Appendix Testis Research Articles

Coincidence of hydatid of Morgagni and undescended testis: more common than expected !

As part of aretrospective data analysis over aperiod of 6years, the coincidence of undescended testis and hydatid of Morgagni (appendix testis) was examined on the basis of 814 operated testes. The overall prevalence of hydatids after opening of the testicular envelope of undescended testes was 62.66%. In addition, we were able to establish acorrelation between patient age and the hydatid size. According to the results of the study, the size of the hydatid-with growth most likely to be influenced by hormones-can be assumed to be associated with the patient's age.

Differential Diagnosis of Acute Scrotum in Childhood andAdolescence with High-Resolution Duplex Sonography.

Acute testicular pain in childhood can be caused by testicular torsion, torsion of the appendix testis, or epididymo-orchitis. Quick and reliable diagnosis is essential for determining the further course of action (surgery or conservative approach). The diagnostic tool of choice is high-resolution sonography with a linear transducer (> 10 MHz) combined with color and spectral Doppler sonography. The Doppler device settings should include a low pulse repetition frequency (< 4 cm/s), a low wall filter (< 100 Hz), and adequate gain. Comparison with the unaffected healthy testis is essential. The most important of the three diseases is torsion of the spermatic cord because it requires immediate surgical intervention and detorsion. The affected testis is enlarged and has an inhomogeneous echotexture with hypoechoic and hyperechoic areas as well as an associated hydrocele. In testicular torsion, color Doppler shows reduced or absent intratesticular vessels in comparison with the healthy contralateral testis. Spectral Doppler shows decreased flow velocities especially during diastole in intratesticular arteries and an increased resistance index. The investigation should always include imaging of the spermatic cord from the outer inguinal ring to the upper pole of the testis. In contrast to a normal finding, the vessels and the ductus deferens are not displayed as linear tubular structures but in form of a spiral twist. Ultrasound shows a target-like structure with multiple concentric rings. Color Doppler sonography shows the typical whirlpool sign. In torsion of the appendix testis, the appendix testis is enlarged in the groove between the testis and epididymis. The longitudinal diameter of the appendix testis can be greater than 5 mm. The echogenicity of the torsed appendage can vary between hypoechoic (acute torsion) and hyperechoic (prior torsion). An associated hydrocele of varying size is usually seen. Color Doppler sonography reveals a lack of perfusion of the enlarged appendix testis and increased vascularity of the testis and primarily the epididymis. Epididymo-orchitis is characterized by an enlarged epididymis and/or testis with inhomogeneous echogenicity (hypoechoic - hyperechoic). Color Doppler sonography shows increased vascularity in comparison with the unaffected testis. Spectral Doppler reveals increased diastolic flow velocities and a decreased resistance index. Idiopathic scrotal edema and an incarcerated inguinal hernia must be ruled out in the differential diagnosis.

Testis Torsiyonu ve Kontralateral Apendiks Testis Torsiyonu

Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.

Nowadays treatment of testicular appendix torsion in children

Introduction. Currently, a modern tactics as to the treatment of testicular appendix torsion in children is not an indisputable axiom but it is a subject of discussion in domestic and foreign literature. Modern diagnostic tools, wide implementation of expert-class equipment as well as gaining more experience have reduced, to a minimum , the risk of diagnostic error with fatal consequences for the gonad. So, it impels to revise the existing algorithms and to consider the conservative treatment as the method of choice in uncomplicated testicular appendix torsion.Objective. To analyze the gained experience in treating testicular appendix torsion and to suggest reasonable algorithms which correspond to modern diagnostic techniques and treatment options. Material and methods. 2875 cases with testicular appendix torsion have been analyzed. Of these, 2 069 (71.96%) patients were operated on; 755 (26.26%) patients had conservative treatment and 51 (1.78%) had to be operated on despite conservative treatment.Results. The material obtained in three statistically homogeneous groups has been аnalyzed. When comparing clinical and ultrasound criteria, it was found out that the incidence of orchalgia in the surgical group is slightly higher than in the conservative one. It may indicate that the adhesive process in the scrotal cavity after surgical trauma is more frequent than after a possible aseptic inflammation. Asymmetry of gonad volumes with smaller diseased testicle was seen in all groups. The decrease in testicular volume is minimal in all cases and is not statistically significant. The incidence of heterogeneity in the testicular and appendage echo structure, which indicates sclerotic changes in the parenchyma, is also not statistically significant in the analyzed groups. Patients who were operated despite their conservative care do not have much worse outcomes after long-lasting follow-up period than groups with other curative options.Conclusion. Torsion of the testicular appendix in children is a challenging problem that is far from being solved. There is no consensus as to the indications for surgical treatment and to the assessment of postoperative outcomes. Modern diagnostic and monitoring techniques allow to dynamically monitor the scrotal organs in conservative treatment. The conservative treatment of testicular appendix torsion is an effective and safe method. The conservative tactics which was changed for surgical one does not lead to gonad deterioration.

