Tunica Vaginalis Research Articles

Mesothelioma of the tunica vaginalis testis (MTVT) is an exceedingly rare tumor. We performed a registry-based study on MTVT patient management and survival in Italy. Cases were extracted from the dataset of the Italian National Mesothelioma Registry. A descriptive analysis of patient characteristics, including asbestos exposure, clinical presentation, diagnostic work-up and therapeutic management, was performed. Overall survival was evaluated. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for selected variables by fitting univariate and multivariable Cox models. Overall, 104 patients with MTVT were included. Median age was 72 years (range 17-92). Epithelioid histotype was the most frequent. Previous asbestos exposure was identified in two thirds of cases. Data on diagnostic and therapeutic management were available for 74 patients (71%). The most frequent presentations were scrotal swelling/mass, hydrocele and inguinal pain. All patients underwent surgery, mostly with orchi-funicolectomy. Adjuvant therapy was administered to 15 patients (20%). Overall median survival was 26.2 months (95% CI 22.1-52.1); 3-, 5- and 10-year survival was 49%, 30% and 18%. Older age at diagnosis and presence of distant metastasis (HR 1.91, CI: 0.85-4.26) were negative prognostic factors. Adjuvant therapy was associated with higher mortality (HR 2.54, CI: 1.25-5.15), indicating a more advanced stage at diagnosis. Surgery remains the mainstay of treatment for MTVT; adjuvant therapy in our study did not improve outcome. Data from cancer registries are essential for rare cancers, but they should be integrated routinely with additional diagnostic and therapeutic information.

Primary Malignant Mesothelioma of the Tunica Vaginalis: A Case Report and Review of the Literature

ABSTRACTMalignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare malignancy originating from mesothelial cells of the testicular tunica vaginalis. Due to its insidious onset and local aggressiveness, most patients are diagnosed at an advanced stage. The treatment modalities for MMTVT primarily include surgery, chemotherapy, and radiotherapy. With the advent of immunotherapy, patient survival has further improved. To standardize and homogenize the diagnosis and treatment of MMTVT in China, the Chinese Alliance of Research for Mesothelioma, combining existing research evidence and nationwide expert opinions, has formulated a national expert consensus on the clinical diagnosis and treatment of MMTVT. This consensus encompasses epidemiology, diagnosis, treatment, prognosis, and follow‐up.

Castration remains a common surgical procedure in equids, yet postoperative complications such as hemorrhage, infection, and eventration persist, influencing surgical outcomes. This retrospective study introduced a novel modified semi-closed castration technique aimed at minimizing these complications. Eighty-five sexually intact mature male equids (including horses, ponies, and donkeys) underwent the described inguinal castration procedure under general anesthesia. The technique involved a carefully managed opening and subsequent secure closure of the parietal vaginal tunic, enabling direct inspection of tunic contents while reducing risks associated with fully open or closed approaches. The median surgery duration was 60 min (range, 45-95), with no intraoperative complications. Postoperatively, only two equids (2.35%) exhibited scrotal swelling, which was resolved rapidly with NSAIDs. No cases of hemorrhage, pyrexia, or infection occurred. Follow-up, conducted via owner interviews after a minimum of three months, confirmed complete recovery and primary intention healing in all patients, who returned to normal activity within two days post-surgery. Compared to previously documented complication rates ranging from 2% to 48%, the present approach demonstrates superior results. Additionally, this study proposes refining existing castration technique classifications, focusing explicitly on the vaginal tunic's status post-procedure (open, semi-closed, closed) for clarity and consistency. This novel semi-closed inguinal technique effectively integrates inspection advantages with closed technique safety, offering significantly reduced complication rates and enhanced postoperative recovery profiles in equids undergoing castration.

