1
|
Shah M, Odugoudar A, Chawla A, Hameed ZB. Transverse testicular ectopia: two rare adult cases and a review of literature. BMJ Case Rep 2020; 13:13/5/e232240. [PMID: 32381525 DOI: 10.1136/bcr-2019-232240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The first case is a 45-year-old man who presented with complaints of right-sided indirect hernia. On examination the left hemiscrotum was empty. Open hernioplasty and mesh fixation with orchiopexy of both testes were done in the same hemiscrotum, followed by MRI for further evaluation. The second case is a 26-year-old man who presented with penoscrotal hypospadias and empty left hemiscrotum, with the left testis not palpable in the scrotum or the inguinal region. MRI, karyotyping and laparoscopic orchidectomy were performed, followed by endocrinology work-up. From our experience, preoperative diagnosis with ultrasonography and/or MRI prior to diagnostic laproscopy is benifical when there is a strong suspicion of mullerian duct remnants. In other cases, diagnostic laparoscopy can be useful in diagnosis and management. Placement of both testes in the same hemiscrotum can be considered safe, although not ideal. Also, in cases with partial gonadal dysgenesis, laparoscopic orchidectomy along with excision of the mullerian remnantsis a better approach than orchiopexy.
Collapse
Affiliation(s)
- Milap Shah
- Department of Urology and Renal Transplant, Kasturba Hospital Manipal, Manipal, Karnataka, India
| | - Aviansh Odugoudar
- Department of Urology and Renal Transplant, Kasturba Hospital Manipal, Manipal, Karnataka, India
| | - Arun Chawla
- Department of Urology and Renal Transplant, Kasturba Hospital Manipal, Manipal, Karnataka, India
| | - Zeeshan Bm Hameed
- Urology, Kasturba Medical College, Manipal, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
2
|
Chen C, Wang YC, Wang YM, Qin C, Song NH. Microdissection testicular extraction for a patient with transverse testicular ectopia and testicular fusion. Asian J Androl 2019; 20:306-307. [PMID: 28869220 PMCID: PMC5952488 DOI: 10.4103/aja.aja_33_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Chen Chen
- Department of Urology, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yi-Chun Wang
- Department of Urology, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Ya-Min Wang
- Department of Urology, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Chao Qin
- Department of Urology, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Ning-Hong Song
- Department of Urology, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| |
Collapse
|
3
|
Raj V, Redkar R, Krishna S, Tewari S. Rare case of transverse testicular ectopia - Case report and review of literature. Int J Surg Case Rep 2017; 41:407-410. [PMID: 29546003 PMCID: PMC5723351 DOI: 10.1016/j.ijscr.2017.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/09/2017] [Accepted: 09/10/2017] [Indexed: 11/16/2022] Open
Abstract
This case report has been reported in line with the SCARE criteria; Consensus-based surgical case report guidelines of International Journal of Surgery 2016. Introduction Transverse Testicular Ectopia (TTE) is a rare condition which manifests with unilateral undescended testis and contralateral hernia. Till now around 100 cases have been described in the literature. The management depends on the anatomy of the vas, vessels and testis found on surgical exploration. An algorithm exists for its management and we propose a modified algorithm for management of TTE. Case presentation Five year male presented with complaints of unilateral undescended testis on the right and hernia on the left. Clinically the right testis was impalpable and left testis palpable in the left hemiscrotum and fluid hernia on the same side. Discussion Transverse testicular ectopia is a rare condition presenting with UDT and contralateral inguinal hernia. Although more than 100 cases have been described in the literature so far, those managed with a transeptal contralateral orchidopexy are two cases to the best of our knowledge. TTE was first described by Von Lenhossek in 1886. The mean age of presentation is around 4 years and most of the cases are diagnosed on surgical exploration. The management of TTE remains controversial even though an algorithm has been described for its management due to its varied presenting scenarios. Conclusion TTE is a rare condition which requires high index of suspicion for diagnosis preoperatively. Whenever suspected we recommend an USG and/or MRI prior to diagnostic laparoscopy and proceed with orchidopexy. Diagnostic laparoscopy is both helpful in diagnosis and management. Transeptal contralateral orchidopexy gives good tension free fixation of testes in the scrotum.
