Abdominal Cryptorchidism Research Articles

The Use of Ketamine, Xylazine and Midazolam Combination for Total Intravenous Anesthesia (Tiva) in Surgical Removal of Abdominal Testis at Stallion

Abstract Equine veterinarians frequently anesthetize horses. In majority of cases performing short-term anesthesia (duration, 20 minutes). But there is substantial need for long term anesthesia. The aim of this work is to present our experience with a long term and short term total intravenous anesthesia in horses. In this paper we are presenting results of anesthesia monitoring of a horse undergoing surgical remove of an abdominal testis (complete abdominal cryptorchid). Sedation of the horsewas conducted with xylazine, 1.0 mg/kg, iv, and midazolam 0.06 mg/kg, iv. The total anesthesia was induced using a combination of ketamine 2.2mg/kg/iv, and midazolam 0.1 mg/kg/iv. After induction the horse was restrained and anesthesia was maintained with continuous intravenous drip of a combination of drugs mixed in infusion bottle with midazolam (0.002 mg/kg/min), ketamine (0.03 mg/kg/min), and xylazine (0.016 mg/kg/min). Additional ketamine (0.03 mg/kg) and midazolam 0.03 mg/kg/iv was administered if the horse moved its head or limbs during the procedure. The duration of anesthesia was 90 minutes. During this time cardiopulmonary parameters and reflexes were monitored continuously.The recovery of anesthesia was 30 minutes and horse stood on the first attempt 40 minutes. Midazolam, ketamine, and xylazine in combination produced TIVA in this horse and can be used for short term, middle term, and longer lasting surgical procedures in the field.

A Rare Combination of VACTERL Association with Prune Belly Syndrome Case Report and Review of Literature

VACTERL association (any three of vertebral, anal, cardiac, tracheo-esophageal, renal/radial and limb defects) and Prune belly syn- drome (complete or partial triad of abdominal muscle deficiency, bilateral cryptorchidism and dilated urinary tract) are cngenital malformations affecting many body systems. These are derivatives of causally nonspecific disruptive events of the developmental field occuring during early blastogenesis. Many of these cases are sporadic in families without much recurrence. These lesions may be associ- ated with other malformations but concurrence of VACTERL with Prune belly syndrome is extremely rare. Routine antenatal check up and ultrasonography can help in diagnosis of most of them. But, many times a detail autopsy examination is needed to detect the variety of malformations and categorise them into specific syndromes. We describe a rare combination of VCTERL with Prune belly syndrome and many associated anomalies of a 28 weeks neonate delivered vaginally by a 37 years second gravida.

Supernumerary Kidney with Ipsilateral Cryptorchidism in a Cat

An 8 wk old male domestic longhair was presented with an abdominal mass and cryptorchidism. A 2 cm mass was palpable in the midabdomen. Ultrasonography confirmed a complex, septated, cystic mass adjacent and caudal to the right kidney. A normally appearing left kidney was present. Pathologic examination of the excised abdominal mass revealed it to be a kidney with an attached, normal caliber ureter. At surgery, this kidney was separate from the parenchyma of the second, cranial, right kidney. Subsequently, the second right kidney became hydronephrotic and was removed together with the cryptorchid testis and an apparently hypoplastic ureter. This is the first report of a supernumerary kidney in a cat, adding it to the differential diagnoses of abdominal masses.

Criptorquidectomía laparoscópica en dos perros utilizando bisturí ultrasónico

RESUMENTradicionalmente, los perros con testículos retenidos abdominales son remitidos para orquiectomía a través de laparotomía media ventral o paraprepucial. Sin embargo, las técnicas mínimamente invasivas realizadas a través de equipos endoscópicos, son una alternativa excelente para efectuar el procedimiento, debido a las ventajas en la reducción del trauma tisular y un menor dolor posoperatorio, además de la reducción de complicaciones posquirúrgicas entre otras ventajas. A continuación se presentan dos casos de pacientes caninos criptórquidos intervenidos quirúrgicamente mediante laparoscopia, para la extracción de los testículos retenidos en las que además se utilizó un bisturí ultrasónico. En Colombia, el desarrollo de las técnicas endoscópicas en cirugía de pequeños animales aún se encuentra muy limitado, y probablemente esta sea la primera publicación en el país acerca del uso de laparoscopia en casos de orquiectomía en pacientes con testículos retenidos en la cavidad abdominal.

