Cremasteric Reflex Research Articles

Clinical Predictors of Testicular Torsion in Children

To distinguish the prognostic factors that decrease the probability of a negative exploration for "acute scrotum." In some institutes, patients with "acute scrotum" undergo immediate exploration after clinical evaluation. Because testicular torsion (TT) accounts only for a fraction of these cases, most infants can be treated conservatively. We performed a retrospective study of all patients treated at our institute from January 2008 to December 2009 for the diagnosis of "acute scrotum." Differences between groups were calculated using the chi-square test or analysis of variance and Mann-Whitney-Wilcoxon test for univariate or multivariate analysis, expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The data from 138 patients were analyzed. The mean age was 9 years, 8 months. Of the 138 patients, 19 (13.8%) had TT. This group was compared with the boys without TT at exploration. The patients with TT were older on average (11 years, 1 month vs 9 years, 1 month, p = .035). Pain for <24 hours (OR 4.2, 95% CI 1.3-13.4), nausea and/or vomiting (OR 21.6, 95% CI 4.9-93.4), abnormal cremasteric reflex (OR 4.8 95% CI 0.7-35.2), and a high position of the testis (OR 18.0 95% CI 1.8-177.1) were associated with an increased likelihood of torsion. In the group of boys with ≥ 2 of these findings present, 100% had TT at exploration, with 0% false-positive results. TT is uncommon among the group of boys treated for "acute scrotum." In particular, a pain duration <24 hours, nausea or vomiting, a high position of the testis, and an abnormal cremasteric reflex had a positive prognostic value for TT. A clinical score might help to avoid unnecessary explorations. In the future, we intend to test the diagnostic set described combined with ultrasonography.

Cysticercosis of the spinal cord

A 15-year-old boy presented with progressive weakness of the right lower limb for 2 months associated with bowel and bladder incontinence. Physical examination revealed weakness of the right lower limb (muscle power 3/5) with spasticity. The knee and ankle jerks were exaggerated bilaterally and the cremasteric reflexes were absent; the plantar response was extensor on the …

Acute Scrotum in Children

This study aimed to compare clinical manifestations, physical examination findings, laboratory, and radiographic dates in pediatric patients with different pathological diagnoses of acute scrotum as well as to accurately establish the true incidence of various pathological diagnoses of acute scrotum. The records of children hospitalized for acute scrotum from 1990 to 2008 were reviewed. A total of 1228 cases were included in the study (103 with testicular torsion, 918 with torsion of the testicular appendix, 72 with tunica vaginalis inflammation, 46 with epididymitis and 89 with other pathological diagnoses). Duration of pain less than 6 hours, fever, vomiting, history of trauma or activities, absence of cremasteric reflex, and abnormal testicle direction were significantly associated with testicular torsion. Blue dot sign and tender nodule were found significantly associated with torsion of the testicular appendix. Ultrasound showed decreased or absent blood flow in 91.3% testicular torsion patients; enlarged epididymis was found in 91.1% and 91.3% patients with torsion of the testicular appendix and epididymitis, respectively; and scrotal wall edema and hydrocele were found significantly associated with tunica vaginalis inflammation. Our salvageability rate in testicular torsion was 30.1%. Overlap existed between testicular torsion and other acute scrotum. The clinical manifestations, physical examination findings, laboratory, and radiographic data were helpful in distinguishing acute scrotum. Doppler ultrasound is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; in the presence of a clinical suspicion of testicular torsion, even with an apparently normal-color Doppler ultrasound, surgical exploration is still indicated.

History and physical examination findings predictive of testicular torsion: An attempt to promote clinical diagnosis by house staff

Objective To standardize the history and physical examination of boys who present with acute scrotum and identify parameters that best predict testicular torsion. Materials and methods Over a 5-month period, a standardized history and physical examination form with 22 items was used for all boys presenting with scrotal pain. Management decisions for radiological evaluation and surgical intervention were based on the results. Data were statistically analyzed in correlation with the eventual diagnosis. Results Of the 79 boys evaluated, 8 (10.1%) had testicular torsion. On univariate analysis, age, worsening pain, nausea/vomiting, severe pain at rest, absence of ipsilateral cremaster reflex, abnormal testicular position and scrotal skin changes were statistically predictive of torsion. After multivariate analysis and adjusting for confounding effect of other co-existing variables, absence of ipsilateral cremaster reflex ( P < 0.001), nausea/vomiting ( P < 0.05) and scrotal skin changes ( P < 0.001) were the only consistent predictive factors of testicular torsion. Conclusion An accurate history and physical examination of boys with acute scrotum should be primary in deciding upon further radiographic or surgical evaluation. While several forces have led to less consistent overnight resident staffing, consistent and reliable clinical evaluation of the acute scrotum using a standardized approach should reduce error, improve patient care and potentially reduce health care costs.

