Testicular Tunica Research Articles

A Rare Case Report of Para Testicular Rhabdomyosarcoma in An Elderly Man

Para testicular embryonal rhabdomyosarcoma (RMS) is a rare tumour arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. We present a rare case of a 67-year-old male diagnosed to have a left sided Para testicular rhabdomyosarcoma managed by surgical excision and followed by chemotherapy.

Ballistic Trauma of the Scrotum with Rupture of the Testicular Tunica Albuginea: A Case Report at Sominé Dolo Hospital in Mopti (Mali)

Since 2012, Mali has been going through a security crisis, characterized by armed attacks against civilians and soldiers; in the form of terrorist attacks or ambushes using different vulnerable agents. The lesions observed are often multiple and serious and can affect all organs to varying degrees. We report a case of ballistic trauma to the right scrotum with rupture of the testicular tunica albuginea in a soldier at his guard post in central Mali. This was a 28-year-old military patient, married, father of a child and with no medical or surgical history. The onset would go back a few hours approximately during an armed attack on their guard post located 30 kilometers from the hospital. Examination of the wound showed a bleeding albuginea with devitalization of a large part of the noble testicular tissue. The patient was hemodinamically stable and the operative blood test was normal. The abdominopelvic ultrasound was unremarkable. A debridement of the necrotic tissues was performed followed by closure of the tunica albuginea. The postoperative course was satisfactory. The patient received antitetanus serum therapy.

Safety Study of an Original Mesenchymal Stromal Cell Secretome-Based Medicinal Product for Spermatogenesis Restoration

SCIENTIFIC RELEVANCE. Currently, there are no effective and safe medicinal products for idiopathic male infertility. Previous studies in two animal models of infertility (short-term cryptorchidism in rats and doxorubicin-induced testicular injury in mice) have shown the effectiveness of an originator medicinal product based on the mesenchymal stromal cell (MSC) secretome.AIM. The aim of the study was to evaluate the toxicity profile of the MSC secretome-based medicinal product in rats after local intratesticular or intramuscular administration.MATERIALS AND METHODS. The MSC secretome is a combination of factors secreted by MSCs in low-glucose Dulbecco’s modified Eagle’s medium (DMEM-LG) for MSC conditioning. In the single-dose toxicity study, the MSC secretome-based medicinal product was injected under the testicular tunica albuginea of male Wistar rats (15 per group) at doses of 15 and 25 relative units (RU) per animal, which are 1.5 and 2.5 times higher than the therapeutic dose (10 RU). In the repeat-dose toxicity study, male Wistar rats (10 per group) received intramuscular thigh injections of the medicinal product on days 1, 6, and 12 at doses of 15 and 25 RU per animal. The local tolerance study involved histopathological examination of the testes and thighs at the injection site. All studies included control groups of intact animals and animals similarly injected with blank DMEM-LG. The early follow-up period was 14 days, and the late follow-up period was 42 days.RESULTS. The rats showed no changes in the general condition after single and repeated doses of the MSC secretome-based medicinal product. Single subtunical doses induced moderate irritation; its signs included pathological changes in individual seminiferous tubules: epithelial atrophy (70% of the animals on day 14; 55% at late follow-up) and sperm stasis (70% of the animals). Similar changes were observed in the blank DMEM-LG group (up to 80% of the animals). There were no pathological changes in the tissues after repeated injections. A transient increase in alkaline phosphatase activity was detected in animals after their third intramuscular injection at a dose of 25 RU; the other biochemical parameters were normal in all study groups.CONCLUSIONS. The MSC secretome-based medicinal product has a favourable safety profile following both intratesticular and intramuscular administration, as it does not cause any permanent changes in the studied organs and tissues.

