Scrotal Wound Research Articles

Rare Complication of Fournie’s gangrene following Alcohol Sclerotherapy for Hydrocele: A Case Report

We present a rare case of an 80-year-old male with a longstanding, asymptomatic right hydrocele seeking repair. Hydrocele, characterized by an abnormal accumulation of serous fluid between the parietal and visceral layers of the tunica vaginalis, is a common condition affecting adult males. While surgical removal remains the gold standard treatment, alternative non-invasive approaches such as sclerotherapy have been explored due to their reported high success rates ranging from 85% to 96%. In this case, the patient underwent a combination of aspiration (340 mL of fluid) and sclerotherapy using 60 mL of absolute alcohol as the sclerosing agent. Following the sclerotherapy procedure, the patient experienced the development of a scrotal wound within 72 hours, which progressed to a necrotic point with associated hyperemia at 96 hours. Subsequently, the patient presented with an unusual necrosis in the scrotal sac, rapidly progressing to Fournier’s gangrene, requiring surgical debridement three surgical debridements seven days post-procedure, followed by antibiotic therapy and 35 hyperbaric sessions. Remarkably, the patient’s condition progressed painlessly, and complete closure of the necrotic lesion was achieved. However, this case underscores the importance of cautious evaluation when considering alcohol sclerotherapy in elderly patients, despite its minimally invasive nature. It serves as a reminder of the potential complications that can arise from non-surgical approaches for hydrocele management and highlights the need for careful patient selection and follow-up in such cases.

(164) Technique of Plaque Excision and Coroporoplasty Using Free Tunica Vaginalis Graft

Abstract Introduction Severe penile curvature causing inability to perform pleasurable sexual activity is the most dreadful sequel of Peyronie disease. Surgical plication methods have their limitations of recurrence of curvature or penile shortening which is not acceptable to patients. In cases of severely calcified plaques, excision of the plaque with grafting of the defect remains the only viable option. Several graft materials have been used for repairing the defect. We present our experience of Plaque excision and coroporoplasty using local tunica vaginalis free graft. Objective To demonstrate the technique of free tunica vaginalis free graft corporoplasty for severe curvature due to Peyronie plaque. Following steps of corporoplasty are demonstrated. Penile degloving, artificial erection and plaque demarcation, dissection of the neuro-vascular bundle, plaque excision, harvesting the tunica vaginalis graft, corporoplasty using tunica vaginalis, restoration of neuro-vascular bundle, closure of scrotal wound and completion of circumcision. Methods 7 patients between the age group of 47 to 68 years (mean age 54.6 years) were operated using this technique between 2018 to 2022. All patients had dorsal penile curvature with hard palpable plaque ranging from 2.5 cm to 5.2 cm. All patients were evaluated objectively using auto-photography. Penile doppler was done in all patients to confirm pre-operative arterial flow. Plaque exposure was done by penile degloving. Tunical graft was harvested by midline scrotal incision. Complete plaque excision was done and graft was sutured with 3–0 Prolene sutures. Results All patients had normal erectile function after the surgery. The maximum follow-up period was 42 months. All patients reported normal sexual function after a month of surgery. 2 patients complained of persistent induration and hardness at the site of graft, however the function being normal. Penile length shortening was noted in 4 patients which ranged between 4–6% of previous length, however it did not alter the sexual function. Conclusions Complete excision of the Peyronie plaque with corporoplasty using free tunica-vaginals graft is an effective, cost-effective and functionally acceptable technique for patients with hard and calcified plaque offering excellent functional outcomes. Disclosure No.