V1711 COMBINED ORCHIECTOMY AND PROSTHETIC EXCHANGE: SURGICAL TECHNIQUE

You have accessJournal of UrologyPediatrics & Reconstruction1 Apr 2011V1711 COMBINED ORCHIECTOMY AND PROSTHETIC EXCHANGE: SURGICAL TECHNIQUE Aditya Bagrodia, Douglas Preuss, and Nicol Bush Aditya BagrodiaAditya Bagrodia Dallas, TX More articles by this author , Douglas PreussDouglas Preuss Dallas, TX More articles by this author , and Nicol BushNicol Bush Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2036AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Historically, placement of testicular implant during orchiectomy for torsion is not recommended despite success during orchiectomy for cancer. We present our surgical technique for combined orchiectomy and prosthetic exchange (COPE) in an adolescent with torsion. METHODS A 16-year old presented with a 4 day history of abdominal pain and diagnosis of gastroenteritis elsewhere. He subsequently developed scrotal erythema and edema and ultrasound confirmed testicular torsion with necrosis. He was offered orchiectomy, contralateral orchiopexy, and simultaneous prosthesis. The patient received peri-operative vancomycin and gentamicin. The torsed hemiscrotum was entered through a midline incision and the testicle was detorsed. After contralateral ochiopexy, orchiectomy of the torsed testicle was performed with preservation of the tunica vaginalis. The spermatic cord was identified intravaginally and ligated using 4-0 polyglactin. Two 3-0 polypropylene sutures were placed at the proximal spermatic cord stump and tagged. Three individual 4-0 PDS sutures were preplaced in the superior, middle and inferior portions of the tunica vaginalis for later reapproximation. A large (20 ml capacity) saline-filled, adjustable testicular prosthesis (Coloplast, Denmark) was then filled with 16 ml of saline and secured near the cord stump through the tab of the prosthetic. The preplaced tunica sutures wrapped the prosthesis within the tunica. Finally, a 4-0 polyethylene terephthalate suture secured the most dependent portion of the tunica to scrotal dartos. After hemostasis and repeat antibiotic irrigation, the dartos fascia was closed in two layers (polyglactin) prior to subepithelial skin closure. The patient was discharged the same day with opioid pain medication and 5 day course of ciprofloxacin. RESULTS Left orchiectomy, right orchiopexy, and simultaneous left prosthesis placement were successfully performed. Total operative time was 62 minutes. Estimated blood loss was 10 ml. No infectious complication occurred. At 6-week follow up, the incision was healed, bilateral cremasteric reflexes were elicited, and scrotal symmetry was evident. CONCLUSIONS Our initial experience with COPE for torsion demonstrates the procedure to be safe and effective. In addition to well-documented body self-esteem advantages of prosthetic placement, advantages of COPE potentially include obviating the need for two anesthetics, decreasing number of days missed from school/work, and cost advantages associated with a single procedure. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e687-e688 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Bagrodia Dallas, TX More articles by this author Douglas Preuss Dallas, TX More articles by this author Nicol Bush Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Commentary to “History and physical examination findings predictive of testicular torsion: An attempt to promote clinical diagnosis by house staff”

Often in boys with testicular torsion, the history and physical examination so strongly suggest the diagnosis that imaging only delays treatment. In boys with an unsalvageable testis at exploration who have had an ultrasound, two questions are unavoidable: Was the ultrasound necessary for diagnosis? Did time waiting for the ultrasound change a salvageable testis to an unsalvageable one? The predictors associated with testicular torsion are not the strength of this paper. The association of nausea/vomiting and absent cremasteric reflex with testicular torsion is not novel, and drawing conclusions from a multivariate logistic

Testicular Torsion in Children: A 20-Year Retrospective Study in a Single Institution

