Intra-abdominal Testes Research Articles

6694 A Case of an Extraneous Organ: A Uterus Found in a Genotypic and Phenotypic Male

Abstract Disclosure: R.A. Zielinski: None. S. Shteyman: None. A.G. Samat: None. Background: Persistent Mullerian Duct Syndrome (PMDS) is a rare entity that occurs when a phenotypic male is found to have female reproductive organs. In our case we describe an XY male who was found to have an abdominal mass consistent with a uterus on pathology. Clinical Case: Our patient is a 58-year-old male with hypertension, obesity, and obstructive sleep apnea who presented to the ED with 3 weeks of left upper quadrant pain. Abdominal CT showed two homogeneous enhancing oval lesions in the pelvis superior to the urinary bladder; 8.3 x 4.6 cm on the right and 3.6 x 3 cm on the left. Exploratory laparotomy was performed, and intraoperatively the mass was firm with a left satellite lesion and two fibrous bands that appeared similar in structure to round ligaments. Microscopically the tissue contained mullerian-type epithelium and smooth muscle with cystic degeneration. It was CK7 positive, estrogen receptor variable positive, and CK20 negative. Genetic testing confirmed the patient’s karyotype to be XY without genetic mosaicism. Our patient had two children spontaneously, regular spontaneous erections, and occasional hot flashes. Physical exam revealed an obese male (BMI 51) with bilateral gynecomastia and normal testicular size. He had no history of intra-abdominal or undescended testes requiring surgery. Labs showed increased total estrogen (283.7 pg/mL, n 60-190 pg/mL) and estradiol (39 pg/mL, n <= 29 pg/mL), decreased total testosterone (86 ng/dL, n 250-1,100 ng/dL), and normal free testosterone when corrected for SHBG (140 ng/dL, n 110-574 ng/dL). Testicular ultrasound was unrevealing. 3 years postoperatively his estradiol level normalized (34 pg/mL) and his total testosterone improved from 86 ng/dL to 223 ng/dL after losing 40 pounds on semaglutide. Discussion and Conclusion: Although the exact incidence of PMDS is unknown, it is a rare phenomenon. Only 200 cases between 1964 and 2000 and 34 cases between 2013 and 2017 have been reported. Mullerian ducts are embryologic structures present in both XY and XX fetuses until week 8 of life, when XY fetuses produce anti-mullerian hormone (AMH). In PMDS, the XY fetus either fails to produce AMH, or there is a defect in the AMH receptors, leading to the persistence of mullerian ducts. These ducts can then differentiate into a uterus, fallopian tubes, and/or the upper vagina. Our patient is a genotypical and phenotypical male with a uterus-like organ. The mild elevation in his estrogen level is likely secondary to his obesity. The estrogen could have increased the size of the uterus, causing the patient’s initial symptoms of abdominal pain which prompted his presentation to the hospital.

ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes

Abstract Aim SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015). We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique. Methods Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023). The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above. A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure. Results The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.

Comparative Outcomes of Single-Stage versus Two-Stage Laparoscopic Fowler-Stephens Orchidopexy: A Systematic Review snd Meta-Analysis.

Intra-abdominal testis (IAT) remains a challenging and controversial subset within the management of cryptorchidism. While Fowler-Stephens orchidopexy (FSO) is still being advocated as the gold standard for the treatment of this entity, there is new and conflicting evidence on the comparative outcomes between single- or two-stage laparoscopic FSO (LFSO). The aim of the study is to investigate whether staging has benefits in children receiving LFSO. We searched the PubMed, Medline, Embase, and Cochrane Trials databases for studies comparing single- with two-stage LFSO in children from January 1, 1995 to December 31, 2023. We assessed the identified studies for quality and performed a systematic review and meta-analysis in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses. The main outcome measures examined were success rate (in terms of the scrotal position of the testis) and testicular atrophy, which were analyzed using fixed effect models. We included 17 eligible studies that involved a total of 499 operated testes. The overall success rates of single- and two-stage LFSO were 79.4 and 90.3%, respectively. The overall testicular atrophy rates of single- and two-stage LFSO were 17.3 and 11%, respectively. Fixed effect model analysis showed that two-stage LFSO is significantly superior to single-stage LFSO in overall success rate (odds ratio [OR: 2.57]; 95% confidence interval [CI]: 1.50-4.39, p = 0.0006) and testicular atrophy rate (OR: 0.48; 95% CI: 0.28-0.79, p = 0.004). There is no heterogeneity in the reports, and the funnel plot showed no publication bias. Two-stage LFSO remains the first choice of operation for children with a high IAT, with a significantly higher success rate and a lower testicular atrophy rate.

