Concurrent Placement of the Testicular Prosthesis in Children Following Orchiectomy/Testicular Loss.

Introduction: Testis is essential for male sexual hormone production, fertility, and psychological well-being of a male. In the unfortunate event of testicular loss, placement of a testicular prosthesis perhaps will offer a sense of well-being, improved body image, and overall confidence in the growing child. Aims: The aim is to evaluate the feasibility and assessment of outcomes following concurrent placement of testicular prosthesis in children following orchiectomy. Materials and Methods: This is a cross-sectional study conducted by reviewing the reports of patients who underwent simultaneous insertion testicular prosthesis following orchiectomy for various indications between January 2014 and December 2020 at tertiary hospitals in Bengaluru. Children <18 years were included in this study. A transscrotal approach was preferred in cases where a transscrotal orchiectomy was done. Transinguinal approach was preferred in children undergoing prosthesis insertion as an isolated procedure. The size of the prosthesis was chosen based on the age of the child and the size of the scrotum. Outcomes were assessed on follow-up. Results: A total of 29 children underwent prosthesis insertion (25 unilateral and four bilateral). The mean standard deviation age was 5.58 (3.92) years. The indications for prosthesis insertion were cryptorchidism with atrophic testis (22), torsion (3), Leydig cell tumor (2), and severely virilized Congenital adrenal hyperplasia (CAH) (2). Of these, three children (9%) had complications (wound gaping in two and wound infection in one) that needed removal of the implant. The mean duration of follow-up was 49.23 months. All the parents reported a good outcome, and none of the children who underwent prosthesis placement needed a change during this follow-up. Conclusion: Concurrent placement of a testicular prosthesis is technically easy and a safe procedure, achieves satisfactory cosmetic appearance with minimal morbidity.

Is Routine Excision of Dysplastic Testicular Remnants/Nubbins Associated with Nonpalpable Testis Necessary? Is Routine Fixation of Contralateral Solitary Testis Indicated? A Survey on the Prevalent Practice among Indian Pediatric Surgeons.

Background and Aims: Dysplastic nubbin also referred to as testicular regression syndrome (TRS) is found in 5% of cases of the Non palpable testis (NPT). There is no consensus on the excision of the above and fixation of the contralateral solitary testis. We aimed to survey the prevalent practice of the same among members of the Indian Association of Pediatric Surgeons (IAPS). Methods: A structured questionnaire was sent through group e-mail and social media platforms to IAPS members to identify their practices in management. Results: A total of 132 surgeons responded to the questionnaire. Excision of intra-abdominal and inguinoscrotal TRS remnants was practiced by 84% (95% confidence interval [CI] 77%-89%) and 82% (95% CI 74%-87%). Fixation of contralateral solitary testis was practiced by 62% (95% CI 53%-70%) in the above scenario. Among the respondents, 30% reported encountering torsion of solitary testis during their career and this experience was a significant factor (P = 0.01) in deciding contralateral orchidopexy. Scrotal infection/necrosis was not encountered by a majority (72%) and it was not a deterrent factor in preventing contralateral orchidopexy (P = 0.68). Conclusions: The majority of pediatric surgeons favored the removal of intra-abdominal/inguinoscrotal TRS remnants identified during laparoscopy for NPT. A majority favored sutureless fixation of the contralateral solitary testis.

Antenatal ultrasound visualization of left testis that then vanished after birth.

A 10-month-old infant was referred for disappearance of the left testis, which had been confirmed as present on antenatal ultrasound at 38 weeks of gestation, as well as at the newborn physical exam and the 4 month exam. The right testis was enlarged, whereas the left testis was palpated as a nubbin. The right testis measured on ultrasound was 1.6 × 0.8 × 1.0 cm; the testicular volume was 0.67 cm(3). The left nubbin was hyperechoic, and accurate measurement of testicular components was difficult. At the age of 1 year 8 months, with the diagnosis of left vanishing testis, inguinal exploration was undertaken to rule out intra-abdominal cryptorchidism. A fibrous nodule that connected to the spermatic vessels and the vas deferens was resected. Histopathology indicated a testicular remnant containing seminiferous tubules, hemosiderin deposits, calcification and marked fibrosis of the stroma, suggesting hemorrhagic infarction in utero.

Histopathological Features of Vanishing Testes in 332 Boys: What Is Its Significance? A Retrospective Study From a Tertiary Hospital.

The purpose of this study is to analyze the histopathological features of resected testicular remnant specimens, ascertain the incidence of the presence of either germ cells (GCs) or seminiferous tubules (SNTs), and assess whether surgical excision of the remnant is necessary. A total of 332 boys with vanishing testis underwent surgical removal of unilateral testicular remnants, with age 7-164 months (median age 25 months). Among the total 332 cases, 212 (63.8%) were younger than 36 months and 143 (66.5%) were found to have hypertrophied contralateral testes larger than 1.6 cm in longitudinal diameter under sonography. SNTs were only present in 21 (6.3%) cases and GCs were present in 7 (2.1%) cases. Compared to the review studies, the very low incidence of SNTs and GCs in which implies extremely low chances of potential malignancy. We propose that surgical removal of vanishing testis remnants in an inguinal or scrotal position may not be necessary.