A Case of Prune Belly Syndrome

Prune belly syndrome (PBS) is a rare congenital disorder characterized by deficient abdominal wall muscles, urinary tract malformation, and, in males, cryptorchidism. We present a case of PBS in China. The patient was a newborn baby boy who had wrinkled, "prune-like" abdominal skin, bilateral cryptorchidism, and urinary system malformation, complicated with hypoplasia of the lung and branch of the coronary artery-right ventricular fistula. His kidney function was inadequate. The patient subsequently died at age 28 days due to septicemia from a severe urinary tract infection.

Comparison of Peritoneal Fluid Values after Laparoscopic Cryptorchidectomy using a Vessel‐Sealing Device (Ligasure™) Versus a Ligating Loop and Removal of the Descended Testis

To determine the effect of unilateral laparoscopic cryptorchidectomy and removal of the descended testis on peritoneal fluid values, and to compare effect between 2 methods for cryptorchid testis vessel hemostasis. Randomized clinical study. Stallions (n = 10) with unilateral abdominal cryptorchid testis. During standing laparoscopic cryptorchidectomy, blood vessels within the mesorchium of the cryptorchid testis were either sealed and transected with the LigaSure Atlas™ or 2 ligating loops were placed proximal to the testis and the tissue transected with laparoscopic scissors. The testis was removed through the body wall. After laparoscopic cryptorchidectomy, stallions were anesthetized and the descended testis was removed using a closed technique leaving the scrotal incision open. Abdominocenteses were performed before surgery, and 24, and 72 hours after surgery. Values for peritoneal total nucleated cell count (TNCC), total protein concentration (TP), and red blood cell count (RBCC) were all elevated at 24 and 72 hours when compared with baseline. Median TNCC for LigaSure™ (59,780 cells/μL) was nearly twice that of the ligating loop (32,880 cells/μL) at 24 hours postoperatively. There was no statistically significant difference in TNCC, TP, or RBCC between groups. TNCC, TP, and RBCC increase appreciably from baseline 24 hours after laparoscopic cryptorchidectomy and closed castration but are markedly reduced by 72 hours.

Seminoma Arising from Intra-abdominal Cryptorchidism with Ipsilateral Renal Agenesis: A Rare Association.

Unilateral renal agenesis is usually asymptomatic and may be found incidentally during examination for other causes. The incidence of testicular tumors arising from cryptorchidism is well established, but if it is coexistent with ipsilateral renal agenesis, the diagnosis and management becomes a challenge. Only three cases of such association have been reported in literature so far. This association has to be kept in mind when dealing with a case of testicular tumor arising from abdominal cryptorchidism, so that the function of the other kidney can be assessed before surgery, and protection given to it in the event of using radiotherapy in an adjuvant setting.

Abdominal cryptorchidism presenting with an acute abdomen

Abdominal cryptorchidism presenting with an acute abdomen

Crossed-Fused Testicular Ectopia: A Case for the Use of Laparoscopy to Evaluate Nonpalpable Testicles