Background: Urethro- cutaneous fistula in pediatric population is very common after hypospadias surgery ranging from 4-25% in world literature. Other acquired and congenital causes are rare. Successful repair of UCF depends on different technical factors and basic surgical principles. Considering the agony of multiple surgeries in a child and plan after failure is uttermost import and demands more challenge than the primary surgery. We are discussing our experience of UCF management in a tertiary care centre. Methods: The study was conducted during February 2021 to January 2025 in the Department of Pediatric Surgery among 89 boys with urethrocutaneous fistula. Results: Among 89 patients post urethroplasty (84), post traumatic (2), post circumcision (2) and 1 congenital urethrocutaneous fistula was selected. Proximal fistula (46), multiple fistula (18) and 8 among 20 distal fistula patients were repaired with Tunica Vaginalis reinforcement. TV reinforcement resulted in 87.7% success rate and only 9 patients with recurrence. Post circumcision fistula and post traumatic UCF repair is also difficult considering its location. Conclusions: The treatment plan for a fistula must be individualized based on certain variables and basic surgical principles. The significantly improved success rate with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurnce rather than to reserve it for future options during UCF repair.

Introduction: Scrotal trauma is rare, accounting for less than 1% of all traumas. The prognosis depends on the degree of the injury and the quality of care, in order to reduce the risk of severe functional sequelae. We present a clinical case of penetrating scrotal trauma without associated lesions of neighboring organs. Clinical case: A 39-year-old man with no particular history presented to the emergency department after a direct impact road traffic accident. The clinical examination found a left scrotal wound of 6 cm long axis, not touching the vaginal tunic, with a non-expansive epididymal hematoma classified grade II according to the AAST (American Association for the Surgery of Trauma), without other associated lesions. The treatment consisted of washing the wound and closing the different scrotal layers. The postoperative follow-up was simple. Conclusion: Scrotal trauma remains rare but can impact the functional prognosis. The surgical procedure depends on the extent of the lesion. Keywords: Road traffic accident, wound, scrotum.

PurposeTo propose a novel surgical approach for managing inflammatory adhesions of the tunica vaginalis (TV) during vasoepididymostomy (VE), and to report surgical outcomes.Materials and MethodsA T-shaped incision of the TV was used to expose the epididymis and vas deferens in cases with adhesions between the TV and the testis. We retrospectively analyzed data from five patients who underwent microsurgical VE for obstructive azoospermia (OA) secondary to epididymal obstruction. Operative time, postoperative patency rate and semen analysis, and natural pregnancy rates were recorded. For comparison, 50 patients who underwent conventional longitudinal TV incision were included to assess operative time, while 46 and 36 of these patients were used to compare patency and pregnancy rates, respectively, with the T-shaped incision group.ResultsThe T-shaped incision involves a longitudinal incision of the TV at the epididymal-testicular junction followed by an incision (T) in the direction towards the epididymis and vas deferens area. Among the five patients who underwent this approach, four (80.0%) had sperm detected in semen two months postoperatively, and their partners achieved natural pregnancy (4/5, 80.0%) within one year after VE. No postoperative wound infections occurred. No statistically significant differences were observed in mean operative time, patency rates, or pregnancy rates between the T-shaped and longitudinal incision groups.ConclusionsThe T-shaped TV incision is a feasible approach for VE in OA patients with inflammatory TV-testis adhesions, providing adequate epididymal access without compromising operative time or surgical outcomes.

Is the Autologous Testicular Tunica Vaginalis Graft Effective in Persistent Urethrocutaneous Fistulas After Hypospadias Surgery? A Comparative Study

Abstract Surgery at an early age is recommended for one of the most prevalent congenital genital defects, hypospadias. It is gradually evolving, frequently by repurposing decades-old therapeutic approaches. Preputial onlay flaps were most frequently utilized in the 1980s, although there is currently a resurgence of interest in the tunica vaginalis flap. In a selected number of patients with severe anomalies, hypospadias is surgically repaired in one stage. The process includes creating a neourethra and correcting the curvature of the penile shaft. For optimal functional and cosmetic outcomes, this neourethra requires an intermediate layer to be covered. The tunica vaginalis flap is one of the better choices for usage as an intermediate layer among the several local flaps.