Incarcerated Intestine by Testicular Mass in Huge Scrotum: A Case Report

Large testicular tumor is not a commonly seen entity in the modern era. While treatment of large testicular tumors is via inguinal radical orchiectomy, large testicular tumors carry the dilemma of delivering these large masses via the inguinal or scrotal approach. Our case was a 90 years old man with obstruction signs and huge scrotum that shows incarcerated large bowel with huge testicular mass, that in his surgery we did Radical Orchiectomy and we replace incarcerated Large Bowel in scrotum and discharge him successfully. Giant testicular cancer is considered one of the largest testicular masses in the world. Delayed seeking medical advice and appropriate management is the major cause behind this rare presentation. Increasing the awareness regarding self-examination and eliminating the stigma is the cornerstone to markedly reduce this type of unusual presentation since any testicular size change and mass can be easily noted by the patient. Surgical exploration and adjuvant chemotherapy seems as a reasonable treatment option in the setting of bilateral intra-abdominal testis tumor in an adult patient. The study underscores the effectiveness of the intervention in promoting preventive behaviours against testicular cancer among university students, laying the groundwork for future educational initiatives. Although testicular cancer (TC) is the most common malignancy in males between the ages of 18 and 50 years, little effort has been made to increase public awareness about TC and testicular self-examinations (TSEs). Intestinal obstruction without a past surgical history of abdominal surgeries or trauma is a rare and challenging clinical situation. This case report describes the presentation, diagnosis, and management of intestinal obstruction in a patient with an uncommon aetiology of small bowel obstruction. Chronic hernia incarceration can lead to weakening and ischemia of the bowel, and minimal trauma can lead to perforation of the weakened segment. In such presentations, bowel resection and repair of the defect with a biological material is safe and feasible.

Shehata technique versus Fowler-Stephens orchidopexy in intra-abdominal testis: A meta-analysis

IntroductionThe management of intra-abdominal testis (IAT) represents a significant clinical challenge, necessitating the transposition of the testis from the abdominal cavity to the scrotum. This procedure is rendered complex by the abbreviated length of the testicular vessels. ObjectiveOur purpose in this study was to conduct a systematic review and meta-analysis comparing Shehata technique (ST) versus Fowler Stephens technique (FST) in treating patients with IAT. Study designWe conducted a comprehensive literature search using several databases, including Ovid Medline, Cochrane, PubMed, Google Scholar, Web of Sciences, EMBASE, and SCOPUS until February 2024. This study included research that compared ST and FST for managing intra-abdominal testis. We evaluated the rates of atrophy and retraction, as well as the overall success rates, for both techniques. ResultsSix studies were identified as appropriate for meta-analysis, comparing orchidopexy performed using the ST with 169 patients, against the FST involving 162 patients. The comparison showed no statistically significant age difference at the time of surgery between the groups (I2 = 0%), (WMD 0.05, 95% CI − 1.24 to 1.34; p=0.94). Operative time in first the stage was lower in the FST group than ST group (I2 = 95%), (WMD 10.90, 95% CI 1.94 to 19.87; p=0.02). Operative time in the second stage was lower in the ST group than FST group (I2 = 83%), (WMD - 6.15, 95% CI - 12.21 to -0.10; p=0.05). Our analysis showed that ST had a similar atrophy rate (I2=0%) (OR: 0.45, 95% CI: 0.20 to 1.01; p=0.05). No difference was found between techniques in terms of retraction rate (I2=0%) (OR: 0.64, 95% CI: 0.17 to 2.47; p=0.52). The ST demonstrated a notably higher overall success rate compared to FST (I2=1%) (RR: 1.14, 95% CI: 1.03 to 1.27; p=0.009). Overall success rate in ST and FST were 87% and 74%, respectively. Overall atrophy rate in ST and FST were 5% and 12%, respectively. Overall retraction rate in ST and FST were 5% and 10%, respectively. DiscussionThe ST, renowned for its pioneering two-stage laparoscopic approach that leverages mechanical traction to lengthen the testicular vessels, is gaining popularity due to its recognized safety and efficacy. Conversely, the Fowler-Stephens technique, a traditional method that relies on collateral blood supply for testicular mobilization, has come under examination for its potential link to an increased risk of testicular atrophy. ConclusionThis meta-analysis reveals that the Shehata technique has similar or better outcomes compared to the Fowler-Stephens technique in IAT management. Further prospective multicentric randomized controlled trials are warranted.

