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Hallabro N, Hambraeus M, Börjesson A, Salö M. Mapping of referral patterns for undescended testes - Risk factors for referral of children with normal testes. J Pediatr Urol 2023; 19:320.e1-320.e10. [PMID: 36898865 DOI: 10.1016/j.jpurol.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/29/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Accurate referral of boys with suspected undescended testes (UDT) is of importance to preserve fertility and reduce risk of future testicular cancer. While late referral is well studied, there is less knowledge about incorrect referrals, hence, referral of boys with normal testes. OBJECTIVE To evaluate the proportion of UDT referrals that did not lead to surgery or follow-up, and to assess risk factors for referral of boys with normal testes. STUDY DESIGN All UDT referrals to a tertiary center of pediatric surgery during 2019-2020 were retrospectively assessed. Only children with suspected UDT in the referral (not suspected retractile testicles) were included. Primary outcome was normal testes at examination by a pediatric urologist. Independent variables were age, season, region of residence, referring care unit, referrer's educational level, referrer's findings, and ultrasound result. Risk factors for not needing surgery/follow-up were assessed with logistic regression and presented as adjusted odds ratios with a 95% confidence interval (aOR, [95% CI]). RESULTS A total of 378 out of 740 included boys (51.1%) had normal testes. Patients >4 years (aOR 0,53, 95% CI [0,30-0,94]), referrals from pediatric clinics (aOR 0.27, 95% CI [0.14-0.51]) or surgery clinics (aOR 0.06, 95% CI [0.01-0.38]) had lower risk of normal testes. Boys referred during spring (aOR 1.80, 95% CI [1.06-3.05]), by a non-specialist physician (aOR 1.58, 95% CI [1.01-2.48]) or referrer's description of bilateral UDT (aOR 2.34, 95% CI [1.58-3.45]), or retractile testes (aOR 6.99, 95% CI [3.61-13.55]) had higher risk of not needing surgery/follow-up. None of the referred boys that had normal testes had been re-admitted at the end of this study (October 2022). DISCUSSION Over 50% of boys referred for UDT had normal testes. This is higher or equal to previous reports. Efforts to reduce this rate should in our setting probably be directed towards well-child centers and training in examination of testicles. The main limitation of this study is the retrospective design and the rather short follow-up time, which however should have very modest effect on the main findings. CONCLUSION Over 50% of boys referred for UDT have normal testes. A national survey regarding the management and examination of boys testicles has been launched and directed at well-child centers to further evaluate the findings of the current study.
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Affiliation(s)
- Nilla Hallabro
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Mette Hambraeus
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Anna Börjesson
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden
| | - Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, 221 85, Lund, Sweden.
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2
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Hori S, Aoki K, Tachibana A, Nishimura N, Tomizawa M, Morizawa Y, Gotoh D, Fukui S, Nakai Y, Miyake M, Torimoto K, Yoneda T, Tanaka N, Fujimoto K. Usefulness of clinical factors for diagnosing and differentiating types of testicular malposition in boys: A retrospective study. Int J Urol 2021; 29:57-64. [PMID: 34655119 DOI: 10.1111/iju.14715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate useful objective variables and factors supporting the diagnosis of retractile testis and cryptorchidism by primary care providers, including urologists. METHODS This retrospective study included 512 boys diagnosed with retractile testis or cryptorchidism at our institute. Boys with retractile testis were followed up and underwent orchiopexy once the testis became undescended, while boys with cryptorchidism underwent orchiopexy immediately. We investigated trends in the prevalence of testicular malposition and explored useful diagnostic factors for retractile testis and cryptorchidism. RESULTS Of 512 boys, 199 were diagnosed with retractile testis and 313 were diagnosed with cryptorchidism. Comparison of clinical information between retractile testis and cryptorchidism showed that age at diagnosis, laterality, and location of the testis were significantly different between the groups (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The comparison of surgical information also showed that epididymal abnormality and state of processus vaginalis is patency or closure were significantly different between the groups (P = 0.0088 and P = 0.0003, respectively). Multivariate analysis showed that diagnosis at age 0-1 years, unilaterality, and canalicular testis were predictive factors for cryptorchidism (P = 0.001, P < 0.0001, and P < 0.0001, respectively). CONCLUSIONS Age at diagnosis, laterality, and location of the testis could be factors to aid the diagnosis of retractile testis and cryptorchidism.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Tachibana
