Superficial Inguinal Pouch Research Articles

Malignancy Yield of Testis Pathology in Older Boys and Adolescents with Cryptorchidism.

We performed a retrospective, single-institution study to characterize the pathological findings of testis tissue specimens from older boys and adolescents with cryptorchidism. With institutional review board approval, pathology reports were obtained for testicular specimens from patients age 10 years or older at a pediatric hospital from 1994 to 2016. Reports were excluded if they lacked clinical records, lacked testicular parenchyma, were from a descended testis or were from a patient with differences of sexual development. Variables of interest included age, testis location, procedure and pathological findings. Presence of malignancy among intra-abdominal versus extra-abdominal undescended testes was compared using Fisher's Exact Test. Seventy-one patients met inclusion criteria. The median age was 15.3 years (range 10.1-27.7). None had a history of testicular malignancy. Forty-five unilateral orchiectomies, 22 unilateral orchiopexies with biopsy and 4 bilateral procedures were performed. Seventeen testes (22.7%) were intra-abdominal, 42 (56.0%) were in the inguinal canal, 9 (12.0%) were at the external inguinal ring, 3 (4.0%) were in the superficial inguinal pouch and 4 (5.3%) were in the scrotum. Malignancy was detected in 2/71 patients (2.8%). By location, 2/16 patients (12.5%) with intra-abdominal testis and 0/55 patients (0%) with extra-abdominal testis demonstrated malignancy (p=0.048). Among males with cryptorchidism ages 10 years and older without differences of sexual development, 2/16 patients with intra-abdominal testis and 0/55 patients with extra-abdominal testis demonstrated malignancy. In older boys and adolescents, orchiectomy or biopsy is indicated for intra-abdominal testes but may not be necessary for extra-abdominal undescended testes.

English

A 46-year-old gentleman presented to casualty with a reducible right groin swelling (Figure 1) present since childhood which had suddenly become painful and irreducible for the past 6 hours. He gives history of absent right testis since childhood. There’s no history of vomiting, abdominal distension or obstipation. He had no surgeries in the past, no testicular disease or infertility problems. Physical examination revealed obstructed inguinal hernia with doubtful strangulation, absent right testis and normal appearing left testis. After evaluation, patient underwent emergency exploration of right inguinal hernia under general anaesthesia which revealed gangrenous small bowel, omentum in between external oblique aponeurosis and skin without a hernia sac (Figure 2) and; ectopic right testis in the superficial inguinal pouch (Figure 3). Segmental resection of gangrenous bowel with primary anastomosis and right orchidectomy performed through the same inguinal approach. Anatomical repair of posterior wall followed by approximation of external oblique aponeurosis was performed. Histopathology report showed gangrenous ileum with patchy necrosis; testis with tubular atrophy and hyalinisation, maturation arrest of spermatogonia and hyperplasia of interstitial Leydig cells. Post-operative recovery was uneventful.

Ectopic testis: an experience of a tertiary-level urology center at Upper Egypt

BackgroundTesticular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016.ResultsOut of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%).ConclusionsTesticular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease

Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1-20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD.

Cryptorchidism in Boys With Cerebral Palsy Is Associated With the Severity of Disease and With Co-Occurrence of Other Congenital Anomalies.

