Transverse Testicular Ectopia Research Articles

Testicular ectopia: Why does it happen and what do we do?

Background/aimTesticular ectopia is rare, but the large range of anatomical locations described in the literature has spawned an abundance of possible theories to explain etiology. However, as the anatomical characteristics of normal testicular descent have only been elucidated recently, many of the theories of testicular ectopia do not incorporate this new perspective. In this study we aimed to determine what was in the literature about ectopic testis since 1980, and then try to explain the different anatomical variants in the light of current knowledge about testicular descent. MethodsA literature search was performed and all articles in English published since 1980 about testicular ectopia using several key words were identified. ResultsA total of 271 articles in English were found, of which 31 addressed the pathophysiology and are the primary focus of this study. Case reports and reviews described perineal ectopia (×4), transverse testicular ectopia (×11), and abdominal ectopia (×2), along with 3 reviews/case reports addressing diagnosis and management. A range of proposed causes were found, including obstructed ‘third inguinal ring’ at neck of scrotum, abnormal CGRP function, aberrant distal gubernacular attachment, mechanical hindrance from retained Müllerian ducts, defective gubernacular formation or disruption of the gubernacular attachment to the testis. ConclusionAfter reviewing the proposed theories, we propose a unifying theory, based on current knowledge of testicular descent, where testicular ectopia can be explained by a) anomalous attachment of the gubernaculum to the anterior abdominal wall during transabdominal descent, or b) aberrant migration of the gubernaculum during the inguinoscrotal phase of testicular descent.

Persistent mullerian duct syndrome: A 24-year experience

BackgroundPersistence of mullerian duct derivatives in otherwise normal male child is a very rare disorder. This may lead to diagnostic as well as management dilemma. Materials and methodsThe medical record of 27 cases of persistent mullerian duct syndrome (PMDS) operated in three teaching hospitals more than a period of 24years is retrieved and analyzed for demography, clinical presentation, investigations, and treatment. ResultsThere were a total of twenty seven male children with PMDS. The age was ranged between 3months and 19years. Ten patients presented with isolated bilateral UDT, six patients with bilateral UDT and unilateral inguinal hernia (4 left and 2 right sided inguinal hernia), and eight patients presented with right inguinal hernia and left sided UDT. Eight of 27 patients showed familial trends i.e. four pairs of brothers had PMDS in our series. In 21 patients, the diagnosis was made incidentally while operating for UDT and inguinal hernia. At operation 5 patients had female type of PMDS and 22 patients had male type PMDS. In 6 patients (male type), the PMDS was associated with transverse testicular ectopia. In 18 patients the initial operation was performed through inguinal incision with excision of mullerian remnants in the same settings in 12 patients. In 4 patients, straightforward laparotomy performed (familial cases) to excise mullerian remnants. In 5 patients, the PMDS was diagnosed on laparoscopy; initially biopsy of these remnants and gonads was done followed by excision of remnants by laparotomy approach. Biopsies taken from gonads in each patient revealed testicular tissue with variable degree of immaturity and dysplasia. The biopsy of mullerian remnants did not reveal any malignancy. All patients were genotypically male. ConclusionIsolated undescended testes, left UDT and right inguinal hernia, bilateral UDT and unilateral inguinal hernia are the main presenting features of PMDS. About 30% of the patients showed familial tendency. Inguinal exploration for UDT or inguinal hernia, and laparoscopy for UDT reveal incidental findings of mullerian remnants. PMDS can be managed as single stage procedure however two stage procedure including gonadal biopsies in first stage followed by mullerian remnants excision and orchidopexy in the second stage can be opted if there is doubt about gonads and genotype.

TRANSVERSE TESTICULAR ECTOPIA

Crossed testicular ectopia (CTE) is a rare congenital anomaly14. It is also knownas transverse testicular ectopia (TTE). In this condition both testis descend/migrate towardsthe same hemi-scrotum. About 100 cases have been reported so far. It may be associatedwith other congenital anomalies which include persistent Mullerian Duct Syndrome, truehermaphroditism, pseudo-hermaphroditism, inguinal hernia, hypospadias and scrotalanomalies. We are reporting one such case in 6 years old boy who presented to CMH Malir inMarch 2014 with left inguinal hernia and per-operatively found to have right testis in left inguinalcanal. Left testis had descended into left upper scrotum. Vasa were tethered together in upperportion by fibrous tissue. Right testis and vas was separated, mobilized extra-peritonially anddone in right scrotum (ipsilateral). Left orchiopexy was done in left scrotum. Hernia repair wasthen preformed. Post-op u/s scan was done to detect any other associated pathology whichwas negative. In most of the published reports diagnosis was made per-operatively as was thecase in this patient.