874 Mesothelioma of the Tunica Vaginalis Testis: A Clinicopathologic Study of 14 Patients with Evaluation of Markers of Mesothelial Malignancy

Introduction: In recent years, the modified Koyanagi-Hayashi technique has attracted considerable interest due to its satisfactory results and low risk of major postoperative complications for the patient during surgery for severe hypospadias. The aim of this work is to evaluate this technique and compare our results with those of other research series. Materials and methods: A single-center prospective study of an inhomogeneous series of 32 children with proximal hypospadias and a mean age of 44 months was operated on by the same surgeon using the Koyanagi-Hayashi technique. Preoperative hormonal stimulation with testosterone was indicated in 17 children. The tunica vaginalis was used as the urethroplasty covering plane for all patients. Functional results were assessed, and a questionnaire was completed to evaluate the functional and aesthetic satisfaction of the parents and the surgeon. Results: Complete curvature of the penis was obtained in all patients except 2, who retained a minimal curvature, not requiring surgical correction at this time. There were 6 cases of urethral fistula, 2 cases of total urethroplasty release, 2 cases of partial release, 9 cases of glanduloplasty release, one urethrocele, and 2 meatus strictures. Overall, the success rate after the first procedure was 31.20%, rising to 74.95% after the first repeat procedure and 84.32% after the second. The result was very satisfactory for the parents at 84.37% and satisfactory at 15.62%. Conclusion: The Koyanagi technique modified by Hayashi is a good alternative for severe forms of hypospadias. Correction of the curvature of the penis is generally achieved without further procedures, and the aesthetic result is generally satisfactory. Using the tunica vaginalis as an intermediate plane to cover the urethroplasty has greatly reduced the rate of serious complications. The complication rate is high, and parents need to be aware of the risk of repeat surgeries. But these complications are always easy to manage

Abstract Background Aims We present a case of small bowel obstruction in a massive inguinoscrotal hernia, with loss of abdominal domain, treated successfully by emergency surgery. The chronicity of the condition resulted in a large pendulous pelvic stomach, with the Duodeno jejunal flexure within the hernia and constricted by the hernial ring. Method The first contact with surgical team was as emergency, since initial referral to surgical outpatients was deferred by the patient, due to his embarrassment. After initial attempts to decompress the stomach through nasogastric tube and with nutritional support with parenteral nutrition, the patient was counselled for surgery. Informed consent was taken for right orchidectomy, possibility of open abdomen with delayed reconstruction, stoma, respiratory compromise, multiorgan failure and death.Prior to intervention, Intensive Therapy unit was consulted for admission following surgery, with plans to use Botox in the abdominal wall, to improve compliance, in case of abdominal compartment syndrome or respiratory failure. Results Through an inguinoscrotal incision, the inguinal canal was opened and the cord structures were transfixed and divided. The internal ring was divided laterally to allow gradual compression and replacement of the hernia intraabdominally. Over 8 litres of fluid was removed from Nasogastric aspirate. Lymphoedema in the scrotum made the laterality of the testis seen in the operative field ambiguous. The hernia was repaired with Bassini repair of the muscles, followed by polypropelene mesh. Following surgery, patient was discharged home with no immediate complications. Histology of the sac and Tunica Vaginalis revealed an atrophic right testis. Conclusion Distorted anatomy from chronicity of common surgical pathology may present challenge to even experienced surgeons. Unusual presentation of common pathology requires thinking outside the box. Since the lymphoedema in the scrotal hernial sac made the laterality of the testis unclear, an informed decision was taken not to remove the single testis seen in the operative field. The histology confirmed that this was the right decision, since the atrophic right testis was included in the operative specimen. Post operative imaging confirmed what was left, was the left testis.

