Testicular Preservation Research Articles

What matters in testicular torsion? Association of hospital transfer, race and socioeconomic factors with testicular outcomes in a single center experience

IntroductionTesticular torsion is a surgical emergency that is managed with either septopexy-only or tunica vaginalis flap with septopexy if the testis is potentially viable or orchiectomy if not. Minimizing time from ischemia onset to surgery maximizes the likelihood of testicular preservation. While factors such as time from door to OR can be easily targeted, others such as inequalities in access to care are more difficult to address. ObjectiveWe sought to determine whether patient transfer affects testicular outcomes intraoperatively and in the long-term. Secondary goals included investigating the impact of race and Child Opportunity Index (COI) on testicular torsion outcomes and defining the optimal time cutoff from symptom onset to presentation that predicts salvage. MethodsWe reviewed our prospective testicular torsion database to identify boys who underwent operative intervention for testicular torsion between January 2015 and March 2022. The association of race and COI with testicular salvage, defined as septopexy-only, was evaluated with univariate and multivariate logistic regression controlling for time to presentation, while the association of transfer with salvage was evaluated with univariate and multivariate logistic regression controlling for age, time to presentation, and time to OR. To determine the optimal cutoff for time to presentation to predict testicular salvage, the Youden index was calculated. ResultsRace and COI were not associated with testicular salvage on either univariate or multivariate logistic regression that controlled for time to presentation. Transfer status was not associated with salvage, while age, time from symptoms to presentation, and time from institutional arrival to OR were associated with salvage. The optimal time cutoff to predict salvage using the Youden index was 10.5 hours from symptom onset to presentation and 14.5 hours from symptom onset to detorsion. DiscussionTime to presentation was the strongest, modifiable risk factor associated with testicular salvage. As it may be difficult for children to accurately communicate their symptoms, diagnosis and prompt management of testicular torsion can be delayed. Improvement in outcomes can be achieved by placing greater efforts into patient, parental, and primary care provider education of the signs and symptoms of testicular torsion. ConclusionsRace, COI, and transfer status were not found to have a statistically significant effect on testicular salvage outcomes in patients presenting with testicular torsion. Despite the common premise of a six-hour window until testicular loss, we found that intervention within the acute window of 14.5 hours from symptom onset is still associated with salvage.

SURGICAL REPAIR FOLLOWING TRAUMATIC TESTICULAR RUPTURE : OUTCOME OF 3 CASES

Scrotal traumas are relatively uncommon. Most are blunt trauma caused by a direct blow to the scrotum. Early surgical exploration has considerably improved the prognosis of testicular trauma and reduced the rate of orchiectomy. Ultrasound has also improved the management of scrotal trauma. But there is controversy over the accuracy of ultrasound in predicting the presence or absence of testicular rupture. Its important to acknowledge the potential long-term repercussions such as testicular atrophy and infertility. We report three clinical cases, all young and victims of scrotal trauma with unilateral testicular rupture, all three of whom benefited from scrotal exploration with testicular preservation.

Pathomorphological and immunohistochemical characteristics of the testicle in children with critical ischemia during acute torsion

