduled for laparoscopic bilateral orchidopexy, performed under general anesthesia without muscular relaxation, combined with ecoguide bilateral TAP block


Assuntos
Humanos , Masculino , Pré-Escolar , Distrofia Miotônica/complicações , Orquidopexia/métodos , Criptorquidismo/cirurgia , Anestesia por Condução/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Anestésicos Locais/administração & dosagem , Síndromes da Apneia do Sono/complicações , Intubação Intratraqueal/métodos
3.
Mymensingh Med J ; 28(3): 542-546, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391424

RESUMO

Bianchi squire first described scrotal incision orchiopexy as an alternative to the traditional approach in the1980s. In maximum premature and some mature infants, palpable testis is a common surgical problem. There are several surgical technique applied to overcome this surgical problems like combined inguinal and scrotal incision or single high transverse scrotal incision. The goal of this study assessed single high transverse scrotal incision for the management of PUT as regards to evaluate operative time, postoperative success and final cosmetic results. One hundred twenty patients were managed at the Paediatric Surgery Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with PUT during the period from 2015 to March 2018. We operated all cases between 6 to 12 months and excluded more than 12 months of age and recurrent cases. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as a fixation is performed. After fixation of testis high transverse scrotal incision was given, all layers were separated. Then enter into inguinal cannel by cutting of external ring. After dissecting the testis come down through the incision. After making dartos pouch through the same incision and orchidopexy done. All infants were followed-up at 1 month, 2 months and 6 months to detect operative times as well as position, testicular atrophy and the final cosmetic appearance. Patient age ranged from 6 months to 12 months. A total of 120 PUTs were operated upon in 100 patients. PUT was bilateral in 15 patients, right-sided in 55 cases and left-sided in 30 cases. Among 120 testes 40 testes were located distal to external inguinal ring (EIR), 70 testes were at internal inguinal ring (IIR) and 10 testes were in between EIR and IIR. A total of 100 patients were successfully placed within scrotum using a single incision. Operative time ranged from 20-36 minutes. There were no cases of testicular atrophy or ascent. The only complications were 3 wound infections (3%), which were successfully treated with antibiotics. Single high transverse scrotal incision was sufficient to deal with PUT especially, in young infants (age 6 months). The procedure results in shorter operative times, similar success and complication rates, and a more cosmetically appealing outcome compared to inguinal orchiopexy.


Assuntos
Criptorquidismo , Orquidopexia , Bangladesh , Criança , Criptorquidismo/cirurgia , Humanos , Lactente , Masculino , Duração da Cirurgia , Orquidopexia/métodos , Escroto
4.
Pediatr Surg Int ; 35(11): 1309-1316, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31435735

RESUMO

PURPOSE: Undescended testes (UDT) are subjected to heat stress, which can disturb gonocyte transformation as well as apoptosis. This study aims to describe the apoptosis pathway occurring during minipuberty of children with unilateral (UDT), and to investigate the role of inhibin-B. METHODS: Testicular biopsies at unilateral orchidopexy of 10 boys (6-9 months old) with normal inhibin-B (n = 5) or low inhibin-B (n = 5) were selected for immunohistochemistry and TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labelling) assay. Testicular tubules were labelled with antibodies against Anti-Müllerian hormone (AMH, Sertoli cell marker), mouse Vasa Homolog (MVH) and placental alkaline phosphatase (PLAP) (both germ cell markers), cleaved caspase3 (apoptotic marker), and followed by confocal imaging and cell counting with Fiji/ImageJ. Data were analyzed with GraphPad Prism. RESULTS: In males with low and normal inhibin-B, there was no statistical difference (p > 0.05) in the percentage of testicular tubules containing TUNEL + cells, number of cleaved caspase3 ± germ cells/tubule, total number of germ cells/tubule, and the percentage of fibrotic tubules or number of Sertoli cells/tubule. CONCLUSIONS: These results suggest that inhibin-B does not regulate cell death of gonocytes and further studies are required to uncover any role of inhibin-B in gonocyte transformation.