Torsion of the appendix testis in undescended testes as a rare cause of groin swelling

A 10 year-old boy presented to the emergency department with torsion of an Appendix Testis in an undescended testis. The diagnosis was suspected clinically and confirmed by ultrasound imaging. Intra-operatively, the testis was well perfused. A black, necrotic pedunculated Appendix Testis was present, excised and an orchidopexy performed. It is likely that torsion of an Appendix Testis in undescended testes is under-reported. With this case report, we wish to highlight torsion of Appendix Testis as a relevant differential diagnosis in patients presenting with groin swelling and undescended testis.

Emergency scrotal exploration in children: Is it time for a change in mindset in the UK?

Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. We sought to find the incidence of finding TT during emergency scrotal exploration in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis. A retrospective review of 50 consecutive scrotal explorations done for acute scrotal pain at four tertiary pediatric surgical centres in 2019, including the preoperative utilisation of DUS, was analysed. Additionally an online survey was also sent out to consultant members of the British Association of Paediatric Urology to gauge their threshold for exploration, use of preoperative investigations and incidence of finding TT in their practice. In the four UK centres reviewed, TT was found in 24.5% (SD=8.54) of explorations. The overall utilisation of preoperative DUS was 10%. The online survey revealed a low threshold for exploration. However 72% of respondents recalled finding TT in <50% of explorations, with just over a third reporting finding TT in only 10% of explorations. There was low utilisation of preoperative DUS and clinical risk scores. The incidence of finding TT during exploration in this cohort is the same as the incidence of TT in a population of children presenting with acute scrotal pain. We hypothesise that this is due to low accuracy of clinical assessment, low utilisation of preoperative clinical and radiological aids and the practice of exploring torted testicular appendages. Improving awareness and training in these modalities will increase diagnostic accuracy, limiting emergency scrotal explorations to those children with a higher risk of testicular torsion. A care pathway for children presenting with acute scrotal pain is suggested () CONCLUSIONS: There is a low incidence of finding testicular torsion during paediatric scrotal explorations in the UK. There is low preoperative utilisation of clinical risk scores and Doppler ultrasound, which if utilised, could improve diagnostic accuracy.

Surgical findings in cryptorchidism in children with Zika-related microcephaly: a case series

BackgroundComplications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Pernambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zika-related microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent.MethodsA total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchidopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate.ResultsWe found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testis-epididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic gubernacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac.ConclusionsWe herein describe the surgical findings of these children's orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume.