(133) Non-Occupational SCC of the Scrotum; Case Presentation and Management

Abstract Introduction Although the incidence of scrotal malignancies is extremely low Squamous cell carcinoma (SCC) is the most common scrotal malignancy. Its overall annual incidence is approximately 1.5 per 1,000,000 persons in Western countries. It was first linked to the chronic irritation of scrotal skin by the effect of soot in occurring in chimney sweepers hence known as the first described occupational disease. Occupational scrotal SCC was also later described in association with other occupations with chronic carcinogen exposure including cotton mule spinners, paraffin and tar workers, creosote workers, shale oil workers, lathe workers, pitch workers and machine tool setters and operators. Currently most cases result from poor hygiene and chronic inflammation Objective Herein we present a very rare case of SCC of the scrotum referred to us from Dermatology department Methods This 55 years old male patient was referred from dermatology department. He had no underlying occupational hazard. He has been treated for several months of itchy inflammation of the scrotumfor 6 months. Scrotal punch biosy showed moderately differentiated SCC. Clinically there was malignant scrotal ulcer of 4x3 cm with no palpable inguinal lymph nodes. CT staging confirmed localized tumor with no LN or metastatic deposits. Complete excision with 2 cm safety margin confirmed to be negative by frozen section. Final histopathology come to be moderately differentiated SCC pT2Nx. All margins and underlying Dartos were free of tumor infiltration. Results Complete excision could be achieved with intra-operative negative frozen section. Uneventful post-operative course with complete healing of scrotal wound. Conclusions Although rare, scrotal SCC continues to be serious urogenital malignancy which should be suspected even in the absence of occupational exposure. Cooperation and awareness of Dermatologists is important for early detection and management of such rare malignancy. Complete excision with safety margin is usually sufficient for cure. Inguinal Lymphadenectomy is indicated if grossly infiltrated Disclosure No.

Antibiotics Resistance and Plasmid Curing Studies of Staphylococcus aureus associated with Wound Infection amongst Patients Accessing University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Staphylococcus aureus is a common hospital and community-acquired pathogen known to be frequently associated with wound infections, and has become important for its increasing level of resistance to antibiotics. Resistance of Staphylococcus aureus to antibiotics could be as a result of the presence of plasmids or resistance genes. The need to carry out plasmid curing of the isolates is very essential. The aim of the study was therefore to determine the antibiotics resistance pattern of staphylococcus aureus associated with wound infection amongst patients accessing university of Port Harcourt Teaching Hospital, Rivers State, Nigeria. A total of 150 specimens from different types of wounds (traumatic wound, caesarean section, scrotal wound, surgical wounds, burns, diabetic foot, and plastic surgery) were collected from the Hospital for a period of six months and processed for isolation of S. aureus, following standard microbiological procedures. The specimens were cultured on sterile Mannitol Salt Agar (MSA) plates and incubated at 37ºC for 24 hours. Antibiotic susceptibility tests of the isolates was performed using the Kirby-Bauer disc diffusion method, following CLSI guidelines. Plasmid genes of the isolates were cured using acridine orange. The study showed a decrease in antibiotic resistance of 17.3% for ofloxacin (OFL), 13.8% for gentamicin (GEN) and 3.5% for both ceftazidime (CAZ) and ceftriatone (CTR) after plasmid curing, with no apparent change in resistance for the rest of the antibiotics. The results of this study represent serious public health concerns, thus emphasizing the need for proper wound management.

An Innovative Technique of Testicular Preservation in Fournier's Gangrene: Surgical Details and Illustration.

Fournier’s gangrene, which is a necrotizing fasciitis of the perineal region, requires prompt control of infection with emergent surgical debridement. The shameful exposure of gonads, which occurs following debridement, can cause both physiological and psychological impairment to the patient. These can be avoided by the use of this novel technique for testicular preservation.Following debridement of necrotic scrotal skin, this technique involves creation of inguinal pouch by blunt dissection and placement of the testes in the pouch created. Once healthy granulation tissue is achieved in the scrotal wound, closure of the scrotum is performed after bringing down the testes. The advantages of this technique include development of a relatively physiological position to preserve the testes before definitive reconstruction of the scrotum and the easy reproducibility of the technique.A holistic approach to management of Fournier’s gangrene should include resuscitation, administration of antibiotics, debridement, and scrotal reconstruction. However, the psychological impact of shameful exposure of the gonads must also be borne in mind during the management. Our technique represents one of the ways to reduce the stigma and discomfort associated with shameful exposure of the testes.