Background. The occurrence of acute torsion of the testicle in children leads to ischemia of the testicle, and in the absence of timely medical assistance - to the loss of the organ. The period from 12 hours to 24 hours from the onset of the disease leaves only a 20% chance of saving the genital gonad. There are still no exact signs of viability of the affected gonad in case of critical ischemia of the testicle due to its torsion. Therefore, the study of the dynamics of changes in morphological structures in the course of acute testicular torsion, morphological and functional disorders resulting from torsion, is of great practical interest, because there is no consensus on the nature and degree of these changes in the affected gonad. Objective: study of the nature and severity of pathomorphological changes and immunohistochemical features of the acute torsion testicle in children within 12.1-24 hours or more from the onset of the disease. Methods. A histological, histochemical, and immunohistochemical study of testicular tissue biopsies taken during the operation of detorsion and orchiopexy, and orchidectomy within 12.1–24 hours or more from the onset of clinical symptoms of acute unilateral torsion in 16 patients was conducted. Results. The morphological study of the gonads showed that the duration of acute torsion of 12.1–24 hours or more is characterized by severe pathological changes found in the testicles. After 18 hours of acute ischemia, tubules were visualized in many fields of view in the form of shadows with the impossibility of identifying the structures due to hemorrhagic or ischemic infarcts. Immunohistochemical typing demonstrated the absence of expression of vimentin and calretinin, which indicated the death of sustentocytes (Sertoli cells) and Leydig cells. With a duration of acute torsion of 12.1-18 hours, a histochemical study of glycogen in the cytoplasm of spermatogonia, spermatocytes, and sustentocytes using the PAS-reaction showed that some cells of the spermatogenic epithelium were characterized by irreversible changes preceding necrosis, although giant multinucleated spermatids with relatively preserved glycogen, which meant there was a minimal chance for saving the gonad. Conclusion. Total duration of symptoms and degree of male gonadal torsion are the main prognostic factors for testicular preservation or necrosis in episodes of torsion. The duration of an acute torsion of 12.1-18 hours, according to morphological research, leaves in 42,9% of cases the presence of a minimal chance of saving the genital gonad. After 18 hours from the onset of acute complete testicular torsion in children, the operation of choice is orchidectomy.

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.

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3months?

This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3months old. A retrospective analysis was conducted on data collected from infants under 3months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. The study included 42 cases, with 18 patients being followed up for 6-54months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.

Testicular decompression and tunica vaginalis flap in human acute testicular torsion: modified step-by-step technique description and preliminary outcomes.

To report the effects of a tunica vagina flap on testicular compartment syndrome. This single-arm clinical trial was conducted from September 2020 to October 2021. Consecutive patients with suspected testicular torsion within 24 hours of pain onset were included. Patients with past testicular torsion, bilateral torsion, or previous atrophy were excluded. The tunica vaginalis was opened, and the intratesticular pressure was measured before testicular retrieval from the scrotum and detorsion (P1), after detorsion (P2), and after transverse incision (P3). A tunica vaginalis flap was performed and a new intratesticular pressure was recorded (P4). The contralateral testicular pressure was recorded before fixation (Pc). The minimum follow-up period was 6 months. Fifteen patients were recruited from September 2020 to October 2021. Nine patients completed the follow-up. The median age (range) was 15 years (9-19). The mean P1, P2, P3, P4, and Pc (range) were 43, 60, 23, 20, and 14mmHg, respectively. The atrophy rate was 66.3% and the viability was 88.9%. No major complications were observed. The modified tunica vaginalis flap in acute testicular torsion decreased intratesticular pressure. Furthermore, normal testicular pressure can improve testicular preservation. It can also decrease testicular pressure to normal levels and preserve the testicular parenchyma. Testicular torsion causes orchiectomy in more than 80% of the cases after 24 hours of pain onset. Testicular detorsion only (P1-P2) showed a small difference in intratesticular pressure (median 4mmHg). Testicular incision (P2-P3) only demonstrated a major pressure decrease (median, 45mmHg). The final pressure after TVR was similar to the non-twisted testicle pressure (median, 1mmHg). Testicular salvage (88.9%) and atrophy (66.3%) rates were slightly higher than the previous literature reports, perhaps the initial learning curve of this novel technique.

Testicular torsion, time is of the essence: a case for testicular preservation

Testicular torsion around the spermatic cord causes arterial and venous occlusion, which can lead to swelling, ischemia, and eventually necrosis of the testicle. It is a urologic emergency that requires a time-dependent diagnosis to prevent testicular loss. This is a case report of an atypical presentation of a 15-year-old male with a 5-day history of testicular torsion, that resulted in preservation of testes viability immediately after detorsion and at 4-week follow-up.

Spermatic cord torsion: a retrospective analysis.