Collapse
Affiliation(s)
- Vinod Raj
- Lilavati Hospital & Research Centre, India.
| | | | | | | |
Collapse
|
4
|
Kajal P, Rattan KN, Bhutani N, Sangwan V. Transverse testicular ectopia with scrotal hypospadias but without inguinal hernia - Case report of a rare association. Int J Surg Case Rep 2017; 31:167-169. [PMID: 28152494 PMCID: PMC5288328 DOI: 10.1016/j.ijscr.2017.01.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022] Open
Abstract
TTE associated with scrotal hypospadias but without inguinal hernia is an extremely rare anomaly and possibly has never been reported in literature. The diagnosis of TTE is usually considered when unilateral hernia and concurrent cryptorchidism of the contralateral side are present but it can also present without inguinal hernia as in our case. Presence of inguinal hernia should never be considered a prerequisite for a clinical diagnosis of TTE. In suspected cases, ultrasonographic evaluation, MRI of the pelvis and laparoscopy may be helpful in diagnosing this condition before surgery. Management is either trans-septal orchiopexy or extraperitoneal transposition orchiopexy.
Transverse testicular ectopia is an extremely rare anomaly, in which both the testis migrate towards the same hemiscrotum through the same inguinal canal. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome, true hermaphroditism, inguinal hernia, pseudohermaphroditism, and scrotal anomalies; the association with inguinal hernia being the commonest. We, here, report a case of transverse testicular ectopia in a 12 years old boy having the ectopic testis in contralateral hemiscrotum without any inguinal hernia but having scrotal hypospadias with severe chordee. The diagnosis was made on clinical examination and confirmed on ultrasonography. Trans-septal orchiopexy was done for ectopic testis and hypospadias and chordee were managed by staged repair.
Collapse
Affiliation(s)
- Pradeep Kajal
- Deptt. of Pediatric Surgery, PGIMS, Rohtak, Haryana, India.
| | | | | | | |
Collapse
|
5
|
Shih TY. Transverse testicular ectopia associated with hemiscrotal hemangioma. FORMOSAN JOURNAL OF SURGERY 2014. [DOI: 10.1016/j.fjs.2014.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
6
|
Alp BF, Demirer Z, Gürağaç A, Babacan O, Sarı E, Sarı S, Yavan I. Persistent Mullerian duct syndrome with transverse testicular ectopia and seminoma. Int Urol Nephrol 2014; 46:1557-62. [PMID: 24554220 DOI: 10.1007/s11255-014-0667-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.
Collapse
Affiliation(s)
- Bilal Fırat Alp
- Department of Urology, Gulhane Military Medical Academy, Etlik, 06018, Ankara, Turkey,
| | | | | | | | | | | | | |
Collapse
|
7
|
Karakuş SC, Kılınçaslan H, Ertaşkın I, Koku N, Deliağa H. Delayed and incidental diagnosis of transverse testicular ectopia. Balkan Med J 2012; 29:447-9. [PMID: 25207052 DOI: 10.5152/balkanmedj.2012.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 08/17/2012] [Indexed: 11/22/2022] Open
Abstract
Transverse testicular ectopia is a rare malformation in which both testes are placed in the same inguinal region. Most of the patients are diagnosed incidentally during inguinal exploration. We here report three cases of transverse testicular ectopia and discuss the causes of delayed and incidental diagnosis of this infrequent malformation. Although the mean age at presentation was reported as 4 years, the mean age of our patients was 7.7 months. We detected the contralateral testis in the inguinal canal in all of our patients preoperatively. The most important diagnostic criteria are to be aware of this rare malformation and getting suspicious in patients with one side inguinal hernia and an empty hemiscrotum on the other side. It is essential to perform an ultrasound scan in patients with such a clinical presentation.