ACTIVITY OF MALATE-ASPARTATE SHUTTLE ENZYMES OF BULLS AND BOARS REPRODUCTIVE ORGANS AND EPIDIDIMAL SPERMATOZOA

The activity of malate-aspartate shuttle enzymes in the reproductive organs and epididimal sperm of bulls and boars was studied.&#x0D; The research was conducted on bulls of the Ukrainian black-spotted dairy breed (n = 5; aged 14 - 16 months) and boars of the Great White breed (n = 3; aged 10 - 12 months). After slaughter, the testes and testicular appendages were removed and the spermatozoa were washed with 0.9% sodium chloride solution. Testicular and epididimal tissues were homogenized and centrifuged. Aspartate aminotransferase (AST), malate dehydrogenase (MDG) and protein concentration were determined in the supernatant and epididimal sperm.&#x0D; The specie and tissue specificity of aspartate aminotransferase and malate dehydrogenase activity have been established. In particular, in bulls, the activity of AST in the tissues of the testis, head and body of the epididymis of bulls is almost the same (116.5 - 118.3 nmol/min×mg of protein) and on 18.5 - 19.7% (р&lt;0,05) higher in the tail of the appendix. In this case, MDG activity in the reproductive organs shows wavy changes: in the testicular tissue is high (1.96 ± 0.15 nmol / min × mg of protein), and in the epididymis: in the head is reduced (3.5 times ; p &lt;0,001), increased in the body (p &lt;0,05) and decreased again in the tail. In the sperm of bulls, the activity of AST from the head of the appendix - 69.3 ± 8.06 nmol / min × mg of protein, from the body - increased (p &lt;0.05) and again (p &lt;0.001) decreased from the tail of the appendix. MDG activity in sperm from the head of the epididymis was 0.50 ± 0.04 nmol/min×mg of protein, lower by 38.0% (p &lt;0.05) from the body and 50.0% (p &lt;0.001) higher in the tail.&#x0D; In boars, the activity of AST in testicular tissue - 20.3 ± 5.22 nmol / min × mg of protein and higher in the appendix: 45.6% - in the head, 59.0% - in the body and 64.0 % - in the tail. Similarly, the activity of MDG in testicular tissue was 0.22 ± 0.02 nmol / min × mg of protein, increases by 40.6% in the head and remained at the same level in the body of the appendix, and in the tail tissue above 2, 5 - 2.7 times (p &lt;0.001). In bovine germ cells, the activity of AST and MDG from the body of the appendix was, respectively, 102.3 ± 6.1 and 13.20 ± 0.15 nmol / min × mg of protein, lowered twice (p &lt;0,001) and 10.7 % in the head and more than four times (p &lt;0,001) and 61,2% (p &lt;0,001) in the tail of the appendix.

The Spectrum of Testicular Pathologies Upon Scrotal Exploration for Acute Scrotum: A Retrospective Analysis.

BackgroundThe term acute scrotum encompasses a plethora of testicular pathologies that are detrimental to the survival and sustenance of testes. The aim of the present study is to determine the spectrum of these testicular pathologies upon scrotal exploration performed in the aftermath of acute scrotal pain in the pediatric population.MethodsThis multicenter retrospective cross-sectional study was conducted at the department of pediatric surgery at two hospitals. During the study period, the clinical characteristics of the 76 patients that underwent scrotal exploration for acute scrotum were assessed. These included age, duration of symptoms on presentation, and identification of the etiology underlying scrotal pain. The data obtained was eventually analyzed using the Statistical Package for the Social Sciences (SPSS) 23.0 software (IBM Corp., Armonk, NY).ResultsA total of 76 scrotal exploration procedures were performed. The involvement of the left side of the scrotum was more common than the right side. Most of the patients who presented were older than five years of age. A majority of the patients presented after 24 hours of the commencement of their symptoms. Of the included participants, 36 patients (47.47%) were found to have an underlying torsion of appendix testes that was appropriately managed. Testicular torsion was observed in 15 patients, out of which eight viable testes were salvaged with a subsequent orchidopexy while seven torsions required orchiectomy owing to their non-viability. Other findings included epididymo-orchitis and infected hydrocele. A total of 19 testes appeared completely normal upon scrotal exploration.ConclusionScrotal exploration should be considered as part of the medical and surgical workup and in the management of acute scrotum, as it divulges the specific underlying testicular pathology. Prompt scrotal exploration can aid in ascertaining the underlying etiology and is, therefore, pivotal in the apt management of the underlying pathology.

Clinical Characteristics of Testicular Torsion and Identification of Predictors of Testicular Salvage in Children: A Retrospective Study in a Single Institution

Purpose: Testicular torsion (TT) is a serious surgical emergency. Prompt diagnosis and treatment of TT are essential to improve the incidence of salvaged testes. The aim of this study was to evaluate the historical features, physical examination findings, laboratory tests, and ultrasound examinations in children with TT, as well as to identify the predictors of testicular salvage in children. Materials and Methods: We retrospectively reviewed the records of 136 males who presented with TT to our institution. Clinical findings, physical examinations, laboratory data, color Doppler ultrasound findings, operating results, and the results of follow-up were collected and analyzed. Patients with neonatal torsion, negative scrotal exploration, or testicular appendix torsion were excluded. A multivariable logistic regression model was used to identify predictors of testicular salvage. Receiver operator characteristics analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting. Results: A total of 136 children with TT were identified. Patients were aged from 1 to 16 years, with a mean age of 9.7 years (median, 12; range, 1–16 years). The peak incidences of TT were found between ages of 12 and 14 years. Acute TT is significantly more common in the winter. Testicular salvage occurred in 49 (36%) cases. Of the 49 cases of testicular salvage, 5 patients developed subsequent testicular atrophy. Cutoff values of 13.5 h and 530 degrees of torsion would provide sensitivities of 96 and 61%, with specificity of 80 and 70%, respectively. Multivariate analysis showed that time to surgery and degree of testicular twist were correlated with the risk of a non-salvageable testis. Conclusions: Testicular salvage can be predicted by the duration of symptoms along with degree of twisting. Early scrotal exploration based on careful physical examination decreases the risk of misdiagnosis of spermatic cord torsion. A certain percentage of children with TT presenting with lower abdominal pain should have their testicles checked to make sure that they do not have torsion, especially those visitors in cold season.