To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1-D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

Chlamydia Trachomatis Masquerading as Scrotal Masses in Adolescents

ObjectiveTo present a case series of 3 post-pubertal adolescent males with Chlamydia trachomatis presenting as scrotal masses. Scrotal masses are worrisome for malignancy, especially when imaging confirms intratesticular lesions. However, there are benign conditions which may mimic testicular cancer. Some of these conditions may not be readily considered in the pediatric population. This phenomenon is rare in the pediatric population, and this represents only the second report in the literature of this finding. MethodsThree cases of adolescent males who presented with a scrotal mass were reviewed. Traditional work up was performed, and results are reviewed. ResultsMedian age for these patients was 16 years (range 16-17). All patients underwent scrotal ultrasound confirming intratesticular lesions. Two of the 3 patients denied sexual activity within the past year. Two patients underwent orchiectomy after counseling and shared decision making, with both specimens demonstrating no malignancy. All 3 patients were eventually diagnosed with Chlamydia trachomatis and treated with appropriate antibiotic therapy. ConclusionAdolescent males who are sexually active can present with Chlamydia trachomatis infection masquerading as a scrotal mass. It is important to consider infectious etiologies in this patient group as it has been documented that many adolescents are hesitant to admit to sexual activity. Thus, routine sexually transmitted infection (STI) screening warrants consideration, and testicular preservation should be sought when it is a viable management option.

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.

Male genital injuries treated at a tertiary hospital in the western region of Nepal: A two-year snapshot.

Background: Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic intervention may lead to loss of fertility due to infections and anatomical disruption of normalcy. This study highlights the clinical scenarios, etiology and outcome of male genital injury cases that were managed at a tertiary care center in Nepal. Such injuries are not frequently encountered as patients are hesitant to report such injuries. The present study is the first from Nepal which depicts a comprehensive report on male genital injuries. Methods: A retrospective analysis of discharge summaries of the cases of male genital injuries was reviewed during June 2020. All the treated cases during the two-year period from April 2018 to April 2020 at Lumbini Medical College, Nepal were included in the study. Results: There were eight cases of genital trauma admitted and treated during the study period. All the patients were males and age ranged from six to 71 years with a mean age of 33 ± 21.45 years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause in the majority of cases. Conclusion: Superficial injuries to the penis and scrotum do not require surgical exploration and could be managed conservatively. However, deeper and complicated injuries, testicular preservation, the functionality of the part and cosmetic issues are taken into consideration which might require a multi-disciplinary approach. Apart from the medical issues pertaining to genital injuries, there are legal and psychological aspects of such events too which should not be ignored.

Canine and Feline Testicular Preservation.

Simple SummaryTesticular cryopreservation enables the maintenance of reproductive potential, the creation of germplasm banks and the transport of genetic material between different regions. This biotechnology represents the only possibility of preserving the fertility of prepubertal animals that have already died or that need to undergo gonadotoxic treatments. Despite advances in the use of cryopreserved testicular fragments, protocols that can be used in the clinical routine of dogs and cats have not yet been established. Due to the great importance of the topic, the objective of this review is to provide an overview of the subject, approaching the main works on testicular cryopreservation in dogs and cats.The increased interest in breeding dogs and cats and their use as models for other canids and felids demand research to improve reproductive techniques. Among them, testicular cryopreservation stands out. Testicular cryopreservation enables the maintenance of reproductive capacity and allows the establishment of germplasm banks for several species of commercial value or at risk of extinction. Furthermore, it enables the transport of genetic material among different regions. It is noteworthy that this biotechnology represents the only possibility of preserving the fertility of prepubertal animals that have died, so it has great importance in the propagation of the genetic material of animals. The spermatogonia present in the testes can be cultivated in vitro and the sperm obtained can be used in artificial reproduction programs. Although advances have been achieved with the use of testicular fragments to obtain viable and functional germ cells, the establishment of protocols that can be used in clinical routine have not been concluded yet. The testicular cryopreservation process can be carried out through techniques such as slow freezing, fast freezing and vitrification. However, the protocols used for the canine and feline species are still in the experimental phase. Given the importance of the topic, the aim of this review is to draw a profile of the subject approaching the main works on testicular cryopreservation in dogs and cats.