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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3
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Kato K, Yabuki S, Otani K, Nikaido T, Otoshi KI, Watanabe K, Kikuchi SI, Konno SI. Ossification of the ligamentum flavum in the thoracic spine mimicking sciatica in a young baseball pitcher:a case report. Fukushima J Med Sci 2021; 67:33-37. [PMID: 33731510 PMCID: PMC8075556 DOI: 10.5387/fms.2020-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thoracic ossification of the ligamentum flavum (OLF) is a pathological condition that causes myelopathy, with unilateral lower extremity pain rarely a feature in the presenting complaint. Moreover, most symptomatic cases of thoracic OLF occur in middle-aged men, with younger individuals rarely affected. We present a rare case of severe and chronic unilateral buttock and leg pain mimicking sciatica due to thoracic OLF in a professional baseball pitcher. A 28-year-old, right-handed, Japanese professional baseball pitcher experienced intractable left leg pain with numbness and spasticity. After the initial presentation, extensive testing focusing on lumbar, hip, and pelvis lesions failed to identify a cause for the pain. One year after onset, careful neurological examination showed signs of upper motor neuron disturbance, and thoracic computed tomography and magnetic resonance imaging revealed thoracic OLF at the level of the thoracolumbar junction. After resection of the thoracic OLF, the pain, numbness, and spasticity completely resolved. He resumed full training and was pitching in top condition within four months after surgery. Though rare, thoracic OLF should be considered in the differential diagnosis of lower extremity pain in young athletes, especially amongst high-level baseball pitchers.
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Affiliation(s)
- Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Ken-Ichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine.,Department of Sport Medicine, Fukushima Medical University School of Medicine
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-Ichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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4
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Ehman D, Mugarab Samedi V, Kalaniti K, Daspal S. Neonatal Escherichia coli infection in twins: clinical spectrum and management dilemma. BMJ Case Rep 2021; 14:14/1/e238470. [PMID: 33504527 PMCID: PMC7843350 DOI: 10.1136/bcr-2020-238470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A's blood culture grew E. coli, while twin B's blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.
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Affiliation(s)
- Dylan Ehman
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica Mugarab Samedi
- Royal University Hospital, Saskatoon, Saskatchewan, Canada .,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kaarthigeyan Kalaniti
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sibasis Daspal
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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5
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Hori S, Aoki K, Nishimura N, Morizawa Y, Gotoh D, Fukui S, Nakai Y, Miyake M, Torimoto K, Yoneda T, Tanaka N, Fujimoto K. Trends in treatment outcomes for retractile testis in Japanese boys: A single-center study. Int J Urol 2020; 28:327-332. [PMID: 33302323 DOI: 10.1111/iju.14458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the natural course of retractile testis by analyzing its prevalence and outcomes. METHODS This retrospective study included 215 boys in whom retractile testis was diagnosed after reviewing the medical history and physical examinations of the patients. Orchiopexy was performed once the testis became undescended. We investigated the trends in the prevalence and outcomes of retractile testis and compared clinical factors between cases that resolved spontaneously and those that required orchiopexy. RESULTS Of 