Bilateral Undescended Testes Research Articles

Cryptorchidism: its influence on male fertility and the risk of the testicular tumor

In the embryonic stage, the testes develop in the abdomen and descend to scrotum, just before or at birth. The undescended testis is the result of the arrest of descent of testis in some part along its path, to the scrotum. The bilateral undescended testis is called Cryptorchidism which means hidden testis. The factors that contribute to the descent of testis includes Gubernaculum testis, the differential growth of abdominal wall, intra-abdominal pressure and temperature, Calcitonin gene-related peptide (CGRP), male sex hormones, insulin-like hormone 3 (INSL3) and maternal gonadotrophins. The descent of testis may become erratic and gives rise to undescended testis, ectopic testis, congenital hernia, and hydrocoele etc. As a rough estimate approximately 2-4% of male infants are born with Cryptorchism, thus making it, one of the most common congenital anomalies, in the male genitalia. It was found that the incidence of azoospermia in unilateral cryptorchidism was 13%, but in untreated bilateral cryptorchidism, it reaches up to 89%. Cryptorchid boys have increased the risk of a testicular tumor, mainly seminoma. Persistent exposure to high temperature in cryptorchidism could allow maturation of the neonatal gonocytes that has failed to mature as spermatogonia or undergo apoptosis. These cells may persist in testes for years together and eventually become carcinoma in situ cells with a high risk of testicular malignancy later in life i.e., 20-40 years of age. This review addresses the cryptorchidism, its influence on fertility and the risk of developing testicular germ cell tumor. The hormonal factors involved in testicular descend or otherwise is also highlighted.

Correction to: Case Report: Laparoscopic Approach for Orchiopexy in a 26-Year-Old Man with Accidently Discovered Persistent Müllerian Duct Syndrome and Bilateral Undescended Testis by Noureldin ME, Tawfeek AM, and Shaker HS. J Endourol Case Rep 2018;4:75-77. DOI: 10.1089/cren.2018.0035.

[This corrects the article DOI: 10.1089/cren.2018.0035.].

A history of undescended testes in young men with Klinefelter syndrome does not reduce the chances for successful microsurgical testicular sperm extraction

Klinefelter syndrome (KS) and undescended testes (UDT) are known etiologies for non-obstructive azoospermia (NOA), and coexistence of both etiologies is not uncommon. Patients with both KS and a history of UDT are therefore considered to have extremely reduced chances for paternity. We aimed to analyze the impact of previous surgically corrected unilateral or bilateral UDT on sperm retrieval rates (SRRs) by microsurgical testicular sperm extraction (mTESE) in azoospermic men with KS. Age, testicular volumes, and hypothalamo-pituitary-gonadal axis function were investigated in relation to SRRs in 29 non-mosaic KS patients (47,XXY) with a history of UDT (group 1) who underwent mTESE between 2008 and 2016 in our center and compared to the data of age- and serum testosterone-matched non-mosaic KS controls with eutopic testes at birth (group 2), and to those of 51 men with NOA and a normal male karyotype (46,XY), but previous UDT (group 3). SRRs in KS patients with surgically corrected UDT during childhood were comparable to SRRs of KS patients with eutopic testes at birth: 31% (35% in unilateral and 22% in bilateral UDT) vs. 38% (p=0.581). SRRs and Leydig cell function in group 1 were negatively correlated with age. Significantly higher SRRs (66%) were found in euploid azoospermic men with surgically corrected UDT (p<0.001). A history of UDT does not preclude chances for future fatherhood in young azoospermic males with KS. In one of three men with previous unilateral UDT and in one of 4-5 in those with previous bilateral UDT, spermatozoa can be harvested by mTESE during late adolescence or young adulthood for immediate or future use in assisted reproduction.