Two-stage orchiopexy for intra-abdominal testis with short spermatic vessels wrapped in anti-adhesion conduit. 25 years of experience

Treatment of high cryptorchidism can be challenging, often with frustrating results. We report 25 years of experience in the treatment of the cryptorchidism with very short spermatic vessels using an original two-stage orchiopexy that preserves the spermatic vessels. We reviewed the clinical charts of children affected by cryptorchidism with very short spermatic vessels treated through our original surgical approach in tree Institutes of Pediatric Surgery. The first stage of the procedure started with an inguinal incision and a standard orchiopexy with a deep mobilization in the retroperitoneum to straighten the spermatic vessels that are entirely preserved. After realizing intraoperatively that such maximal retroperitoneal mobilization cannot ensure a satisfactory scrotal position of the testis, the spermatic cord is wrapped in a thin sheet of polytetrafluoroethylene (PTFE) shaped as a conduit. The testis is fixed to the bottom of the scrotum which remains invaginated due to the tension. [Fig.A - scheme of the operation]. This first stage can also be performed in laparoscopy, with a video-assisted positioning of the PTFE conduit [Fig.B - laparoscopic view with vessels and vas respectively marked by black and white arrows]. The second surgical stage is scheduled after 6-12 months to remove the PTFE conduit. A group of 100 children affected by cryptorchidism and very short spermatic vessels (9 bilateral, 86 intra-abdominal, 23 "peeping" at the internal ring) for a total of 109 testes underwent surgery with a two-stage procedure. From the first to the second stage, a progressive lowering of each testis towards the scrotum was observed. During the second stage, after removal of the PTFE sheet, the preserved cord was loose in the inguinal canal and all the testes were located in the scrotum: 68 testes were found correctly located with no further care needed, while 41 were still in a high scrotal position. However, the latter were easily detached from the scrotal bottom and re-fixed in a more satisfactory location. At 1-9 years follow-up all the testes but one (99%) were in the correct scrotal position with stable or increased testicular volume [Fig.C], while 1 testis vanished. No complications were observed all along the follow-up. This long term 25-year review indicates that our original surgical technique guarantees a high rate of success with neither evident contraindications nor drawbacks for patients affected by undescended testes with spermatic vessels so short to be untreatable through a standard orchiopexy.

Comparison between staged laparoscopic technique in children with high intra-abdominal undescended testis: a systematic review and meta-analysis.

