Nonpalpable Testis Research Articles

Utility of diffusion weighted Magnetic Resonance Imagining to detect non-palpable undescended testis.

To assess the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of non-palpable undescended testis (NPUT) and to compare DW-MRI results with surgical findings. This descriptive, cross-sectional study was carried out at Dow Institute of Radiology, Dow University of Health Sciences. Karachi on a cohort of patients who underwent DW-MRI for suspected NPUT between 15th September, 2022 to 16th March, 2023. The study included 175 boys below the age of 16 years with history of clinically non-palpable testes. MRI scans were acquired using additional DWI sequence. Two radiology faculty of more than five years of experience independently evaluated the DW-MRI images for the presence or absence of testes in its normal anatomical position, abnormal location, side and size of testes. Out of the 175 patients, DW-MRI successfully detected 128 (73.1%) non-palpable undescended testes. Statistical analysis in clinically detected cases of showed sensitivity of NPTU 0.8%, specificity of 92.5%, diagnostic accuracy 94.29%, positive predictive value 97.7%, and negative predictive value 84.1% for localizing undescended testes with Diffusion Weighted DW-MRI taking surgical findings as gold standard. DWI sequences complement the conventional MRI, increasing its sensitivity and diagnostic accuracy. By facilitating early and accurate diagnosis, DW-MRI has the potential to streamline patient management, reduce unnecessary surgical exploration, and ultimately improve the long-term reproductive health and quality of life for individuals with undescended testes.

The role of the radiologist in the evaluation of male infertility: recommendations of the European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for scrotal imaging.

The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging. The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field. Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus "additional risk factors" or with "starry sky" TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients. So far, ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility were not available. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on testicular volume, inhomogeneity, localization, varicocele, vas deferens and epididymal abnormalities, and assessing cryptorchidism, testicular microlithiasis and lesions in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal sperm parameters in an evidence-based manner, and provide a standardized report to patients.

Diagnostic value of high-resolution ultrasound in localization and status of non-palpable undescended testis in children

Diagnostic value of high-resolution ultrasound in localization and status of non-palpable undescended testis in children

Surgical and Morphological Outcome of One Stage Laparoscopic Orchidopexy with Preservation of Gubernaculum and Interruption of Spermatic Vessels in Comparison to Two Stages Fowler–Stephens’s Orchidopexy Technique with Preservation of Gubernaculum for Impalpable Testis

Abstract Introduction Laparoscopy has attained full acceptance, both diagnostically and therapeutically for the management of non-palpable testis. Conventional laparoscopic Fowler-Stephens’s orchidopexy is a common accepted technique for cases where spermatic vessels` length can preclude tension-free testicular mobilization in the scrotum. Gubernaculum sparing with cutting of testicular vessels has an important role to keep a good vascularity of the testis. Our study suggests performing F-S technique with preservation of the gubernaculums in one stage instead of two stages with the same final results. Patients and Methods This was a Randomized controlled clinical trial (RCT), conducted on Boys with Non-palpable testicle between 1 year to 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022.The patients met our inclusion criteria were divided into 2 groups to compare their outcome (atrophy and success rate): ( Group A with 25 impalpable testicle were subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculums, while Group B with 25 impalpable testicle were subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculums). Results The mean age of all patients were (3.9 ± 1.8), 113 non-palpable testicle were examined during the period of our study, 50 non-palpable tesicle were met our inclusion criteria. They were divided into 2 groups according to surgical procedure. There were no significant differences between the 2 groups according to age, preoperative testicular volume. Post operative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage. Conclusion One-stage laparoscopic orchidopexy with preservation of gubernaculum and ligation of testicular vessels to be as effective as two-stage laparoscopic Fowler–Stephens’s orchidopexy with preservation of gubernaculum.

Gubernaculum-sparing orchiopexy versus gubernaculum excision; A randomized trial on success and atrophy rates

Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy. This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman's tests were used where appropriate. Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25±17 months (range 6-84). The mean testis size of cases intraoperatively was 460±226, 396±166, and 520±258mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p<0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p=0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p=0.002). Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint. https://irct.ir/trial/58842.

Does the presence of blind-ended vas deferens and spermatic vessels in laparoscopic exploration of non-palpable testes conclusively indicate testicular absence?