Megacystis microcolon intestinal hypoperistalsis syndrome overlapping prune belly syndrome

Abstract Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital visceral myopathy. We experienced a case of an infant with MMIHS with prune belly syndrome (PBS). A pregnant woman was transferred at 16 gestational weeks for a cyst in the fetal bladder. Fetal bladder punctures and a vesicoamniotic shunting were performed. At 31 gestational weeks, a male preterm infant weighing 2432 g was born. After birth, a urinary catheter was inserted through the hole left by the fetal shunt. Bilateral undescended testicles, a dilated urinary tract, and deficient abdominal wall musculature compatible with PBS were also found. On day 5, microcolon and non-obstructive urethra were diagnosed by radiography. An upper gastrointestinal examination showed no movement of the stomach or intestine. Based on these findings, MMIHS was diagnosed. On day 76, a gastrostomy and ileostomy were performed. The histological findings showed no abnormality of the nerve plexus. The infant died at age 4 months. Fatty degeneration of the liver was found at autopsy. MMIHS has a bad prognosis due to liver dysfunction. Our patient had severe progressive liver dysfunction and symptoms of PBS. We speculate that MMIHS and PBS might fall along the same disease spectrum.

PD09-08 NO DIFFERENCE IN SEMEN PARAMETERS FOR INFERTILE MEN WHO HAD EARLY OR LATE ORCHIOPEXIES FOR UNDESCENDED TESTIS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I1 Apr 2018PD09-08 NO DIFFERENCE IN SEMEN PARAMETERS FOR INFERTILE MEN WHO HAD EARLY OR LATE ORCHIOPEXIES FOR UNDESCENDED TESTIS Sangwoo Leem, Susan Lau, Kirk C Lo, Ethan D Grober, and Keith A Jarvi Sangwoo LeemSangwoo Leem More articles by this author , Susan LauSusan Lau More articles by this author , Kirk C LoKirk C Lo More articles by this author , Ethan D GroberEthan D Grober More articles by this author , and Keith A JarviKeith A Jarvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cryptorchidism or undescended testis (UDT) is a common urological condition that affects 1-3% of newborns, with a prevalence of 0.8-1.5% by 1 year of age. To attempt to preserve testicular function, current guidelines recommend early orchiopexies (2 years old or younger). This study aims to investigate the sperm parameters of infertile men who had ″early″ (≤ 2 y/o) or ″late″ (> 2 y/o) orchiopexies. METHODS This is a retrospective study, of a prospectively collected database, of information captured on self-administered computerized questionnaires completed by men who presented for infertility between 2008 and 2017 at a men′s infertility clinic. RESULTS Of the 8918 men completing the questionnaires, 347 and 140 men reported having had a unilateral or bilateral orchiopexy for UDT. The average age of the men at the time of the orchiopexies was 8.09 and 7.43 for men with unilateral and bilateral UDT, respectively. Unilateral orchiopexy at ≤ 2 y/o or > 2 y/o was reported in 66 and 213 men (mean age of the ″late″ group 10.3 yrs), respectively. Bilateral orchiopexy at ≤ 2 y/o or > 2 y/o was reported in 27 men and 106 men (mean age of the ″late″ group 9.1 yrs), respectively. There was no significant difference in the sperm count or motility for patients having the orchiopexies (unilateral or bilateral) ″early″ or ″late″. While azoospermia was a common finding (45/164 unilateral and 36/81 bilateral), there was no difference in the frequency of azoospermia in men having ″early″ or ″late″ orchiopexies. A total of 92 men reported having had orchiopexies at an age > 10 y/o. Even for men having bilateral orchiopexies > 10 y/o, the average sperm count was still 7.51 X 106/mL, which was not significantly different than the sperm counts of men having ″early″ bilateral orchiopexies. CONCLUSIONS This is the largest published study on semen parameters of infertile men with a history of UDT. In our population of men, sperm parameters were similar whether or not the orchiopexy was performed ″early″ (≤ 2 y/o) or ″late″ (> 2 y/o). This study does not support the present concept that early intervention for UDT improves fertility potential. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e225 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Sangwoo Leem More articles by this author Susan Lau More articles by this author Kirk C Lo More articles by this author Ethan D Grober More articles by this author Keith A Jarvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Denys-Drash Syndrome: a case report

