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Shreyas K, Rathod KJ, Sinha A. Management of high inguinal undescended testis: a review of literature. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Undescended testis is one of the most common paediatric surgical diagnoses. A lot of research has been done to date, to standardise the surgical management of intra-abdominal and extra-abdominal undescended testis. High inguinal undescended testis is a unique clinical encounter which demands additional surgical measures over conventional orchidopexy for better surgical results.
Main body of abstract
Open inguinal orchidopexy is a routine and quite straightforward operation for the majority of extra-abdominal undescended testis. However, there are instances in which the testis, even though situated in the inguinal region, poses a challenge for surgeons, to bring it in the scrotum by routine open inguinal orchiopexy. High inguinal testis can be defined as “any intra-canalicular testis present higher up in the inguinal canal and cannot be brought down easily to the scrotum by routine surgery as in standard orchiopexy (open or laparoscopy) and require additional lengthening manoeuvres”. It needs additional surgical lengthening manoeuvres like Prentiss, along with the steps of routine orchiopexy to bring it down in the scrotum. This review article describes the various nomenclatures of undescended testis, appropriate investigations and also various additional surgical measures in the management of difficult high inguinal testis.
Conclusion
High inguinal undescended testis poses a unique technical challenge even to well-experienced surgeons. It is very important that surgeons dealing with this condition are well aware of the anatomy in this region and also various different manoeuvres described to date to bring the testis down in the scrotum.
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Vikraman J, Hutson JM, Li R, Thorup J. The undescended testis: Clinical management and scientific advances. Semin Pediatr Surg 2016; 25:241-8. [PMID: 27521715 DOI: 10.1053/j.sempedsurg.2016.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Undescended testes (UDT), where one or both testes fail to migrate to the base of the scrotum, can be congenital (2-5% of newborn males) or acquired (1-2% of males). The testis may be found in any position along its usual line of descent. Cryptorchidism affects the developing testicular germ cells and increases the risk of infertility and malignancy. Clinical management aims to preserve spermatogenesis and prevent the increased risk of seminoma. Examination to document the testicular position will guide the need for imaging, medical management and the surgical approach to orchidopexy.
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Affiliation(s)
- Jaya Vikraman
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - John M Hutson
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Department of Urology, The Royal Children׳s Hospital, 50 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Ruili Li
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jorgen Thorup
- Department of Paediatric Surgery and Surgical Clinic, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Emad-Eldin S, Abo-Elnagaa N, Hanna SAZ, Abdel-Satar AH. The diagnostic utility of combined diffusion-weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes. J Med Imaging Radiat Oncol 2016; 60:344-51. [DOI: 10.1111/1754-9485.12458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/04/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Sally Emad-Eldin
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
| | - Nashwa Abo-Elnagaa
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
| | - Sameh AZ Hanna
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
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Coursey Moreno C, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, Hartman M, Mittal PK. Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management. Radiographics 2015; 35:400-415. [DOI: 10.1148/rg.352140097] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ein SH, Nasr A, Wales PW, Ein A. Testicular atrophy after attempted pediatric orchidopexy for true undescended testis. J Pediatr Surg 2014; 49:317-22. [PMID: 24528976 DOI: 10.1016/j.jpedsurg.2013.11.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND/PURPOSE A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy. METHODS We performed a retrospective review of data from children who had an attempted orchidopexy for a true undescended testis from 1969 to 2003 inclusive. REB approval 1000011987. RESULTS There were 1400 attempted orchidopexies involving common (low) type (n=1135), ectopic type (n=174), and high type testes (n=91). There were a total of 111/1400 (8%) atrophic testes, mostly right-sided. 66/111 (59%) were MADE atrophic, and 45 (41%) were FOUND atrophic. Of the 1135 common type, 56 (5%) were MADE atrophic. In the ectopic and high types, the incidence of post-operative testicular atrophy was 1% and 9%, respectively. The most significant risk factors associated with testes MADE atrophic were high testicle, vas problems, and pre-operative torsion. CONCLUSIONS In this series, the incidence of post-operative testicular atrophy that was MADE was 5% in the common (low) type and 9% in the high type. These numbers and the above risk factors should be quoted to the caregiver during pre-operative informed consent.