Cryptorchidism is reported in 40-50% of small case series of cerebral palsy (CP) and attributed to hypothalamic-pituitary-gonadal axis abnormalities, intellectual disability (ID), or cremaster spasticity. We collected demographic and clinical data to define the frequency of cryptorchidism and clinical comorbidities in a large CP population. Electronic health record data were collected for all male patients ≥7 years of age seen in a large, multidisciplinary CP clinic between 2000 and 2016. Variables including age, testicular position, surgical findings, CP severity, birth history, and comorbidities were tested for association using univariable and stepwise backward logistic regression analyses. Of 839 established patients, testis position was scrotal in 553, undescended in 185 (24%), retractile in 38 (5%), and undocumented in 63 cases. Cryptorchidism were diagnosed at a mean age of 5.8 years, with 20% documented as acquired, and testes were most commonly in the superficial inguinal pouch (41%) and associated with an inguinal hernia (56%). Severity was bilateral in 114/166 (69%) undescended and 24/36 (66%) retractile cases, respectively. Mean birth weight and the frequency of prematurity (55, 58, and 54%) and multiple birth (14, 13, and 9%) were not significantly different among the three groups. We observed a strong ordinal trend in the frequency of comorbidities, including quadriplegia, syndromic features/known genetic disease, intrauterine growth restriction (IUGR), death, brain malformations, seizures, gastrostomy, absent continence, ID and hearing, speech or visual impairment, with the retractile group holding the intermediate position for the majority. The stepwise multivariable analysis showed independent positive associations of cryptorchidism with quadriplegia, syndromic features/known genetic disease, hearing loss, and absent continence, and inverse associations with gestational age and multiple birth. These data suggest that cryptorchidism is less common than previously reported in CP cases, but most strongly associated with quadriplegia. Delayed diagnosis may be related to an acquired condition or to the multiple additional functional deficits that occur in this population. Our data suggest that UDT and CP may both be components of malformation syndromes occurring in singleton births whose clinical features are more likely to include earlier delivery, IUGR, hearing loss, and/or global spasticity.

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania

Background: Undescended testes (UDT) are prone to a lot of complications but early detection and correction give good results. There is paucity of published data on UDT in our setting. This study describes the clinical presentation, management and outcome of this condition at Bugando Medical Centre (BMC) in northwestern TanzaniaMethods: This was a retrospective study of patients who were admitted and operated for undescended testis at BMC between July 2006 and June 2014. Results: A total of 84 patients with 102 UDT were studied. Forty-six (54.9%) patients were aged above 5 years. Majority (72.5%) UDT were non-palpable. The right side was involved in 54.8%; left side in 23.8% while 21.4% were bilateral. Associated inguinal hernia was reported in 48 (77.4%) patients. Ultrasonography was performed in 34 (45.9%) patients with non-palpable testes and was used to locate 12(35.3%) testes. Laparoscopy was not used in any patient. At surgery, 54 (52.9%) testes were found in the inguinal canal, 28 (27.5%) in the superficial inguinal pouch, 10 (9.8%) in the abdomen and 10 (9.8%) testes were not found. Out of the 92 (90.2%) visible testes, 69 (75.0%) underwent orchidopexy (single stage in 54 (78.3%) testes and multistage in 15 (21.7%) testes) and 23 (25.0%) orchidectomy. Single stage procedures were more likely in patients less than 5 years, with palpable testes and those with testes located at the superficial inguinal pouch (p < 0.001). Postoperative complications were recorded in 8(9.5%) patients. The overall success rate of treatment was 95.7%. In this study, only 12 (14.3%) patients were available for follow up at 12 months after discharge.Conclusion: Patients with UDT presented late in our hospital because diagnosis by birth attendants was rarely made even though the anomaly was obvious at birth. The parents, patients themselves and development of complications drew attention to undescended testis. Health awareness campaign, thorough genital examination after birth and regular screening of toddlers for UDT may result in early presentation

Cryptorchidism and the value of ultrasonography.

The aim of this study was to evaluate the usefulness and accuracy of ultrasonography in investigating cryptorchidism. Case notes were reviewed of all children with cryptorchidism who had undergone ultrasonography for their testes between February and October 2010. Preoperative ultrasonography findings for presence or absence and position of testes were noted and compared with the operative findings. The sensitivity and specificity of ultrasonography were calculated. A total of 50 testes in 42 boys were examined by ultrasonography preoperatively during the study period. The median age was 6 years. All had single B-mode greyscale ultrasonography using greyscale and Doppler imaging. Of the 50 testes, 42 were visualised intracanalicularly or in the superficial inguinal pouch, 2 were intra-abdominal and 6 could not be detected. However, on examination under anaesthesia, 37 out of the 50 testes were palpable in the groin and 13 were impalpable. Two out of the remaining thirteen were found to be atrophic on diagnostic laparoscopy. The sensitivity and specificity of ultrasonography in determining the presence of testes was 85% and 25% respectively. Ultrasonography has low sensitivity and specificity in determining the presence of testes and localisation of their position. When performing an examination under anaesthesia and using a laparoscopic technique, ultrasonography is not recommended in cases of cryptorchidism.