Background: Denys-Drash syndrome (DDS) is a very rare genetic disease. Wilms' tumor, genital abnormalities, and congenital glomerulopathy are the main features of DDS which resulted from a heterozygous mutation in the WT1 gene. Case Presentation: First case of DDS has been diagnosed in Saudi Arabia in four months newborn who admitted to nephrology department with ambiguous bilateral undescended testis, and nephropathy. On admission, he had normal vital signs except high blood pressure. His kidney function tests showed abnormal kidney function. Ultrasonography and MRI were done to figure out his nephropathy and undescended testis, respectively. Both Abdominal ultrasonography and kidney histopathology confirmed diffuse mesangial sclerosis (DMS). MRI graph located the un-identical ectopic testis. The autosomal dominant inherited pathogenic missense mutation in exon 9 of WT1 gene (c.1181G>A (p.Arg394GLu)) was confirmed by DNA direct sequencing analysis. At his 4th year of age, his nephropathy developed to End Stage Renal Disease (ESRD). Conclusion: DDS should be considered in new born baby with nephrotic syndrome and ambiguous gonads. DNA direct sequencing analysis for WT1 gene is very helpful for confirmation of DDS.

Prevalence and Chronological Changes of Testicular Microlithiasis in Isolated Congenital Undescended Testes Operated On at Less Than 3 Years of Age

To clarify the prevalence and chronological changes of testicular microlithiasis in isolated congenital undescended testes, retrospective chart review was performed. Among children with palpable isolated undescended testes who underwent orchiopexy at less than 3 years of age between January 2009 and May 2016, those who had preoperative testicular ultrasonography were enrolled. Testicular microlithiasis was classified as limited or classic. Sixty-five patients (54 unilateral undescended testes and 11 bilateral undescended testes) were enrolled. Preoperative evaluation demonstrated limited testicular microlithiasis in only 2 undescended testes in 2 patients (1 with unilateral undescended testes and 1 with bilateral undescended testes). Of these patients, 1 with unilateral undescended testes had limited testicular microlithiasis and the other with bilateral undescended testes had classic testicular microlithiasis after surgery. Among 53 unilateral undescended testes without microlithiasis preoperatively, limited and classic testicular microlithiasis was found in 1 and 6 testes, respectively, during follow-up. Testicular microlithiasis was identified in 2 on the contralateral descended testis of unilateral undescended testes postoperatively. Among 10 patients with bilateral undescended testes without microlithiasis preoperatively, limited testicular microlithiasis was detected in 4 during follow-up. Testicular microlithiasis was not diminished or resolved during follow-up. The overall prevalence of testicular microlithiasis in undescended testes (21.1%) was significantly higher than that in the contralateral descended testis in patients with unilateral undescended testes (3.7%) (P < .01). Most testicular microlithiasis was identified postoperatively and never improved. The prevalence of testicular microlithiasis in isolated congenital undescended testes increased with time even if operated on early in life.

Genes Involved in Long-Term Memory Are Expressed in Testis of Cryptorchid Boys and Respond to GnRHa Treatment

It has been known for many years that boys with unilateral or bilateral undescended testis (cryptorchidism) tend to have a low IQ, and those who belong to the high infertility risk (HIR) group perform less well at school than low infertility risk (LIR) patients. However, the molecular biological processes underlying this phenomenon are not understood. In this study, we report the outcome of testicular RNA profiling for genes involved in long-term memory formation. We analyzed the histology and the transcriptome of testicular biopsies from bilateral HIR cryptorchid boys, comparing those who received GnRHa treatment for 6 months after the first surgery with those who did not receive GnRHa before the second surgery. We found that GnRHa treatment alters the testicular mRNA levels of neuronal genes that are involved in long-term memory and testosterone synthesis. These data highlight a possible molecular link between cryptorchidism, impaired mini-puberty, and diminished cognitive functions. Our results are consistent with the hypothesis that hypogonadotropic hypogonadism in cryptorchid boys with altered mini-puberty may affect neuronal genes important for memory and learning, which could help explaining the negative correlation between cryptorchidism and intellectual abilities.