215 boys, 145 were finally evaluated. The mean age at diagnosis was 2 years, and 100 boys were aged ≤2 years when they were hospitalized. Seventy-three boys were referred to our institution through health examinations as babies. The condition improved spontaneously in 89 boys, while 43 boys underwent orchiopexy, and 13 boys remained under follow-up. The follow-up period between diagnosis and resolution was significantly longer in the spontaneous resolution group than in the surgical intervention group (P = 0.011). Bilateral retractile testis improved spontaneously in significantly more boys compared to unilateral retractile testis (P = 0.0010). Spontaneous resolution was observed in boys of all ages, but those diagnosed at ≤3 years of age had a significantly higher rate of spontaneous resolution compared to those who were diagnosed at >3 years of age (P = 0.0019). CONCLUSIONS Our findings suggest that retractile testis cannot be affirmed as a variant of normal testis. Performing examinations at a young age is critical for preventing misdiagnosis, screening failures, and unnecessary surgery.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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6
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Sengul G, Ertekin C. Human cremaster muscle and cremasteric reflex: A comprehensive review. Clin Neurophysiol 2020; 131:1354-1364. [DOI: 10.1016/j.clinph.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
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7
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: Ultrasound assessment and differential diagnosis. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Schwarz GM, Hirtler L. The cremasteric reflex and its muscle - a paragon of ongoing scientific discussion: A systematic review. Clin Anat 2017; 30:498-507. [DOI: 10.1002/ca.22875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Gilbert M. Schwarz
- Division of Anatomy; Center for Anatomy and Cell Biology, Medical University of Vienna; Vienna Austria
| | - Lena Hirtler
- Division of Anatomy; Center for Anatomy and Cell Biology, Medical University of Vienna; Vienna Austria
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9
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. RADIOLOGIA 2017; 59:391-400. [PMID: 28117098 DOI: 10.1016/j.rx.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.
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Affiliation(s)
- C Sangüesa Nebot
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Llorens Salvador
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - S Picó Aliaga
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Garcés Iñigo
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
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10
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Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay S, Stein R, Undre S, Tekgul S. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol 2016; 12:335-343. [PMID: 27687532 DOI: 10.1016/j.jpurol.2016.07.014] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Undescended testis is the most common endocrinological disease in the male newborn period. Incidence varies between 1.0% and 4.6% in full-term neonates, with rates as high as 45% in preterm neonates. Failure or delay of treatment can result in reduced fertility and/or increased testicular cancer risk in adulthood. OBJECTIVE To provide recommendations for the diagnosis and treatment of boys with undescended testes which reduce the risk of impaired fertility and testicular cancer in adulthood. EVIDENCE ACQUISITION Embase and Pubmed were searched for all relevant publications, from 1990 to 2015 limited to English language. Data were narratively synthesized in light of methodological and clinical heterogeneity. The risk of bias of each included study was assessed. EVIDENCE SYNTHESIS There is consensus that early treatment, by 18 months at the latest, for undescended testes is mandatory to avoid possible sequelae regarding fertility potential and cancer risk. The current standard therapy is orchidopexy, while hormonal therapy is still under debate. However, in some individuals the successful scrotal placement of previously undescended testes may not prevent potential negative long-term outcomes regarding fertility and testicular malignancy. CONCLUSIONS There is good evidence for early placement of undescended testes in the scrotal position to prevent potential impairment of fertility and reduce the risk of testicular malignancy. No consensus exists on the various forms of hormonal treatment, which are assessed on an individual basis.