Assuntos
Diferenciação Celular , Criptorquidismo/patologia , Inibinas/sangue , Túbulos Seminíferos/citologia , Apoptose , Caspase 3/metabolismo , Criptorquidismo/cirurgia , Células Germinativas/citologia , Células Germinativas/metabolismo , Humanos , Imuno-Histoquímica , Marcação In Situ das Extremidades Cortadas , Lactente , Masculino , Orquidopexia
6.
Andrologia ; 51(9): e13357, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264256

RESUMO

The purpose of this study was to evaluate the predictive value of haematologic parameters for testicular survival in torsion. Children with testicular torsion (TT) treated in Beijing Children's Hospital from January 2006 to December 2018 were enrolled in this study. Patient data collected in this study included age, symptom duration, preoperative preparation time, cryptorchidism testicular torsion or not, spermatic cord torsion degree, orchiectomy/orchiopexy, testicular volume 3 months after operation by ultrasound in orchiopexy patients and haematologic parameters. The orchiopexy group comprised of 54 patients with a mean age of 135.6 ± 43.73 months, and the orchiectomy group included 58 patients with a mean age of 119.36 ± 60.82 months. The multivariate analysis showed that symptom duration (Odds Ratio = 1.11, p < 0.001), spermatic cord torsion degree (Odds Ratio = 1.006, p = 0.002) and mean platelet volume (MPV; Odds Ratio = 3.697, p = 0.044) were significant predictors of orchiectomy. The cut-off value for MPV during window time for orchiectomy was 10.55 fl (10-9  L) and provided a sensitivity of 47.8% and a specificity of 92.6%. This study found that symptom duration, spermatic cord torsion degree and MPV could be indicators of testicular viability in testicular torsion. MPV can provide valuable information before operation which can guide doctors and family members of the patients to select the appropriate treatment.


Assuntos
Criptorquidismo/sangue , Volume Plaquetário Médio , Seleção de Pacientes , Torção do Cordão Espermático/sangue , Testículo/patologia , Adolescente , Criança , Pré-Escolar , Criptorquidismo/complicações , Criptorquidismo/cirurgia , Humanos , Masculino , Orquiectomia/estatística & dados numéricos , Orquidopexia/estatística & dados numéricos , Tamanho do Órgão , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Torção do Cordão Espermático/complicações , Torção do Cordão Espermático/cirurgia , Testículo/diagnóstico por imagem , Testículo/cirurgia , Fatores de Tempo , Ultrassonografia
7.
Int Braz J Urol ; 45(5): 1064-1070, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31184456

RESUMO

The anti-Müllerian hormone triggers the regression of uterus and fallopian tubes in male embryos; if there are problems in the synthesis or action of this protein, Müllerian structures persist in an otherwise phenotypic male. The most frequent clinical presentation of Persistent Mullerian Duct syndrome is cryptorchidism and inguinal hernia. The few cases reported in adults are incidental findings or inguinal hernias. However, we present an adult male with history of bilateral cryptorchidism with unsuccessful orchidopexy, who presents with a large abdominal mass with the finding of a seminomatous tumor and persistence of Müllerian structures, in whom the variant c.916delC (p.Leu306Cysfs*29) in the AMHR2 gene not previously reported was documented.


Assuntos
Transtorno 46,XY do Desenvolvimento Sexual/genética , Homozigoto , Mutação , Fenótipo , Adulto , Hormônio Antimülleriano/genética , Colômbia , Criptorquidismo/genética , Criptorquidismo/cirurgia , Análise Citogenética , Transtorno 46,XY do Desenvolvimento Sexual/cirurgia , Humanos , Masculino , Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/cirurgia , Seminoma/genética , Seminoma/cirurgia , Síndrome , Neoplasias Testiculares/genética , Neoplasias Testiculares/cirurgia
8.
Hum Exp Toxicol ; 38(8): 899-913, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30995857