In this paper, we evaluated the historical features and physical examination findings, as well as laboratory tests and ultrasound examinations, in children with testicular torsion (TT), in order to improve diagnosis and treatment in this population. A retrospective review of patients with diagnosis of TT between January 1990 and January 2010 was performed. We included 118 cases in the study, accounting for 9.01% of all cases of acute scrotum. Mean patient age was 9.3 ± 5.6 years. The left side was predominantly affected. The median duration of symptoms up to surgical exploration was 64 h. Absence of cremasteric reflex presented in 94.9% patients. All boys had an ultrasound of the scrotum; decreased or absent blood flow was observed in all orchidectomy patients. Heterogeneous echogenicity presented in all cases of orchidectomy. At surgery, viable testes were present in 46 boys (39%) and preserved; in 72 boys with nonviable testes, they were removed. The median duration of symptoms at presentation was 12 h when the testes were successfully conserved and 90 h when they were removed. Testicular salvage depends critically on early surgical intervention. Ultrasound is a useful tool for the clinical assessment of patients with TT, however, sonographic interpretation must be in conjunction with the clinical manifestations. We advocate immediate surgical exploration with suspected TT. Long-term hormonal levels are within the normal range regardless of the fate of the testis. Further follow-up is needed to confirm fertility after TT.

Spontaneous ejaculation after spinal cord trauma

Dear Editor, I am Dr Hossam A. Yasien, from the Department of Dermatology, Andrology & STDs, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt. Spinal cord lesions in humans are associated with impaired ejaculation 1, suggesting that the effects of descending pathways on the spinal ejaculatory mechanism are predominantly excitatory. In rodents, however, there may be an additional and important descending inhibitory pathway 2. We report a case of a patient in whom a spinal trauma was unusually associated with spontaneous ejaculation. A 23-year-old male patient presented to our Department of Andrology with spontaneous ejaculation. The patient is single and was previously normal until he experienced an accident by falling from the fifth floor about 8 months ago. The patient was then paraplegic with absent sensation of both lower limbs, urinary and stool incontinence, absent erection including morning erection. Both spinal computerized tomography (CT) and magnetic resonance imaging (MRI) revealed fracture of vertebrae T12, L1 and L2. Neurological examination at that time revealed Grade A impairment according to the American Spinal Injury Association (ASIA impairment scale) with no sacral sparing. Till that time the patient did not report any abnormality in the ejaculation. Neurosurgeons then decided to perform immediate fixation of the fractured vertebrae, which had been already done to the patient. After 1 month, the patient started physiotherapy for 7 months, after which he gained lower limb power, urinary and fecal control and even erection on excitation, but began to experience spontaneous ejaculation without desire, erection and even in unsatisfactory circumstances like praying in the mosque and during manual work. This complaint occurs many times per week and sometimes per day without any sexual desire, sexual excitation or any provocative factors with preserved orgasm at every time ejaculation occurs. However, ejaculation occurs normally during masturbation and night emission as well. By examination, the patient had hyperesthesia of both lower limbs, normal to exaggerated cremasteric and bulbocavernosal reflexes. Anal reflex was normal. The patient's ejaculate was tested for the presence of sperms and was positive. Routine investigations of the patient including fasting and postprandial blood sugar were normal. Drug history revealed a course of broad-spectrum antibiotics, Metronidazole, Vitamin B12, drugs that decrease edema, like alpha-chemotrypsin and non-steroidal anti-inflammatory drugs. No drugs were received for the current complaint. Earlier reports of this association have been anecdotal 3, and cord pathology is generally found to lead to the impairment of ejaculation. It is, however, known that a reflex mechanism exists in the T9-L2 (sympathetically driven emission of semen) and S2-3 cord segments (somatically driven propulsion of semen) from which involuntary ejaculation may be produced 2. Thus in patients with spinal injuries above T9, ejaculation can be induced using electroejaculation, vibrator stimulation or sympathetic stimulation below the level of the lesion 4, 5. In rodents this spinal sexual mechanism receives descending inhibition to pudendal motor neurons and lumbosacral interneurons, and, in male animals with a spinal cord transection ejaculation, can be induced by fluid distension of the urethra or by mechanical stimulation of the glans 6 in a manner reminiscent of our patient's symptomatology. We think that the lesion in this patient was compression more than a cut injury and edema following the fracture or the surgical procedure is global, and affecting not only the site of the injury but extending above and below as well. Denervation supersensitivity of the post-synaptic receptors, which occurs after a long period of compression, may be the cause of this condition. In summary, we conclude that in humans the overriding supraspinal influence on sexual function is usually excitatory, but it is possible that spinal lesions could result in a situation resembling that in rodents by selectively interfering with an additional, smaller descending inhibitory pathway projecting to the spinal ejaculatory mechanism. In addition, we should consider the phenomenon of denervation supersensitivity in these cases.