Urethroplasty for the management of long-segment urethral strictures associated with lichen sclerosus presents considerable clinical challenges. Oral mucosal grafts are commonly employed but are vulnerable to posttransplantation infection and recurrent stricture formation. Furthermore, the necessity for anesthesia and oral graft harvesting restricts their application in primary healthcare settings. The single layer of flattened epithelium of the tunica vaginalis can serve as a potential alternative to oral mucosa. Animal experiments have demonstrated that the tunica vaginalis can readily form a tight connection with the multilayered urothelium of the urethra. Utilizing the tunica vaginalis as a scaffold for urethral re-epithelialization may help reduce the risk of recurrence of urethral stricture after surgery. Over a 19 year period, pedicled tunica vaginalis urethroplasty has been used for successfully treating 86 cases. The surgical procedure involves dorsally incising the urethral stricture segment, then covering it with a pedicled tunica vaginalis patch followed by suturing. Postoperatively, the pedicled tunica vaginalis graft exhibits good vascularization and take rate, facilitating urethral re-epithelialization. The surgical procedure is conducted in a sterile environment to mitigate the potential for infectious complications. Moreover, the operation can be executed under spinal anesthesia, which facilitates its implementation in primary healthcare settings.

Background: Tubularized incised plate (TIP) is the most popular technique performed in hypospadias without chordee. However, it is occasionally associated with some complications such as meatal stenosis, or urethrocutaneous fistula. Recent publications suggest that tunica vaginalis flap (TVF) may enhance the urethroplasty process by providing a robust vascularized tissue bed that supports better healing and reduces complications. Objectives: To evaluate the impact of incorporating a TVF into the TIP technique to cover the urethroplasty tube in patients with deficient ventral skin, assessing its effectiveness in improving surgical outcomes and minimizing urethrocutaneous fistula. Patients and Methods: This is a retrospective study involving 18 patients operated upon by TIP urethroplasty technique using TVF as an intermediate protective layer. Operative findings were collected including urethral plate length, pre urethrotomy plate width, post urethrotomy plate width and tunica flap width and length. Also, postoperative complications and follow-up data were evaluated. Results: The most common form of hypospadias was mid-penile, found in 55.6% of cases. The pre-urethrotomy mean urethral plate width was 7.06 mm, increasing to 13.5 mm post-incision, and the mean tunica flap width was 21.5 mm. Complications were relatively low; no fistula or dehiscence occurred; however, meatal stenosis occurred in 22.2% of patients, managed by either dilatation or meatoplasty. Conclusion: Incorporating tunica vaginalis flaps into TIP urethroplasty may represent a significant additional step over the standard technique in selected cases. The use of TVF is an effective means to enhance surgical outcomes and to minimize rates of urethrocutaneous fistula and repair disruption.

The need for health surveillance of former workers exposed to asbestos was provided by law in Italy after the asbestos ban in 1992. We describe the results of the health surveillance of former workers exposed to asbestos, conducted over 27 years, from 1994 to 2020, at the Operative Unit of Occupational Medicine of the University Hospital of Bari. We adopted the health surveillance protocol, which was validated at the national level in 2018. A total of 1,405 former workers exposed to asbestos were examined. We proceeded with diagnosing pathologies in 339 cases (24% of the cohort subjected to surveillance), with diagnoses of some cases involving multiple pathologies. Specifically, pleural plaques were diagnosed in 49.2% of the 339 cases, asbestosis in 35.9%, malignant pleural mesothelioma (MPM) in 20.3%, mesothelioma of the vaginal tunic of the testis (MTVT) in 9.1%, lung cancer in 5.8%, and laryngeal cancer in 0.8%. Despite the 1992 asbestos ban, asbestos-related diseases remain a serious public health issue. It is important to establish criteria that ensure the health surveillance of formerly exposed workers minimizes costs, reduces the number of invasive examinations, and optimizes achievable results.