RESUMO

Cryptorchidism (CPT), the most common male congenital abnormality, is variably associated with other male reproductive tract problems. We evaluated if cryptorchid rats develop enhanced testicular susceptibility to dibutyl phthalate (DBP) or acrylamide (AA) after extended exposure. Three studies with rats were performed: (1) in utero and postnatal exposure to DBP or AA; (2) establishment of CPT and orchiopexy; and (3) in utero and postnatal exposures to DBP or AA associated with CPT/orchiopexy. Seminiferous tubules were histologically scored according to the severity of lesions: (1) Rats exposed to DBP (score 1.5) or AA (score 1.1) presented mostly preserved spermatogenesis. Some seminiferous tubules showed vacuolated germinative epithelium, germ cell apoptosis, and a Sertoli cell-only (SCO) pattern. (2) CPT (score 3.3) resulted in decreased absolute testes weights, degenerated and SCO tubules, and spermatogenesis arrest that were reversed by orchiopexy (score 1.1). (3) Exposure to DBP or AA with CPT/orchiopexy led to atrophic testes, spermatogenesis arrest, germ cell exfoliation/multinucleation, and SCO tubules (both chemicals score 2.5). Exposure to chemicals such as DBP or AA prevented the recovery of cryptorchid testes by orchiopexy. The possible role of environmental contaminants should be considered when looking for factors that modulate human testicular disorders associated with CPT.


Assuntos
Acrilamida/toxicidade , Criptorquidismo/cirurgia , Dibutilftalato/toxicidade , Testículo/efeitos dos fármacos , Animais , Criptorquidismo/patologia , Modelos Animais de Doenças , Feminino , Masculino , Troca Materno-Fetal , Orquidopexia , Gravidez , Ratos Sprague-Dawley , Testículo/patologia
11.
Zygote ; 27(2): 101-110, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30888311

RESUMO

SummaryCryptorchidism, characterized by the presence of one (unilateral) or both (bilateral) undescended testes, is a common male urogenital defect. Cryptorchidism can lead to male infertility, testicular cancer being the most extreme clinical symptom, as well as psychological issues of the inflicted individual. Despite this, both knowledge about the aetiology of cryptorchidism and the mechanism for cryptorchidism-induced male infertility remain limited. In this present study, by using an artificial cryptorchid mouse model, we investigated the effects of surgery-induced cryptorchidism on spermatogenic cells and seminiferous epithelial cycles. We found that surgery-induced cryptorchidism led to a reduced testicular weight, aberrant seminiferous epithelial cycles and impaired spermatogenesis characterized by degenerating spermatogenic cells. We also observed multinucleated giant cells after surgery-induced cryptorchidism. Transmission electron microscopy, terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) and western blot assays demonstrated cryptorchidism-induced apoptosis of spermatogenic cells. Moreover, we identified the occurrence of autophagy in germ cells after surgery-induced cryptorchidism. Interestingly, apoptosis and autophagy were synchronous, suggestive of their synergetic roles in promoting germ cell death. Our results provide novel insights into the cryptorchidism-induced male infertility, thereby contributing to the development of male contraceptive strategies as well as treatment options for male infertility caused by cryptorchidism.


Assuntos
Criptorquidismo/patologia , Criptorquidismo/cirurgia , Testículo/patologia , Animais , Apoptose , Autofagia , Modelos Animais de Doenças , Marcação In Situ das Extremidades Cortadas , Infertilidade Masculina/etiologia , Infertilidade Masculina/patologia , Masculino , Camundongos , Microscopia Eletrônica de Transmissão , Tamanho do Órgão , Epitélio Seminífero/fisiopatologia , Espermatogênese , Espermatozoides/patologia , Espermatozoides/fisiologia
14.
J Laparoendosc Adv Surg Tech A ; 29(4): 531-537, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30807243