A 1-year-old male was referred for evaluation of a nonpalpable right testicle. In children with nonpalpable testicles, it our practice to proceed with diagnostic laparoscopy in an attempt to identify an intra-abdominal testicle or blind-ending spermatic vessels regardless of ultrasound findings. In the operating room, we performed diagnostic laparoscopy through the umbilical stump. We identified a vas deferens passing from the right side to the left side, and what appeared to be a testicle in the area of the left internal inguinal ring (Figures 1 and 2). In the left groin, we found both testicles fused together with a common blood supply, but a separate vas deferens. We placed the right testicle transseptally into the right hemiscrotum.Figure 2Right testicle entering the left inguinal ring.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Crossed testicular ectopia, or transverse testicular ectopia, is an extremely rare finding on exploration for an undescended testicle, with just slightly more than 100 cases reported in the literature to date.1Lam W.W. Le S.D. Chan K.L. Chan F.L. Tam P.K. Transverse testicular ectopia detected by MR imaging and MR venography.Pediatr Radiol. 2002; 32: 126-129Crossref PubMed Scopus (45) Google Scholar, 2Malik M.A. Iqbal Z. Chaudri K.M. Malik N.A. Ahmed A.J. Crossed testicular ectopia.Urology. 2008; 71 (984 e5-6)Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar A classification system has been proposed that accounts for accompanying anomalies, including hernias and mullerian duct structures.3Gauderer M.W. Grisoni E.R. Stellato T.A. Ponsky J.L. Izant Jr., R.J. Transverse testicular ectopia.J Pediatr Surg. 1982; 17: 43-47Abstract Full Text PDF PubMed Scopus (88) Google Scholar The ectopic testicle is usually structurally normal; however, it does carry a risk of malignancy, similar to that associated with other forms of intra-abdominal testicles.4Berkmen F. Persistent mullerian duct syndrome with or without transverse testicular ectopia and testis tumours.Br J Urol. 1997; 79: 122-126Crossref PubMed Google Scholar, 5Naouar S. Maazoun K. Sahnoun L. Jouini R. Ksia A. Elezzi O. et al.Transverse testicular ectopia: a three-case report and review of the literature.Urology. 2008; 71: 1070-1073Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar Although there are reports of successful diagnosis of this anomaly using ultrasonography6Pinto C.W. Toro R.C. Mansilla K.H. Castro T.A. Fuente-Alba C.S. Crossed testicular ectopia.J Ultrasound Med. 2010; 29: 847-849PubMed Google Scholar or magnetic resonance imaging1Lam W.W. Le S.D. Chan K.L. Chan F.L. Tam P.K. Transverse testicular ectopia detected by MR imaging and MR venography.Pediatr Radiol. 2002; 32: 126-129Crossref PubMed Scopus (45) Google Scholar during evaluation of nonpalpable testicles, neither of these studies is sufficiently sensitive to safely rule out an ectopic testicle.7Gokce M.I. Burgu B. Aydogdu O. Fitoz S. Soygur T. Transverse testicular ectopia associated with persistent Mullerian duct syndrome: another entity in which magnetic resonance imaging is unreliable.Urology. 2010; 76: 1475-1477Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 8Tasian G.E. Copp H.L. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis.Pediatrics. 2011; 127: 119-128Crossref PubMed Scopus (93) Google Scholar Laparoscopy has consistently demonstrated superior diagnostic accuracy in nonpalpable testicles9Papparella A. Romano M. Noviello C. Cobellis G. Nino F. Del Monaco C. et al.The value of laparoscopy in the management of non-palpable testis.J Pediatr Urol. 2010; 6: 550-554Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 10Cortesi N. Ferrari P. Zambarda E. Manenti A. Baldini A. Morano F.P. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy.Endoscopy. 1976; 8: 33-34Crossref PubMed Scopus (278) Google Scholar, 11Jordan G.H. Winslow B.H. Laparoscopic single-stage and staged orchiopexy.J Urol. 1994; 152: 1249-1252PubMed Google Scholar, 12Siemer S. Humke U. Uder M. Hildebrandt U. Karadiakos N. Ziegler M. Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study.Eur J Pediatr Surg. 2000; 10: 114-118Crossref PubMed Scopus (33) Google Scholar and is instrumental in their evaluation and treatment as underscored by this unusual finding on exploration.