Role of laparoscopy and ultrasound in the management of “impalpable testis” in children

Undescended testes is one of the most common congenital abnormalities in boys. In cases of impalpable testes, ultrasound is often used to find the testis, which frequently provides false-negative results. Recently, laparoscopy has become popular in the management of impalpable testes. Retrospective study of all children with impalpable testes presenting for laparoscopy between August 2007 and July 2011 who had undergone ultrasound examinations without localizing the testes was conducted and the role of laparoscopy in diagnosing impalpable testes was evaluated. Twenty-three patients presented with impalpable testes for laparoscopy. All patients underwent ultrasound examinations in which the testes could not be identified. Of the 23 patients, Five patients were found to have palpable testes in the superficial inguinal pouch under anesthesia and proceeded to conventional open exploration during which the testes were brought into the scrotum. Eighteen patients were found to have impalpable testes in an evaluation under anesthesia (EUA) and proceeded to laparoscopy. Twelve patients were found to have intra-abdominal testes and underwent laparoscopic-assisted orchidopexy. Three patients underwent a two-stage Fowler-Stephens procedure, and two patients with "vanishing" testes with the vas and atrophic vessels entering a closed internal ring proceeded to open exploration and orchidectomy for atrophic testes. In addition, a teenager with atrophic testes underwent laparoscopic orchidectomy. Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.

English

Traumatic displacement of the testis is a rare occurrence and is defined as the displacement of one or both testis to a position other than the scrotum (1) .Traumatic displacement of testis is commonly a delayed diagnosis during treatment occurs as a consequence of high velocity road traffic accident (2) usually following a motorcycle collision, in what is referred to as fuel tank injury. Early identification and subsequent surgical management is of utmost importance to maintain normal spermatogenesis in the displaced testis. We report a case of traumatic displacement of testis in superficial inguinal pouch in a young man presented 1 year after a road traffic accident. The clinical diagnosis was well supported by USG. The patient was successfully treated by inguinal exploration and repositioning of testis in scrotum, under spinal anesthesia.

The secondary external inguinal ring and associated fascial planes: surgical anatomy, embryology, applications

Classically, two inguinal rings are defined: internal and external. We previously introduced a third one, the secondary internal inguinal ring, deep to the classic internal. Here, we present a fourth ring, the secondary external inguinal ring, initially described by McGregor (Surg Gynecol Obstet 49:273-307, 1929), but now forgotten. Embryologically, this ring may be formed by evagination of Scarpa's fascia during testicular descent. Anatomically, it is located 2 cm below the pubic tubercle. It is formed by Scarpa's fascia that covers the spermatic cord anteriorly; medial and lateral fascial reflections delineate the ring and form the spermatic cord canal. The cord is attached to the posterior wall of the canal. The canal ends at the entrance of the scrotum, where Colles' fascia fuses with coverings of the cord. Adjoining the secondary external ring, at the same surgical layer and communicating with the subcutaneous abdominal space, are four subcutaneous pouches: laterally, the superficial inguinal pouch; medially, the perineal, femoral, and pubic pouches. Surgically, an inguinoscrotal hernia passes though the secondary external ring and obtains an extra outer layer by entering the spermatic cord canal. Underdevelopment of the ring leads to incomplete testicular descent or ectopic testis. We recommend reconstruction of Scarpa's ring after orcheopexies and herniotomies in children. After urethral rupture distal to the urogenital diaphragm, urine may fill the subcutaneous abdominal space, pouches, and scrotum, due to their communication around the secondary external ring. In females, this ring was not found, possibly because of the non-descent of the ovaries through (and beyond) the inguinal canal.