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Affiliation(s)
- Christian Radmayr
- Paediatric Urology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Hasan S Dogan
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Radim Kocvara
- Department of Urology, General Teaching Hospital in Praha, and Charles University 1st Faculty of Medicine, Praha, Czech Republic
| | - Rien Nijman
- Department of Urology, Division of Paediatric Urology, University of Groningen, Groningen, The Netherlands
| | | | - Raimund Stein
- Division of Paediatric Urology, Department of Urology, Mainz University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Shabnam Undre
- Department of Paediatric Urology, Great Ormond Street Hospital for Sick Children, London, UK
| | - Serdar Tekgul
- Hacettepe University, Faculty of Medicine, Department of Urology, Division of Paediatric Urology, Ankara, Turkey
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11
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 14. Natural History of Undescended Testes. Pediatr Dev Pathol 2016; 19:183-201. [PMID: 25105691 DOI: 10.2350/14-05-1483-pb.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cryptorchidism is one of the most frequent problems encountered in pediatric urology. Its causes, associated lesions, and prognosis in terms of fertility have been a source of interest and discrepancies for pediatric pathologists and urological surgeons.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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12
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Stark JE, Bellman LA, Kamel SH, Whittam BM, Christenson JC, Webber EC. Escherichia coli Bacteremia, Epididymo-Orchitis, and Scrotal Abscess in a Neonate. J Pediatric Infect Dis Soc 2012; 1:340-2. [PMID: 26619427 DOI: 10.1093/jpids/pis057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/06/2012] [Indexed: 11/12/2022]
Abstract
Epididymo-orchitis (EO) is a rare but important cause of scrotal swelling in pediatric patients. EO is caused by bacteremia leading to hematogenous seeding or ascending infection of the urinary tract. EO can be associated with abscess, bacteremia, and other serious infections, and must be distinguished from other causes of scrotal swelling such as testicular torsion. We present a case of a 16-day-old male with EO, scrotal abscess, and bacteremia from Escherichia coli.
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Affiliation(s)
| | | | - Sarah H Kamel
- Indiana University School of Medicine Department of Pediatrics
| | | | - John C Christenson
- Indiana University School of Medicine Department of Pediatrics Section of Pediatric Infectious Disease Riley Hospital for Children, Indianapolis, Indiana
| | - Emily C Webber
- Indiana University School of Medicine Department of Pediatrics Pediatric Hospital Medicine Program Riley Hospital for Children, Indianapolis, Indiana
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13
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Abstract
Torsion of the testis, also referred to as torsion of the spermatic cord, is a subject of debate among physicians and surgeons. Testicular torsion is an acute vascular event causing the rotation of the vascular pedicle of the testis, thereby impeding the blood flow to the testis and the scrotal contents. It could be either within or outside the tunica vaginalis. Testicular torsion causes immediate circulatory changes and long-term sequelae such as testicular function and fertility. It is considered a surgical emergency, as a delay causes irreversible testicular damage. The diagnosis and treatment of testicular torsion are discussed in this review, which also illustrates an algorithm and a scoring system for the diagnosis and management of this condition based on current literature.
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Affiliation(s)
- S Pentyala
- Departments of Urology, School of Medicine, State University of New York, Stony Brook, NY 11794-8093, USA
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14
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Chiang MC, Chen HW, Fu RH, Lien R, Wang TM, Hsu JF. Clinical features of testicular torsion and epididymo-orchitis in infants younger than 3 months. J Pediatr Surg 2007; 42:1574-7. [PMID: 17848251 DOI: 10.1016/j.jpedsurg.2007.04.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE Testicular torsion (TT) and orchitis/epididymo-orchitis (EO) are confusing and difficult for physicians to diagnose in infants younger than 3 months. The aim of the study was to delineate the etiology and the clinical features of TT and EO in this age group. METHODS During the period between April 1994 and September 2004, medical charts of infants younger than 3 months with TT and EO were reviewed retrospectively. RESULTS Sixteen patients were eligible for the study, including 9 with TT and 7 with orchitis/EO. Two infants had postnatal torsion, and the testicles were salvaged by emergent surgery. Eighty-six percent (6/7) of infants with EO/orchitis had either abnormal physical signs (fever or scrotal tenderness) or abnormal laboratory findings (leukocytosis or elevated C-reactive protein level). The sensitivity of color Doppler ultrasound to diagnose TT and EO/orchitis was 88% (7/8) and 100% (6/6), respectively. All infants (6/6) with EO/orchitis who were checked for urinary tract infection and sepsis had positive test results. CONCLUSIONS Pediatricians should examine the testicles meticulously after a baby is born. Orchitis/EO is highly suspected for patients associated with abnormal physical signs and laboratory findings. Prompt prescription of antibiotics is mandatory to avoid serious sequelae.