Role of percutaneous testis biopsy in management of patients with azoospermia

Purpose of the study. To determine the practical value of puncture methods for obtaining spermatozoa in azoospermia. Patients and methods. The results of 127 puncture biopsies of testis (TESA) and testicular appendage (PESA) in patients with azoospermia of presumably obstructive origin were analyzed. The sperm production frequency (SPF) was calculated, as well as the frequency of transition to an open testicular biopsy. Was built a logistic regression model to analyze factors influencing the result, TESA / PESA, which included as independent variables the following parameters: patient age, duration of involuntary infertility, the level of sex hormones (testosterone, estradiol, luteinizing hormone, follicle-stimulating hormone, prolactin, progesterone, inhibin B), the total volume of testes, presence of varicocele, the presence of chemotherapy or radiation therapy, a history of alcohol abuse, Smoking, regular violation of the thermal mode, surgery in the inguinal and scrotal region. Indicators of the probability ratio (PR) with a 95% confidence interval (95% CI) were obtained. Results. 92 biopsy attempts out of 127 were successful, and the NPV was 72.4%. Independent statistically significant predictors of PESA / TESA success were testicular volume (PR = 1.113; 95% CI = 1.026–1.207) and inhibin b level (PR = 1.026; 95% CI = 1.011–1.041). In 35 patients whose spermatozoa were not found during the puncture biopsy, conversion to open microsurgical biopsy was performed. Conclusion. PESA and TESA have only limited effectiveness in azoospermia. We believe that puncture biopsy of the testicles and epididymis is justified only in patients with normal testicular volume and high levels of inhibin B. PESA / TESA should be performed in conditions that allow immediate transition to an open biopsy in case of failure.

Ultrasound imaging of acute scrotum: Pictorial review with etiological correlation

High resolution ultrasound with color Doppler is the first-line imaging investigation in the evaluation of acute scrotum. It plays a crucial role in distinguishing urological emergencies necessitating immediate surgical exploration from those that can be managed conservatively. Acute scrotal pathologies can involve the scrotal sac or its contents like testis, epididymis and testicular appendages and could range from benign, self-limiting conditions to emergencies. In this pictorial essay, we briefly review the ultrasonographic technique, scrotal anatomy and characteristic imaging features of various pathologies presented as acute scrotum.

Ultrasound imaging of acute scrotum: Pictorial review with etiological correlation

High resolution ultrasound with color Doppler is the first-line imaging investigation in the evaluation of acute scrotum. It plays a crucial role in distinguishing urological emergencies necessitating immediate surgical exploration from those that can be managed conservatively. Acute scrotal pathologies can involve the scrotal sac or its contents like testis, epididymis and testicular appendages and could range from benign, self-limiting conditions to emergencies. In this pictorial essay, we briefly review the ultrasonographic technique, scrotal anatomy and characteristic imaging features of various pathologies presented as acute scrotum.

Correlation between insulin-like peptide 3 and appendix testis length in congenital cryptorchidism.

The appendix testis (AT) is a vestigial remnant of Müller's paramesonephric duct. Insulin-like 3 hormone (INSL3) is produced in the Leydig cells of the testis. We investigated the possible correlation between AT length and plasma INSL3 concentrations in patients with congenital cryptorchidism (CCO) and patients with hydrocele, who served as controls. A total of 40 patients with CCO and 34 patients with hydrocele and orthotopic testes were investigated. Sixteen patients presented high cryptorchidism and 24 low cryptorchidism. During surgery, AT was identified in 34 patients with CCO (high cryptorchidism:15, low cryptorchidism:19) and 28 controls. Plasma INSL3 levels were measured with a spectrophotometry enzyme immunoassay Elisa sandwich technique. AT was present in 85.0% of the boys with CCO and 82.4% of the controls. A significant positive correlation was found between the AT length and INSL3 concentrations in CCO patients. A longer AT may reflect better testicular function in boys with CCO, since it is correlated with higher INSL3 concentrations.