Different surgical findings in congenital and acquired undescended testes

To compare surgical findings in congenital and acquired undescended testes (UDT). A review of 139 boys with 158 congenital UDT and 69 boys with 84 acquired UDT was performed. The most caudal testicular position preoperatively, testis position at surgery, patency of the processus vaginalis and epididymal anomalies were prospectively recorded. In the congenital group, orchiopexy had been performed at median age (range) 4.9 (1.5-14.6) years, while the median age (range) in the acquired group was 11.9 (3.8-23.3) years. Preoperatively, only congenital UDT were found not palpable or emergent inguinal, while only acquired UDT could be manipulated in an unstable scrotal position. In comparison with congenital UDT, acquired UDT were significantly more often located at the scrotal entrance, 27/158 vs 32/84 respectively (P < 0.001). At surgery anorchia, vanished testis or testes lying intra-abdominally were only registered in the congenital UDT group. Also 37/158 congenital UDT were located in the superficial inguinal pouch vs 52/84 of the acquired UDT (P = 0.04). In congenital UDT the processus vaginalis was wide open in 74/158, while in acquired UDT the processus vaginalis was closed in 46/84 (P < 0.001) and small open in 26/84 (P = 0.04). Epididymal anomalies were more often seen in the congenital UDT group (37%) than in the acquired group (11%). The most caudal position of congenital UDT after manipulation before surgery was at the scrotal entrance. These testes were frequently associated with epididymal anomalies and wide open processus vaginalis. This was in contrast to acquired UDT, which can often be pushed down well below the scrotal entrance and are more likely to be situated in the superficial inguinal pouch, with a normal epididymis and closed processus vaginalis.

Expression of estrogen receptors α and β in paratesticular tissues in boys operated on for unilateral cryptorchidism between the 1st and 4th years of life

SummaryBackgroundThe aim of this study was to assess the expression of estrogen receptors α and β in paratesticular tissues in a group of boys with and without cryptorchidism, and evaluation of karyotypes, localization, morphology and the major length of the undescended testes.Material/MethodsFifty boys (1–4 years old) with unilateral cryptorchidism were evaluated. Fifty healthy boys within the same age range, with inguinal hernia, served as a control group. Measurements concerning expression of ERα ERβ receptors were preformed using monoclonal mouse antibodies against human receptor α and β.ResultsIn the mesothelial layer, the expression of ERα was higher in the patients group with undescended testes and it was statistically significant (p=0.04). There was no difference in the expression of ERβ in this layer between groups. In the stromal cell layer there was statistically significant higher expression of ERβ (p<0.05) in the group of patients with undescended testes.ConclusionsThere was no difference between expressions of ERα in stromal cell layer. In the endothelial layer there was no difference in expression of ERα and ERβ. In the smooth muscle layer there was no expression of ERα in either group. The expression of ERβ in the smooth muscle layer was nearly identical in both groups. Undescended testes were generally found in the superficial inguinal pouch (n=46). The major lengths of the undescended testes were smaller in comparison to the testes positioned normally. In 9 of the cases the testes had different shape, and turgor deficit, and epididymides were smaller, dysplastic and separated from the testis.