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Affiliation(s)
- Ming-Chou Chiang
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Chang Gung Children's Hospital, Taiwan
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15
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Kilgo MS, Howard MA, Kaplan G, Rabbani F, Scardino PT, Cordeiro PG. Evaluation of Genitofemoral Nerve Donor Site Morbidity After Radical Prostatectomy. Ann Plast Surg 2005; 55:57-61; discussion 61-2. [PMID: 15985792 DOI: 10.1097/01.sap.0000168029.74274.b7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sural nerve is commonly used as a donor site for cavernous nerve grafting. However, the genitofemoral nerve is accessible and easily dissected and may represent an improved donor site for this procedure. METHODS Fourteen patients underwent radical prostatectomy followed by cavernous nerve grafting using the genitofemoral nerve. Seventeen donor sites (3 patients underwent bilateral grafts) were assessed by questionnaires (including the McGill Pain Scale) and focused neurologic examination. RESULTS Residual numbness in the genitofemoral nerve distribution was noted in 9 of 17 donor sites (53%). No patients reported that the deficits interfered with normal daily activities. All patients denied the presence of burning, cold sensitivity, or pain. All patients scored 0 on each of the 3 pain rating components of the short form McGill Pain questionnaire (sensory, affective, or total). Furthermore, no patients documented pain on either the PPI or VAS portions of the questionnaire. On examination, patients were unable to discriminate between sharp versus dull stimuli in 3 donor sites (17.6%), while 7 donor sites (41.2%) showed decreased light-touch sensation. The Semmes-Weinstein testing demonstrated that 8 (47.1%) were found to have distinct areas with sensory deficit ranging in size from 23 to 63 cm (mean, 16.6 cm). The highest-pressure thresholds for each of the 17 donor sites ranged from 3.61 to 6.45 g/mm (mean, 4.91 g/mm). The mean pressure threshold for the control regions (n=11) was 3.35 g/mm (range, 2.38--4.71 g/mm, P=0.014). Only 50% of the sensory deficits documented by the Semmes-Weinstein test were clinically apparent to the patients. CONCLUSIONS Due to its low donor site morbidity, the genitofemoral nerve is an excellent donor source for cavernous nerve grafting during radical prostatectomy. In the majority of the patients, the sensory deficit produced by resection of this nerve is minimal and caused no other adverse symptoms. Harvest of this nerve prevents the additional morbidity associated with a donor site located elsewhere on the body (ie, sural nerve).
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Affiliation(s)
- Matthew S Kilgo
- Division of Plastic and Reconstructive Surgery and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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16
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Abstract
The cremaster reflex has been reported to be absent in 100% of cases of testicular torsion, making it a useful sign in this difficult diagnosis. The authors report a case of surgically confirmed testicular torsion in which the cremasteric reflex clearly was present at presentation. The background of this sign and its utility in the evaluation of the acute scrotum are discussed.