Circumferential Esophageal Reconstruction Using a Tissue-engineered Decellularized Tunica Vaginalis Graft in a Rabbit Model

Purpose Hypospadias is an anomaly wherein the urethral opening is ectopically located on the ventral aspect of the penis. The most common complications after hypospadias repair are urethrocutaneous fistula (UCF) and meatal stenosis. Long Chain Cyanoacrylate (LCCA) tissue adhesive promises safety, feasibility, and durability due to its tensile strength and bacteriostatic and hemostatic properties. We conducted this study to ascertain whether LCCA tissue adhesive can prove a more effective adjunct to traditional suturing techniques. Methods Patients were divided into two groups. Group A underwent surgery with conventional reconstruction of the neourethral tube along with the buttressing layer using Buck's fascia or Tunica Vaginalis. In addition to the traditional procedure of GroupA, Group B patients were administered a layer of LCCA tissue adhesive as an adjunct between the neourethral suture line and the buttressing layer. Patients were followed up for six months and were evaluated for complications like UCF, meatal stenosis, hematoma, skin infection, glans dehiscence, and flap necrosis. Results Thirty-eight children in the age group 1-6 years were studied, of which 20 were in Group A and 18 in Group B. Among patients of Group A seven (35%)developed complications. In contrast, only four (22.2%)patients developed complications in Group B. The statistical significance in the complication rates between the two groups could not be achieved due to the modest sample size. However, the numerical and proportional reduction in the number of complications was noted. Conclusion LCCA adhesive as an adjunct numerically reduces the number of complications compared to traditional suturing alone in patients undergoing surgery for hypospadias and UCF.

A well-differentiated papillary mesothelial tumor (WDPMT) and malignant mesothelioma are 2 well-recognized entities arising from the testis tunica vaginalis. Another mesothelial lesion exclusively seen at this site is mesothelioma of uncertain malignant potential (MUMP)-a lesion reminiscent of WDPMT yet demonstrating variable proportions of more complex architectural patterns that could be confused with invasion. MUMP was first described in 2010 with a total of 11 cases reported to date. Herein, we describe 19 additional patients who underwent hydrocelectomy, excision, and/or orchiectomy. Novel morphologic patterns found in addition to the 2010 series include spindle cells, keloidal-type collagen, and multicystic architecture lined by bland mesothelial cells. Clinical follow-up in 9 patients for more than 1 year (1.5 to 22.5y, median 4.5y) revealed no evidence of disease recurrence or metastases. Despite greater architectural complexity, MUMP has (1) bland cytology; (2) merging in with WDPMT areas; (3) low mitotic rate and Ki-67 nuclear labeling index; (4) retention of MTAP and BAP1 expression; and (5) benign clinical follow-up. If these cases were malignant mesotheliomas, one would have expected at least some of the patients to demonstrate disease recurrence/progression without adjuvant therapy within the available follow-up time, particularly with limited resection in most patients. Thus, we propose that "mesothelioma of uncertain malignant potential" be renamed as "complex mesothelial tumor of the tunica vaginalis." Using the term "complex" draws a contrast with the simple cuboidal lining and simple papillary architecture seen in WDPMT. Also, labeling the lesion as "tumor" removes the stigmata of "uncertain malignant potential" and "mesothelioma" that are alarming to patients and clinicians, and potentially could unduly lead to more extensive surgery in an attempt at "complete" resection. At the same time, not definitively labeling the lesion as benign allows recommendations for follow-up.

Outcome Between Dartos Fascia and Tunica Vaginalis Flap in Tubularized Incised Plate Urethroplasty for Distal Penile Hypospadias Repair

A 12-y-old, male Dachshund was presented for elective orchiectomy. The testes were of normal size. The left testis had numerous dark-red, blood clot-like foci within the vaginal tunic over the pampiniform plexus, epididymis, and testis. Histologically, the red foci were limited to the vaginal tunic and consisted of disorderly growing, variably sized, thin-walled blood vessels lined by a single layer of endothelial cells without mitoses and supported by a thin layer of pericytes. The blood vessels were distended by erythrocytes without thrombus formation. Endothelial cells had cytoplasmic immunolabeling for CD31; pericytes had strong cytoplasmic immunolabeling for α-smooth muscle actin. Our case of subclinical unilateral vascular hamartomas of the vaginal tunic in a dog has not been reported previously in domestic animals or humans, to our knowledge.