Serum AMH concentration as a marker evaluating gonadal function in boys operated on for unilateral cryptorchidism between 1st and 4th year of life

The aim of this study was to measure the serum AMH (anti-Mullerian hormone) concentrations in a group of boys with or without cryptorchidism, evaluation of karyotypes, testicular position, morphology, and major length of the undescended testes. Fifty boys who were 1–4 years old (median = 2.4 years) with unilateral cryptorchidism were evaluated. All of them underwent orchidopexy in 2010. Prior to the procedure, all of the subjects had undergone karyotyping to exclude chromosomal abnormalities. Fifty healthy boys within the same age range (median = 2.1 years) admitted for planned inguinal hernia repair in 2010, served as controls. Blood samples were collected, while obtaining blood for standard laboratory tests routinely performed before the surgeries. Medians of AMH in boys with cryptorchidism were lower than in boys with inguinal hernia and differed significantly between two groups. Undescended testes were generally found in superficial inguinal pouch (n = 46), in two cases were noted to be in the external ring of the inguinal canal, and in another two instances, in the abdominal cavity. The major lengths of the undescended testes were smaller in comparison to the testes positioned normally (mean of 1 cm vs. a mean of 1.5 cm, respectively). In nine of the cases, the testes had turgor deficit, a drop shape, with epididymides that were small, dysplastic, and separated from the testis. The authors found that AMH was lower in boys with unilateral cryptorchidism (also found to have smaller testis) when compared with the control group.

Surgical Findings in Acquired Undescended Testis: an Explanation for Pubertal Descent or Non-descent?

Surgical findings were studied to find an explanation for the phenomenon that some acquired undescended testes (UDT) descend spontaneously whereas others need orchiopexy. In patients with acquired UDT spontaneous descent was awaited until at least Tanner stage P2G2. Orchiopexy was performed when a stable scrotal position had not been achieved by the end of follow-up. Orchiopexy was needed in 57 of 132 cases (43%). In cases requiring orchiopexy, the difference in testis volume compared to the contralateral healthy testis was significantly larger than for spontaneously descended testes. 41 (72%) undescended testes were found in the superficial inguinal pouch; 16 (28%) at the external annulus. 26 of the 41 testes in the superficial inguinal pouch position (63%) could be manipulated preoperatively into a non-stable scrotal position; 15 could only reach the scrotal entrance prior to surgery. None of the 16 testes located at the external annulus could reach a scrotal position. Inguinal exploration in most cases revealed a fibrous string or a partially open processus vaginalis. The mobility of acquired UDT located within the external annulus is limited. It is mainly the fibrous string and the partially open processus vaginalis that prevent normal elongation of the spermatic cord with growth. These testes are unlikely to descend spontaneously. Acquired UDT lying in the superficial inguinal pouch can often be pushed down well below the scrotal entrance. We speculate that under normal hormonal stimulation at puberty, some of these growing testes may overcome the strength of the fibrous string in the spermatic cord and descend again spontaneously.

A modified technique for scrotal fixation during orchiopexy

Undescended testes are a common problem, affecting up to 3% of newborn males. The goals of orchiopexy in humans are to provide adequate scrotal fixation, to prevent recurrent torsion of the testis and spermatic cord or ascent of the testis, and to achieve these goals with minimal trauma to the testis. The best method of achieving fixation remains controversial. The aim of our study is to evaluate our modified extra Dartos pouch technique in retaining testis in the scrotum. A prospective randomized study included 159 patients with 185 orchiopexies age ranging from 5 months to 14 years with the mean age of 49.5 ± 33.3 months (4.08 years). They were divided into two groups: Group I for whom the extra Dartos pouch technique was applied were compared to Group II for whom classic sub-Dartos pouch technique was done. Testis was located in the superficial inguinal pouch in 102 cases (64.1%) and intra-canalicular in 57 cases (35.6%). Hernial sac was found in 153 cases (96.2%), postoperative wound infection occurred in 3 cases (1.9%) and hematoma formation in three cases (1.9%); one case reported ascent of the testis and another one had testicular atrophy in the follow-up period which extends now up to 3 years and we are still in follow-up with those cases. Our modified technique for extra Dartos pouch fixation seems to be a fast reliable method for orchiopexy; however, comparative studies and long-term assessment is still needed to establish this method.