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Affiliation(s)
- Caleb P Nelson
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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17
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Miller OF, Stock JA, Cilento BG, McAleer IM, Kaplan GW. Prospective evaluation of human chorionic gonadotropin in the differentiation of undescended testes from retractile testes. J Urol 2003; 169:2328-31. [PMID: 12771792 DOI: 10.1097/01.ju.0000065823.80051.bb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We prospectively evaluated the efficacy of human chorionic gonadotropin (HCG) in the treatment of undescended testis and sought to determine whether HCG assists in the differentiation of undescended testis from retractile testis. MATERIALS AND METHODS Patients with undescended testes were offered HCG. Testis position, laterality and the presence or absence of a hypoplastic scrotum were noted. The same physician (G. W. K.) recorded physical findings prospectively and stated clinical impression of descent. RESULTS A total of 67 patients with 90 undescended or retractile testes were treated and evaluated with HCG. Of the 64 undescended testes 13 (20%) descended with HCG therapy, with none requiring subsequent surgery. Of the 26 retractile testes 15 (58%) descended with HCG (p <0.001). Based on physical examination, 100% of retractile testes descended if the testis was in the high scrotal position but only 40% descended if the testis was in the superficial pouch or inguinal area. In the undescended testes group no ectopic or nonpalpable testis descended with HCG. Evaluation of HCG with age demonstrated minimal response (15%) to HCG at less than 24 months, and a peak response between ages 2 and 6 years (75%) with response decreasing thereafter. CONCLUSIONS HCG may have a limited role in the evaluation of undescended testis in patients younger than 2 years. HCG can serve as an adjunct in the clinical diagnosis of retractile testis in older children.
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Affiliation(s)
- Oren F Miller
- Children's Hospital and Health Center, and Naval Medical Center San Diego, San Diego, California, USA
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18
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Abstract
Regardless of age, any presentation of an acute scrotum requires prompt triage and immediate evaluation. The potential for significant reduction in morbidity and mortality exists if timely diagnosis and treatment are provided. Often overlooked, an early scrotal examination in the emergency department may produce the most accurate information into the underlying pathologic process, be it systemic or localized to the scrotum. Although the immediately lethal conditions presenting as acute scrotal pain should be considered, the combined incidence and morbidity associated with testicular torsion make its exclusion paramount in acute scrotal presentations. Similarly, a painless scrotal mass must be assumed to be a testicular neoplasm until proven otherwise, with appropriate work-up and rapid urologic follow-up assured.
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Affiliation(s)
- D Marcozzi
- Brown University School of Medicine, Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
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19
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Abstract
PURPOSE A clinical study has been planned to define the clinical characteristics of cremasteric reflex (CR) for deciding on the possibility of a prolonged suprascrotal stay of a testis through this reflex. METHODS Five hundred boys from 3 days to 16 years of age were divided into 6 groups according to their ages and were evaluated for the presence of the CR. After evoking CR, the presence or absence of changes in testicular location and the most elevated position of the testis were recorded. Testicular position difference (TPD), the duration of the stay of testis in the most elevated position (DEP), and the interval for reevoking the CR (IRCR) were determined. The number of consecutive responses after repetitive evokings were recorded as reproducibility (R). Mean TPD, DEP, IRCR, and R values for both sides were calculated and compared among groups. The boys with a positive reflex were classified further according to their TPD, DEP, IRCR, and R values. Three groups were established according to the aforementioned criteria by dividing the values into 3 equal parts. The association of each of the parameters to other parameters were compared. RESULTS Bilateral positive CR was encountered in 42.7% of newborns, 36.3% of the boys between 1 month and 1 year old, 38.1% of the boys between 2 years and 4 years old, 75.2% of the boys between 5 years and 8 years old, 70.3% of the boys between 9 years and 12 years old, and 72.1% of the boys between 13 and 16 years old. The highest percentage of the contralateral activations during ipsilateral evokings were encountered in boys who were between 5 and 8 years of age. The highest mean TPD and mean R, the longest mean DEP, and mean IRCR were encountered in boys between 5 and 8 years of age. Boys with the highest TPD did not have shortest IRCR and highest R values. Similarly, boys with the longest DEP or shortest IRCR and highest R values did not have the association of other parameters that would suggest a hypersensitivity. CONCLUSIONS The rate of presence and the characteristics of a positive CR vary largely. However, suprascrotal location of a testis for extended periods through the activation of this reflex does not seem to be likely. Instead of a hyperactive reflex, the clinical condition, so called the retractile testis, might have resulted through alterations within the cremaster muscle itself. J Pediatr Surg 36:863-867.