The purpose of this study was to determine whether the presence of blind-ended vas deferens and spermatic vessels (VDSV) during laparoscopic exploration of non-palpable testes (NPT) indicates testicular absence or atrophy. A retrospective analysis was conducted on clinical data of patients diagnosed with NPT and treated with surgical intervention at our center from April 2013-April 2023. The dataset encompassed information such as the children's age, affected side, size of the contralateral testis, surgical procedures employed, outcomes, and histopathological examination results. All patients underwent physical examination and ultrasonography preoperatively, followed by a combination of laparoscopic exploration and exploration through inguinal or scrotal incisions during surgery. Long-term follow-up was conducted postoperatively. A total of 476 cases comprising 504 NPT were included in this study: 302 cases on the left side, 146 cases on the right side, and 28 cases bilaterally. All patients underwent surgical treatment within 6-126 months (median 13 months). During laparoscopic exploration, blind-ended VDSV were found in 90 testes (72 on the left side, 18 on the right side), while exploration through inguinal or scrotal incisions revealed 52 (57.8%) testicular nodules with atrophy, which were excised, leaving 38 (42.2%) without any findings. Histopathological examination of atrophic nodules revealed fibrosis as the most common finding in 41 cases (78.8%), followed by involvement of the vas deferens in 33 cases (63.5%), calcification in 24 cases (46.2%), epididymis in 23 cases (44.2%), and hemosiderin deposition in 7 cases (13.6%). Fibrosis, calcification, hemosiderin deposition, involvement of the vas deferens, and epididymis were found in combination in 47 specimens (90.4%). Seminiferous tubules (SNT) were found in 3 specimens (5.7%), and germ cells (GC) were found in 1 specimen (1.9%). The presence of blind-ended VDSV during laparoscopic exploration of NPT does not necessarily indicate testicular absence or disappearance. It is possible that atrophic testicular nodules are located within the inguinal canal or scrotum. This understanding contributes to the management of non-palpable testes. Considering their unpredictable malignant potential, we recommend excision.

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 &amp; 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.

Management of pediatric vanishing testes syndrome based on pathological diagnosis: a single-center retrospective study

This study aims to explore the optimal management strategy for pediatric vanishing testes syndrome (VTS) based on pathological characteristics. We retrospectively analyzed clinical data and pathological results of children with unilateral VTS who underwent surgical treatment at our center from July 2012 to July 2023. The children were categorized into the testicular excision group and testicular preservation group based on the surgical approach. Clinical characteristics and outcomes were compared between the two groups. Pathological examination results of excised testicular tissues were collected and analyzed, and long-term follow-up was conducted. A total of 368 children were included in this study. The age of the children at the time of surgery was 27 months (range, 6–156). Among them, 267 cases (72.6%) had VTS on the left side, and 101 cases (27.4%) on the right side. There were no statistically significant differences (P > 0.05) in age, affected side, contralateral testicular hypertrophy (CTH), testicular location, and preferred surgical incision between the testicular excision group (n = 336) and the testicular preservation group (n = 32). In the preservation group, two children experienced scrotal incision infections, showing a statistically significant difference compared to the excision group (P < 0.05). Pathological examination of excised tissues revealed fibrosis as the most common finding (79.5%), followed by vas deferens involvement (67%), epididymis involvement (40.5%), calcification (38.4%), and hemosiderin deposition (17.9%). Seminiferous tubules (SNT) was present in 24 cases (7.1%), germ cells (GC)in 15 cases (4.5%), and ectopic adrenal cortical tissue(EACT) in 1 case (0.3%). VTS belongs to a type of non-palpable testes (NPT) and requires surgical exploration. Considering the risk of scrotal incision infection after preserving atrophic testicular remnants and the unpredictable malignant potential, we recommend excision.

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

Surgical treatment of cryptorchidism: current insights and future directions.

Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child's age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.

Long-term Outcome of Laparoscopic Surgery for Nonpalpable Undescended Testis.

The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 × length × breath × height. A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm3) was smaller than the normal nonoperated side (mean = 2.524 cm3). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm3), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT.

European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes.

The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT). An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA). Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role. Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.

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.

Disorders of sexual development: structured radiological reporting and practical approach.

Disorders of sexual development (DSD) comprise a complex group of conditions with varied clinical presentations, such as atypical genitalia, non-palpable testes, primary amenorrhea, or infertility. Besides being associated with other congenital anomalies, DSDs bear substantial ethical issues regarding assigning the sex of rearing to the child and future fertility options. Establishing the correct diagnosis is essential for the appropriate management of such cases. Various imaging modalities, such as ultrasonography, genitography, and MRI, when complemented with detailed clinical evaluation and karyotyping, are the key to diagnosing the condition. This article attempts to present a concise approach to various patterns of DSD, which will aid radiologists to solve these diagnostic dilemmas.