Outcomes of surgical correction of Peyronie's disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

ObjectivePeyronie's disease (PD) is an abnormal wound healing in the penile tunica albuginea. After fibrotic plaque excision, different graft materials have been used to repair the defects, but the optimal graft remains unknown. This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD. MethodsA retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021. The patients were divided into two groups depending on the type of graft used. For 15 patients in Group B, testicular tunica vaginalis grafts were used to repair the defect, while for 18 patients in Group A, bovine pericardium grafts were used. Data of the patient's age, comorbidities, sexual function, penile curvature, postoperative complications, need for further treatment, change in penile length, and satisfaction were gathered and compared between the groups. Sexual function was evaluated using the 5-item version of the International Index of Erectile Function (IIEF-5), and a functional less than 20-degree penile curvature after surgery was considered a successful intervention. ResultsThere was no difference in age, comorbidities, degree of curvature, perioperative IIEF-5, operative time, plaque size, or complication rates. After surgery, a statistically significant improvement in curvature degree (p<0.05) and satisfactory penile appearance (p<0.05) were seen in both groups without any superiority between the two groups (p=0.423 and p=0.840, respectively). With a 30-month follow-up, the IIEF-5 was consistent in both groups, with no statistical significance between the groups (p=0.492). The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance (p=0.255 and p=0.101, respectively). ConclusionPartial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Management of Metastatic Paratesticular Tumour in a Resource-Poor Setting

Abstract Paratesticular tumours are tumours that arise from the testicular tunics, spermatic cord, epididymis, or vestigial remnants. The tumours are rare and account for approximately 5% of intrascrotal neoplasms. About 75% of these tumours arise from the spermatic cord. Paratesticular tumours most commonly manifest as painless scrotal masses. Alternatively, the tumour may be incidentally noticed when a scrotal ultrasound scan is done for another intrascrotal pathology such as hydrocele, inguinoscrotal hernia, epididymo-orchitis, or suspected testicular tumour. We present a case of metastatic paratesticular tumour in a 21-year-old Nigerian male, who presented at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, in September 2018 at the age of 19 years with a painless right hemiscrotal mass. The patient was clinically evaluated with scrotal ultrasonography, testicular tumour markers, and liver function test. Biopsy specimen obtained was ignorantly discarded by the patient who was subsequently lost to follow-up. Histologic diagnosis of mesenchymal tumour (myxoid liposarcoma) was made two years after his initial presentation when he developed both inguinal and retroperitoneal lymph node metastasis at the age of 21 years. He was evaluated as clinical stage IV disease and then commenced on chemotherapy after baseline investigations. Our objective of presenting this report is to highlight the effect of delayed diagnosis in the management outcome, challenges in the provision of resources in low- and middle-income countries, and to emphasise the rarity of the tumour in our subregion.

Unilateral testicular atrophy and epididymal lithiasis in a Gramasree rooster

Testicular atrophy is a condition impairing the reproductive health of male chicken. Lithiasis or stone formation in testicles or epididymis adds to the gravity of the problem. The present study describes a case of unilateral testicular atrophy with epididymal lithiasis in a one-year-old male Gramasree cock. The carcass, was brought to the Department of Veterinary Pathology, College of Veterinary and Animal Sciences, Pookode, for postmortem examination. The lesions were recorded and tissues for histopathology were collected in 10% neutral buffered formalin, sectioned, and stained using routine hematoxylin and eosin staining procedure. Grossly, there was diffused congestion of the testicular tunic with atrophy of right testis. The epididymis was congested with multifocal white spots. Histologically, seminiferous tubules were severely degenerated. The efferent ductules of epididymis were dilated with basophilic amorphous and granular liths in multiple locations. Sperm stasis was evident in a few ductules and rete testes. The lith formation might have caused sperm stasis and degeneration and atrophy of the testis.

PDE5 inhibitors and male reproduction: Is there a place for PDE5 inhibitors in infertility clinics or andrology laboratories?

The objective of this review study is to evaluate the therapeutic role of PDE5 inhibitors (PDE5is) in the amelioration of oligoasthenospermia in infertile males. PDE5is have a beneficial influence on the secretory function of the Leydig and Sertoli cells, the biochemical environment within the seminiferous tubule, the contractility of the testicular tunica albuginea, and the prostatic secretory function. In several studies, the overall effect of sildenafil and vardenafil increased quantitative and qualitative sperm motility. Furthermore, some studies indicate that PDE5is influence positively the sperm capacity to undergo capacitation under biochemical conditions that are known to induce the sperm capacitation process. Additional research efforts are necessary in order to recommend unequivocally the usage of sildenafil, vardenafil, or avanafil for the alleviation of male infertility.