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Affiliation(s)
- M Bingöl-Koloğlu
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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20
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Hughes ME, Currier SJ, Della-Giustina D. Normal cremasteric reflex in a case of testicular torsion. Am J Emerg Med 2001; 19:241-2. [PMID: 11326357 DOI: 10.1053/ajem.2001.22663] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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22
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Okuda Y, Mishio M, Kitajima T, Asai T. Cremasteric reflex test as an objective indicator of spinal anaesthesia. Anaesthesia 2000; 55:587-9. [PMID: 10866724 DOI: 10.1046/j.1365-2044.2000.01424.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied 100 men who were scheduled for urological surgery (Group 1) and another 50 men for orthopaedic surgery (Group 2). We attempted to anaesthetise both sides of the lower body in Group 1 and to anaesthetise one leg in Group 2 by injecting 0.3% hyperbaric dibucaine intrathecally. The presence or absence of the cremasteric reflex and loss of sensation to pinprick higher than the first lumbar dermatome were examined by two researchers who were blind to each other's results. In Group 1, both the reflex and the pinprick sensation were always absent bilaterally 5 min after intrathecal injection. In Group 2, in 23 of 50 patients the reflex had become absent bilaterally; in all these patients, bilateral sensory loss was detected. In the remaining 27 patients, both the reflex and the pinprick sensation were absent on the operation side, whereas both were present on the nonoperation side. Sensitivity, specificity and positive or negative predictive value for the cremasteric reflex were all 100%. Disappearance of the cremasteric reflex is a simple objective indicator of spinal anaesthesia at the first lumbar dermatome. This test may be useful in patients who cannot give reliable answers to conventional tests, such as the pinprick test.
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Affiliation(s)
- Y Okuda
- First Department of Anaesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, 321-0293, Japan
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23
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Bingöl-Koloğlu M, Demirci M, Büyükpamukçu N, Tanyel FC. Cremasteric reflexes of boys with descended, retractile, or undescended testes: an electrophysiological evaluation. J Pediatr Surg 1999; 34:430-4. [PMID: 10211648 DOI: 10.1016/s0022-3468(99)90493-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Retractile testis traditionally has been regarded as suprascrotal location of testis resulting from hyperactivity of the cremasteric reflex (CR). However, the activity of CR is evaluated poorly in the literature. Electrophysiological characteristics of CR in boys with various testicular localizations have been evaluated comparatively. METHODS Cremasteric responses that were evoked by electrical stimulation of the upper-inner aspect of thigh were recorded using a concentric needle electromyography (EMG) electrode inserted into the cremaster muscle. Evoked EMGs of groups, each consisting of 10 boys with bilateral descended (DT), unilateral retractile (RT), or unilateral undescended testes (UT) were compared for response latencies and durations. RESULTS Three components with different onset latencies (R1, R2, and R3) were identified in EMG responses. In patients with UT, the latency of the R1 was shorter than that of the patients with DT, and the duration of R2 was longer than those of the patients with DT and RT. The differences between patients with RT and DT regarding the latency and duration of R1 and R2, although similar to those differences between UT and DT, were not significant. There were no significant differences of the latencies of R3 between groups. In patients with RT and UT, response latency and duration in the descended and retractile-undescended sides were similar. CONCLUSIONS Defined by shortened latency and prolonged activity of cremasteric responses, which probably reflect a diminished neuronal inhibitory control, CR is hyperactive in UT. Disinhibited motor neurons leading to overactivity of cremaster muscle might have hampered the descent of testis. Our results do not provide a definite support for or against the hypothesis of CR hyperactivity in RT.