Evaluation of Pediatric Undescended Testes with Elastosonography

BackgroundUndescended testes, which are defined as the failure of testes to descend to scrotum, are the most common developmental defect in male infants. Indirect evaluation of histologic damage can be performed with the help of palpation during operation. Hard texture of testes tissue is likely related with histological damage. Real-time elastography is an emerging technology of ultrasonic imaging of soft tissue strain and elasticity, it aims at providing information regarding the mechanical properties of tissues, such as their hardness or stiffness. This study aim was to investigate the changes in strain and elasticity of testes tissue by using elastography technique. Materials and methodsA total of 32 patients, who had undescended testes were included in this study. Only two patients had bilateral undescended testes, other patients had unilateral. The age of the patients were recorded according to the time of ultrasonographic (USG) examination. The undescended testes was displayed in the elastographic box with the neighbouring subcutaneous fat tissues. The strain ratios were measured as the ratios of the elasticities of the subcutaneous fat tissue to the elasticities of the undescended testes. ResultsA total of 32 patients with 34 testes were included in the study. The mean age of the patients with undescended testes was 32.6 months (range 7–60 months). The mean strain ratios were 0.67 (range 0.12–1.41) for the undescended testes and there were no significant differences in undescended testes strain ratios related to patient age (p=0.453). ConclusionThis preliminary study showed that there were no significant fibrosis which can be demonstrated with elastosonography before the age of 5 years old. Additional studies with histopathological results are needed to identify sensitivity and specificity of elastosonography in undescended testis and in planning optimal operation time for these patients.

Can laparoscopy be part of a paediatric surgery outreach service?

INTRODUCTION The aim of this study was to assess the outreach laparoscopic service delivered by four paediatric surgeons to a district general hospital (DGH). METHODS A retrospective review was carried out of all laparoscopic procedures performed in a single DGH between January 2004 and November 2014 by the four paediatric surgeons providing the outreach service. All operations were identified from the electronic theatre system and archived correspondence. Demographic and clinical details were obtained from contemporaneous records. RESULTS Over the 11-year study period, 1,339 operations were performed as part of the outreach paediatric surgery service, with 128 patients (9.6%) undergoing laparoscopy. The indications for laparoscopic surgery were impalpable unilateral or bilateral undescended testes (UDT) (n=79, 62%) or request for insertion of a feeding gastrostomy (n=49, 38%). All but six UDT cases (96%) were performed as day surgery and the median length of stay for gastrostomy patients was 3 days (interquartile range: 2-3 days). There were three UDT cases with surgical complications and one had complications related to the anaesthesia. One gastrostomy case required transfer to our tertiary centre for management of postoperative urinary retention and urethral injury. CONCLUSIONS Elective laparoscopic procedures in young children can be provided safely as components of an outreach paediatric surgery service in a DGH setting as part of an increasing volume of operations performed by specialist paediatric surgeons. This enables children to have a high quality service as close to their home as possible.

Extended clinical features associated with novel Glis3 mutation: a case report

BackgroundMutations in the GLI-similar 3 (GLIS3) gene encoding the transcription factor GLIS3 are a rare cause of neonatal diabetes and congenital hypothyroidism with 12 reported patients to date. Additional features, previously described, include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay, facial dysmorphism, osteopenia, sensorineural deafness, choanal atresia, craniosynostosis and pancreatic exocrine insufficiency.Case presentationWe report a new case for consanguineous parents with homozygous novel mutation in GLIS3 gene who presented with neonatal diabetes mellitus, severe resistant congenital hypothyroidism, cholestatic liver disease, bilateral congenital glaucoma and facial dysmorphism. There were associated abnormalities in the external genitalia in form of bifid scrotum, bilateral undescended testicles, microphallus and scrotal hypospadias which might be a coincidental finding.ConclusionsWe suggest that infants with neonatal diabetes associated with dysmorphism should be screened for GLIS3 gene mutations.