RESUMO

AIMS OF THE STUDY: To assess the short-term clinical outcome of the novel Shehata technique of laparoscopic traction-lengthening for abdominal testes in a single center over a 12-month period (January-December 2014). An ethics approval of the study and appropriate consents were obtained for all patients before inclusion in our study. MATERIALS AND METHODS: A total of 47 consecutive boys presented with impalpable testes in the ipsilateral hemiscrota, 3 of them were bilateral summing up to a total of 50 U of impalpable testes to a single center over 12 months (January-December 2014). Those boys underwent a preoperative ultrasound (US) Doppler scan for the ipsilateral and contralateral testes. They then proceeded to a first-stage laparoscopic exploration for the testes in which the cranial testicular artery and the caudal vas deferens were traced to their meeting point to locate the abdominal testes that were either found (peeping at the internal inguinal ring [IIR] or more cranially) or otherwise vanishing (intraabdominally blind-ending vas and vessels or extra-abdominally passing through the IIR). All 50 testes failed to stay at the contralateral IIR when brought there mandating a preliminary lengthening of the testicular vessels by lateral dissection, traction, and fixation to a point 1-2 cm superolateral to the contralateral anterior superior iliac spine (ASIS), essentially a mobile traction point. After 12 weeks, all underwent a second-stage laparoscopic-assisted ipsilateral subdartos orchidopexy for the testes under traction. Occasional slippage of the testis under traction mandated an otherwise second-stage retraction and a third-stage orchidopexy. All underwent US Doppler scan 3 and 6 months after orchidopexy. RESULTS: The 47 cryptorchid boys presented at a mean age of 3 years 2 months (range: 6 months-8 years). Out of the 50 impalpable testes, 9 were nonvisualized on preoperative US Doppler scan and 16 were vanishing on laparoscopic exploration: 5 abdominally (in utero vascular accident) and 11 scrotally (perinatal torsion). The remaining 34 testes were fixed loosely near the contralateral ASIS in the first-stage laparoscopic exploration. Out of which, 3 had slipped traction at the second stage. The 12-week traction interval went uneventfully and a predefinitive US Doppler scan confirmed viability of all testes under traction. All 34 elongated testes were mobilized and fixed in the ipsilateral hemiscrota inside a created subdartos pouch (of de Netto). All 34 fixed testes were confirmed viable on US Doppler scan 1, 3, and 6 months after orchidopexy. CONCLUSION: The novel Shehata technique of staged laparoscopic traction-lengthening for abdominal testes is safe, easy, and convenient as evidenced by our limited early experience. Neither internal herniation complicated the traction period nor testicular atrophy (by undue tension) complicated the traction or follow-up periods. We believe it is a good alternative to the Fowler-Stephens staged orchidopexy that entails risky division of the testicular vessels.


Assuntos
Criptorquidismo/cirurgia , Laparoscopia/métodos , Orquidopexia/métodos , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Masculino , Tração
15.
Urology ; 127: 113-118, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30779890

RESUMO

OBJECTIVE: To study the effect of testicular vessel division on testicular volume during laparoscopic staged Fowler Stephens orchiopexy (LSFSO). METHODS: Testicular dimensions were prospectively measured intraoperatively at both first (S1) and second stages (S2) of LSFSO, and with scrotal ultrasound 3-12 months postoperatively. Testicular volumes were compared to reference ranges. Volume changes were tracked with a change of >20% considered clinically significant. RESULTS: A total of 52 nonpalpable testes treated with LSFSO between 2008 and 2018 were included in the study. After a median follow-up of 6.8 (3-91.3) months, 46 (88.5%) testes were palpable in a scrotal location without adjunctive procedures and 39 (75%) maintained vascular flow on duplex ultrasound. One testis retracted to an inguinal position and was successfully treated with inguinal orchiopexy for an overall success of 90.4% (47/52). Of 36 testes with intra- and postoperative testicular volume documentation, only 2 (5.6%) had significant volume loss after S1. Both testes had catch-up growth after S2. Eight (22.2%) testes had significant volume loss after S2. At follow-up, 24 (66.7%) testes were smaller than the mean for age, of which 20 (83.3%) were small at baseline. Only 41.7% of testes larger than mean for age at follow-up, were small at baseline (P = .02). CONCLUSION: Significant testicular volume loss does not occur after testicular vessel division at S1, but expected in approximately 1 quarter of testes after S2. We propose that testicular atrophy after LSFSO is primarily due to defective testicular development and rarely due to vascular compromise during S2.