Orchio-Septopexy: A new technique to cover and fix detorsed testis undergoing fasciotomy of tunica albuginea.

ABSTRACTPurpose Compartment Syndrome (CS) has been recognized as a potential factor that worsens testicular viability after detorsion, especially in borderline cases of prolonged ischemia. Fasciotomy of the testicular tunica albuginea to relieve the pressure associated with CS has been proposed to accommodate edema after detorsion, embracing the raw fasciotomy area with tunica vaginalis flap (TVF) or graft. Fashioning the TVF can be tedious in cases of severe scrotal edema. Herein we present a technique that facilitates and expedites the procedure, maintaining the fasciotomy area decompressed.Materials and Methods In testicular torsion, where the testis remains with dark coloration and questionable viability after detorsion a longitudinal releasing incision is made in the tunica albuginea (fasciotomy) to decrease compartmental pressure. If signs of parenchymal recovery (bleeding points, better color) are seen an orchio-septopexy is performed, suturing the incised albuginea’s edges to the septum with a running suture, avoiding CS as well as re-torsion.Results Orchio-septopexy was performed in 11 cases with a mean age of 11.9 years (3-17). All cases had clinic follow-up and testicular Doppler US with a mean of 9.5 months (6-24). 6/11 cases (54%) were salvaged, with good vascularity in the Doppler US and maintained more than 50% testicular volume compared to the contralateral side.Conclusion Orchio-septopexy after testicular fasciotomy is a simple and fast technique that can be utilized in cases of prolonged testicular ischemia and questionable viability. More than half of the testes recovered, encouraging us to propose its utilization as well as its validation by other surgeons.

Prognosis and Management of Communicating and Non-communicating Hydrocele

Hydrocele can be found as a collection of fluid within the testicular tunica vaginalis. According to the etiology and pathophysiology of the disease, it can be classified into primary and secondary. Furthermore, primary hydrocele might include the closed or non-communicating, the communicating type, the congenital and or neonatal type. Many management approaches have been proposed for both the communicating and non-communicating hydrocele with different post-operative and prognostic outcomes. In this literature review, we have discussed the current management approaches and prognosis of communicating and non-community hydrocele. Adequate diagnosis of the condition is the first step to achieve favorable management outcomes. Although the reported management outcomes are reported to be effective in the literature, the surgical approaches seem to be superior. However, many side effects might be associated with these operations. Estimates show that following varicocelectomy procedures, ipselateral (left) hemi-scrotal varicocele is the most common condition to occur, which might even develop following the procedure by several months and years (in some cases). Further investigations are still needed because the current evidence is largely based on case reports and small case series investigations. Therefore, larger studies are needed to help draw effective management protocols and enhance the outcomes and prognosis.

Epidydimal leiomyosarcoma: a rare case of scrotal swelling

Sarcomas of the genitourinary tract are extremely uncommon and accounts for only 1-2% of genito urinary malignancies. Sarcomas of the para testicular region, comprising tissues such as the epididymis, spermatic cord, inguinal canal and testicular tunica are also extremely rare. epidydimal leiomyosarcoma accounted only for 4 percentage of all para testicular tumours and only 16 cases are reported so far in literature and they account 4% of all Para testicular sarcomas. We are presenting a 61-year-old patient presented with a hard welling of 1 year duration, with no other associated symptoms. On ultrasound evaluation, it was reported as extra testicular lesion, possibly from epididymal tail. We performed a high inguinal orchidectomy. Histopathological examination revealed a para testicular leiomyosarcoma arising from epididymis. This case has discussed because of the rarity of the disease and possible cure if diagnosed early and treated aggressively.

Leiomyoadenomatoid tumour of testicular tunica – A rare entity

Adenomatoid tumors are distinctive genital tract neoplasms that occur in both men and women. These are commonly located in epididymis, uterus, fallopian tubes, ovary, testicular tunica and spermatic cord. Rarely they are seen in extragenital locations like adrenal, bladder, pancreas, heart, pleura, mesentry, omentum and lymph nodes. Adenomatoid tumors arising from the testis are rare as compared to those arising from epididymis. Leiomyo-adenomatoid (LMAT) tumor is a variant of adenomatoid tumor with predominance of smooth muscle component. Twelve cases of Leiomyo-adenomatoid (LMAT) tumor of uterus and only three cases of LMAT of epididymis have been reported. We report an extremely rare case of LMAT arising from tunica of testis in a 58 year old male.