Collapse
Affiliation(s)
| | - Hüseyin Kılınçaslan
- Department of Pediatric Surgery, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Idris Ertaşkın
- Department of Pediatric Surgery, Gaziantep Children Hospital, Gaziantep, Turkey
| | - Naim Koku
- Department of Pediatric Surgery, Gaziantep Children Hospital, Gaziantep, Turkey
| | - Hasan Deliağa
- Department of Pediatric Surgery, Servergazi State Hospital, Denizli, Turkey
| |
Collapse
|
8
|
Yanaral F, Yildirim ME. Testicular fusion in a patient with crossed testicular ectopia: a rare entity. Urol Int 2012; 90:123-4. [PMID: 23147372 DOI: 10.1159/000343685] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/18/2012] [Indexed: 11/19/2022]
Abstract
Crossed testicular ectopia (CTE) is a well-described, rare congenital abnormality of testicular descent, in which both testes migrate through one inguinal canal. The objective of this work is to present a case of fused two testicles in a hemiscrotum as a rare entity of CTE. We describe a rare case of CTE in a 19-year-old boy presenting to the Department with left testis placed in the right hemiscrotum with right inguinal hernia. Ultrasound and magnetic resonance imaging revealed fused testes with their own vasa deferentia in the left hemiscrotum. Azoospermia was detected in semen analysis. The patient was referred to microTESE and ICSI procedure for his infertility problem. CTE should be kept in mind in patients with an inguinal hernia and contralateral nonpalpable testis.
Collapse
Affiliation(s)
- Fatih Yanaral
- Department of Urology, Siirt Government Hospital, Siirt, Turkey
| | | |
Collapse
|
9
|
Naji H, Peristeris A, Stenman J, Svensson JF, Wester T. Transverse testicular ectopia: three additional cases and a review of the literature. Pediatr Surg Int 2012; 28:703-6. [PMID: 22610649 DOI: 10.1007/s00383-012-3105-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Transverse testicular ectopia (TTE) is a well described, rare congenital abnormality of testicular descent, in which both testes migrate through one inguinal canal. The objective of this work was to present three cases of TTE, one of them with a common vas deferens. To our knowledge, a fused vas deferens has only been reported four times in previously published reports. METHODS Three patients presented with inguinal hernia and contralateral cryptorchidism. In case 1, the diagnosis of TTE was made preoperatively by palpating two testes in one hemiscrotum. The diagnosis of case 2 was made intraoperatively and was found to be of a rare form in which the two vasa deferentia fused in the inguinal canal to form a common vas deferens. The diagnosis of case 3 was also done intraoperatively and a laparoscopy was performed to document the anatomy of TTE and to rule out the presence of Müllerian duct remnants. We also performed a literature search for other reports of TTE. RESULTS The three cases were operated with trans-septal orchidopexy. In addition, laparoscopy was performed in case 3 to clarify the anatomy. Biopsy revealed normal testicular tissue from both testes in the first two patients. Follow-up with ultrasound, 6 months after operation showed normal size and blood flow of both testes. CONCLUSION Transverse testicular ectopia should be suspected in a boy with an inguinal hernia and contralateral non palpable testis. Trans-septal orchidopexy is recommended when vasa deferentia are fused. Laparoscopy is useful to document the anatomy and to rule out the presence of Müllerian remnants.
Collapse
Affiliation(s)
- Hussein Naji
- Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
10
|
Hasegawa Y, Kanemitsu I, Ueoka K. Transverse testicular ectopia with splenogonadal fusion: A case report. Int J Urol 2011; 18:466-8. [DOI: 10.1111/j.1442-2042.2011.02746.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Deshpande AV, La Hei ER. Impact of laparoscopy on the management of transverse testicular ectopia. J Laparoendosc Adv Surg Tech A 2009; 19:443-6. [PMID: 18991523 DOI: 10.1089/lap.2008.0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Transverse testicular ectopia (TTE) is an uncommon condition with different clinical presentations. A significant proportion of cases are diagnosed only during surgery and it is important to define the precise anatomy and associated anomalies in every case of TTE. Laparoscopy is being increasingly adopted in the treatment of undescended testis, especially in cases where the testis is impalpable. We hereby report a child with a variant of TTE wherein laparoscopy proved enormously beneficial in diagnosis and treatment and where a routine groin exploration was likely to have yielded an incorrect diagnosis. We also review the available literature on the use of laparoscopy in the management of TTE and its impact on the ability of surgeons to diagnose and treat TTE and its associated conditions.