A Polyorchid Dog

ContentsThe case of a polyorchid Irish Setter is presented here. Castration and intra‐abdominal testis removal were performed one year of age when one scrotal and one cryptorchid testis near the right inguinal canal were removed. Later it became apparent that there was still testosterone production. A third testis, abdominal cryptorchid, was found on the right side cranially and right to the bladder. The third testis had a strong cranial suspensory ligament and the tail of the epididymis was elongated. The ductus deferens did not enter the prostate but followed the gubernaculum to the inguinal canal near the stump of the previous operation on the caudal right testis. This suggests that two right cryptorchid testes had common ductus deferens.

Laparoscopic-assisted diagnosis of anomalous unilateral abdominal cryptorchidism

This report describes an unusual case of unilateral abdominal cryptorchidism in a Shetland pony. On the cryptorchid side, no testicular structures were present in the inguinal area but testicular/epididymal remnants at the distal end of a pedunculated structure could be discerned in the abdomen at laparoscopic examination. Furthermore, the deferent duct was disconnected from the epididymal remnants and the deferent duct was visible at the caudal aspect of the bladder, traversing over the lateral ligament of the bladder into the vaginal ring where it ended blindly in the vaginal process. After laparoscopic removal of the testicular/epididymal remnants and castration of the contralateral normally descended testicle, the hCG stimulation test was negative and the pony no longer exhibited masculine behaviour.

Rare association of prune belly syndrome with pouch colon

Rare association of prune belly syndrome with pouch colon M Ragavan1, U Haripriya1, PV Pradeep1, J Sarvavinothini21Department of Endocrine Surgery, 2Department of Anaesthesia, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, IndiaAbstract: Prune belly syndrome is a triad characterized by abdominal wall musculature deficiency, cryptorchidism and urinary tract abnormalities, and is often associated with other anomalies. Although associated anorectal anomalies have been reported with this syndrome, only two cases of pouch colon, a rare type of anorectal malformation, have been reported. We report a case of prune belly syndrome with pouch colon presenting with retention of urine.Keywords: prune belly, triad syndrome, pouch colon, anorectal malformation

Bilateral abdominal cryptorchidism with large left testicular seminoma and failed right urogenital union

This is a case report of a 32-year-old male with bilateral intra-abdominal cryptorchidism. A large seminoma had developed on the left testis with paraaortic lymph nodes metastasis. The tumour was excised easily. The right testis was found just inside the deep inguinal ring, without the vas deferens in the spermatic cord. The patient requested orchidopexy despite the well-explained risk of cancer development. Therefore, a second right groin incision was performed. In the right inguinal canal, there was a normal-looking vas deferens that ended in an atrophic nubbin of fibrous tissue without an epididymis. This is the sixth case in the literature of failed urogenital union resulting in complete separation of testis and vas deferens. The patient underwent orchidopexy and had four cycles of chemotherapy, which led to complete remission of the metastasis. This case highlights the fact that an impalpable undescended testis and finding of blind-end vas deferentia are not enough to establish the diagnosis of vanished testis. The decision to undergo orchiectomy in cases of bilateral cryptorchidism after puberty is also discussed. In our opinion, the choice should be made by the patient after a discussion of the risk for cancer development in the salvaged testis.

The Role of the Monfort Abdominoplasty in Association with Elective Mitrofanoff in the Prune-Belly Syndrome

Purpose The prune-belly syndrome consists of a triad of abnormalities, including deficient abdominal wall musculature, bilateral cryptorchidism and variable amounts of dilatation of the urogenital tract. The reported incidence of eventual renal failure in patients with the prune-belly syndrome is 25 to 30%. To our knowledge the role of the abdominoplasty alone or in association with elective appendicovesicostomy is not clearly understood and defined. We reviewed our experience with this approach evaluating clinical evolution, renal function and urinary and bowel habits. Material and Methods We reviewed all patients that underwent a Monfort abdominoplasty in association with an elective Mitrofanoff surgery. We identified 7 patients, 5 of them diagnosed antenatally for hydronephrosis and 2 had undergone fetal decompression (bladder punction and vesicoaminiotic shunt). One patient underwent initial vesicostomy before abdominoplasty. Two patients had concomitant VUR bilateral. Mean age at surgery was 3.8 years (1 to 8). Results Mean follow-up was 4.3 years (1 to 9), presently 4 patients perform CIC every 4 hours, whereas other 3 have no residual volumes. Most patients had eventual UTIs but only the two cases with VUR had chronic pyelonephritis and underwent a antireflux surgery. Cosmetical aspect was very favorable. Conclusions We believe that abdominoplasty in association with elective abdominoplasty adds limited morbidity in the procedure and allows a more aggressive approach to follow bladder emptying. In the present follow-up, 42% of our patients were able to void completely, therefore not needing CIC any more.