Incidence of Staphylococcus aureus Wound Infection amongst Patients Attending University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Staphylococcus aureus is a common hospital and community-acquired pathogen known to be frequently associated with wound infections. Therefore, the aim of the research was to determine the incidence of Staphylococcus aureus in patients with wound infection at University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. A total of 150 specimens from different types of wounds (traumatic wound, caesarean section, scrotal wound, surgical wounds, burns, diabetic foot, and plastic surgery) were collected from the Hospital for a period of six months and processed for isolation of S. aureus, following standard microbiological procedures. Samples were cultured on sterile mannitol salt agar (MSA) plates and characterized phenotypically based on cultural and biochemical identities. Data obtained showed 38.7% of the wound cases were contaminated with Staphylococcus aureus isolates. It was observed that the organism mainly occurred in burns (52.63%), while the lowest incidence was related to plastic surgery (18.2%) contamination. The study showed that 10.3% of isolates were associated with biofilm formation, while gamma hemolysis and beta-hemolysis was observed in 93.1% and 6.9% of isolates, respectively. The results of this study represent serious public health concerns, thus emphasizing the need for proper wound management.

Whistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound

Patient: Male, 72-year-old Final Diagnosis: Pneumoscrotum Symptoms: Dyspnea • facial swelling Medication: — Clinical Procedure: Chest tube Specialty: Critical Care Medicine • Urology Objective: Unusual clinical course Background:Pneumoscrotum is a rare clinical occurrence in which air accumulates in the scrotum. The origin of air is primarily from trauma, but spontaneous pneumoscrotum can develop from gastrointestinal or pulmonary sources. Physical examination of pneumoscrotum typically includes crepitus of the perineal region and scrotal swelling and associated findings depending on the origin of the free air. However, pneumoscrotum in the setting of a scrotal wound, which allows air to pass freely outside the body, has not been previously documented in the literature.Case Report:A 72-year-old man who recently underwent a scrotal incision and drainage for recurrent epididymitis presented to a local emergency room with chief concerns of “whistling scrotum” and dyspnea. The chest CT revealed bilateral pneumothoraces, pneumomediastinum, and excessive subcutaneous emphysema throughout his abdomen, perineum, and scrotum. His scrotum had a dehiscent wound without any gross edema or air trapping contained within the scrotum. He received bilateral chest tubes and subcutaneous air drains with complete resolution of his pneumothoraces. The pneumoscrotum and associated subcutaneous emphysema of the perineum and thighs resolved after a prolonged period, and necessitated additional scrotal surgery.Conclusions:Prompt evaluation for source control is necessary with pneumoscrotum, as the source likely requires immediate stabilization or surgical intervention. This case report describes a unique presentation of a common entity (pneumothorax) within pulmonology/critical care in a patient with an open scrotal wound from a recent scrotal procedure, which allowed the air to escape from his abdominal compartment, and resulted in his “scrotal whistling.” It is unclear how the air passing through the scrotum affected the patient’s presentation, such as allowing more air to build up in the subcutaneous tissues versus developing critical illness.

A rare case of male Fournier\u2019s gangrene with mixed Actinomyces turicensis infection

BackgroundFournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species.Case presentationWe report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG.ConclusionsFG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.

Meshed Versus Sheet Skin Graft for Scrotum and Perineal Skin Loss: A Retrospective Comparative Study.