Initial Pre-Scrotal Approach for Palpable Cryptorchid Testis: Results During a 3-Year Period

Pre-scrotal orchiopexy is emerging as an alternative approach for cryptorchid testes that can be preoperatively mobilized into the scrotum. We present our 3-year pre-scrotal orchiopexy series for all palpable cryptorchid testes regardless of their mobility into the scrotum preoperatively. We retrospectively reviewed all patients who underwent pre-scrotal orchiopexy during a 3-year period. Data collected included preoperative and postoperative testicular position, mobility of the testis into the scrotum preoperatively or with the patient under general anesthesia, patency of processus vaginalis, operative times and complications. A total of 88 cryptorchid testes were treated using single pre-scrotal incision orchiopexy. Mean patient age was 4.9 years. Of the testes 74 (84.1%) could be milked down to the scrotum preoperatively and 14 (15.9%) could not. Of the 14 immobile testes 8 were intracanalicular and 6 were in the superficial inguinal pouch. Pre-scrotal orchiopexy was successful in all 74 testes that were mobilized into the scrotum preoperatively. However, 6 of 14 testes (43%) that could not be moved to the scrotum were effectively managed by a single pre-scrotal incision, while 8 (57%) required an additional groin incision for successful orchiopexy. No complications were observed during a mean followup of 7.1 months. Orchiopexy using a pre-scrotal approach is a viable alternative for palpable cryptorchid testes that can be preoperatively mobilized into the scrotum. Cryptorchid testes that are palpable but cannot be moved to the scrotum can be managed by the pre-scrotal approach alone in 40% of cases or with an additional groin incision in 60%.

Perioperative surgical findings in congenital and acquired undescended testis

Purpose Perioperative surgical findings in congenital and acquired undescended testis (UDT) were prospectively assessed. Methods We included all boys with congenital or acquired UDT who underwent orchidopexy at our hospital between January 2006 and August 2009. Perioperatively, we scored the position and volume of the testis, the insertion of the gubernaculum, the patency of the processus vaginalis, and the obtained position. Results We included 69 boys (aged 0.9-14.6 years) with 76 congenital UDT and 28 boys (aged 2.2-18.5 years) with 30 acquired UDT. In the congenital group, the testis was in intracanalicular position in 55 cases (72%), whereas in the acquired UDT group, this was in 11 cases (37%; P < .001). The insertion of the gubernaculum was at the bottom of the scrotum in 13 cases (17%) of the congenital UDT group and in 12 cases (40%) of the acquired UDT group ( P < .05). The processus vaginalis was open in 63 cases (83%) of the congenital and in 9 cases (30%) of the acquired UDT group ( P < .001). Conclusion Compared to congenital UDT, acquired UDT are more likely to be situated in the superficial inguinal pouch, to have a normal insertion of the gubernaculums, and to have a closed processus vaginalis.

Sir Denis Browne: Contributions to Pediatric Urology

Sir Denis Browne, a surgeon at the Hospital for Sick Children, Great Ormond Street, was the first surgeon to confine his practice solely to pediatric surgery. He made numerous important contributions to the field of pediatric surgery in orthopedics, otolaryngology, plastic surgery and urology, and is thus known as the father of modern British pediatric surgery. We reviewed the original publications, historical records and medical literature on Denis Browne and his contributions to urology. Sir Denis Browne used his anatomical studies to elucidate many of the problems he faced. He classified undescended testis into two groups still recognized today: 'normal variations of development (retractile testis) which only need leaving alone' and 'congenital deformities which need operation'. During orchidopexy he stressed cord mobilization rather than testicular fixation and tension on the blood supply. He was also the first to describe the superficial inguinal pouch, which bears his name, as a common site for the undescended testis. He devised a new operation for hypospadias based on the principle that a buried strip of skin will epithelialize the surrounding tissue into a tube. The simplicity of his technique made hypospadias surgery available to the average surgeon. As an inventor, he designed many surgical instruments, including a circular retractor holder, as well as a universal golf club, a circular tennis racquet and a modified bicycle seat. Sir Denis Browne was an innovator and nonconformist with regard to the traditional teaching and practice of pediatric surgery and urology of his day. His innovations in surgical theory, technique and instrumentation resulted in major contributions to the advancement of urology as well as pediatric surgery.