The Effect of PDE5 Inhibitors on the Male Reproductive Tract.

The therapeutic range of cyclic nucleotide phosphodiesterase 5 inhibitors (PDE5) inhibitors is getting wider in the last years. This review study focuses on the potential employment of PDE5 inhibitors as an adjunct tool for the therapeutic management of male infertility. The literature tends to suggest a beneficial effect of PDE5 inhibitors on Leydig and Sertoli cells secretory function. It also appears that PDE5 inhibitors play a role in the regulation of the contractility of the testicular tunica albuginea and the epididymis. Moreover, scientific data suggest that PDE5 inhibitors enhance the prostatic secretory function leading to an improvement in sperm motility. Other studies additionally demonstrate the role of PDE5 inhibitors in the regulation of the sperm capacitation process. Placebo-controlled, randomized, blind studies are necessary to unambiguously incorporate PDE5 inhibitors as an adjunct tool for the pharmaceutical treatment of semen disorders and male infertility.

Ultrasonografía modo B en la evaluación de testículos de ovinos

Our objective was to evaluate the testicular integrity of sheep by B-mode ultrasound. We used 16 male sheep of no defined breed, aged from 6 to 36 months weighing from 16 to 71kg, raised in semi-intensive system. Prior to the ultrasound evaluations, the males were weighed and a general inspection and palpation evaluation was performed to detect possible changes in the reproductive system by inspection and palpation. The ultrasound examination was performed fortnightly, obtaining images of each testis, corresponding to the positions: sagittal (longitudinal) and transverse (lateromedial), by a single operator, with the animal in quadrupedal position, without trichotomy, and manual restraint, using an ultrasound. (Honda® - HS1500V) coupled to a 7MHz linear transducer with 8.0 MHz frequency in all evaluations. It was possible to easily identify in the sonographic images the testicular parenchyma, mediastinum and the tunics delimiting the parenchyma. In the central region of the testicular parenchyma, the mediastinum, one line and one point are observed when evaluated in the sagittal and transverse planes respectively and always presented a hyperechoic characteristic in relation to the parenchyma. Testicular tunics, a characteristically hyperechoic structure delimiting the testicular parenchyma, were always observed in the images, visualized as a bright, hyperechogenic line that surrounds the testicular parenchyma separating it from the scrotum. Among the animals submitted to ultrasound examination, three of them one with 16 months of age in reproductive activity and two with 36 months and in sexual rest presented images with points suggestive of testicular calcifications observed until the end of the study. However, several studies did not correlate them with pathologies, and there are controversies regarding their presence when considering the age and composition of the finding. The testicular integrity of sheep can be assessed by B-mode ultrasound. Ultrasound examination of the genital system of sheep may be a useful technique that can be successfully and conveniently used for diagnostic purposes of the sheep testis.

Stimulation of Spermatogenesis and Synthesis of Testosterone by Allotransplantation of Neonatal Testicular Tissue under Tunica Albuginea of Cryptorchid Testis.

The abdominal type of cryptorchism was modeled on random-bred albino rats by replacing both testes from the scrotum into the abdominal cavity for 3 weeks; thereupon they were manipulated into the scrotum. In control rats, no additional surgery was performed. In experimental rats, the testicular tissue obtained from 1-2-day rat pups was transplanted under testicular tunica albuginea. Prior to orchiopexy, the weight of testes decreased by 62.5-64.1%. In 6 month after the surgery, it increased by 36.1% in the control group, whereas in experimental rats the weight of testes elevated by 123.2% and approximated the normal value. Histologically, the control group demonstrated persistent disturbance in spermatogenesis with emptiness of numerous seminiferous tubules where only Sertoli cells could be revealed and with pronounced dystrophic alterations in the spermatogenous epithelium of the partially preserved tubules where spermatogenesis was blocked at the spermatogonial level. In contrast, the transplantation region of the experimental testes exhibited formation of novel mature testicular tissue enclosed by a connective tissue capsule incorporating the seminiferous tubules with differentiated epithelium and with the clusters of Leydig cells in the stroma. In 6 month, spermatogenesis was observed in most seminiferous tubules of the host testicular tissue, which had spermatozoa in the lumens. To the moment of orchiopexy, the blood testosterone decreased by about 2.5-fold. In control group it remained diminished during entire observation period (up to 6 month), while in the experiment group its level normalized completely as early as in 2 month and remained even elevated to the end of observation period.