BackgroundA wide array of diseases can lead to skin defects of the male genitalia. Although reconstructive options have been debated in the literature, no study has compared the effectiveness of a meshed split-thickness skin graft (STSG) and a sheet STSG in perineal and scrotal wound coverage. In this study, we report our experience in a tertiary trauma center.MethodologyIn this retrospective study, we included cases with a skin defect of the male genitalia, for which genital reconstruction with a skin graft was performed at our hospital from December 2017 to February 2020. This study was approved by the institutional review board. The analysis was performed at 95% confidence interval using the Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA).ResultsA total of 27 patients were included in the study. The most common indication for genital reconstruction was Fournier’s gangrene (59.3%). In 15 (55.6%) patients, a meshed skin graft was utilized to cover the defect, whereas a sheet graft was utilized in 12 (44.4%) patients. Out of the 15 patients who underwent genital reconstruction with a meshed graft, 10 (66.6%) had complete graft take. On the other hand, out of the 12 (44.4%) patients who underwent genital reconstruction using a sheet graft, five (41.6%) had complete graft take. A statistically significant relationship was found between aesthetic and functional outcomes and the type of skin graft used. The satisfaction rate was higher among meshed skin graft recipients (86.2%) compared to sheet skin graft recipients (41.7%) (p = 0.014).ConclusionsBased on our observational experience, we found that meshed STSG to cover male genital skin defects is safe with satisfactory cosmetic outcomes. Further prospective randomized studies are needed.

Fournier's gangrene complicating severe acute pancreatitis: a case report and literature review

Abstract Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis (EPN). Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported. However, extension of retroperitoneal necrosis to the scrotum causing Fournier's gangrene is uncommon. We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation. He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay. During the 3rd month of hospital stay, the patient started developing pain and ulceration over the scrotum. He was diagnosed with Fournier's gangrene based on clinical examination and was planned for debridement. During surgery, the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination. The case highlights a rare but potentially fatal complication of Fournier's gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement. Concomitant management of two potentially fatal conditions poses numerous challenges.

PSI-41 Impacts of Flunixin Meglumine injection on wound score and swelling appearance of either rubber ring castrated and tail docked or surgically castrated and docked lambs

Abstract Our hypothesis was that administering Flunixin Meglumine (FM) to lambs that were either rubber ring castrated and docked (RR) or surgically castrated and emasculator docked (SC) would decrease swelling and wound appearance score. Rambouillet ram lambs (n = 181) were allocated in a completely randomized design in a 2 x 2 factorial arrangement of treatments to determine the effects of RR or SC and emasculator docking on ram lambs with administration of FM (2.2 mg/kg of BW) or saline (S; 2.2 mg/kg of BW). Wounds were assessed on days 4 and 7 post-treatment. The Wound Assessment Scale ranged from 1 – 5 and was determined from levels of discharge, scabbing, and wound healing. The swelling score was also a 1 - 5 scale, varying from no swelling, large amounts, or healed. Scrotal wound exhibited a treatment x day interaction (P < 0.001), however tail wound score (P = 0.84) and scrotal swelling (P = 0.36) were not affected. The SC treated lambs had a higher wound score on day 4 and 7 when compared to the RR treated lambs for both the scrotum and tail score (P < 0.001). Flunixin Meglumine had no effect on wound score of the scrotum (P > 0.50) and tail (P > 0.43) for both RR and SC groups. However, RR treated lambs had higher swelling scores on day 4 and 7 (P < 0.001). Flunixin Meglumine administration did not influence swelling score in treated lambs (P > 0.43). Surgical castration resulted in an increase in wound score compared to rubber ring castrated and docked lambs, but rubber ring castrated and docked lambs had an increase in wound swelling. Flunixin Meglumine did not have an impact on either wound score or wound swelling, regardless of castration method.

Effect of perioperative penicillin G procaine on bovine castration wound infection rate

Perioperative administration of B-lactam antimicrobials, including penicillin G procaine, is commonly performed at the time of bovine surgical castration despite a paucity of published evidence regarding rate of bovine castration wound infections and efficacy of single-dose perioperative antimicrobial therapy for bovine castration. The best data on frequency of bovine castration complications was generated from a survey of US bovine veterinarians, which reported wound infection, swelling, gait stiffness, and hemorrhage as the most common complications. This same survey identified that a narrow majority of bovine veterinarians routinely utilized perioperative antibiotics, most commonly β-lactams class drugs, including penicillin G procaine. Increasing public demand for antimicrobial stewardship is elevating professional and consumer scrutiny around veterinary antimicrobial use in food animals. In the current climate that increasingly emphasizes judicious use of antimicrobial drugs, it is imperative to base decisions to incorporate antimicrobial prophylaxis into routine protocols on quality evidence. Currently, there is no published data to suggest that perioperative use of PPG reduces scrotal wound or generalized tetanus infection following routine surgical castration of calves. The objective of the study is to establish whether perioperative administration of penicillin G procaine at the time of surgical castration with the Henderson castrating tool decreases the risk of postcastration surgical wound infections.

