Cryptorchidism Research Articles

Rethinking Prophylaxis: Evaluating Surgical Site Infection Rates in Pediatric Orchidopexy without Prophylactic Antibiotics

Introduction: Undescended testes (UDT) is the most common congenital anomaly of the urogenital system in male newborns. Testicular descent into scrotum is necessary for normal spermatogenesis. The scrotal temperature is 2-7 degrees below body temperature. UDT are prone to impaired spermatogenesis, Surgical site infection (SSI) is a leading cause of postoperative morbidity and mortality. It is the third most common cause of hospital acquired infections. However injudicious use of antibiotics is responsible for increased costs, unwanted drug side effects like Clostridium difficile infection as well as the emergence of resistant strains and multidrug resistant infections. Objective: To determine the frequency of surgical site infection in pediatric patients undergoing orchidopexy without the administration of prophylactic antibiotics. Study Design: Descriptive Study Setting: Department of pediatrics, Lady Reading Hospital Peshawar. Duration of Study: From 08-July-2020 to 08-January-2021. Materials and Methods: In overall 126 respondents of undescended testis were selected in a consecutive manner OPD and subjected to orchidopexy. Follow up was done to detect the presence or absence or SSI. Results: The average age of the sample was 12.9+6.8 months. Mean weight of the included children was 12.8 4.9 kg and mean height was 73.1+ 13.5 cm. 50.8% Presented with right side undescended testis and 57.1% were in ASA class Mean operative time for orchidopexy was 44.4 10.3 minutes. SSI was recorded in 31 (24.6%) of children. Conclusion: Surgical site infection (SSI) is a significant concern in pediatric patients undergoing orchidopexy for unilateral undescended testis. Additional investigation is required to determine the factors that contribute to surgical site infections (SSI) in children and create successful measures for prevention. The use of prophylactic antibiotics should be carefully considered, considering the potential risks and benefits. Addressing SSI in this population is crucial for improving patient outcomes and reducing the burden of complications. Keywords: Orchidopexy, pediatrics, surgical site infection

The effect of scrotal versus inguinal orchiopexy on the testicular function of children with clinically palpable, inguinal undescended testis: a randomized controlled trial.

To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism, a randomized controlled trial was conducted involving boys who were 6-12 months old at surgery and were diagnosed with clinically palpable, inguinal undescended testis. Between June 2021 and December 2021, these boys at Fujian Maternity and Child Health Hospital (Fuzhou, China) and Fujian Children's Hospital (Fuzhou, China) were enrolled. Block randomization with a 1:1 allocation ratio was employed. The primary outcome was testicular function assessed by testicular volume, serum testosterone, anti-Müllerian hormone (AMH), and inhibin B (InhB) levels. Secondary outcomes included operative time, amount of intraoperative bleeding, and postoperative complications. Among 577 screened patients, 100 (17.3%) were considered eligible and enrolled in the study. Of the 100 children who completed the 1-year follow-up, 50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy. The testicular volume, serum testosterone, AMH, and InhB levels in both groups increased markedly after surgery (all P < 0.05), but there were no apparent differences between groups at 6 months and 12 months after operation (all P > 0.05). No differences between the scrotal and inguinal groups were noted regarding the operative time ( P = 0.987) and amount of intraoperative bleeding ( P = 0.746). The overall complication rate (2.0%) of the scrotal group was slightly lower than that of the inguinal group (8.0%), although this difference was not statistically significant ( P > 0.05). Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism, with similar operative status and postoperative complications. Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism.

A Case Report: Ruptured Testicular Seminoma in a Female with Ambiguous Genitalia, Dr. Sulman Alamin Medical Center, Elhassaheisa, Gezira State, Sudan; 2023