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Affiliation(s)
- Sigmund H Ein
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8.
| | - Ahmed Nasr
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Paul W Wales
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Arlene Ein
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
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Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. AJR Am J Roentgenol 2013; 200:578-85. [PMID: 23436847 DOI: 10.2214/ajr.12.9064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of our study was to analyze the enhancement patterns of various intratesticular mass lesions at dynamic contrast-enhanced subtraction MRI and assess the value of the technique in distinguishing between benign and malignant lesions. MATERIALS AND METHODS We retrospectively evaluated the records and images of 44 consecutive men (11 benign and 16 malignant intratesticular lesions) who presented to the department of urology with a variety of clinical symptoms and were referred for imaging. Dynamic contrast-enhanced subtraction MRI was performed using a 3D fast-field echo sequence after the administration of paramagnetic contrast medium. Patients were divided into three groups according to the final diagnosis: benign intratesticular lesions, malignant intratesticular lesions, and normal testes. The patterns of contrast enhancement of both the normal testes and the intratesticular lesions were evaluated. Time-signal intensity plots were created and classified according to shape: Type I presented a linear increase of contrast enhancement throughout the examination, type II showed an initial upstroke followed by either a plateau or a gradual increase in the late contrast-enhanced phase, and type III presented an initial upstroke followed by gradual washout of the contrast medium. The relative percentages of peak height, maximum time, and mean slope were also calculated. RESULTS Normal testes enhanced homogeneously with a type I curve. Most benign intratesticular lesions showed inhomogeneous or homogeneous contrast enhancement and a type II curve. Testicular carcinomas showed heterogeneous contrast enhancement with a type III curve. The relative percentages of maximum time to peak proved the most important discriminating factor in differentiating malignant from benign intratesticular masses (p < 0.001). CONCLUSION Dynamic contrast-enhanced MRI may be used to distinguish between benign and malignant intratesticular mass lesions.
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MRI of Patients With Suspected Scrotal or Testicular Lesions: Diagnostic Value in Daily Practice. AJR Am J Roentgenol 2012; 199:609-15. [DOI: 10.2214/ajr.11.7349] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Undescended testis is one of the common surgical disorders in childhood and twenty percent of the undescended testes are nonpalpable. Surgical management is required in almost all cases for the repositioning or removal of the undescended testes and early intervention is preferred for optimal outcome. Use of imaging studies for accurate preoperative localisation of the nonpalpable testis is a wide prevalent practice. However, available evidences have questioned the need of such studies.
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Affiliation(s)
- Manas Ranjan Pradhan
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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Magnetic Resonance Arteriography/Venography is Not Accurate to Structure Management of the Impalpable Testis. J Urol 2008; 180:1805-8; discussion 1808-9. [DOI: 10.1016/j.juro.2008.04.075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Indexed: 11/19/2022]
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Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P. US–MR Imaging Correlation in Pathologic Conditions of the Scrotum. Radiographics 2007; 27:1239-53. [PMID: 17848688 DOI: 10.1148/rg.275065172] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ultrasonography (US) is usually the initial imaging modality for evaluation of pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging can be useful as a problem-solving tool when sonographic findings are equivocal. MR imaging allows characterization of scrotal masses as intratesticular or extratesticular and can demonstrate various types of lesions and tissue, including cysts or fluid, solid masses, fat, and fibrosis. MR imaging may be of value when the location of a scrotal mass is uncertain or when US does not allow differentiation between a solid mass and an inflammatory or vascular abnormality. Gadolinium-enhanced MR imaging can help differentiate between a benign cystic lesion and a cystic neoplasm. Gadolinium-enhanced imaging can also be used to demonstrate areas of absent or reduced testicular perfusion, such as in segmental testicular infarct. Finally, MR imaging can demonstrate an intraabdominal undescended testis, which can be difficult to detect with US, and is superior to US in differentiation between an undescended testis and testicular agenesis.