English

Crossed testicular ectopia (CTE) is a rare congenital anomaly 14 . It is also known as transverse testicular ectopia (TTE). In this condition both testis descend/migrate towards the same hemi-scrotum. About 100 cases have been reported so far. It may be associated with other congenital anomalies which include persistent Mullerian Duct Syndrome, true hermaphroditism, pseudo-hermaphroditism, inguinal hernia, hypospadias and scrotal anomalies. We are reporting one such case in 6 years old boy who presented to CMH Malir in March 2014 with left inguinal hernia and per-operatively found to have right testis in left inguinal canal. Left testis had descended into left upper scrotum. Vasa were tethered together in upper portion by fibrous tissue. Right testis and vas was separated, mobilized extra-peritonially and done in right scrotum (ipsilateral). Left orchiopexy was done in left scrotum. Hernia repair was then preformed. Post-op u/s scan was done to detect any other associated pathology which was negative. In most of the published reports diagnosis was made per-operatively as was the case in this patient.

Transverse testicular ectopia: What surgeons must know; Insights in embryology and management

Transverse testicular ectopia (TTE) is a rare congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome (PMDS), true hermaphroditism, inguinal hernia, hypospadias, pseudo-hermaphroditism, and scrotal anomalies. Most of the reported cases are in children with very few reported cases in adults. We report a case of 30-year-male, who presented with right reducible inguinal hernia and left undescended testis. Diagnosis was confirmed preoperatively by ultrasound followed by diagnostic laparoscopy and open inguinal exploration for orchiopexy. Bilateral transseptal orchiopexy and hernioplasty were performed. He had an uneventful recovery. Due to lack of awareness most of these cases are diagnosed accidentally intraoperatively. Preoperative diagnosis can be achieved by proper knowledge and imaging techniques (ultrasonography and magnetic resonance imaging). Surgeons who frequently repair inguinal hernias should be aware of disease and appropriate surgical management options available to them when this condition is unexpectedly identified during inguinal exploration. The embryology, clinical features and management algorithm are discussed herewith with review of pertinent literature.

Crossed Testicular Ectopia-A Rare Anamoly

AbstractCrossed Testicular Ectopia (CTE)/Transverse Testicular Ectopia (TTE) is a rare but well-known congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome, True Hermaphroditism, Inguinal Hernia, Hypospadias, Pseudohermaphroditism, and scrotal anomalies. We report a case of 6 years old male child with right undescended testis and empty left scrotum. Diagnosis was confirmed preoperatively by ultrasound followed by open inguinal exploration for orchidopexy.

English

We report a case of Persistent Mullerian Duct Syndrome (PMDS) with Transverse Testicular Ectopia (TTE) in a 27yr old male discovered during surgery for right irreducible inguinal hernia. Tension free hernioplasty and excision of pmds was done. The specimen sent for histopathologic examination (hpe). Hpe revealed pmds.

A rare presentation of transverse testicular ectopia as an incarcerated inguinal hernia

Transverse testicular ectopia/crossed testicular ectopia is a rare but well-recognized entity in which both gonads migrate towards the same hemiscrotum. However, the initial presentation of this anomaly in an adult as an incarcerated inguinal hernia is extremely rare. In this report, we describe a 23-year-old male who presented to the emergency department of our hospital with a right incarcerated inguinal hernia. He underwent emergency surgical exploration and both the spermatic cords and testes were found in the right inguinal canal and hemiscrotum respectively. After surgical reduction for the incarcerated hernia and right inguinal herniorraphy, the right testis was fixed into the right hemiscrotum, and a left trans-septal orchiopexy was performed.

Panoramic Laparoscopic View of Transverse Testicular Ectopia

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. We present a case of TTE in a 33-year-old man. Laparoscopy showed the left spermatic vessels, accompanied by parietal peritoneum, which formed a septum that divided the pelvic space into two, were extending transversely from the left lateral side of the descending colon toward the right internal inguinal ring over the sigmoid colon. A panoramic laparoscopic view of the spermatic vessels in TTE can clearly demonstrate the descending pathway and partly contribute to our understanding of the etiologic mechanisms of TTE.

Transverse testicular ectopia in adults: A case series

Introduction: transverse testicular ectopia (ttE) or transverse aberrant testicular maldescent is a rare clinical entity where both testes descend into one side of scrotum. the patients having ttE often present with ipsilateral inguinal hernia associated with migrated ectopic testis and contralateral empty hemiscrotum and nonpalpable testis. case series: We are reporting two cases of a rare testicular descent anomaly where both patients presented with unilateral inguinal hernia with contralateral non-palpable testis and were diagnosed as transverse testicular ectopia intraoperatively. On examination, two separate cords were found to be coming out from same inguinal canal. there were no cord anomalies or remnant of Mullerian duct. In both of the cases inguinal hernia repair with orchiopexy was done. conclusion: In a patient with unilateral inguinal hernia and contralateral absent testis, a strong suspicion of ttE should be kept and

Transverse Testicular Ectopia: A Case Report

Transverse testicular ectopia (TTE) is a rare scrotal anomaly occurring consequent to the migration of both gonads to the same hemiscrotum. In this case we aim to present a 24 years old male patient who has pain and swelling its diagnosed Transverse Testicular Ectopia in our clinic

Transverse testicular ectopia associated with hemiscrotal hemangioma

Transverse testicular ectopia is a rare congenital disorder characterized by both testes descending from the same inguinal canal. We report three cases of variant presentations of transverse testicular ectopia: no inguinal hernia, both testes in one hemiscrotum, and capillary hemangioma in the contralateral hemiscrotum. All patients received a simple trans-septal orchiopexy. Follow-up revealed no inguinal hernia or testicular atrophy.

