Localization Of Undescended Testis Research Articles

Role of Diffusion Weighted Imaging in Localization of Non-palpable Undescended Testes Taking Laparoscopic Finding as Gold Standard

Objective: To ascertain the accuracy of diffusion-weighted imaging (DWI) in the localization of undescended testes. Material & Methods: This prospective cross-sectional study was conducted in the radiology department of a tertiary care hospital from 01-06-2022 to 15-12-2023. Total of 150 patients were included in the study. Two experienced radiologists independently examined, one observing conventional MRI alone and the other observing DWI-MRI. Following that, all of the patients underwent laparoscopic examination. The data was entered into a proforma. The findings of conventional MRI alone and DWI-MRI were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of DWI in comparison to laparoscopy. Results. The average age was 10.37 +/- 5.663. Conventional MRI imaging localized 50.6 % of the cases in our study, 55% of cases via DWI-MRI and 60% by laparoscopy. Sensitivity, specificity, PPV, NPV, and accuracy of conventional MRI were 72 %, 83 %, 86 %, 66 % and 76 % respectively, while for DWI-MRI was 82 %, 86 %, 93 %, 89 %, and 78 % respectively. Conclusion: The detection of undescended testes is improved by DWI-MRI. DWI-MRI is a recommended imaging tool for improving MRI's preoperative diagnostic accuracy in localization and identification of nonpalpable undescended testes.

To determine the sensitivity, specificity, and diagnostic accuracy of diffusion-weighted MRI in localization of non-palpable undescended testes taking laparoscopic findings as the gold standard: A cross-sectional study from Pakistan

BackgroundCryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. MethodsA cross-sectional study was conducted in the radiology department of a tertiary care hospital from September 27, 2018 to September 26, 2019. A total of 416 patients were included. Abdomen-pelvic and scrotal ultrasound were performed. Preoperative abdominal and pelvic DW-MRI was performed with a 1.5-T MRI system using a body coil. All study patients underwent laparoscopic exploration. Intra-abdominal atrophic testes were treated with laparoscopic orchiectomy and orchiectomy samples were taken for histopathologic examination. DW-MRI findings were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW-MRI taking laparoscopy as the gold standard. ResultsThe mean age was 17.08 ± 7.99 years and the mean BMI was 19.36 ± 4.96 kg/m2. In our study, 34.1% of cases were diagnosed as undescended testes localized by DWI-MRI and 51% of cases were diagnosed as undescended testes localized via laparoscopy. Sensitivity, specificity, PPV, NPV and accuracy were 65.1%, 98%, 97.2%, 73% and 81.3% respectively. ConclusionDW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes.

When to ask for an MRI of the scrotum.

BackgroundMultiparametric MRI (mpMRI) of the scrotum has been established as a useful second‐line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology.ObjectiveTo update current research on when to ask for an MRI of the scrotum.MethodsPubMed database was searched for original articles and reviews published during 2010–2021.ResultsEighty‐three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord‐stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis‐sparing surgery), differentiation between seminomas and non‐seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non‐diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists.ConclusionMultiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem‐solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.

Awareness of Common Pediatric Surgical Entities among Practicing Indian Pediatricians.

Aim:Common pediatric surgical entities often get a delayed referral to the pediatric surgeon in the average Indian scenario. This study was conducted to assess the awareness about management of select common pediatric surgical entities among practicing pediatricians.Materials and Methods:An online multiple-choice questionnaire consisting of twenty questions related to the diagnosis and management of common pediatric surgical entities encountered by pediatricians in their routine office practice was prepared, and the electronic link was circulated among the practicing pediatricians of India. Each question had one correct response.Results:One hundred and seventy-five responses were obtained, collated, grouped, and analyzed. Overall, 35% of all responses were correct. Individually, 56% of respondents marked 51%–75% of answers correctly; only 7% scored above 75%. Some clinical observations were disparate: 65% were unfamiliar with preputial adhesions and 51% would discharge a preterm neonate with inguinal hernia without a surgical consult. There is a tendency toward unnecessary imaging (60% – localization of undescended testis, 91% – wet umbilicus, and 51% – postanal dimple) and overzealous medical management (propranolol for the involuting hemangioma). However, 82%–88% concurred on the standard conservative or surgical management in index conditions such as hypospadias and umbilical problems.Conclusion:There was a concurrence in the principles of management of common pediatric surgical entities between pediatricians and pediatric surgeons in 35%. Misdiagnosis, unwarranted investigations, overzealous medical management, and delayed surgical consults figured in 65%. A systematic professional interaction between the physicians and surgeons would facilitate a coordinated management. A larger study would yield more meaningful data.