A rare case of colonic perforation presenting as Fournier’s gangrene

A 48-year-old obese gentleman with mild pain over abdomen for 10 days followed by pain and swelling in the right side of scrotum with skin discolouration for 2 days. Clinically necrotic patch with pus discharge was noted on the right side of scrotum. Extensive debridement over scrotum was done following which inflamed omentum and fecal contents were noticed from the inguinal canal. Patient underwent laparotomy and an ascending colonic perforation was found. A loop colostomy with partial omentectomy and inguinal hernia repair along with serial debridement of scrotal wound was done. Although uncommon, gastrointestinal perforations should be considered as a potential etiology in Fournier’s gangrene.

Presentation of Undescended Testis to a Paediatric Referal Centre in Jos

Background: Undescended testis is the commonest disorder affecting the male urogenital tract. Late presentation has significant socio-medical impact on the individual’s quality of life. Aim: To evaluate the presentation of undescended testis and age at surgery in our centre. Methods: A 9-year retrospective analysis of the clinical records of patients Results: A total of 73 records were analysed, 58 (79.5%) presented > 1 year. Median age at presentation was 4 years, range 1 day - 16 years. Males 73 (100%), only 17 (23.3%) were referred by health personnel, while 56 (76.7%) self-referred. Commonest site involved was the left 33 (45.2%), 29 (39.7%) right and 11 (15.1%) bilateral. There were 13 (17.4%) who had associated congenital malformations. Hypospadias 7 (53.8%), isolated micropenis 4 (30.8%) and 1 each (7.7%) had myelomeningocele and hernia. Median age at presentation for bilateral involvement was 30 days, with associated hypospadias was 12 days, while those with isolated micropenis was 7.5 years. Median age at surgery for bilateral involvement was 2 years, overall median age at surgery was 4 years. Surgery Findings: Supra-scrotal testis 47, canalicular 25 (34.2%), and bilateral abdominal 1 (1.4%). Outcome: Wound infections 4 (5.5%), scrotal wound breakdown 1, Recurrence 3 and testicular atrophy 1. Conclusion: Our patients presented very late beyond the recommended age for surgery, evaluating for DSD also contributed to delay in intervention even when these patients presented early. We advocate for early screening at birth, during routine child immunization and school enrollment, with prompt referral.

Neglected inguinoscrotal hernia complicated by scrotal fecal fistula in an infant: A case report and review of literature

Spontaneous scrotal fistula is an extremely rare complication of incarcerated hernia, especially in children. To date, only 12 cases in children have been reported in the literature worldwide. We present the case of a 31-day-old male infant who had scrotal fecal discharge from an irreducible right inguinoscrotal swelling. Inguinal exploration revealed an incarcerated right inguinal hernia containing a segment of the ileum with a 3 cm perforation on its antimesenteric border. Segmental resection and end-to-end anastomosis along with debridement and closure of the scrotal wound were successful in the management of this index patient. This complication appeared to be the result of a neglected inguinoscrotal hernia. This report aims to highlight the morbidity associated with this complication and to review the available literature. We conclude that early repair of inguinal hernias in infants and children of all ages would reduce this complication and its attendant morbidity and mortality.

Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele.