Deletion of Hepatocyte Nuclear Factor-1-Beta in an Infant with Prune Belly Syndrome

Prune belly syndrome is a rare congenital disorder characterized by deficiency of abdominal wall muscles, cryptorchidism, and urinary tract anomalies. We have had the opportunity to study a baby with prune belly syndrome associated with an apparently de novo 1.3-megabase interstitial 17q12 microdeletion that includes the hepatocyte nuclear factor-1-beta gene at 17q12. One previous patient, an adult, has been reported with prune belly syndrome and a hepatocyte nuclear factor-1-beta microdeletion. Hepatocyte nuclear factor-1-beta is a widely expressed transcription factor that regulates tissue-specific gene expression and is expressed in numerous tissues including mesonephric duct derivatives, the renal tubule of the metanephros, and the developing prostate of the mouse. Mutations in hepatocyte nuclear factor-1-beta cause the "renal cysts and diabetes syndrome," isolated renal cystic dysplasia, and a variety of other malformations. Based on its expression pattern and the observation of two affected cases, we propose that haploinsufficiency of hepatocyte nuclear factor-1-beta may be causally related to the production of the prune belly syndrome phenotype through a mechanism of prostatic and ureteral hypoplasia that results in severe obstructive uropathy with urinary tract and abdominal distension.

Estimation of Leidig cell population under experimental therapy by fortified cell culture in abdominal cryptorchidism

Estimation of Leidig cell population under experimental therapy by fortified cell culture in abdominal cryptorchidism

The effect of diethylstilbestrol on inducing abdominal cryptorchidism and relevant genetic expression in rats

To study the effect of diethylstilbestrol (DES) at different doses on transabdominal testicular descent in rats and the expression of INSL3 in the testis and HOXA10 in the gubernaculum. Fifty E13.5 (embryonic day 13.5) pregnant female SD rats were randomly divided into five groups that received a subcutaneous injection of DMSO, 2.5, 5.0, 10.0 and 20.0 mg/kg DES (group A, B, C, D and E), respectively. Male offspring were killed at E19.5, and then fetal mortality, the degree of transabdominal testicular ascent (DTA) was determined by a stereomicroscope. The mRNA expressions of INSL3 in the testis and HOXA10 in the gubernaculum were determined by RT-PCR. The expression of INSL3 protein was determined by Western blotting. Male fetal mortality in group A, B, C, D, and E were 3.57%, 6.90%, 12.00%, 19.23% and 36.36%, respectively, which showed a dose-effect relationship between DES and the male fatal mortality (r=0.999, P<0.01). DTA in group B, C, D and E were (23.7+/-1.7) U, (38.8+/-1.9) U, (49.3+/-1.8) U and (58.6+/-2.1) U that were significantly larger than that in group A [(8.5+/-1.3) U] (q=46.12, 88.53, 120.44 and 141.37, respectively, P<0.01). There was also a dose-effect relationship between DES and DTA. In group B, C, D, and E, the expression of INSL3 mRNA were 0.9570+/-0.1490, 0.6760+/-0.1380, 0.0170+/-0.0040 and 0.0013+/-0.0003, respectively; the expressions of INSL3 protein were 0.8360+/-0.1520, 0.5310+/-0.1070, 0.0140+/-0.0020 and 0.0011+/-0.0003, respectively, which were significantly larger than the expression of INSL3 mRNA (1.801+/-0.126) and INSL3 protein (1.612+/-0.134) in group A (qmRNA=40.4840, 52.4402, 83.1585 and 82.0582, respectively, and qprotein=38.6151, 52.2747, 77.2756 and 76.1983, respectively, P<0.01). The expression of HOXA10 mRNA in group A, B, C, D, and E were 0.945+/-0.125, 0.940+/-0.119, 0.656+/-0.115, 0.544+/-0.118 and 0.463+/-0.114, respectively. Compared with the expression of HOXA10 mRNA in group A, the expression of group B was not significantly different (q=0.2213, P>0.05), those in other groups were down-regulated significantly (q=12.4304, 17.2477 and 20.2789, respectively, P<0.01). DES inhibited transabdominal testicular descent dose-dependently via down-regulating the expression of INSL3. HOXA10 may play no role in low-dosage DES induced intra-abdominal cryptorchidism, but down-regulated HOXA10 mRNA was involved in high-dosage DES induced ones.