Clinical predictors for testicular torsion as seen in the pediatric ED

Objective The aim of the study was to identify clinical findings associated with increased likelihood of testicular torsion (TT) in children. Design This study used a retrospective case series of children with acute scrotum presenting to a pediatric emergency department (ED). Results Five hundred twenty-three ED visits were analyzed. Mean patient age was 10 years 9 months. Seventeen (3.25%) patients had TT. Pain duration of less than 24 hours (odds ratio [OR], 6.66; 95% confidence interval [CI], 1.54-33.33), nausea and/or vomiting (OR, 8.87; 95% CI, 2.6-30.1), abnormal cremasteric reflex (OR, 27.77; 95% CI, 7.5-100), abdominal pain (OR, 3.19; 95% CI, 1.15-8.89), and high position of the testis (OR, 58.8; 95% CI, 19.2-166.6) were associated with increased likelihood of torsion. Conclusions Testicular torsion is uncommon among pediatric patients presenting to the ED with acute scrotum. Pain duration of less than 24 hours, nausea or vomiting, high position of the testicle, and abnormal cremasteric reflex are associated with higher likelihood of torsion.

Acute scrotum -etiology, clinical presentation and seasonal variation

The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation of acute scrotal problems in children. A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital Heraklion between January 1989 and December 2006 was performed. A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis (35%, 95%CI: 27%-43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant (p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter. The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the appendages.

Testicular Nodules in a 16-Year-Old Boy

16-year-old male from a village in northern Israel presented to the pediatric emergency department complaining of erythema, swelling, warmth, and tenderness of his left scrotum, which had gradually developed over a 3-week period. There was no history of trauma, fever, upper respiratory illness, or intestinal symptoms. The patient denied urinary complaints, urethral discharge, and sexual activity. Other than diabetes mellitus diagnosed at age 12, he had no active medical problems. Ten days before admission he was seen by an urologist and was treated with a 10-day course of cephalexin. When there was no improvement, the patient was referred to the pediatric emergency department. The patient was a healthy-appearing adolescent male in no distress. His temperature was 37°C, heart rate was 113 beats/min, and blood pressure was 120/80 mm Hg. Physical examination was normal except for left scrotal swelling, erythema, tenderness, and warmth. There was no urethral discharge. Cremasteric reflex was present, and the right testis was normal.

The frequency of undescended testis from birth to adulthood: a review

Dear Sir, I read the article titled ‘The frequency of undescended testis from birth to adulthood: a review’ that appeared in International Journal of Andrology (31: 1–11, 2008) with interest (Sijstermans et al., 2008). In the second paragraph of page 9, it was written that the cremasteric reflex peaks in boys 5–8 years old (Bingöl-Koloǧlu et al., 2001) and it is generally accepted that retractile testis may represent hyperactivity of the cremasteric reflex (Farrington, 1968; Tanyel, 2004). Since two articles of ours are cited (Bingöl-Koloǧlu et al., 2001; Tanyel, 2004), this sentence tells that we agree on the views about the effect of cremasteric reflex on the localization of a testis. However, it is clearly described in those mentioned articles that cremasteric reflex cannot explain the suprascrotal localization of a testis. Therefore those articles oppose to the idea of the place of the cremasteric reflex, which is very contrary to their use in the aforementioned article. Since my articles are not cited in their exact meaning, I think that the readers of your Journal should be informed about their exact views. In those articles, it is described that a reflex arc cannot be reactivated during the active state. The reflex arc can be reactivated after the completion of the precedingly activated arc. If a testis is retracted because of activities of this reflex, it should go up and down. However, such a testis does not exist. Furthermore, the cremasteric reflex is subjected to desensitization. It cannot be reactivated continuously. Therefore the cremasteric reflex cannot explain the suprascrotal localization of a testis (Bingöl-Koloǧlu et al., 2001). My description includes the development of smooth muscle in the gubernaculum to descend the testis. Testis is descended through the processus vaginalis via peristaltic activity. After descent, the smooth muscle should undergo programmed cell death for the obliteration of processus vaginalis. The initiation of programmed cell death requires a decrease in sympathetic, but an increase in parasympathetic tonus. Undescended testis results from early activation of this pathway that diminishes the amount of smooth muscle to descend the testis. Undescended testis is associated with a permanent decrease in sympathetic and increase in parasympathetic tonuses. Such an alteration in signalling increases cytosolic calcium in the cremaster muscle. Even if the amount of smooth muscle is initially enough for descent, the permanent increase in cytosolic calcium results in contraction, and furthermore contracture formation of the cremaster muscle. As it will be noticed in the cited articles, I think that not the cremasteric reflex, but the contractile status of cremaster muscle defines the retraction or ascent of a testis (Bingöl-Koloǧlu et al., 2001; Tanyel, 2004).

Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies

Aim Inguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions. Methods Patients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant. Results Seventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9), undescended testicle (n:14), retractile testicle (n:12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group ( P = .028). Although the latencies were shortened in undescended testicle group, no significant difference detected ( P > .05). Conclusion Prolonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in younger age groups with large number of patients are needed to support our suggestions.

Testicular torsion: a race against time

Torsion of the testis is a medical emergency that is most commonly encountered in adolescents. Patients usually present with sudden onset scrotal pain associated with nausea and vomiting. On physical examination the involved testis is tender, high riding and usually horizontal. The cremasteric reflex is usually absent. If left untreated irreversible ischaemia starts appearing in 6 h. Doppler ultrasound is the diagnostic imaging of choice. The ideal treatment is surgical exploration and orchidectomy with contralateral orchidopexy or bilateral orchidopexy depending on the condition of the affected testis. If surgical options are delayed then manual detorsion should be attempted.

Electrophysiological Evaluation of Cremasteric Reflex in Experimental Testicular Torsion

The aim of the study was the electrophysiological evaluation of the cremasteric reflex after experimental testicular torsion. Ten male Wistar rats were enrolled into the study. Genitofemoral nerve (GFN) motor conduction and cremasteric reflex (CR) responses were evaluated electrophysiologically after being subjected to anesthesia with intramuscular ketamin hydrochloride. Testicular torsion was performed by rotating the right testicle 720 degrees in a clockwise direction from a midscrotal incision. Electrophysiological evaluations were repeated in the early (30 minutes) and late (90 minutes) periods of testicular torsion. Subsequently, detorsion of the testicles was performed and electrophysiological recordings were completed after 60 minutes of detorsion. The CR was also evaluated clinically before each electrophysiological evaluation. The latency and duration of GFN motor conduction and CR responses was compared for base, early torsion, late torsion and detorsion recordings. Friedman's test for repeated measurements was used for statistical analysis. The CR, which was detected clinically before torsion and after detorsion, was not detected during torsion. When base, early torsion, late torsion and detorsion recordings were compared, there was no statistical difference with respect to both latency and duration of GFN motor conduction and CR responses (p > 0.05). Although CR was not detected clinically during testicular torsion, the electrophysiological parameters of the reflex did not differ in the early and late periods of torsion in rats. The GFN motor conduction parameters also showed no differences. In conclusion, the absence of the CR after testicular torsion could not be confirmed by electrophysiological studies.

Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum

The acute scrotum in the paediatric population is a clinical dilemma where a definitive diagnosis can only truly be made at surgical exploration. We postulate that surgical exploration in all cases allows truly accurate diagnoses, treats the torted appendage testes and enables the validity of clinical signs associated with scrotal pathology to be assessed. We retrospectively reviewed all boys less than 15 years old who presented to our institution with scrotal pain over a 2 year period. A total of 121 patients attended of whom 113 had exploratory surgery, 31 (27%) had testicular torsion, 64 (57%) had a torted appendage testis, 12 (11%) had epididymitis, 1 (1%) had fat necrosis and 5 (4%) had no abnormality detected. On exploration 9 (29%) of the torted testis were unsalvageable and thus required excision. The initial clinical impression was frequently demonstrated to be flawed. Two patients with testicular torsion presented with a painless swelling and two further patients had necrotic testes despite a history of pain for less than 4 h. A normal cremasteric reflex and a visible blue dot were detected in boys with testicular torsion. Doppler ultrasound scans were not reliable with 50% sensitivity to clearly differentiate between torsion of the testis and that of the appendage testis. Absolute dependence on clinical features can lead to a misdiagnosis of testicular torsion. The surgical treatment of torted appendage testis is safe, allowing accurate diagnosis and pain relief with minimal morbidity. Early scrotal exploration of all cases with testicular pain ensures maximal testicular salvage.

Retractile Testis—Is it Really a Normal Variant?