The study summarizes the effectiveness of ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome (NCS)-associated varicocele. Cases of NCS-associated varicocele were recruited between December 2012 and December 2018. Prior to the operation, all patients were tested for the internal diameter and blood flow velocity of left renal vein, testicular volume, maximum venous diameter and venous retrograde flow in the pampiniform plexus of veins during the Valsalva maneuver by Color Doppler ultrasound. Moreover, the direction of left spermatic and inferior epigastric vein was marked. All patients underwent ligation of the internal spermatic veins and left spermatic-inferior epigastric vein anastomosis under microscopy. Color Doppler ultrasound, urinary and semen analysis (above age 18years old) were reviewed during the follow-up period. 53 patients (94.6%) underwent spermatic-inferior epigastric vein anastomosis with the mean operation time of 78.4 ± 14.2min. The hospital stay was 4-7days. Scrotal hydrocele, wound infection and testicular atrophy did not occur after operation. However, there were 5 cases of left varicocele recurrence and 2 cases of vascular anastomotic thrombosis. 51 cases had decrease in blood peak flow rate of left renal vein and improvement in nutcracker syndrome while scrotal bulge symptoms resolved in 26 cases. 10 cases had microscopic hematuria disappearance with symptom improvement in 2 cases. 19 cases of left testicular hypotrophy experience no further deterioration after surgery, of which 16 cases had catch-up testicular growth. Ultrasound-assisted microsurgical left spermatic-inferior epigastric vein anastomosis assisted is safe, easy and effective for treating nutcracker syndrome-associated varicocele.

Open mesh and laparoscopic total extraperitoneal inguinal hernia repair under spinal and general anesthesia.

IntroductionMesh placement is the main standard in repair of inguinal hernia, and laparoscopic repair is the standard of care via spinal, epidural, or combined anesthesia. Here, we compared open and laparoscopic total extraperitoneal (TEP) repairs under general (GA) and spinal anesthesia (SA).MethodsInguinal hernia patients (n=440) were analyzed retrospectively. There were four groups: Group 1 was TEP under GA (TEP-GA) (n=111); Group 2 was open mesh repair (OM) under SA (n=116) (OM-SA); Group 3 was open mesh repair under GA (n=117) (OM-GA); Group four was TEP under SA (n=96) (TEP-SA). The age, body mass index, duration of operation, hospital stay, postoperative Visual Analog Scale scores, recurrence, postoperative pain, urinary retention, headache, and patient satisfaction were all recorded.ResultsThere was no significant difference in terms of hypotension, vomiting, seroma and scrotal edema, recurrence, and wound infection incidence between the groups. However, the operation duration, hospital stay period, headache, urinary retention, postoperative Visual Analog Scale scores, chronic pain, and patient satisfaction showed significant differences between groups.ConclusionLaparoscopic TEP hernia repair is a safe and effective method along with its advantages of shorter hospital stay, less recurrence, less postoperative pain, higher patient satisfaction, and similar postoperative complication rates. SA has the disadvantage of higher incidence of headache and urinary retention compared to GA.

Usefulness of Preoperative Ultrasound for the Evaluation of Testicular Rupture in the Setting of Scrotal Gunshot Wounds

A scrotal gunshot wound may result in testicular injury, necessitating urgent scrotal exploration and attempted testicular salvage. Scrotal ultrasound is highly sensitive and specific for testicular rupture in the setting of blunt scrotal trauma but it has been poorly studied in the setting of scrotal gunshot wounds. Our objective was to determine the accuracy of scrotal ultrasound to identify testicular rupture following a scrotal gunshot wound. We retrospectively reviewed the records of patients with a scrotal gunshot wound from 2003 to 2014 in whom preoperative ultrasound was done prior to scrotal exploration. A heterogeneous echo pattern of testicular parenchyma with contour loss was considered a positive examination for testicular rupture. Patients underwent scrotal exploration within 24 hours of presentation. The sensitivity and specificity of ultrasound were estimated and compared to operative findings. ROC curve analysis was done. Of 75 patients who sustained a scrotal gunshot wound ultrasound was positive in 30 and negative in 45. No ultrasound revealed bilateral injuries. Scrotal exploration demonstrated a total of 40 testicular ruptures in 35 patients, of which 30 testicles were salvaged. Ten orchiectomies were performed. The sensitivity and specificity of ultrasound were 60% and 95%, respectively, with 16 missed injuries and 6 false-positive findings. Positive predictive value was 80% and negative predictive value was 87%. The ROC AUC was 0.79. In 6 of the 16 missed injuries there was an ipsilateral hematocele or hematoma. The sensitivity of scrotal ultrasound is limited for evaluating testicular rupture after a scrotal gunshot wound. Large coincident hematoceles or hematomas may obscure the diagnosis of testicular rupture. Negative ultrasound should not preclude scrotal exploration after a scrotal gunshot wound is sustained.