Варианты осложнений при синдроме острой мошонки у детей

To establish causes of complications and repeated surgical procedures in patients with acute scrotal pathology during the short- and long-term follow-up. The treatment results of 3315 patients aged 0 to 18 years with various forms of acute scrotal pathology were analyzed. A total of 43 complications were documented, 32 of them required surgical intervention. The most common complication is testicular necrosis due to incorrect judgement of viability after torsion with performing an organ-preserving procedure, which is dictated by the surgeons desire to preserve a testicle. Such a decision is made without objective data and in all cases leads to repeated procedure due to testicular necrosis. Inappropriate surgical hemostasis is often associated with improper surgical technique and underestimation of inflammatory tissue changes. Purulent complications are the most common in acute epididymitis and are caused by the presence of an inflammatory focus in the scrotum. Wide revision of the scrotum in case of testicular appendages pathology is not justified, since the second appendage is rarely found, while the invasiveness of the procedure increases. Complications were more common in the early postoperative period (88.4%). Purulent complications are directly dependent on the duration of the disease and are exacerbated by the secondary inflammatory process. Most of complications are treatable; performing of preventive measures helps to avoid them.

Role of methylprednisolone on mRNA expression of BAX, BCL-2 gene in testicular torsion-detorsion of male albino Wistar rats

Study Background : Testicular torsion is a genitourinary emergency most common in children and emergencies requiring second surgery in adolescents after acute appendicitis1. Testicular torsion is more common on the left with a 1.2: 1 ratio, which is probably caused by a slightly longer spermatic cord on the left2. Testicular torsion can occur at any age, but the peak incidence is at age 14, with a peak of second occurrence at 1 year of age3. At 1 year of age, testicular torsion is a major cause of acute scrotum (83%). At the age of 3 - 13 years, the most frequent diagnosis is the torsion of the testicular appendix. After the age of 17 years, epididymitis is the most frequent diagnosis (75%)4. Method: This study is an experimental study, post-test only control group design, the sample was randomly divided into 4 groups, 2 intervention groups and 2 control groups. In this study the independent variables are the duration of the right torsion-detection treatment of the testes and the injection of Methylprednisolone in Wistar male rats. The dependent variables are mRNA expression in apoptosis and anti-apoptosis genes in rats’ ipsilateral and contralateral testes. . Results and Discussion: In this study, two-way ANOVA is used to analyze data between groups. Significant decrease in BAX gene mRNA expression (p <0.05) with Methylprednisolone was present when group 2 (TD) was compared with group 4 (TD-MP). Significant increase in the expression of BCL-2 anti-apoptotic gene (p <0.05) with Methylprednisolone was present when group 1 (T) was compared with group 3 (T-MP). When group 2 (TD) compared with group 4 (TD-MP) also showed a significant increase in the expression of BCL-2 anti-apoptotic gene (p <0.05). Conclusion: The administration of Methylprednisolone in the case of testicular torsion proved to be significant in increasing the expression of the BCL-2 gene that could be a protective mechanism against germ cell apoptosis in testicular tissue.

Non-Neoplastic Testicular and Paratesticular Lesions Study from A Remote Indian Island