Background: Ambiguous genitalia represent a sequel of sexual development disorders where the external genitalia don’t have a typical resemblance to that of male or female. Methods: This was a female case of ambiguous genitalia, her age was twenty-eight years, ultrasound examination revealed atrophied uterus and bilateral undescended testes. She complained of gradual size increase of her left testicle in the last 6 months. Due to sudden trauma, she developed severe pain and swelling in her left groin. On examination: patient looked unwell, in pain, afebrile, locally there was swelling about 10 cm in size with shiny and red looking, it was very tender, otherwise it was unremarkable. So, this was considered as a case of left testicular trauma that need urgent left groin exploration. The patient was counselled and consented about possible orchidectomy. Intra-operative note: under spinal anesthesia patient was put on supine position, skin painted by yamidin, left inguinal incision was made and hematoma was evacuated, the left testicle was found to be hugely enlarged and ruptured. The spermatic cord was clamped and orchidectomy was done. No intra operative complications. Result: Histological examination of the testicular specimen confirmed that it was a germ cell tumor [Seminoma]. Patient was recommended to for: (1) Chemotherapy at the Oncology Department, (2) Laparoscopic search for her right undescended testis to confirm whether it is a testis or an ovary, (3) Buccal biopsy for sex determination and (4) Surgery, for the right side, if needed. Conclusion and recommendation: Neglected cases of undescended testis may have a serious outcome. Screening for ambiguous genitalia, and early exploration and management was highly recommended.

Assessment of Prior Well Child Checks in Children With Concerns for Testicular Position: Opportunities for Early Referral From an Integrated Health System

To assess, through an integrated primary and specialty care pediatric health system, the association of well-child checks prior to referral with final urological diagnosis with the aim to identify opportunities for earlier referral of care STUDY DESIGN: We performed a retrospective review of children referred from primary care to urology for UDT within our integrated primary-specialty care health system in 2019, comparing children who had undescended testicles to those with either normal or retractile testicles based on the final urology examination. Demographics, including age, comorbidities, and the status of prior WCC within primary care, were reviewed. Outcomes of age at referral and surgical intervention for UDT were compared across referral categories. Stratifying by final diagnosis of 88 children included in the analysis, children with UDT were referred much later (85 months, IQR 31-113) than children without UDT on final diagnosis (33 months, IQR 15-74, p = 0.002). Furthermore, children with UDTs had a greater proportion with prior abnormal WCCs (N = 21/41, 51%) than those without UDT (N = 8/47, 17%) (P < 0.001). Children with prior abnormal WCCs were more likely to have a final diagnosis of UDT, with prior abnormalities being documented approximately 12 months prior to referral, indicating opportunities for improved referral patterns to urology.

(504) Subinguinal Microsurgical Cremasteric Muscle Division for Painful Retractile Testis: Single Center Experience

Abstract Introduction Cremasteric muscle division or release is a procedure performed in patients with chronic orchialgia associated with hyperactive cremaster muscle reflex who do not respond to medical therapy. This condition was first described in the literature by Dr. Thomas in 1927 and the first procedures releasing or removing cremaster muscle were first described in the 1930s. Nowadays, cremasteric muscle division is usually performed with a surgical microscope to improve accuracy and avoid injury of cord structures. However, data about outcomes of this procedure are sparse. To our knowledge, the only series of cases was reported by Dr. Kavoussi in 2019 who reported resolution of retraction in 100% of the patients that had this procedure and resolution of orchialgia in 92% of them. Objective Our main objective was to describe and evaluate outcomes of microsurgical cremasteric muscle division in a men’s health practice in Boston, MA and to determine if prior results described in the literature are similar to our current experience. Methods We performed a retrospective review of cases performed in our institution between 2018-2022 and recorded different outcomes including post-operative pain, post-operative physical exam, ED visits and complications. Results We performed a total of 4 cremasteric muscle divisions for unilateral retractile testis in 3 and bilateral retractile testis in 1 of the patients. All of the cases had retraction of the testis with reproducible findings on preop physical exam, and all of them endorsed pain and discomfort associated with retraction. The patient age ranged 21 to 56. All cases were performed using a surgical microscope. After a median follow-up of 52 days, 100% of the patients had improvement in the position of the testicle with no further episodes of retraction, and 75% (3/4) had complete resolution of pain. Regarding complications, only 1 patient had an episode of mild epididymitis that improved with a short course of NSAIDS and there were no visits to the emergency department or other complications. Conclusions Our experience is similar to prior case series reported in the literature showing resolution of testicular retraction in all the patients that had microsurgical cremasteric muscle release and resolution of pain in the majority of the cohort with a low rate of post-operative complications. Future multicenter studies with a larger sample size should be performed to confirm these results, compare outcomes to other more conventional approaches such as scrotal orchiopexy, and to explore preoperative characteristics associated failure to resolve pain. In addition, future studies should assess differences in outcomes in procedures using surgical microscope compared to the traditional open approach. Disclosure No