Retractile testes are thought to represent a normal variant of descended testes in prepubertal boys. We studied retractile testes to determine their natural history. We retrospectively reviewed the charts of 122 boys (mean age 5.4 years) who were referred for a suspected undescended testis and were found to have a retractile testis. A retractile testis was defined as a suprascrotal testis that could be manipulated easily into the scrotum and remained there without traction until the cremasteric reflex was induced. The boys were followed by annual examinations, which demonstrated the presence of retractile, descended (nonretractile) or undescended testes, and the presence or absence of a taut or inelastic spermatic cord in association with a retractile testis. Of 204 retractile testes 61 (30%) descended (became nonretractile), 66 (32%) became UDTs and 77 (38%) remained retractile. Of the 62 retractile testes with a taut or inelastic spermatic cord 35 (56%) became UDTs. Of the 61 orchiopexies performed 8 (13%) showed a patent processus vaginalis. Boys in whom UDTs vs descended testes developed were a mean of 4.9 vs 6.6 years old (p = 0.001). The chance of spontaneous descent was 58% in boys 7 years or older, compared to 21% in boys younger than 7 (p <0.0001). A retractile testis is not a normal variant. Retractile testes have a 32% risk of becoming an ascending or acquired undescended testis. The risk is higher in boys younger than 7 years old, or when the spermatic cord seems tight or inelastic. Boys with retractile testes should be monitored annually until the testes have clearly descended.

Surgical Management of 33 Ilioinguinal and Iliohypogastric Neuralgias at Louisiana State University Health Sciences Center

This is a retrospective review of 33 charts of patients with ilioinguinal and iliohypogastric neuralgias who underwent a neurectomy at Louisiana State University Health Sciences Center between 1967 and 2000. Operations associated with neuralgias and postoperative pain outcomes were analyzed. There were 23 ilioinguinal and 10 combined ilioinguinal-iliohypogastric neuralgias, and the side of the lesion and sex of the patient were found to be evenly distributed in this group. Nerve blocks must have resulted in a complete or substantial decrease in pain before a neurectomy was recommended. Twenty-nine (88%) of 33 neuralgia patients had injuries from iatrogenic causes, and 4 (12%) injuries were caused by blunt trauma. In the 23 isolated ilioinguinal neuralgias, the operation associated with neuralgias in 13 (57%) of 23 patients was a herniorrhaphy. This was followed by 4 (17%) neuralgias after an appendectomy and 3 (13%) after a hysterectomy. Three (13%) patients had neuralgias resulting from blunt trauma. Nine (90%) of 10 ilioinguinal-iliohypogastric lesions were caused by iatrogenic causes, and 1 (10%) neuralgia resulted from blunt trauma. A neurectomy was performed in all patients. The neurectomy resulted in considerable pain relief in 21 (91%) of 23 patients with ilioinguinal lesions and 9 (90%) of 10 patients with ilioinguinal-iliohypogastric lesions. Postoperative side effects were persistent numbness below the resected nerve and loss of the cremasteric reflex. Minor postoperative complications consisted of two superficial skin infections. Ilioinguinal and ilioinguinal-iliohypogastric neuralgias are infrequent conditions; however, 33 patients from the Louisiana State University Health Sciences Center were accrued and analyzed in this study, and most had significant pain relief after neurectomy.

Constipation: Can't Tether the Symptoms to the Diagnosis

Constipation: Can't Tether the Symptoms to the Diagnosis

Central and peripheral motor conduction to cremasteric muscle

The few electrophysiologic studies of the cremasteric muscle (CM) have mainly been restricted to the cremaster reflex with no reference to central and peripheral nerve conduction to the muscle, probably for technical reasons.Twenty-six normal adult male volunteers were studied by transcranial magnetic cortical stimulation (TMS) and stimulation of thoracolumbar roots. The genitofemoral nerve (GFN) was stimulated electrically at the anterior superior iliac spine and a needle electrode was inserted into the CM for conduction studies. The motor latency to the CM from the cortical TMS ranged from 20 to 33 ms among the subjects (25.8 +/- 2.9 ms, mean +/- SD). Magnetic stimulation of the lumbar roots produced a motor response of the CM within 9.6 +/- 1.9 ms (range, 6-15). The central motor conduction time to the CM was 16.5 +/- 2.8 ms (range, 10-21). Stimulation of the GFN produced a compound muscle action potential with a mean value of 6.4 +/- 1.8 (range, 4-10) ms in 23 of the 26 cases. Thus, central motor nerve fibers to the CM motor neurons exist, and there may be a representation area for the CM in the cerebral cortex. The GFN motor conduction time to the CM may have clinical utility, such as in the evaluation of the groin pain due to surgical procedures in the lower abdomen.