Laparoscopic –Assisted Orchidopaxy in Non-Palpable Testes in Adult Population

ABSTRACT:&#x0D; &#x0D; Objectives: To present our experience of managing impalpable undescended testes in post-pubertal patients with intention of testicular preservation using laparoscopic assisted orchidopaxy. &#x0D; &#x0D; Study Design: Descriptive Case series.&#x0D; &#x0D; Place &amp;&#x0D; Duration of&#x0D; Study: Department of Urology, Jinnah Postgraduate Medical Center (JPMC) Karachi, between Jan 2015 to Dec 2020 with minimal 6 months follow-up.&#x0D; &#x0D; Methodology: We included all patients with clinically impalpable testes with aged 12 and above. All patients had ultrasound abdomen performed as initial screening test followed by laparoscopic assessment and definite procedure. Patients with normal or hypo-plastic testes were underwent single staged orchidopaxy, while patients with testicular atrophy were planned for orchiectomy. Intraoperative testicular biopsy and Semen analysis were not routinely performed in our study.&#x0D; &#x0D; Results: Total 36 patients with 41 impalpable testes underwent laparoscopic localization and management. Mean age of patients was 20.75+ 5.98 years. 50% of testes were on the right side, 36.1% on left sided while 3.88% were bilateral. 5 (12.1%) patients had clinical inguinal hernia.. Diagnostic yield of ultrasound was (75.6%) and 100 % in laparoscopy. 33 testis were true intra-abdominal while 4 were inguinal and 4 were vanishing testes Normal looking testes were observed in 24 testes (64.86%) followed by hypoplastic in 11(29.72%) while 2 testes (5.40%) were atrophic. Two intra-operative complications included urinary bladder injury and vas deferens injury in one patient each. Postoperatively testicular ischemic necrosis in one (2.4%) and wound infection in 2 (4.8%) patients were noted. Late follow up revealed one port site hernia (2.4%) and one testicular atrophy (2.4%). Success rate of orchidopaxy in our study was 94.6%.&#x0D; &#x0D; Conclusions: Laparoscopic has been proved as excellent diagnostic and therapeutic tool for the management of intra- abdominal undescended testes in adolescent and post-pubertal patients.&#x0D; &#x0D; &#x0D; Key words: Impalpable testes, Laparoscopic-assisted orchidopaxy, Adolescent, Adult

Testicular blood supply and growth in children with high cryptorchidism treated with gubernaculum preserving vs. cutting laparoscopic orchiopexy: A pilot trial

It is still controversial whether the frenum of testis should be retained in laparoscopic testicular fixation. It is a prospective experiment to study testicular preservation on testicular growth in children with high cryptorchidism. From January 2018 to June 2020, 120 children with high cryptorchidism in Inner Mongolia Maternal and Child Health Care Hospital and The Fourth Hospital of Baotou were randomly divided into retention group (60 cases in group P, aged 1-3 years, average 1.85±0.58) and cutting group (60 cases in group C, aged 1-3 years, average 1.75±0.66) (P=0.52). PSV, EDV, RI and testicular volume were measured by color Doppler ultrasound before operation and 1,3,6,12 months after operation. No, there was significant difference between the two groups (P>0.05). There is no significant difference in testicular blood supply and growth between laparoscopic testicular fixation and frenulum amputation in children with high cryptorchidism.

MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY Rafael Ribeiro Zanotti, Luis Gustavo Morato de Toledo, André Costa Matos, Marcos Broglio, Sergio Paolillo, and Jorge Ricardo Gois e Cunha Rafael Ribeiro ZanottiRafael Ribeiro Zanotti More articles by this author , Luis Gustavo Morato de ToledoLuis Gustavo Morato de Toledo More articles by this author , André Costa MatosAndré Costa Matos More articles by this author , Marcos BroglioMarcos Broglio More articles by this author , Sergio PaolilloSergio Paolillo More articles by this author , and Jorge Ricardo Gois e CunhaJorge Ricardo Gois e Cunha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular torsion is the most potential harmful cause of acute scrotal pain. To date, the most significant efforts in terms of testicular rescue rates have been based on early detorsion. Compartment syndrome has been increasingly recognized as important in enhancing the ischemic insult of several organs limited by their natural sheaths, such as the testis. Therefore we evaluate the impact of albugineotomy with reconstruction using a vaginal tunica flap in testicular salvage rate and late viability. METHODS: This study was conducted after institutional approval by local Research Ethics Committee. We randomized testicles that appeared to be ischemic even after detorsion and heating (which traditionally would be treated by orchiectomy), in one group for albugineotomy with tunica vaginalis flap coverage and another group for orchiectomy. Testicles with signs of good perfusion were not randomized, and so treated by orchidopexy. The follow-up was maintained for further analysis of testicular viability. Time from pain to surgery was not a variable that would determine the technique. Doppler sonography was performed at 6 postoperative months to assess the symmetry of blood flow and the volume in relation to the contralateral testis. Viable testes were defined as those with detectable flow and more than 50% of contralateral testis volume. RESULTS: From December 2018 to August 2020, a total of 28 patients were treated. Ten patients were randomized to albugineotomy and 7 to orchiectomy. Eleven patients were not randomized because the affected testicle had good perfusion aspect, so they underwent orchidopexy. The median time between the onset of pain and surgery was 48 hours (4 to 140 hours). This late presentation was mainly caused by the transfer of patients from other centers. Upon arriving at our service, the patient was immediately referred to treatment in the operating room. In the group with good reperfusion after detorsion and heating; and therefore, not randomized, only 22% of the testicles did not suffer atrophy after 6 months. Of those who underwent the technique under study, 25% did not atrophy. CONCLUSIONS: The application of albugineotomy with tunica vaginalis flap resulted in decrease of orchiectomy rates and avoids long-term testicular atrophy in a significant percentage of gonads (25%) that would otherwise be considered for orchiectomy, without causing major complications. We can conclude that albugineotomy allows to increase the intraoperative and long-term testicular preservation rate. Only 22% of testicles considered viable in the intraoperative, non-randomized, did not present atrophy after 6 months. The use of albugineotomy for these patients with late presentation but good perfusion aspect has not yet been studied. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e961-e962 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Ribeiro Zanotti More articles by this author Luis Gustavo Morato de Toledo More articles by this author André Costa Matos More articles by this author Marcos Broglio More articles by this author Sergio Paolillo More articles by this author Jorge Ricardo Gois e Cunha More articles by this author Expand All Advertisement Loading ...

Male genital injuriesattending a tertiary hospital inawestern region of Nepal:Atwo-year snapshot.

Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic interventionmaylead to chances of loss of fertility due to infections and anatomical disruption of normalcy.This study highlights the clinical scenarios, etiology and outcome of malegenitalinjury cases that were managed at a tertiary care center in Nepal.Such injuriesare not frequently encounteredaslack of reportingbypatients means cases are rare.The present study isthefirst from Nepal which depicts a comprehensive report on male genital injuries. Methods:A retrospective analysis of discharge summarieswas carried out and the cases of male genital injuries were reviewed duringJune2020. All the treatedcasesduring thetwo-yearperiod from April 2018 to April 2020at Lumbini Medical College, Nepalwere included in the study. Results:There wereeightcases ofgenitaltrauma admitted and treated during the study period. All thepatients weremales and age ranged fromsixto 71 years with a mean age of33±21.45years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause inthemajority of cases. Conclusion:Superficial injuriestothepenis and scrotum do not require surgical exploration and could be managed conservatively. However,deeperand complicated injuries, testicular preservation, the functionality of the partandcosmetic issuesaretaken into consideration which might requireamulti-disciplinary approach.Apart from themedical issues pertaining togenital injuries, there arelegal and psychological aspects of such eventstoo which should not beignored.

Zero-ischemia testis-sparing surgery for probably benign pediatric testicular tumors.

Permanent ischemia-induced testicular damage may occur as early as 30min in prepupertal rats. With the goal of potentially enhancing testicular function and fertility preservation, we performed testis-sparing surgery (TSS) without ischemia for testicular lesions in select children with negative markers and high likelihood of benignity on ultrasonography. Preliminary experience suggests that off-clamp TSS should be more liberally encouraged, especially in infants and prepubertal children, given their particularly vulnerable spermatic cord elements.