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Affiliation(s)
- M Bingöl-Koloğlu
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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24
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Bingöl-Koloğlu M, Sara Y, Tanyel FC, Onur R, Büyükpamukçu N, Hiçsönmez A. Contractility and electrophysiological parameters of cremaster muscles of boys with a hernia or undescended testis. J Pediatr Surg 1998; 33:1490-4. [PMID: 9802798 DOI: 10.1016/s0022-3468(98)90482-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE The cremaster muscle (CM) has been considered to participate in regulation of blood flow and temperature of the testis. Its contribution to testicular descent has been suggested. However, there is limited information about the CM in physiological and pathological states. Therefore, an experimental study has been conducted to evaluate and compare the contractile and electrophysiological properties of CM in boys with descended or undescended testes. METHODS Identical CM strips were obtained from eight boys who underwent orchidopexy with a mean age of 3+/-2.2 years and from eight boys who underwent herniorrhaphy with a mean age of 4+/-1.3 years. Muscle strips of 3 x 8 mm were vertically attached to an isometric force displacement transducer, and direct muscle contractions were elicited by rectangular electrical pulses. Direct isometric muscle contractions were recorded in an organ bath containing mammalian Ringer's solution. In electrophysiological experiments, conventional microelectrode techniques were used. RESULTS Direct electrical stimulation of CM strips obtained from patients with descended and undescended testes elicited muscle twitches and frequency-dependent contractile responses. Tetanic contractions of undescended testes at 100 Hz were 67% greater in amplitude than that of descended testes (P< .002). Muscle strips of both groups exhibited increased twitch amplitudes by 105%+/-37% when the temperature of the bathing solution was increased from 22 degrees to 37 degrees C (P< .001). The electrophysiological findings were similar. CONCLUSIONS Contrary to other striated muscles, elevated temperature increases the contractility of CM. If the increased contractility by an increase in temperature is a property unique for CM, it should reflect the attempts at regulating testicular blood flow or temperature. The increased amplitude of contractions encountered among the CM of boys with undescended testis suggests the CM to have a role on the location of the testis.
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Affiliation(s)
- M Bingöl-Koloğlu
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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25
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Abstract
Every boy with acute onset scrotal pain and swelling requires an immediate evaluation. Our protocol (Fig. 6) for the evaluation of these children is based on the history and physical examination combined with the selective use of imaging studies. When used appropriately, this protocol facilitates the rapid identification of children with torsion and minimizes the number of unnecessary scrotal explorations. When the duration of the pain is brief, and history and physical examination suggest that torsion is the most likely diagnosis, urgent surgical exploration without additional imaging studies is recommended. When it is not possible to definitely diagnose or exclude the diagnosis of testicular torsion, or when the duration of pain is greater than 12 hours, then diagnostic imaging can provide significant information. Color Doppler sonography is, in the authors' opinion, preferable to nuclear imaging for the evaluation of children with acute scrotums. When normal or increased blood flow is present, scrotal exploration is not required. When the study demonstrates decreased blood flow or does not provide a definite diagnosis, scrotal exploration is recommended. The authors recommend this approach because less than one third of these children have testicular torsion, and if routine scrotal exploration is performed for all boys with acute scrotums, a significant number of unnecessary surgical procedures will result.
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Affiliation(s)
- E J Kass
- Division of Pediatric Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
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26
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Bragato F, Ferrarese P, Serra F, Santacatterina U, Bargelloni U. Current Diagnostic Possibilities in Cryptorchidism. Urologia 1996. [DOI: 10.1177/039156039606300213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From a review of Literature on the subject, the Authors have followed developments in diagnosing cryptorchidism. The objective examination is still fundamental, but nowadays ultrasound, NMR, CT, phlebography and laparoscopy can be used. Surgical exploration remains a valid method for completing the above examinations.
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Affiliation(s)
- F. Bragato
- Divisione Urologica - Ospedale Civile - Cittadella (Padova)
| | - P. Ferrarese
- Divisione Urologica - Ospedale Civile - Cittadella (Padova)
| | - F. Serra
- Divisione Urologica - Ospedale Civile - Cittadella (Padova)
| | | | - U. Bargelloni
- Divisione Urologica - Ospedale Civile - Cittadella (Padova)
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