This study performed a systematic review and meta-analysis to compare the outcomes of the staged laparoscopic Fowler-Stephens Laparoscopic Orchiopexy (FSLO) and Staged Laparoscopic Traction Orchiopexy (SLTO) in patients with intra-abdominal testes (IAT). This study reviewed literature published from 2016 to 2024. A systematic literature search was conducted on three databases: PubMed, ScienceDirect, and Google Scholar, using keywords (High intra abdominal testis) AND (("Fowler Stephens laparoscopic orchiopexy" OR (FSLO)) OR (Staged Laparoscopic traction orchiopexy OR (SLTO)). Non-randomized trials and observational studies comparing staged laparoscopic FSLO and SLTO, without any time range restriction are included. Studies without FLSO orchidopexy as a control, case reports, case studies, duplicate publication, no full text and non-English studies are excluded. This study used the PRISMA protocol, the Jadad Scale, and the Newcastle Ottawa Scale (NOS) to evaluate the included studies. To analyze statistical data, the Review Manager (RevMan) software was used. The Chi-squared test was used to calculate statistical heterogeneity in the meta-analysis. There were 240 patients from 5 studies (109 in the SLTO group and 131 FSLO in group). The primary outcome of this study is testicular descent and atrophy. There were no significant differences in testicular descent (RR:1.08[0.96 - 1.23],p<0.20,I 2:0%) and atrophy rate (RR:0.45[0.19 - 1.09],p<0.08,I 2:0%). Secondary outcomes are the duration of operation in both the first and second stages. Statistical analysis reveals a significantly lower first-stage operation time in the FSLO group (MD:9.31[7.08,11.55], p<0.05;I 2:94%). At the same time, lower second-stage operation times are significantly reported in the SLTO group (MD:-4.05[-7.99,-0.12],p<0.05; I 2:60%). In terms of testicular descent and testicular atrophy the SLTO technique yields similar results to the FSLO technique. Both techniques have advantages and disadvantages, and we recommend SLTO as the first choice in children with a high IAT of <4 cm. CRD42023412407.

Retrospective analysis of laparoscopic and open orchidopexy for non palpable intra-abdominal testes in a tertiary care centre

Purpose: Patients with non-palpable testes has numerous treatment options, the most effective treatment is still controversial. Laparoscopy has nowadays gained the trust as the most reliable modality for the management of impalpable testis. The aim of our study was to retrospectively analyse the laparoscopic and open orchidopexy procedures and report the outcome of our series. Material and methods: 120 patients with 130 non palpable testes with a mean age of patients about 2.7 years who had undergone orchidopexy by open and laparoscopic methods over past 8 years. Results: Mean age of open group was similar to laparoscopic group (2.7 ± 1.7 vs 2.5 ± 1.5 years; p &gt; 0.05). 10 patients (8.33%) presented with bilateral non palpable testes. 10 testes from the open group and 8 from the laparoscopic group were of vanishing variety. Fowler -Stephens staged procedure was done for 4 testes in laparoscopic group. The mean operative time was more in the laparoscopic group than the open (63min vs 47min). Laparoscopic orchidopexy group had generally lesser use of analgesics. The mean hospital stay between the open and laparoscopic groups was 2.1 vs 1.3 days (p &lt;0.05). 12 cases of testicular atrophy were noted, 7 from the open group and 5 from the laparoscopic group. Conclusion: Results of open and laparoscopic orchidopexy procedures were fairly constant. Although, laparoscopy gives significantly less morbidity, is less painful, has lesser hospital stay and is cosmetically better. Keywords: cryptorchidism; laparoscopy; orchidopexy; testis

The Safety and Effectiveness of Single-Stage, Vessel-Preserving, Laparoscopic Orchiopexy for Intra-Abdominal Testes in Pediatric Patients: A 10-Year Single-Center Experience.