Management of neonates with large abdominal wall defects and undescended testis

Objectives To assess, in a retrospective study, the outcome of different treatment modalities in newborns with undescended testes secondary to large abdominal wall or diaphragmatic defects. Large abdominal and diaphragmatic defects are known to be associated with cryptorchidism, yet the reported incidence varies widely. Methods A total of 112 neonates with large abdominal wall or diaphragmatic defects were treated from 1981 to 2005. Of the 55 male patients in this series, 9 (16.4%) presented with abdominal testes and 4 had an extra-abdominal testis (7.3%). Results The 2 patients undergoing primary orchiopexy had testes of normal size and in the normal position at last follow-up. In one of these patients in whom the testis was brought down to the internal inguinal ring, spontaneous descent occurred and the testis on the affected side was normal. The other patient required additional surgery and had an atrophic testis at last follow-up. In 1 patient with severe concomitant malformations, primary orchiectomy was performed. The 4 patients who did not receive initial treatment all lost their testes owing to atrophy. Conclusions The results of the present study have indicated that primary orchiopexy should be attempted in all cases of abdominal wall defects associated with abdominal cryptorchid testes because it yields better testicular salvage rates. In cases in which the spermatic cord is not long enough to place the testis into the scrotum, mobilization and fixation at the lowest site possible resulted in better outcomes than leaving the testis in the abdomen.

Proliferation and apoptosis of spermatogonia in postpuberal boar ( Sus domesticus) testes with spontaneous unilateral and bilateral abdominal cryptorchidism

Cryptorchidism is a frequent male sexual disorder in mammals, which affects the histology of the tunica propria, interstitial tissue, blood vessels, seminiferous epithelium and testis functioning. In this paper, proliferation and apoptosis were examined in the seminiferous epithelium of both testes from unaffected boars and from boars suffering unilateral and bilateral cryptorchidism. In germ cells, proliferation was studied using the immunohistochemical PCNA technique, and apoptosis was analysed by in situ TUNEL labelling. An index was obtained for the proliferation and apoptosis observed in seminiferous tubules. In abdominal testes the epithelium contained few spermatogonia and Sertoli cells. In the testes of unaffected boars, numerous spermatogonia proliferated, whereas in cryptorchid testes such proliferation was lower and the proliferation/apoptosis ratio diminished. In the unaffected group, the TUNEL-positive germ cells were spermatogonia and spermatocytes in different phases of meiosis. In abdominal testes, the TUNEL-positive germ cells were spermatogonia alone. The apoptosis index of both abdominal and scrotal testes was similar. In conclusion, spontaneous cryptorchid testes showed a lower rate of spermatogonia proliferation in the seminiferous epithelium.

Incidence of cryptorchidism in dogs and cats

Over a period of 54 months, 3518 dogs and 3806 cats were castrated; 240 of the dogs and 50 of the cats were cryptorchid. Pedigree dogs, in particular the German...