Paratesticular Soft-Tissue Masses in Orchiectomy Specimens: A 17-Year Survey of Primary and Incidental Cases From One Institution.

The paratestis (PT) is defined by the testicular tunics, epididymis, spermatic cord, rete testis, and embryonic remnants. It gives rise to a large diversity of pathologies, including those of soft tissue, which may prompt orchiectomy. We performed a 17-year search of our database for orchiectomies for a PT soft-tissue mass. In a total of 4741 orchiectomy specimens, 138 orchiectomies were performed for primary neoplastic or nonneoplastic masses of the PT soft tissue or had an incidental PT soft-tissue mass. Of these, 65.9% were neoplastic. The mean age was 40.2 years (range: <1 to 87 years) and was similar for neoplastic and nonneoplastic lesions. The most common malignancies were rhabdomyosarcoma (31/63 malignancies), liposarcoma (19/63), and leiomyosarcoma (5/63), with the former occurring in younger patients (average: 18.3 years). No malignancies were incidental. The most common benign neoplasm was spermatic cord lipoma (24/28 of benign neoplasms); however, most were incidental. This was followed by leiomyoma (3/28) and hemangioma (1/28). The most common nonneoplastic lesions were adrenal rests (22/47 nonneoplastic cases); however, all were incidental findings. Of 47 nonneoplastic masses, 22 prompted orchiectomy, and of these, the most common diagnosis was fibrous/nodular periorchitis (11/47). Of 88 nonincidental lesions, 25 were either benign neoplasms (3/25) or nonneoplastic (22/25). These data indicate that PT soft-tissue neoplasms prompting orchiectomy are disproportionately rhabdomyosarcomas, though these are principally in young patients. In older patients, malignancies are more frequently liposarcomas. However, almost one-third of orchiectomies performed for PT soft-tissue masses yield benign lesions, indicating an opportunity to reduce unnecessary procedures.

Reproductive Parameters of the West African Dwarf Bucks Raised in the Guinea Savannah Zone of Nigeria

Thirty West African Dwarf (WAD) bucks were evaluated for reproductive parameters in relation to age. The age of the WAD bucks was determined using the dentition estimation method and varied from less than one year to two years. Reproductive samples (scrotal circumference, testicular density, scrotal weight, left and right testicular weights, left and right tunica weights, left and right testicular length, left and right caput epididymal weights, left and right corpus epididymal weights, left and right caudal epididymal weights) from the bucks were collected twice weekly from Modern Market and Wurukum Abattoirs in Makurdi town, Benue State, Nigeria for a period of three months and evaluated at the Anatomy Laboratory, College of Veterinary Medicine, University Agriculture, Makurdi. Scrotal circumference values recorded (18.97± 1.14, 18.57±0.21 and 23.90±1.04cm) for the bucks that were less than one year were similar with those of the one year old bucks and these values were significantly (P 0.05) from one another. Right testicular length, left testicular length, right caudal epididymal and left corpus epididymal weight values recorded for the various age brackets were 7.67±0.21, 8.17±0.18, 8.87±0.27cm; 7.60±0.20, 8.11±0.16, 8.93±0.27cm; 2.40±2.17, 2.66±0.08, 3.05±0.18 and 0.47 ±0.04, 0.53±0.22, 0.59±0.04g espectively. Generally, values recorded for the two years old bucks were higher than other values. The result of this study suggests that overall weights of reproductive organs of WAD goats increased with age. Key Words: Reproductive Parameters, West African Dwarf Goats.