Objectives: Intra-abdominal testes are located in a variety of intra-abdominal positions, most less than 2 cm from the internal ring. Various surgical techniques of laparoscopic orchiopexy have been described to date. The aim of this study was to evaluate the safety and long-term efficacy of a single-stage, vessel-preserving, laparoscopic orchiopexy for intra-abdominal testes in pediatric patients. Methods: A retrospective search of the medical records of 32 children (34 testes) who underwent single-stage, vessel preserving, laparoscopic orchiopexy for intra-abdominal testes between 1 January 2014 and 31 December 2023 was performed. Single-stage laparoscopic orchiopexies were performed in all patients for whom sufficient length of the spermatic cord was achieved during the procedure. The volume of each patient's testes was measured using ultrasound before and 6 months after laparoscopic orchiopexy. The main outcome of this study was testicular volume before and after the procedure. The secondary outcomes were the occurrence of early and late complications, the duration of surgery, and the length of hospital stay. Results: The median age at the time of surgery was 10 months (interquartile range-IQR 9, 13). The majority of the children (n = 24; 75%) were less than 12 months old at the time of surgery. A normal testis was found in 24 patients (70.6%), while a hypotrophic testis was visible in 10 cases (29.4%). The majority of the testes were located near the internal ring (n = 19; 55.9%), while in the remaining cases, the testes were located near the iliac blood vessels. The median duration of the surgical procedure was 37.5 min (IQR 33, 42.5). The duration of hospitalization was one day for all the children. No intraoperative complications were observed. One child had a wound infection at the site of the umbilical trocar, which was treated conservatively. In two cases (5.5%), testicular atrophy was detected during long-term follow-up. In three cases, the testis was found in a higher position in the scrotum during the follow-up period, but in two cases, the position was normal during the follow-up period, while in one case, the position in the scrotum remained unchanged. At long-term follow-up with a median of 35 months (IQR 19, 60.5), the overall success rate was 94.5%. The median testicular volume at 6-month follow-up increased from 0.31 mL (IQR 0.28, 0.43) to 0.40 mL (IQR 0.33, 0.53) (p = 0.017). Conclusions: Single-stage, vessel-preserving, laparoscopic orchiopexies for intra-abdominal testes are safe and effective in pediatric patients in whom adequate spermatic cord length can be achieved during the procedure.

Laparascopic management of non-palpable testis

We present a new approach to high intraabdominal testis (IAT) for elongation of the testicular vessels without division. The technique entails fixation of the testis to a point one inch above and medial to the contralateral anterior superior iliac spine for 12 weeks. Subdartos orchiopexy is then done as the second stage. Both stages are laparoscopically assisted. The a new approach to high intraabdominal testis, two-stage laparoscopic traction-orchiopexy, is useful and resulted in significant elongation of the testicular vessels without atrophy. It is a safe and valid alternative to the two-stage laparoscopic Fowler–Stephens technique, which entails division of the main testicular vessels.

Commentary to Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? a multicentric comparative study

Commentary to Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? a multicentric comparative study

Response to commentary on: Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division Vs traction? a multicentric comparative study

Response to commentary on: Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division Vs traction? a multicentric comparative study

PIEZO1 loss-of-function compound heterozygous mutations in the rare congenital human disorder Prune Belly Syndrome

Prune belly syndrome (PBS), also known as Eagle-Barret syndrome, is a rare, multi-system congenital myopathy primarily affecting males. Phenotypically, PBS cases manifest three cardinal pathological features: urinary tract dilation with poorly contractile smooth muscle, wrinkled flaccid ventral abdominal wall with skeletal muscle deficiency, and intra-abdominal undescended testes. Genetically, PBS is poorly understood. After performing whole exome sequencing in PBS patients, we identify one compound heterozygous variant in the PIEZO1 gene. PIEZO1 is a cation-selective channel activated by various mechanical forces and widely expressed throughout the lower urinary tract. Here we conduct an extensive functional analysis of the PIEZO1 PBS variants that reveal loss-of-function characteristics in the pressure-induced normalized open probability (NPo) of the channel, while no change is observed in single-channel currents. Furthermore, Yoda1, a PIEZO1 activator, can rescue the NPo defect of the PBS mutant channels. Thus, PIEZO1 mutations may be causal for PBS and the in vitro cellular pathophysiological phenotype could be rescued by the small molecule, Yoda1. Activation of PIEZO1 might provide a promising means of treating PBS and other related bladder dysfunctional states.

A prospective study on disorders of sex development in Duhok city, Kurdistan region, Iraq: Genetic, etiology and clinical presentation.