Delayed treatment of undescended testes may promote hypogonadism and infertility.

Undescended testes at birth may be caused by testosterone deficiency during fetal development. It is unclear whether the process of failed descent contributes to permanent endocrine impairment. To evaluate the impact of age at treatment of undescended testes on endocrine and spermatogenic testicular function in middle-aged men. Reproductive hormone and semen data of 357 men with previously undescended testes were evaluated with respect to age at correction of testicular position and compared to those of 709 controls with eutopic testes at birth and normozoospermia. Men with undescended testes had higher mean Luteinizing Hormone levels (p < 0.0001) and lower mean testosterone levels (p = 0.003) compared to controls. They also had lower bi-testicular volumes, higher Follicle Stimulating Hormone levels, and lower sperm concentrations (all p < 0.0001). Lowest mean sperm concentrations were found in subjects with bilateral undescended testes. Normal sperm concentrations were found in 21 % of cases (in 27 % of men with unilateral and in 12 % with bilateral undescended testes), while oligozoospermia was diagnosed in 44 %, and azoospermia in 35 % (in 28 % with unilateral, 46 % with bilateral undescended testes). Subjects with reduced semen quality had higher gonadotropin levels than those with normozoospermia. Age at correction (median: 6 years (1-39)) was inversely correlated with bi-testicular volumes and sperm concentrations, and positively correlated with FSH and LH, but not with serum testosterone. Latent, rarely decompensated hypogonadism is a potential long-term consequence of undescended testes, besides infertility and testicular cancer, preferentially affecting subjects with delayed or unsuccessful correction of testicular position. Impaired Leydig cell function is likely to contribute to compromised fertility. These observations support correction of cryptorchidism during early infancy.

Association of Levels of Serum Inhibin B and Follicle-stimulating Hormone with Testicular Vascularity, Volume, and Echotexture in Children with Undescended Testes.

Aims:The aim of our study was to assess the association between reproductive hormones (inhibin B [inh B], follicle-stimulating hormone [FSH]) with testicular volume, echogenicity, and blood flow (resistive index [RI]) in children with undescended testis (UDT).Settings and Design:This was a prospective study of 1-year study duration.Materials and Methods:A total of 33 patients (16 unilateral and 17 bilateral) UDTs aged 5–12 years with palpable UDT were included in the study. Morning fasting blood samples were taken for estimation of serum inh B and FSH as well as inh B/FSH ratio. Testicular ultrasound was done to compute testicular volume, testicular echogenicity, and testicular vascularity in terms of RI.Results:The mean age of patients enrolled in the study was 8.29 years for unilateral UDT and 7.97 years in bilateral UDT and it was comparable. The study groups were further subdivided into two age-wise subgroups school goers (5–8 years) and prepubertal (9–12 years). The values of inh B, FSH, and inh B/FSH ratios as well as mean testicular volume were comparable between both groups and subgroups. Overall mean testicular volume had a positive correlation with FSH, inh B, and inh B/FSH, but statistical significance was reached only for inh B (P < 0.001) in children with both unilateral and bilateral UDT. Apart from five patients with hypoechogenicity within the testis, all remaining testes were of homogenous echotexture with no instances of irregular echogenicity or tumor. Children with RI >0.6 were separately studied. The incidence of high RI (>0.6) was also comparable in unilateral or bilateral disease. These subjects had unfavorable biochemical parameters in terms of low inh B levels and high FSH levels.Conclusions:Our findings hint to the fact that palpable UDT forms a homogenous group, whether unilateral or bilateral, whereas impalpable testes may form a separate category and need further studies to substantiate this hypothesis.

Sex Ambiguity in a 1-year-old Child having Penoscrotal Hypospadias with Bilateral Undescended Testes (Cryptorchidism)

Sex Ambiguity in a 1-year-old Child having Penoscrotal Hypospadias with Bilateral Undescended Testes (Cryptorchidism)

Focal Dermal Hypoplasia (Goltz Syndrome): A Cross-sectional Study from Eastern India.