AB169. Clinical aspects and molecular genetics of persistent mullerian duct syndrome associated with transverse testicular ectopia: report of three cases.

Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism, characterized by the presence of a uterus and fallopian tubes owing to failure of müllerian duct regression in genotypically normal males. The association between a persistent müllerian duct and transverse testicular ectopia (TTE) is even more uncommon. PMDS with TTE is a very rare pathological association, often discovered during repair for inguinal hernia or cryptorchidism. We report three cases of Chinese patients with PMDS associated with TTE. Hysterectomy was performed, with resection of the underdeveloped fallopian tubes. Both gonads were placed into subdartos pouches in each scrotum by the transseptal approach. PMDS with TTE is a rarely encountered form of male pseudohermaphroditism usually unexpectedly found at surgery for cryptorchidism or inguinal hernia. Surgical treatment should avoid damage of fertile testes and vasa deferens.

Transverse Testicular Ectopia: A Rare Anomaly

Crossed Testicular Ectopia (CTE)/Transverse Testicular Ectopia (TTE) is a rare but well known congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome, True Hermaphroditism, Inguinal Hernia, Hypospadias, Pseudohermaphroditism, and scrotal anomalies. We report a case of 10 month old male child with left inguinal hernia with suspicious left inguinal swelling and empty right scrotum. Diagnosis was confirmed preoperatively by ultrasound followed by diagnostic laparoscopy and open inguinal exploration for orchiopexy.

Persistent Mullerian duct syndrome with transverse testicular ectopia and seminoma

Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.

Transverse testicular ectopia

Described herein are six cases of transverse testicular ectopia. All patients who underwent orchidopexy at the one pediatric surgical unit between October 2001 and January 2008 were evaluated. The medical records of all patients diagnosed with transverse testicular ectopia were evaluated retrospectively. Five patients (84%) were admitted with a symptomatic right inguinal hernia and empty scrotum on the left side. Only one child (16%) had left-sided hernia and right non-palpable testis (age ranged from 1 month to 3 years). Four patients (66%) were diagnosed in the operating theatre and the last two (33%) on inguinal ultrasound preoperatively. Magnetic resonance imaging was also performed in the last patient. Herniorrhaphy with fixation of the ectopic gonad to the opposite hemiscrotum through a transseptal incision was performed in all patients. Postoperative complications were not observed.

Crossed testicular ectopia: Report of six cases.

Crossed testicular ectopia or transverse testicular ectopia is an extremely rare anomaly characterised by migration of one testis towards the opposite inguinal canal, usually associated with unilateral inguinal hernia. This report describes six cases of crossed ectopic testes, one of the largest series, and with unusual clinical histories.

English

Transverse testicular ectopia, an anomaly due to deviation in the testicular descent resulting in unilateral location of both testes as both the testis descends through single inguinal canal. Patient usually presents with inguinal hernia on one side and cryptorchidism on other side during early childhood. A case of one year old boy clinically presenting as right inguinal hernia with left sided cryptorchidism at tertiary level referral center is reported. Surgeon's role is pivotal as preoperative diagnosis and postoperative follow-up for malignancies in these cases are very crucial.

Retroperitoneal lymphatic malformation and transverse testicular ectopia: A unique clinical presentation

This case report presents a fetal patient diagnosed in utero with a retroperitoneal lymphatic malformation by ultrasound and followed through gestation. At birth the child was noted to have a right inguinal hernia with two palpable testicles. Plan for partial resection and hernia repair with postoperative sclerotherapy was made. At the time of hernia repair, transverse testicular ectopia was diagnosed, and subsequent extraperitoneal transposition orchiopexy was performed following partial resection of the lymphatic malformation. Delayed sclerotherapy in combination with partial resection afforded definitive treatment of the residual lymphatic malformation as the patient demonstrates no recurrence over one year later. This is the first reported case to suggest a direct relationship between transverse testicular ectopia and a retroperitoneal lymphatic malformation.

Ectopic testis in children: Experience with seven cases

BackgroundEctopic testis is a rare congenital anomaly in which the testis is abnormally located away from normal line of decent. AimTo report varied clinical presentation, embryogenesis, and management aspects of ectopic testis with a brief review of the literature. Materials and MethodsA retrospective chart review of children with undescended testis from January 2008 to August 2011. ResultsSeven children (3.6%) treated for ectopic testes were diagnosed among 190 children operated on for undescended testis. There were five perineal testes, one penile testis, and one transverse testicular ectopic testis. Laparoscopy was the diagnostic and therapeutic modality in transverse testicular ectopia. Other ectopic testes were managed by open orchidopexy. The length of the testicular vessels and vas deferens was adequate in every case. ConclusionExamination of boys with an empty scrotum should include examination of ectopic sites as well. The gubernaculum bulb has preprogrammed growth toward the scrotum unless anatomical blockade prevents its descent. Open orchidopexy reveals normal characteristics of perineal, penile testis, and its elements. Surgical correction for ectopic testis as early as possible facilitates proper psychological development and prevents complications.