Disorders of Sexual Development (DSD) encompass all types of intersex cases and have been reported globally. However, in Iraq, studies related to DSD are scanty. The current single-center prospective study was carried out to find out the frequency, genetic and clinical presentation of different types of DSDs in the sample population of Duhok, Iraq. The sample comprises 40 DSD patients who have been referred to Hivi Pediatric Teaching Hospital in Duhok, Kurdistan region, Iraq, from June 2017 to June 2022. We conducted karyotype-based classification, laparoscopic-based internal organ diagnosis and abdominal ultrasound to diagnose DSDs in the target population. Of the total 40 cases, 19 (47.5%) were males, and 21 (52.5%) were females. Among them, 85 % were diagnosed as peno- scrotal hypospadias, 10% had clitoromegaly and the remaining were diagnosed as under-developed female-like genitalia. The majority of the patients were diagnosed with congenital adrenal hyperplasia (CAH) (55%), 37.5% were Testicular Feminization Syndrome (TFS) and the remaining were rare categories that we did not reach final diagnosis. Laparoscopy was done for 77.5 % of the participants of whom 30% had small uterus and ovaries, 25% had Intra-abdominal testes and the remaining had testes &ovaries, Mullerian Inhibitory Factor (MIF) deficiency and TFS. The study found different types of DSDs in the target population that requires both physical and psychological intervention. Future studies should focus on evaluating DSDs in larger populations and at multi-centers to understand the condition's trajectory in the Iraqi population.

Comparison between staged laparoscopic technique in children with high intra-abdominal undescended testis: a systematic review and meta-analysis

Background: This study performed a systematic review and meta-analysis to compare the outcomes of the staged laparoscopic Fowler-Stephens Laparoscopic Orchiopexy (FSLO) and Staged Laparoscopic Traction Orchiopexy (SLTO) in patients with intra-abdominal testes (IAT). Methods: This study reviewed literature published from 2016 to 2023. A systematic literature search was conducted on three databases: PubMed, ScienceDirect, and Google Scholar, using keywords (High intra abdominal testis) AND (("Fowler Stephens laparoscopic orchiopexy" OR (FSLO)) OR (Staged Laparoscopic traction orchiopexy OR (SLTO)). Non-randomized trials and observational studies comparing staged laparoscopic FSLO and SLTO, without any time range restriction are included. Studies without FLSO orchidopexy as a control, case reports, case studies, duplicate publication, no full text and non-English studies are excluded. This study used the PRISMA protocol, the Jadad Scale, and the Newcastle Ottawa Scale (NOS) to evaluate the included studies. To analyze statistical data, the Review Manager (RevMan) software was used. The Chi-squared test was used to calculate statistical heterogeneity in the meta-analysis. Results: This study included four studies of 151 patients (72 SLTO group and 79 FSLO group). There was no significant difference between the two groups in terms of testicular descent (p=0.08), and there was no testicular atrophy in the SLTO group compared to the FSLO group (p=0.04). Statistical analysis revealed a significantly shorter first-stage operation time in the FSLO group (p 0.0001), whereas the SLTO group reported a significantly shorter second-stage operation time (p = 0.04). Conclusions: In terms of testicular descent, the SLTO technique yields similar results to the FSLO technique. The SLTO position is preferable to the FSLO position. Both techniques have advantages and disadvantages, and we recommend SLTO as the first choice in children with a high IAT of 4 cm. PROSPERO registration: CRD42023412407

Techniques of staged laparoscopic orchidopexy for high intra-abdominal testes in children: A systematic review and meta-analysis.

Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis. The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy. The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures. Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.

Morris syndrome (Androgen Insensitivity Syndrome)