Laparoscopic Assisted Orchiopexy for Treatment of Intraabdominal Testis

Undescended testis is one of the most common problems in children it affecting about 1% of boys especially at age of 1 years, however about 20% have a non-palpable testis as well as the later infertility. Laparoscopy has gradually become the gold standard for the treatment of non-palpable testicle with the different in success rate and complication.

Surgical and morphological outcome of one-stage laparoscopic orchidopexy with preservation of gubernaculum and interruption of spermatic vessels in comparison to two-stages fowler–Stephens’s orchidopexy technique with preservation of gubernaculum for impalpable testis

Background For the care of nonpalpable testis, laparoscopy has acquired complete acceptability in both diagnostic and therapeutic settings. Standard laparoscopic for situations where the length of the spermatic arteries can prevent tension-free testicular mobilization in the scrotum, Fowler-Stephens’ (F-S) orchidopexy is a widely used and acknowledged procedure. Maintaining a healthy testis’ vascularity requires gubernaculum sparing with testicular vessel cutting. Our research recommends using the F-S approach with the preservation of the gubernaculum in a single stage rather than two phases for the same outcomes. Setting: the pediatric surgery outpatient clinic at hospitals affiliated with Ain Shams University and the Armed Forces Hospitals. Patients and methods This was a Randomized controlled clinical trial (RCT), conducted on boys with nonpalpable testicles between 1 and 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022. The patients who met the inclusion criteria were divided into two groups to compare their outcome (atrophy and success rate): (group A with 25 impalpable testicles was subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum, while group B with 25 impalpable testicles was subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum). Results The mean age of all patients was (3.9±1.8), 113 nonpalpable testicles were examined during the period of our study, and 50 nonpalpable testicles met our inclusion criteria. They were divided into two groups according to surgical procedure. There were no significant differences between the two groups according to age, and preoperative testicular volume. Postoperative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage. Conclusion To conclude, one-stage laparoscopic F-S orchidopexy with preservation of gubernaculum is as effective as two-stage laparoscopic F-S orchidopexy with preservation of gubernaculum.

Heresy - Is there a role for ultrasound in management of the non-palpable testicle?

AUA Guidelines do not support the routine use of ultrasound (US) in evaluation of boys with an undescended testicle (UDT) prior to urology referral. Multiple studies have demonstrated that real time US is inferior to a physical examination by a pediatric urologist in detecting an UDT. However, improved US technology, which now permits detection of the non-palpable testis located just proximal to the internal ring, may aid in guiding the surgical approach to the non-palpable testis. We evaluated US findings of boys deemed to have a non-palpable UDT and compared them to surgical findings. To assess the role of pre-operative ultrasonography in guiding surgical management in boys deemed to have a non-palpable testis by a pediatric urologist. US of boys with a non-palpable UDT, as reported by a pediatric urologist on physical exam, during a 3-year period, were reviewed. All US were performed jointly by a technician and pediatric radiologist. Patient demographics, laterality, and intra-operative findings were assessed. Thirty-one boys with a non-palpable testicle on physical exam underwent scrotal/inguinal/pelvis US at a median age of 7.5 months (IQR 2.5-12.3 months). Two patients had bilateral non-palpable testicles, 21 had a non-palpable left sided testicle and 8 had a non-palpable right sided testicle. Of the 33 non-palpable testes, 5 (15.2%) were identified in the inguinal canal. Sixteen (48.5%) were visualized in the lower pelvis just proximal to the internal ring and graded as intra-abdominal. Four (12.1%) nubbins or very atrophic testes were identified in the inguinal region or scrotum and 5 (15.2%) testes were not identified on US. Three (9.1%) testes were observed to be mobile between the lower pelvis just proximal to the internal ring and the inguinal canal. Of the 8 patients with testes that were identified in the inguinal canal, or mobile between the lower pelvis and inguinal canal, 7 avoided a diagnostic laparoscopy and underwent an inguinal orchiopexy. Of the 16 testicles located in the lower pelvis proximal to the internal ring, only 2 underwent laparoscopy/laparoscopic orchiopexy. In cases of a non-palpable testicle following a physical examination by a urologist, an ultrasound can impact the operative plan, and allow for patients to avoid laparoscopy. In our cohort, 87.5% of non-palpable testes avoided laparoscopic surgery after ultrasound identification of a viable testis. US in the evaluation of cryptorchidism can guide surgical management in select cases in which a testis is non-palpable following careful examination by a urologist.