A short report on current fertility preservation strategies for boys.

Advances in cancer treatment have led to improved long-term survival after childhood cancer, but often at a price of impaired future fertility. Fertility preservation (FP) in male children and early adolescents poses unique challenges as efficacy is unproven. To describe characteristics of testicular tissue cryopreservation (TTCP) specimens taken from paediatric and adolescent patients, stratified by age, and prior chemotherapy, if any, and to demonstrate evidence for germ cells. Retrospective review of gonadal biopsies and clinical records of patients consented into the Royal Children's Hospital FP programme between 1987 and 2015. Tissue was sliced into blocks, with one section sent for histopathology prior to cryopreservation. In boys ≥12years where spermatogenesis could be expected, a portion of tissue was disaggregated completely to look for mature sperm and if found, additional tissue was dissected and the resulting suspension frozen. Testicular tissue cryopreservation specimens in 44 males (0.3-16.8years) provided an average of 7.8 slices per patient. All the specimens were taken at the same time as another necessary surgical procedure, under one general anaesthesic. There was only one complication of scrotal wound dehiscence. Seven of the forty-four (15.9%) patients had chemotherapy prior to testicular biopsy, while the rest were chemotherapy naïve. Five of these were prepubertal, and two were pubertal patients. Eleven subjects had tissue dissected with mature sperm found in eight. Of these eight patients where sperm were found, all were pubertal with testicular size of more than 10mL and showing histological evidence of spermatogenesis. No histologic specimen demonstrated any malignant cells. Testicular tissue cryopreservation can be performed in young patients without delay, preferably prior to cancer treatment. As testicular tissue contains germ cells from which haploid spermatozoa are ultimately derived, future technologies may allow their utilization for fertility in humans. This may be the only hope for biological offspring in some patients undergoing fertility compromising treatment. Retrieval of mature sperm from some pubertal patients, however, offers realistic hope to these patients of future fertility.

Gross testicular abnormalities in indigenous breeds of bulls in Eastern Ethiopia

Objective: This study was conducted to assess the prevalence of different types of gross testicular disorders in bulls, and to evaluate the associations with sampling year, age, and body condition. Materials and methods: In this study, a total of 398 apparently healthy bulls were randomly selected that were brought from different parts of eastern Ethiopia to the Haramaya University abattoir for slaughtering during the period from June 2014 to September 2016. Ante- and post-mortem examinations of the bulls were employed. Visual inspection, palpation, serial and systematic dissections into the parenchyma of the testes and scrotum were performed to determine the presence and the extent of gross pathological changes. Results: Out of 398 bulls, 209(52.5%) were affected by one or more gross testicular abnormalities of unidentified causes. Bilateral testicular hypoplasia was the most prevalent (9.8%; n=39/398) testicular abnormality, followed by unilateral testicular hypoplasia (9%; n=36/398), testicular hematoma (9%; n=36/398), orchitis (8.3%; n=33/398), testicular degeneration (6.5%; n=26/398), scrotal wound (6.3%; n=25/398) and epididymitis (2.5%; n=10/398). Unilateral cryptorchidism was the least prevalent (1%; n=4/398). Age and body condition did not affect the prevalence of any abnormality (P>0.05) except in scrotal wound which was significantly varied among body condition categories (P<0.05). Conclusion: This study reveals that the incidence of gross testicular abnormalities was 52.5% in bulls. Thus, attention should be given to reproductive management of bulls in Ethiopia. http://doi.org/10.5455/javar.2017.d201 XML PubReader