Assuntos
Criptorquidismo/cirurgia , Laparoscopia/métodos , Orquidopexia/métodos , Testículo/anatomia & histologia , Estudos de Coortes , Criptorquidismo/diagnóstico , Bases de Dados Factuais , Seguimentos , Humanos , Recém-Nascido , Cuidados Intraoperatórios/métodos , Laparoscopia/efeitos adversos , Masculino , Orquidopexia/efeitos adversos , Tamanho do Órgão , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Escroto/irrigação sanguínea , Escroto/cirurgia , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
16.
Sex Dev ; 13(1): 20-25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703771

RESUMO

Cerebral palsy is a rare condition following injury of the developing brain and including nonprogressive neurological disorders, spasticity, intellectual impairment and others. Boys with cerebral palsy have a high incidence of undescended testis. Although the motives for treatment (infertility, cancer prevention, psychological aspects, testicular torsion) are not different in boys without neurological impairment, the decision-making process in boys with cerebral palsy is very difficult. Besides medical and surgical arguments the discussion involves challenging ethical issues.


Assuntos
Paralisia Cerebral/complicações , Criptorquidismo/complicações , Criptorquidismo/terapia , Criptorquidismo/fisiopatologia , Criptorquidismo/cirurgia , Ética Médica , Humanos , Laparoscopia , Masculino , Qualidade de Vida , Sexualidade
17.
Sex Dev ; 13(1): 3-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30721907

RESUMO

Abnormal germ cell development in cryptorchidism is not a result of a congenital dysgenesis but is preceded by a hormone imbalance and perturbation in germ cell-specific gene expression during abrogated mini-puberty. Adequate treatment with low doses of GnRHa enables 86% of men to achieve a normal sperm count and, most importantly, prevent development of azoospermia. GnRHa treatment induces a significant transcriptional response, including protein coding genes involved in pituitary development, the hypothalamic-pituitary-gonadal axis, and testosterone synthesis. Furthermore, hormonal treatment to achieve epididymo-testicular descent as a first choice of treatment of cryptorchidism has a long tradition in Europe. It eliminates the necessity of subsequent surgery. Moreover, in the cases of non-responders it facilitates orchidopexy and contributes considerably to a reduced incidence of unilateral and the more serious bilateral complete post-surgical testicular atrophy.


Assuntos
Criptorquidismo/tratamento farmacológico , Hormônios/uso terapêutico , Criptorquidismo/genética , Criptorquidismo/patologia , Criptorquidismo/cirurgia , Elementos de DNA Transponíveis/genética , Humanos , Infertilidade Masculina/terapia , Masculino , RNA/genética , RNA/metabolismo , Contagem de Espermatozoides
19.
J Urol ; 201(2): 239-240, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30634349
20.
Urology ; 129: 197-199, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30610907

RESUMO

Extrarenal Wilms tumor is rare. We describe the first reported case of primary paratesticular extrarenal Wilms tumor with regional metastasis in 8-month old male with left undescended testis. Patient underwent left radical orchiectomy with regional lymph node excision. The inguinal node and paratesticular mass demonstrated the classic Wilms triphasic pattern, stained positively for WT-1 and demonstrated no loss of heterozygosity of chromosomes 1p and 16q. Work-up was negative for primary renal Wilms tumor or distant metastasis. Patient underwent adjuvant chemoradiation therapy for stage III disease. Patient is currently 2 years of age with no evidence of recurrence or metastatic disease.


Assuntos
Criptorquidismo/complicações , Neoplasias Renais/complicações , Neoplasias Testiculares/secundário , Tumor de Wilms/complicações , Biópsia , Criptorquidismo/diagnóstico , Criptorquidismo/cirurgia , Humanos , Lactente , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Masculino , Metástase Neoplásica , Orquiectomia/métodos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/cirurgia , Tumor de Wilms/secundário , Tumor de Wilms/cirurgia
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