Introduction:Focal dermal hypoplasia (Goltz syndrome), is an extremely rare genetic disorder characterized by distinct skin manifestations and a wide range of abnormalities involving the ocular, dental, skeletal, urinary, gastrointestinal, cardiovascular, and central nervous systems. The objective of the present series is to emphasize the different typical as well as unusual features of this rare syndrome.Methology:This cross-sectional observational study was performed over a period of 8 years in a tertiary care hospital of Eastern India. Consecutive patients with the clinical diagnosis of Goltz syndrome were studied.Results:A total of 8 patients with Goltz syndrome were evaluated. Out of them, one patient was a boy and the rest were girl. The age ranged from 3 days to 9 years. There was no family history. A characteristic Blaschkoid hypo- and hyper-pigmented skin lesions, congenital nodular fat herniation, and skin atrophy were present in all patients. Congenital cutaneous aplasia was present in 50% of the patients. Facial asymmetry and ear deformity (megalopinna and low-set ears) were seen in 37.5% and 12.5% of patients, respectively. Cutaneous telangiectasia was noticed in 37.5% of patients. Freckle- and lentigines-like pigmentation within the hypopigmented macules was found in 25% of patients. Raspberry-like papillomas around mouth were documented in 6 (75%) patients. Dysplastic nail changes with ridging were seen in 7 (87.5%) patients. Genital abnormality in the form of bilateral undescended testes and microphthalmia with aniridia were found in one patient each. Limb defects were present in all patients. Left-sided renal agenesis was found in one patient. The patient also had multiple cortical cysts of the right kidney.Limitations:Genetic testing could not be performed in the present series.Conclusions:Our case series showed a few unusual or extremely rare manifestations such as undescended testes, dermal sinus, kyphoscoliosis, aniridia, unilateral kidney agenesis, and renal cortical cysts among others.

Two cases of Oto palate digital syndrome type II: Clinical features and a study of telomere length maintenance pathways.

Objective: To study the clinicopathological features of Oto palato digital syndrome type II (OPD-II) and telomere length maintenance pathway. Design: Case-control study of OPD-II. Setting: Different clinicopathological studies along with telomere length maintenance pathways were investigated. Participants: Clinically diagnosed two OPD-II patients and four randomly selected age-matched normal individual. Main outcome measures: Studied OstiumSecondum Atrial Septal Defects (osASD) by ECG, testes image by USG, subcortical dysrythmia by EEG, image of corpus callosum by MRI, 17 α oH progesterone level in blood. telomere length, expression of telomerase and telomere-associated genes of PBMC were also measured. Results: Two children with OPD-II showed characteristic clinical symptoms such as cleft palate, broad forehead, facial dysmorphism, flat nasal bridge, low birth weight but no abnormality of the digits. The patient-1 exhibited osASD, bilateral undescended testes with hypospadiusand eventually developed seizure disorder in the follow up, ambiguous genitalia and high level of 17 α oH progesterone in blood. Interestingly, this patient showed shorter telomere length of PBMC – (~60%), low (

Manitoba Oculotrichoanal Syndrome: First Case Report From India

Manitoba-oculo-tricho-anal (MOTA) syndrome is very rare syndrome characterized by aberrant hairline, eye anomalies (ocular hypertelorism, cryptophthalmos, and upper eyelid colobomas), bifid nose, omphalocele and anorectal anomalies. MOTA syndrome was first reported in 1992 in Oji-cree community from the Island Lake region of Manitoba, Canada. Till date very few cases of MOTA have been reported and none from India. We report first case of MOTA syndrome from India. A two month old male baby was brought with complaints of defect in right upper eye lid since birth. He was the second born child of a second degree consanguineously married couple at 37 weeks of gestation. On physical examination, the baby had right upper eyelid coloboma , ocular hypertelorism, bifid nose, small nasal ala and bilateral undescended testis. Investigations revealed high anorectal anomaly and right renal agenesis. Whole exome sequencing showed homozygous nonsense variation in exon 25 of the FREM1 gene that resulted in a stop codon. This case gains importance as it is the first case of MOTA being reported from India and bilateral undescended testis which was seen this case is an addition to the variable clinical spectrum of MOTA.