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Affiliation(s)
- Woojin Kim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
Cryptorchidism represents a common condition affecting male infants that has significant clinical implications, including infertility and testicular malignancy. The precise developmental mechanisms leading to cryptorchidism are poorly understood; however, abnormalities in both functional anatomic and hormonal factors during embryogenesis and testicular descent are implicated. Although surgical intervention is ultimately required, there is a defined role for diagnostic imaging in patient evaluation-particularly in the setting of a nonpalpable undescended testis. Consultation among urologists, pediatric surgeons, and radiologists is paramount to optimize patient care.
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Affiliation(s)
- Jared D Christensen
- Department of Imaging Science, University of Rochester Medical Center, Rochester, NY 14642, USA
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Correct answers to multiple choice questions appearing in the European Urology Update Series 2005. BJU Int 2005. [DOI: 10.1111/j.1464-410x.2005.05978.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eggener SE, Lotan Y, Cheng EY. MAGNETIC RESONANCE ANGIOGRAPHY FOR THE NONPALPABLE TESTIS: A COST AND CANCER RISK ANALYSIS. J Urol 2005; 173:1745-9; discussion 1749-50. [PMID: 15821574 DOI: 10.1097/01.ju.0000154349.85794.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For the unilateral nonpalpable testis standard management is open surgical or laparoscopic exploration. An ideal imaging technique would reliably identify testicular nubbins and safely allow children to forgo surgical exploration without compromising future health or fertility. Our goal was to perform a cost and risk analysis of magnetic resonance angiography (MRA) for unilateral nonpalpable cryptorchid testes. MATERIALS AND METHODS A search of the English medical literature revealed 3 studies addressing the usefulness of MRA for the nonpalpable testicle. We performed a meta-analysis and applied the results to a hypothetical set of patients using historical testicular localization data. Analysis was then performed using 3 different management protocols-MRA with removal of testicular nubbin tissue, MRA with observation of testicular nubbin tissue and diagnostic laparoscopy. A cancer risk and cost analysis was then performed. RESULTS MRA with observation of testicular nubbin tissue results in 29% of patients avoiding surgery without any increased cost of care. Among the 29% of boys with testicular nubbins left in situ and observed the highest estimated risk was 1 in 300 of cancer developing, and 1 in 5,300 of dying of cancer. CONCLUSIONS A protocol using MRA with observation of inguinal nubbins results in nearly a third of boys avoiding surgical intervention at a similar cost to standard care without any significant increased risk of development of testis cancer.
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Affiliation(s)
- S E Eggener
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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Affiliation(s)
- Kalpna K Patil
- Department of Paediatric Urology, Guy's & St Thomas' Hospital NHS Trust, London, UK.
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Bldg 54, Room M-121, Washington, DC 20306-6000, USA.
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Woodward PJ, Sohaey R, O'Donoghue MJ, Green DE. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics 2002; 22:189-216. [PMID: 11796908 DOI: 10.1148/radiographics.22.1.g02ja14189] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Testicular carcinoma represents only 1% of all neoplasms in men, but it is the most common malignancy in the 15-34-year-old age group. Germ cell tumors constitute 95% of all testicular tumors. Germ cell tumors are a varied group of neoplasms whose imaging features reflect their underlying histologic characteristics. Seminomas are generally well-defined homogeneous lesions, whereas the nonseminomatous tumors (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed germ cell tumor) have a much more varied appearance. Germ cell tumors follow a predictable pattern of spread via the lymphatic drainage to the retroperitoneal nodes. Choriocarcinoma, which has a proclivity for early hematogenous spread, is a notable exception. Testicular tumors may also arise from the sex cords (Sertoli cells) and stroma (Leydig cells). Although 90% of these tumors are benign, there are no reliable imaging criteria to differentiate them from malignant masses. Some benign testicular masses can be recognized, obviating an unwarranted orchiectomy. A dilated rete testis is a normal variant and appears as a series of small tubules near the mediastinum testis. Other benign lesions that can be suspected on the basis of imaging findings and history include intratesticular cysts, epidermoid cysts, congenital adrenal hyperplasia, and sarcoidosis.
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St, NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
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