Ipsilateral and contralateral patent processus vaginalis in pediatric patients with a unilateral nonpalpable testis.

This study aimed to investigate the incidence of patent processus vaginalis (PPV) in pediatric patients with a unilateral nonpalpable testis and explore the associated factors. From May 2014 to April 2017, 152 boys who were diagnosed with a unilateral nonpalpable testis and underwent laparoscopy in Shanghai Children's Hospital (Shanghai, China) were included in this study. The data were collected and reviewed, and the results were analyzed regarding the age at operation, side, development, and position of the nonpalpable testis. The mean age of the patients was 2.6 (standard deviation: 2.3) years. The testis was absent in 14 cases, nonviable in 81 cases, and viable in 57 cases. The incidence of PPV was 37.5% (57 of 152) on the ipsilateral side and 16.4% (25 of 152) on the contralateral side. The ipsilateral PPV was more prevalent when the nonpalpable testis occurred on the right side (P < 0.01). Besides, patients with a viable testis had a greater incidence of ipsilateral PPV than those with a nonviable or absent testis (P < 0.01). Moreover, this rate was the highest when the testis was in the abdominal cavity and the lowest when the testis was in the scrotum (both P < 0.01). However, the incidence of contralateral PPV was independent of all the factors. In conclusion, in children with a nonpalpable testis, the incidence of an ipsilateral PPV was significantly related to the side, development, and position of the testis, while it was independent of these factors on the contralateral side.

DEGREE OF AGREEMENT BETWEEN ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR DETECTION OF NON-PALPABLE TESTIS AMONG PATIENTS WITH CRYPTORCHIDISM

The current study aimed to determine the degree of agreement between ultrasonography and magnetic resonance imaging to detect non-palpable testis among patients with cryptorchidism. This cross-sectional study was conducted at the Department of Radiology, Jinnah Hospital, Lahore, from 15th May 2014 to 14th November 2014. 120 patients under 12 years of age with cryptorchidism were included to detect the presence or absence of testis by magnetic resonance imaging and ultrasonography. 120 patients had a mean age of 5.10 ± 2.5 years ranging from 2 to 11. 90 patients (75%) showed undescended testes by ultrasonography while MRI detected the presence of undescended testes in 98 patients (81.7%). 84 patients were detected for the presence and 16 for the absence of undescended testes by MRI and ultrasound (kappa = 0.512). It is concluded that the agreement between ultrasonography and magnetic resonance imaging (51.2%) is although moderate yet acceptable for detection of non-palpable testis among patients of cryptorchidism.

A novel DEAH-box helicase 37 mutation associated with differences of sex development.

To determine the genetic etiology of a family pedigree with two patients affected by differences of sex development (DSD). Assess the clinical characteristics of the patients and achieve exome sequencing results and in vitro functional studies. The 15-year-old proband, raised as female, presented with delayed puberty and short stature associated with atypical genitalia. Hormonal profile showed hypergonadotrophic hypogonadism. Imaging studies revealed the absence of a uterus and ovaries. The karyotype confirmed a 46, XY pattern. Her younger brother presented with a micropenis and hypoplastic scrotum with non-palpable testis and hypospadias. Laparoscopic exploration was performed on the younger brother. Streak gonads were found and removed due to the risk of neoplastic transformation. Post-operative histopathology showed the co-existence of Wolffian and Müllerian derivatives. Whole-exome sequencing identified a novel mutation (c.1223C>T, p. Ser408Leu) in the Asp-Glu-Ala-His-box helicase 37 gene, which was found to be deleterious by in silico analysis. Segregation analysis of the variant displayed a sex-limited, autosomal dominant, maternal inheritance pattern. In vitro experiments revealed that the substitution of 408Ser by Leu caused decreased DHX37 expression both at the mRNA and protein levels. Moreover, the β-catenin protein was upregulated, and the p53 protein was unaltered by mutant DHX37. We described a novel mutation (c.1223C>T, p. Ser408Leu) of the DHX37 gene associated with a Chinese pedigree consisting of two 46, XY DSD patients. We speculated that the underlying molecular mechanism might involve upregulation of the β-catenin protein.