Undescended Testis With Seminoma

A 26-year-old male patient was admitted to our hospital because of an empty scrotum. Empty scrotum was noted when he was an infant. But he did not go to the hospital then, because his family thought the undescended testes could descend. It was only 4 years previously that he was admitted to our hospital for help, and computed tomography (CT) of abdomen showed an undescended testis over the left inguinal region, and the right undescended testis was not found. Surgical intervention was suggested, but the patient hesitated and was discharged without management. Loss of outpatient department follow-up was noted thereafter. This time, he was admitted for management of his condition. After admission, nothing remarkable was noted except for the empty scrotum. Laboratory examination revealed normal results. CT of the abdomen was performed, and showed an undescended testis in the left inguinal region and a mass measuring about 63 × 69 mm in size in the pelvic cavity, with the initial impression of seminoma (Figure 1). Excision of the tumor of the pelvic cavity was done, and the pathologic report confirmed the diagnosis of seminoma. Orchiopexy of the left testis was also carried out. The postoperative course was uneventful, and the patient was discharged in stable condition. Outpatient department follow-up was recommended. Undescended testis is common in infants and children. According to the study by Scorer and Farrington,1 undescended testis occurs in about 30% of premature babies and in only 3.4% of full-term babies. Its occurrence decreases to 0.8% at 1 year old, with no change in its occurrence till puberty.1 This infers that it is not easy for the undescended testis to descend into the scrotum spontaneously after 1 year of age. Undescended testis can cause malignant degeneration and infertility. Besides, malignant change in the undescended testis is about 12–40 times that of the testis in the scrotum.2 Seminoma makes up a larger portion of the germ cell tumors in undescended testes (60%) than in tumors of scrotal testes (40–50%).3 Undescended testes should be placed into the scrotum surgically for the following reasons: assure the greatest possibility of fertility, prevent torsion of the testes, repair an accompanying hernia, achieve cosmetic factor, and permit examination for tumor. About 20% of undescended testis cannot be palpated clinically.4–7 These undescended testes can be located anywhere from the renal hilum to the inguinal region.8 Because of the length of time it takes for complete surgical exploration and because the testis may be missed during surgical exploration, preoperative imaging localization of the undescended testis is essential. Ultrasonography (US) is the initial preoperative imaging localization of the undescended testis in pediatric cryptorchid patients. If the result of US is negative or equivocal, then CT is recommended. In patients with cryptorchidism after puberty, CT is recommended as the initial preoperative imaging localization. If the undescended testis cannot be found in the examination using US and CT, then gonadal venography is recommended. Because of the symmetry of normal structures in the human inguinal canals and pelvic cavity, preoperative imaging localization of undescended testis is achieved by the unexplained soft tissue mass in the inguinal canals and pelvic cavity on US (Figure 2) and CT (Figure 1). Diagnosis of undescended testis is made by demonstration of the pampiniform plexus of gonadal vein in gonadal Accepted: November 26, 2009 *Corresponding author. Department of Radiology, Taipei Veterans General Hospital, 201, Shih-Pai Road, Section 2, Taipei 112, Taiwan. E-mail: wangjh@vghtpe.gov.tw CME Credits

The importance of preoperative radiological assessment in intersex patients

[1]. They performed laparoscopy in 14 patients among 80 intersex patients, in order to observe gonadal structures, obtain biopsy if necessary and remove them in selected cases. Out of these 14 patients, five cases with androgen insensitivity syndrome (AIS) underwent laparoscopic gonadectomy with subsequent estrogen replacement following gonadal biopsies. As authors emphasized, the procedure is minimally invasive with low morbidity, shorter postoperative recovery period and less formation of cutaneous scars. It also provides magnified and easy access to the pelvic and peritoneal cavity. However, precise radiological evaluation has to be accomplished for the establishment of additional congenital anomalies related with other organ systems, mainly the urinary system in intersex patients. Since the Mullerian ducts develop in association with the Wolffian ducts and derivatives, the clinician must expect renal abnormalities if maldevelopment or absence of Mullerian structures were noticed. For this purpose, use of magnetic resonance imaging (MRI) technique has some advantages over other imaging modalities. Particularly, good contrast resolution and soft tissue visualization allow exact localization of undescended testes or immature gonadal structures. It was reported that in up to 86% of cases with AIS or true hermaphroditism, gonadal structures were localized accurately with MRI [2]. We recently diagnosed a case of complete ASI with solitary pelvic kidney [3]. She was a 16-year-old female who was admitted initially with the chief complaint of amenorrhea. It was seen that her kidney was localized in bony pelvis between the dome of the bladder and sacrum on left side. In addition, gonadal structures were clearly demonstrated in pelvic sections of MRI. So, coexistence of other congenital anomalies in patients with intersex disorders must be kept in mind. Although detailed evaluation is sometimes regarded as unnecessary and time consuming, it gives the precise localization of pelvic organs to the surgeon, preoperatively. In conclusion, during surgical treatment of these patients, especially with minimally invasive techniques like laparoscopy, preoperative assessment with MRI allows the surgical anatomy to be handled easily. In addition, possible intraoperative injuries to other organ systems could be prevented, especially when experience in laparoscopic procedures is not excessive. Certainly, this is not the case for Dr. Chertin and associates, as they successfully operated more than 80 intersex patients, including 14 cases which were laparoscopically managed without any complication.