Low dose assessment of the carcinogenicity of furan in male F344/N Nctr rats in a 2-year gavage study

Furan is a volatile organic chemical that is a contaminant in many common foods. Furan is hepatocarcinogenic in mice and rats; however, the risk to humans from dietary exposure to furan cannot be estimated accurately because the lowest tested dose of furan in a 2-year bioassay in rats gave nearly a 100% incidence of cholangiocarcinoma. To provide bioassay data that can be used in preparing risk assessments, the carcinogenicity of furan was determined in male F344/N Nctr rats administered 0, 0.02, 0.044, 0.092, 0.2, 0.44, 0.92, and 2 mg furan/kg body weight (BW) by gavage 5 days/week for 2 years. Exposure to furan was associated with the development of malignant mesothelioma on membranes surrounding the epididymis and on the testicular tunics, with the increase being significant at 2 mg furan/kg BW. There was also a dose-related increase in the incidence of mononuclear cell leukemia, with the increase in incidence being significant at 0.092, 0.2, 0.92, and 2 mg furan/kg BW. Dose-related non-neoplastic liver lesions included cholangiofibrosis, mixed cell foci, basophilic foci, biliary tract hyperplasia, oval cell hyperplasia, regenerative hyperplasia, and cytoplasmic vacuolization. The most sensitive non-neoplastic lesion was cholangiofibrosis, the frequency of which increased significantly at 0.2 mg furan/kg BW.

Hypertrophic osteopathy associated with systemic granulomatous disease in a horse

A 4-year-old Criollo stallion was presented at the equine clinic of veterinary hospital of the Federal University of Santa Maria, RS, with a 30-day history of progressive weight loss, anemia and swelling of the forelimbs and face. Physical examination revealed that the swelling was firm and had a bone-like consistency, also radiographs showed extensive periosteal proliferation on the forelimb long bones that suggested hypertrophic osteopathy (Marie´s disease). Physical examinations identified no respiratory findings. However, during ultrasound examination, superficial lung disease was identified. The animal was treated with antibiotics and nonsteroidal anti-inflammatory drugs for 12 days. Due to a complete lack of response to this treatment, the horse was euthanized. At necropsy several granulomatous lesions were identified in the thorax, abdomen and testicular tunics. Bony proliferation was evident on many bones of the appendicular skeleton and face. Based on these findings the diagnosis of hypertrophic osteopathy associated with sarcoidosis was established. It is important to perform a thorough clinical examination and include hypertrophic osteopathy in the differential diagnosis of diseases that are accompanied by swelling of the face and limbs as edema from various causes, fibrous osteodystrophy, for example. Key words: Pulmonary. Periosteal. Sarcoidosis. Pathology

Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy.

Paratesticular fibrous pseudotumours are rare intrascrotal lesions, most frequently affecting the testicular tunics. They are benign in nature; however, their pathogenesis is not completely understood. Presenting features are similar to testicular malignancy, which may result in unnecessary radical surgery. It has been suggested that additional diagnostic imaging combined with frozen section analysis may help prevent orchiectomy in these patients. We describe a case of paratesticular fibrous pseudotumour in a 40-year-old male treated with testicle-sparing surgery aided by intraoperative frozen section analysis.

Repeated self-mutilation of testicles in the context of methamphetamine use – A case report and brief review of literature

We report a case of recurrent genital self-mutilation (GSM) after use of methamphetamine. A 29-year-old male with borderline personality and polydrug misuse attempted the GSM twice. Firstly, he self-amputated his left testicle, and one year later he injected printer ink in his right testicle. An open revision of the injured area revealed a puncture wound in the right testicle, with a palpable accumulation of fluid. No ink was found inside the scrotal sac suggesting that the substance was injected directly to the testis. Due to the absence of left testicle, the urologist decided against orchiectomy. Blue colour of serum, urine and sperm was observed for nine days, and then spontaneously disappeared. An ultrasound imaging showed enlargement of the right testis with hypoechogenic fluid/ink collection. Pathomorphological examination of the testicular tissue revealed focal necrosis and diffuse suppurative inflammation of the testicular tunic. Examination of the sperm showed significantly reduced amount of sperm, with majority of dead spermatocytes. Follow-up examination at six months and two years showed absence of spermatocytes. Some attempts of GSM can be repeated. Therefore, specific preventive measures should be undertaken whenever a standard advice and motivational interviewing proved ineffective. Depending on local and general toxicity of an injected xenobiotic, orchiectomy should be considered as a treatment option of GSM. Injection of potentially low toxic ink into the testicle can lead to its permanent damage and infertility.