Hypogonadotropic hypogonadism with bilateral cryptorchidism and its laparoscopic treatment

Undescended testis is an entity that should be identified from birth. Even when associated with other malformations, it requires a specialized and multidisciplinary approach. Its association with hypogonadotropic hypogonadism is unusual, with a broad spectrum of presentations according to the testicular dysfunction that presents and the consequences of the lack of testosterone action. Diagnostic laparoscopy with laparoscopic orchidopexy is the minimally invasive treatment of choice. We present herein the case of a patient with hypogonadotropic hypogonadism with bilateral undescended testis treated with laparoscopic orchidopexy.

Cryptorchidie : la présence d’un canal péritonéo-vaginal perméable devrait-elle influer dans le choix de la technique chirurgicale ?

Compare the position of the undescended testis at clinical examination and under general anesthesia with the patency of an open processus vaginalis. We included children from 2to 18years of age operated for a unilateral or bilateral undescended testis between January 2006and April 2014at the Annecy Genevois hospital, France. The analysis was conducted considering that the individual was the testis. Testicular position before surgery, under general anesthesia and patency of open processus vaginalis as a surgical finding were prospectively recorded. Three hundred and six children were included. The analysis was conducted over 401testes. The position at clinical examination was significantly linked to a persistent open processus vaginalis (P=0.0045). Over the 282testes considered as candidate for Bianchi's procedure, as to say intra- or supra-scrotal under general anesthesia, 154had a persistent processus vaginalis (55%). There is a link between a persistent processus vaginalis and the location of the undescended testis which should encourage us not to neglect the inguinal approach, and eventually to question the relevance of Bianchi's procedure. 4.

Synchronously detected seminoma of both testis in a middle aged male with bilateral cryptorchidism

&lt;p class="abstract"&gt;Bilateral testicular tumours are rare and 80% occur metachronously. Synchronous bilateral testicular tumours are rare, and bilateral synchronous testicular tumours in bilateral cryptorchidism are extremely rare with only few cases reported previously. A 36 year old male patient presented to surgical OP with complaints of pain in scrotal region of both sides since 6-8 months. He was asymptomatic previously except for complaints of empty scrotal sac. Magnetic resonance imaging performed 6 months back revealed bilateral large oval to mildly irregular inguinal swellings with iso to hyperintense areas measuring 36×23×20 mm on right side and 34×26×20 mm on left side and patient was diagnosed with bilateral undescended testis. Bilateral orchidectomy was performed and the resected specimen was subjected to histopathologic examination. Gross visual examination of the bilateral orchidectomy specimen revealed the larger specimen to measure 7×4×1 cm with grey coloured external surface. Cut section revealed testis measuring 3.5×2 cm and surrounded with fibro adipose tissue. The testicle shows grey brown and grey white areas surrounding a central yellow nodule measuring 1×0.8 cm. The other mass had a yellowish nodular external surface and measured 5.5×4×1 cm. On cut section, normal testicular tissue could not be identified and the entire testis appeared to be replaced by a solid yellowish white homogenous tumour. Sections from the yellowish smaller mass revealed tumour composed of sheets and trabeculae of large polygonal cells with large vesicular nuclei with prominent nucleoli and abundant clear to vacuolated cytoplasm. Focal collections of histiocytes and occasional multinucleated giant cells were also seen. Sections from the other larger mass showed a thick fibrotic tunica albuginea with sclerosed and hypoplastic seminiferous tubules in areas of dense hyaline fibrosis. In the centre, a well circumscribed tumour was seen showing similar histologic features as in the contralateral mass. Epididymis did not show tumour infiltration.&lt;/p&gt;