Background: Testicular and paratesticular lesions can represent a wide range of medical issues, from benign congenital conditions to life threatening malignancies and acute surgical emergencies. Most of the studies are done about the testicular tumors and very little literature is available about non-neoplastic lesions of testis and paratesticular tissue. Hence present study was undertaken to know the histomorphologic spectrum of nonneoplastic testicular and paratestesticuar lesions. Methods: This is a prospective study done over a three year period from Jan 2016 to Jan 2019 includes orchidectomy specimens and paratesticular tissue received for histopathological examination in the Department of Pathology of a newly established medical college on a remote Indian Island. Result: Total 51 orchidectomy specimens and two paratesticular tissues are received for histopathological examination. Out of 51 orchidectomy specimens; non neoplastic testicular lesions (94.1%) were far more common than neoplastic lesions (5.9%). The most common non-neoplastic testicular lesion was torsion testis (19/48=39.6%) and most cases were seen in first two decades. The youngest patient was 11 months and oldest was 42 years of age. Long standing hydrocele, Pyocele and haematocele were the second most common cause for orchidectomy, in forty plus age group. Undescended testis as cause comprised 7.6% of the total orchidectomy specimens. One case of Epididymal cyst was found. Two paratesticular tissues received. One specimen showed appendix of testis and was cause of recurrent epididymo- orchitis in 11 yrs old boy. Gubernaculum was found in another specimen in a case of vanishing testis syndrome. Neoplasms formed a miniscule proportion – only three cases were diagnosed. Conclusion: Nonneoplastic lesions are more common than neoplastic lesions. Torsion testis was the commonest indication for orchidectomy in younger age group while hydrocele, pyocele and chronic haematocele were the common causes in older patients. Appendixes of testis, gubernaculum of vanishing testis, epididymal cyst as non-neoplastic paratesticular lesions found in few cases.

New insights into the expression of androgen and estrogen receptors of the appendix testis in congenital cryptorchidism.

Background The appendix testis (AT) is the most common vestigial remnant of the human testis. Variations in the presence and expression of AT androgen receptor (AR) and estrogen receptor (ER) have been reported in cryptorchidism. We studied the possible association of AR and ER expression of the AT with cryptorchidism. Methods ATs were resected from 40 boys who underwent inguinoscrotal surgery, (20 patients with congenital unilateral cryptorchidism [UC] and 20 controls with orthotopic testes and hydrocele). AR and ER expression was evaluated with immunohistochemistry, and the percentage and intensity of AR and ER expression were evaluated by the Allred scoring method. AT length was compared between the two groups. Correlation of AR and ER expression was evaluated independently in patients and controls. Results The Allred score for AR trended toward lower values in UC compared to controls (p = 0.193), while ER scores presented statistically significant lower values in UC compared to controls (p = 0.017). No significant difference or trend was found in the expression of both receptors between high and low cryptorchidism (p = 0.981 for AR, p = 0.824 for ER) and for the appendiceal length between UC and controls (p = 0.369). Conclusions The findings of a trend for lower AR expression and a statistically significant lower expression of ER in UC may suggest an association of AR and ER with cryptorchidism and may provide an insight into the process of testicular descent.

Testicular Appendage Torsion—To Explore the Other Side or Not?

ObjectiveTo investigate and compare the risks vs benefits of synchronous contralateral scrotal compartment exploration when testicular appendage torsion is diagnosed intra-operatively. MethodsEmergency scrotal explorations performed at the Women's and Children's Hospital between 2002 and 2017 were retrospectively analysed to identify patients with testicular appendage torsion. Primary outcome measures were metachronous acute scrotum re-presentations and returns to theatre. Outcomes were compared between groups that underwent unilateral and bilateral scrotal compartment exploration. ResultsTesticular appendage torsion was diagnosed intra-operatively in 575 patients and 90.4% underwent unilateral scrotal exploration. Re-presentations with metachronous acute scrotum on the non-index side occurred in 8.5% of unexplored and 3.6% of previously explored sides (P = .29). Non-index side returns to theatre occurred in 5.4% of unexplored and 0% previously explored sides (P = .097). Future metachronous contralateral testicular appendage torsion was diagnosed in 4.2%. Post-operative complications were comparably low in both groups. The number needed to treat to prevent a return to theatre for metachronous contralateral testicular appendage torsion is 24. ConclusionThe low morbidity of exploring the contralateral side is justifiable, but confers only limited benefit of preventing low likelihood future metachronous contralateral pathology. In balancing these risks, we recommend contralateral exploration as advisable but not a necessity.

Acute scrotum in children and the role of Doppler sonography in differential diagnosis

Sixty-one patients aged from 2 months to 17 years who were hospitalized between 02.01.2017- 25.05.2019 in the Department of Pediatric Surgery for acute scrotum were investigated by Doppler sonography with S onoscape2 ultrasound equipped with a high-frequency 7-11 MHz linear transducer. Testicular appendage torsion was reported in 49 children, 6 patients were with testicular torsion and 4 were with orchiectomy. Five patients were diagnosed with orchiepididymitis and three patients were with acute scrotum because of different types of trauma. The present article describes the frequency of acute scrotum, its etiology and importance of Doppler investigation in the differential diagnosis of acute scrotum.