Collapse
|
12
|
Misdiagnosed transverse testicular ectopia: a rare entity. Hernia 2008; 13:305-7. [PMID: 18836686 DOI: 10.1007/s10029-008-0434-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/03/2008] [Indexed: 02/05/2023]
Abstract
A rare case of transverse testicular ectopia (TTE) in a 3-year-old child presenting to the department as bilateral undescended testis along with inguinal hernia is described. The patient was misdiagnosed at a peripheral health centre as a case of inguinal hernia and intersex. As TTE in such a condition is very uncommon, hence, it is being reported with a brief review of the relevant literature.
Collapse
|
13
|
Evans K, Desai A. Total laparoscopic correction of transverse testicular ectopia. J Pediatr Urol 2008; 4:245-6. [PMID: 18631938 DOI: 10.1016/j.jpurol.2007.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
Transverse testicular ectopia is a well-described, rare congenital abnormality of testicular maldescent, in which both testes descend through one inguinal canal. There have been few reports on the laparoscopic diagnosis and laparoscopy-assisted management of this condition. We present a case of a 5-year-old boy who underwent laparoscopy for a right impalpable testis. During the procedure, the right testis was identified at the left internal ring. The common investing meso-orchium was divided and the right testis was brought down through the right inguinal canal laparoscopically. As far as we are aware, this is the first case of transverse testicular ectopia managed entirely laparoscopically.
Collapse
Affiliation(s)
- K Evans
- Department of Paediatric Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
| | | |
Collapse
|
14
|
|
15
|
Transverse testicular ectopia with and without persistent Müllerian duct syndrome. Int Urol Nephrol 2007; 39:1167-71. [PMID: 17940848 DOI: 10.1007/s11255-006-9098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 07/31/2006] [Indexed: 10/22/2022]
|
16
|
Ozturk H, Eroglu M, Ozturk H, Uzunlar AK, Okur H. PERSISTENT Müllerian duct syndrome associated with transverse testicular ectopia: report of two cases. Fetal Pediatr Pathol 2007; 26:41-6. [PMID: 17613045 DOI: 10.1080/15513810701394660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTS) is a very rare pathological association, often discovered during repair for inguinal hernia or cryptorchidism. We present 2 cases with PMDS associated with TTS and discuss the diagnosis and management. A hysterectomy was performed, with resection of the underdeveloped fallopian tubes. Both gonads wereplaced into subdartos pouches in each scrotum by the transseptal approach. The diagnosis of PMDS was confirmed postoperatively by genetic and hormonal investigations. Chromosome analysis revealed 46,XY. Pathological findings demonstrated the immature testes and the immature uterus.
Collapse
Affiliation(s)
- Hayrettin Ozturk
- Department of Pediatric Surgery, Abant Izzet Baysal University, Medical School, Bolu, Turkey.
| | | | | | | | | |
Collapse
|
17
|
Oludiran OO, Sakpa CL. Crossed ectopic testis: a case report and review of the literature. Pediatr Surg Int 2005; 21:672-3. [PMID: 16028046 DOI: 10.1007/s00383-005-1436-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2005] [Indexed: 11/29/2022]
Abstract
Crossed or transverse ectopic testis is a rare anomaly of testicular descent. It has been noted that fewer than 100 cases have been reported in the world literature. In this paper, we report a new case found in a 6-month-old infant operated on in West Africa for an obstructed right inguinoscrotal hernia.
Collapse
Affiliation(s)
- O O Oludiran
- Department of Surgery, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria.
| | | |
Collapse
|
18
|
Abstract
Transverse testicular ectopia (TTE) associated with persistent müllerian duct (PMD) is a rare genitourinary anomaly. The authors report a case with a review of the literature and stress the importance of careful physical examination and ultrasonography in making a correct preoperative diagnosis of TTE. One should be careful not to miss the tiny PMD structure at the operation. Transseptal orchidopexy is the surgical treatment of choice.
Collapse
Affiliation(s)
- S Ueno
- Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara-shi, Kanagawa, Japan 259-1193
| | | | | |
Collapse
|
19
|
Literature watch. January-June 2000. J Endourol 2000; 14:699-700. [PMID: 11083415 DOI: 10.1089/end.2000.14.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|