Morris syndrome, also known as Androgen Insensitivity Syndrome (AIS), is an intriguing and extraordinary genetic condition that exerts a remarkable influence on individuals with male sex chromosomes (XY). Within the realm of this rare syndrome, the body displays a captivating indifference to androgens, the very essence of male hormones like testosterone, leading to the emergence of physical characteristics typically associated with the female gender. It is an occurrence that befalls a mere fraction of the population, affecting around 1 in 20,000 individuals. Morris syndrome is caused by a genetic mutation located on the sex X chromosome affecting the AR (androgen receptor) gene. Androgen insensitivity syndrome is characterized by the presence of external female phenotype, 46,XY karyotype, and intraabdominal testes. This syndrome is the third most frequent cause of primary amenorrhea, after gonadal dysgenesis and congenital absence of the vagina. In approximately 40% of AIS patients, there is no family history of the disease. Morris syndrome unfolds with an intricate interplay of internal and nonfunctional testicles, which, despite their presence, fail to fulfill their intended biological purpose of sperm production. Meanwhile, on the external front, the genitalia manifest a striking semblance to that of the female anatomy, featuring a vagina and labia. Additionally, some individuals with Morris syndrome may witness the existence of an enlarged clitoris, bearing an uncanny. Comprehending Morris syndrome is vital for healthcare professionals to offer accurate diagnoses and appropriate treatment modalities. Increased awareness among the general populace can foster an inclusive and supportive environment for individuals navigating life with Morris syndrome. Objective: The objective of this article is to provide a comprehensive understanding of Morris syndrome, also known as Androgen Insensitivity Syndrome (AIS), including its genetic basis, clinical manifestations, challenges faced by individuals with the syndrome, and the importance of accurate diagnosis and appropriate treatment modalities. Methods: To achieve the objective, the article will employ a literature review approach, drawing information from scientific and medical sources. Peer-reviewed research articles, medical textbooks, and authoritative online resources will be consulted to gather relevant information on Morris syndrome.

Incidental Inguinal Tubercular Lymphadenitis in a female of Androgen Insensivity Syndrome- A rarest of rare presentation

Androgen insensitivity syndrome (AIS) is a rare X-linked recessive disorder occurring in phenotypic women with male genotype (46, XY) resulting due to mutation in the X chromosome. On the other hand, tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis, an acid-fast bacillus. We report a case of a 22-year-old unmarried female presenting with bilateral inguinal pain and primary amenorrhea, which, on comprehensive evaluation, revealed complete female external genitalia and intra-abdominal testes. The karyotype was 46 XY, hence a diagnosis of complete AIS was made. One of the ‘probable testes’ removed surgically was an inguinal lymph node with tuberculous lymphadenitis. Isolated inguinal tuberculous lymphadenopathy, by itself, is rare. Co-occurrence of Complete AIS and inguinal tuberculous lymphadenopathy is a highly unusual and rare association that has not been documented in the literature reviewed.

Acquired Intrabdominal Testis Due to Adhesions After Necrotizing Enterocolitis

Un descendent testis (UDT) refers to absence of the testicle in the hemiscrotum. It happens usually due to the stagnation of the testicle during the descent.

Medium-Term Results of Staged Laparoscopic Traction Orchiopexy for Intra-abdominal Testes: A Multicenter Analysis

BackgroundStaged laparoscopic traction orchiopexy (SLTO) is a novel technique for the intra-abdominal testis (IAT) based on elongation of the testicular vessels without separating them. This multicenter study evaluated the medium-term results of this technique. MethodsData of SLTO performed in three pediatric surgical centers between 2013 and 2020 were analyzed retrospectively. In 2021, physical and Doppler ultrasound examinations were performed to determine the position and viability of testes. Success was defined as an intra-scrotal testicle without atrophy. ResultsSLTO was performed on 48 cases (55 testes, 7 bilateral). Mean age at first stage was 2.9 (0.8–12.6) years. High intra-abdominal testes were found in 16.4% and in 60% morphological abnormalities were observed. To fix the testes to the abdominal wall monofilament suture was used in 67.3%, braided in 29.1%. Mean time between the two stages was 16.4 weeks; three testes required redo traction.Perioperative complications occurred in 21 patients (38.2%) including insufficient fixation (11), testicular atrophy (4), wound complications (4), adhesion of the spermatic cords (1) and hydrocele (1). In case of insufficient fixation monofilament sutures were used in 90.9%.In 2021 38 patients (43 testes) had physical and 36 patients (41 testes) had ultrasound examinations. Mean follow-up was 2.7 (0.34–7.9) years. Altogether five atrophies were identified, and three testicular ascents (7.0%) occurred. The overall success rate was 82.2%. ConclusionsSLTO may be a feasible alternative to conventional treatments of IATs. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall. Level of EvidenceLEVEL IV.