Genetics of cryptorchidism and testicular regression.

Cryptorchidism, i.e., undescended testis, is one of the most common genital malformations in newborn male babies. The birth rate of cryptorchidism varies from 1.6 to 9.0 %. Etiology of disrupted testicular descent is complex and predisposing causes include genetic, hormonal, environmental, lifestyle and maternal factors. Testicular descent occurs in two major steps and testicular hormones and normal function of hypothalamic-pituitary-testicular axis are important for normal descent. Several gene mutations are associated with syndromic cryptorchidism but they are rarely found in boys with isolated undescended testis. Testicular regression can also cause an empty scrotum. Normal male genital phenotype indicates that the boy has had functioning testis during development. Torsion of the testis can cause testicular regression but in many cases the reason for vanishing testis remains elusive. In this narrative review we discuss genetics of cryptorchidism and testicular regression.

Testicular remnant "nubbin" and incidental ectopic adrenal cortical rests: A case series and systematic review.

AIM: To determine whether excising a testicular remnant or nubbin is necessary and perform a systematic review of the incidental ectopic adrenal cortical rest associated with undescended testis. MATERIAL AND METHODS: A retrospective analysis of impalpable undescended testis was carried out between May 2016 and June 2019. The demographic data, intra-operative findings and histopathological diagnosis were analyzed. In conjunction with this, systematic search of PUBMED and EMBASE database was performed by using the search terms "undescended testis" AND "ectopic adrenal tissue". Data was collected for demographic characteristics, size and appearance of ectopic adrenal cortical rest and histopathology. Quantitative data has been presented as medians. Categorical variables have been presented as percentages. RESULT: We encountered 43 cases of impalpable undescended testis, out of which, nubbins were identified in 9 cases. Incidence of EACT in nubbin and impalpable UDT was 2/9 (22.22%) and 2/43 (4.7%) respectively. None of the excised nubbin had germ cells. On Systematic review, EACT associated with UDT was seen in 90/2501 (3.6%), while its association with testicular nubbin has been reported only once before in a case report. CONCLUSION: A testicular nubbin is a condition wherein no viable testicular tissue can be grossly identified in a case of impalpable testis. Even when germ cells are not found in the excised nubbin, the presence of ectopic adrenal cortical rest make them prone to later malignant transformation. Association of EACT with UDT has been consistently reported but there is scarcity of such documentation in association with testicular nubbin.

Laparoscopic Finding of Ectopic Adrenocortical Tissue in a 2-Year-Old Boy with Vanishing Testis.

Ectopic adrenocortical tissue (EAT) along the spermatic cord is an unusual condition in children. The author reports on a 2-year-old boy with impalpable testis. On laparoscopy, EAT was detected along the hypotrophic spermatic vessels and excised. These remnants should be removed to prevent hormone production or malignant transformation.

Is excision of testicular nubbin necessary in vanishing testis syndrome?

BACKGROUND/PURPOSE: Vanishing Testes Syndrome1 (VTS) is one of the most common causes of impalpable testes in children. The role of removal of testicular nubbins owing to malignant potential in VTS is unclear. We sought to evaluate whether testicular nubbins need to be excised owing to this potential. METHODS: We conducted a retrospective review of children with a clinical diagnosis of impalpable testes aged 0-18 who presented to our tertiary hospital between 2007 and 2017. VTS was defined as the presence of hypoplastic vas entering a closed internal inguinal ring or remnants of gonadal tissue distally. Data collected included: age at operation, need for laparoscopy, location of nubbin and histopathological findings. RESULTS: We identified 50 consecutive children (mean age 2.4 years, range: 7 months to 12 years) with a clinical diagnosis of impalpable testis. Forty-eight of the 50 underwent laparoscopy with no testicle palpable when examined under anesthesia. Thirty-three children had VTS confirmed at laparoscopy and testicular nubbins identified with three of these being bilateral. Thirty-two children had these nubbins excised with histopathology available for 31 individual testes. Thirty were confirmed testicular nubbins with no viable testicular tissue. No malignancies were identified. CONCLUSION: Results from this study show that testicular nubbins do not have viable germ cells and therefore do not need to be excised on the basis of malignant potential of residual testicular tissue. LEVEL OF EVIDENCE: Level IV treatment study.

Vanishing testis syndrome: report of two cases.

Vanishing testis syndrome or Testicular regression syndrome (TRS) is defined as the absence or an incomplete development of the testis of varying degrees in 46XY patients with normal external genitalia.TRS or vanishing testis syndrome may be seen in less than 5% of all patients of cryptorchidism. We report two cases of TRS who underwent surgical exploration with an initial diagnosis of cryptorchidism with impalpable testis. Grossly testicular tissue was not identified and the vas deferens was ending into a nubbin in both the cases. The presumed testicular remnants were sent for histological examination. The histological sections in both the cases showed vascularised fibrous nodule, structure of the spermatic cord and calcification, supporting the diagnosis of TRS.