Denis Browne: Contributions to Pediatric Urology

Purpose Sir Denis Browne, a surgeon at the Hospital for Sick Children, was the first surgeon to confine his practice to pediatric surgery. He made numerous important contributions to the field of pediatric surgery in orthopedics, otolaryngology, plastic surgery and urology and is known as the father of modern British pediatric surgery. Material and Methods We reviewed the original publications, historical records and the medical literature on Denis Browne and his contributions to urology. Results Sir Denis Browne used his anatomical studies to elucidate many clinical problems. He classified cryptorchidism into two groups: “normal variations of development which only need leaving alone” and “congenital deformities which need operation.” During orchidopexy he stressed cord mobilization rather than testicular fixation. He was the first to describe the superficial inguinal pouch as a common site for the undescended testis. He devised an operation for hypospadias based on the principle that a buried strip of skin will epithelialize the surrounding tissue into a tube. As an inventor, he designed many surgical and nonsurgical instruments, including a circular self-retaining retractor, a universal golf club, a circular tennis racquet and a modified bicycle seat. Conclusions Among his many scientific and operative contributions, Sir Denis Browne categorized undescended testis and described the superficial inguinal pouch as a common location for undescended testis. His buried strip technique for hypospadias was simple and made hypospadias surgery available to the average surgeon. His innovations in surgical theory, technique and instrumentation contributed to advancements in pediatric urology as well as pediatric surgery. Sir Denis Browne, a surgeon at the Hospital for Sick Children, was the first surgeon to confine his practice to pediatric surgery. He made numerous important contributions to the field of pediatric surgery in orthopedics, otolaryngology, plastic surgery and urology and is known as the father of modern British pediatric surgery. We reviewed the original publications, historical records and the medical literature on Denis Browne and his contributions to urology. Sir Denis Browne used his anatomical studies to elucidate many clinical problems. He classified cryptorchidism into two groups: “normal variations of development which only need leaving alone” and “congenital deformities which need operation.” During orchidopexy he stressed cord mobilization rather than testicular fixation. He was the first to describe the superficial inguinal pouch as a common site for the undescended testis. He devised an operation for hypospadias based on the principle that a buried strip of skin will epithelialize the surrounding tissue into a tube. As an inventor, he designed many surgical and nonsurgical instruments, including a circular self-retaining retractor, a universal golf club, a circular tennis racquet and a modified bicycle seat. Among his many scientific and operative contributions, Sir Denis Browne categorized undescended testis and described the superficial inguinal pouch as a common location for undescended testis. His buried strip technique for hypospadias was simple and made hypospadias surgery available to the average surgeon. His innovations in surgical theory, technique and instrumentation contributed to advancements in pediatric urology as well as pediatric surgery.

Traumatic bilateral testicular dislocation: a recovery of spermatogenesis by orchiopexy 15 years after the onset

To report a patient with azoospermia who achieved an induction of spermatogenesis after undergoing orchiopexy of long-standing bilateral traumatic dislocated testes. Case report. Clinical. A 33-year-old man. Imaging studies, orchiopexy, testicular biopsy, and a review of similar cases. Recovery of spermatogenesis after orchiopexy. A patient with azoospermia with bilateral traumatic dislocated testes due to a motorcycle accident 15 years previously. A bilateral testicular dislocation in the superficial inguinal pouch was diagnosed by palpation, imaging studies, and exploration. A recovery of spermatogenesis was obtained after performing orchiopexy of bilateral dislocated testes. The recovery of spermatogenesis in patients with azoospermia with a bilateral testicular dislocation therefore may be successfully obtained after appropriately performing orchiopexy.