Management of cryptorchidism in adolescent and adult males

BackgroundIn developing countries, it is not unusual for patients with undescended testes (UDT) to present in adulthood and the late detection of UDT can be problematic. The limited contribution to fertility and increased potential of malignancy seen in UDT have swayed many authors towards recommending orchidectomy, rather than orchidopexy, for the adult patient presenting with cryptorchidism. With conflicting data, and most guidelines aimed at first world countries with pre-pubertal patients as their focus group, a lot of uncertainty exists regarding the management of adults who present with cryptorchidism. This may result in variation in the approach to management of this patient population.MethodsA retrospective review was conducted of patients with cryptorchidism, aged 12 years or older at the time of surgery. The following data were retrieved: patient’s age, medical and previous surgical history, clinical features of UDT (laterality, position and size), date of surgery, intra-operative findings and procedure performed. Management decisions were compared to the most recent guidelines.ResultsThe mean age of the 106 subjects was 25.4 years. An orchidectomy was performed in a total of 30 (24.2%) of the 124 testicular units. The majority of testes, 91 (73.4%), in this group were preserved. Of these, 43 (47.3%) were older than 18 years of age, 33 (36.2%) were reported as having unilateral UDT with a normal contralateral testis and in 9 (9.8%) of these cases, the preserved testes were described as being atrophic. The majority (59.7%) of UDT in the post-pubertal group (> 18 years) were managed by orchidopexy.ConclusionContrary to the recommended treatment for this group of patients, there was a general tendency towards testicular preservation. The decision on surgical management was made by the attending surgical team. This not only demonstrates variation in the management of UDT, but could also be a reflection of the lack of sufficient guidelines as to the management of the post-pubertal patient presenting with UDT. Further studies, following cryptorchidism through adulthood, are needed to refine guidelines for the optimal management of this group of patients.

Lymphatic sparing laparoscopic varicocelectomy with or without testicular artery preservation: is there a difference?

BackgroundLymphatic sparing laparoscopic Palomo varicocelectomy is a safe and reliable technique for varicocele treatment in adolescents and children. The purpose of this study was to compare the outcomes of lymphatic sparing laparoscopic varicocelectomy with and without testicular artery preservation. The prospective random allocation of selected patients was done at Al-Azhar University Hospital, Pediatric Surgery Department from February 2010 till January 2015. All patients underwent lymphatic sparing laparoscopic varicocelectomy and they were divided into two equal groups, group A underwent laparoscopic Palomo without testicular artery sparing and group B underwent the procedure with testicular artery sparing. The main outcome included operative time, postoperative hydrocele, and persistence of varicocele, together with catch-up testicular growth or testicular atrophy.ResultsOne hundred and sixty male patients presented with left-sided primary varicocele that was diagnosed clinically and affirmed by color Doppler ultrasonography. The mean age was 14.25 ± 1.6 years (ranged 13-16 years). There was one case of persistent varicocele in group A, compared to 8 cases in group B with a statistically significant difference (p = 0.016). A significant difference had been found in the operative time (p = 0.001) between both groups. No hydrocele or testicular atrophy had been detected in both groups. No significant inter-group differences were seen in aspects of age, varicocele grade, and catch-up testicular growth. The mean follow-up period was 42 months (24-60 months).ConclusionLymphatic sparing laparoscopic Palomo varicocelectomy was superior to that with testicular artery preservation as regard varicocele persistence and operative time and hence is preferable for the management of primary pediatric varicocele.

Scrotal Reconstruction—a Simple Method for General Surgeons

Complete denudation of scrotal skin as an aftermath of Fournier’s gangrene is a vexing surgical problem which may leave behind one or both the testes hanging out from the perineum. Healing of this area by second intention not only results in a bad perineal cicatrix with poor cosmetic appearance of scrotum but also potentially endangers the survival of testes by the way either testicular desiccation or cord entrapment in the cicatrix. A new and simple approach is described hereunder, which would achieve the desired goals of both scrotal reconstruction and testicular preservation with relative ease and this procedure could be performed by a general surgeon in a modest surgical setup.