Prospective Investigation on the Paternity Intention and Affecting Factors in 84 Post-treatment Testicular Cancer Patients.

to investigate the factors affecting post-treatment paternity intention in patients followed up after the diagnosis of testicular cancer and to make recommendations for the early postoperative period based on the identified factors. This prospective descriptive study included total 185 patients who presented to our outpatient clinic between February 2000 and July 2020 who had radical orchiectomy due to suspected testicular cancer based on physical examination and other assessments. Contact information was found for 88 of 185 patients, and accordingly, the patients were reached by one-to-one phone calls. Upon literature review, a questionnaire consisting of 10 previously validated items was developed by the researchers. The patients were compared by separating them into two groups composed of patients with (Group 1) and without (Group 2) paternity intention. A total of 84 patients participated in the study, and the participation rate was 95.5%. It was found that 19 of 32 (38%) patients with paternity intention already had children. Only 21 (40%) of 52 patients without paternity intention were married. The mean age was 26.65 (18-39) years in Group 1, while it was 28.73 (19-45) years in Group 2. Tumor volume and serum tumor markers were higher in Group 2 than in Group 1. Parameters such as testicular side in which the tumor was located, smoking status, undescended testis history, and postsurgical chemotherapy history were not statistically significant difference between the two groups. The major findings included that the young aged, unmarried, and serious testicular cancer (Tumor volume and serum tumor markers were higher) can be affecting factors for testicular cancer patients' paternity intention. Early psychological counseling about paternity may be useful for testicular cancer patients.

DEGREE OF AGREEMENT BETWEEN ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR DETECTION OF NON-PALPABLE TESTIS AMONG PATIENTS WITH CRYPTORCHIDISM

The current study aimed to determine the degree of agreement between ultrasonography and magnetic resonance imaging to detect non-palpable testis among patients with cryptorchidism. This cross-sectional study was conducted at the Department of Radiology, Jinnah Hospital, Lahore, from 15th May 2014 to 14th November 2014. 120 patients under 12 years of age with cryptorchidism were included to detect the presence or absence of testis by magnetic resonance imaging and ultrasonography. 120 patients had a mean age of 5.10 ± 2.5 years ranging from 2 to 11. 90 patients (75%) showed undescended testes by ultrasonography while MRI detected the presence of undescended testes in 98 patients (81.7%). 84 patients were detected for the presence and 16 for the absence of undescended testes by MRI and ultrasound (kappa = 0.512). It is concluded that the agreement between ultrasonography and magnetic resonance imaging (51.2%) is although moderate yet acceptable for detection of non-palpable testis among patients of cryptorchidism.

Abstract #1407524: Endocrinopathies in Rubinstein Taybi Syndrome (RTS)

Rubinstein-Taybi syndrome (RTS) is a rare genetic disorder with a constellation of physical characteristic features, including a high-arched palate, broad thumbs, and microcephaly. It is associated with many endocrinopathies that need to be identified and treated. We present a case of RTS with associated hypogonadism, obesity, and type 2 diabetes Mellitus (DM). The patient is a 47 y/o man with a history of Rubinstein-Taybi syndrome, diagnosed at 3, presented to our clinic at age 33 for continued management of hypogonadism. He had been treated with IM testosterone injection but was not compliant. His past medical history was significant for a seizure disorder, recurrent respiratory infection, and undescended testes for which he had surgery at age 5 and 11. Family history was positive for type 2 DM. He denied smoking and illicit drug use; however, he reported occasional alcohol use. Upon initial evaluation, VS: BP 109/63, HR 71, Ht 67.1 inches, Wt 265 lbs with a BMI 41.5. A physical exam showed an obese man with facial dysmorphism of microcephaly, up-slanted palpebral fissure, overcrowded teeth, broad bilateral thumbs, fifth fingers, and first toes. A wide space between the 1st and 2nd toe was noted, with sparse pubic and axillary hair, a small testis on the right, and an empty scrotum on the left. Labs were pertinent for total testosterone 134 ng/dl (264-916 ng/dl), FSH < 0.3 mIU/ml (1.6-8.0 mIU/mL), LH < 0.1 mIU/ml (1.5-9.3 mIU/mL), and WBCs 17.3 x10E3/uL. Initial HbA1c 6.3%. Scrotal US revealed an empty left scrotum and hypovascular small right testis. Persistent leukocytosis was noted, ranging between 17.3-12.4 x10E3/uL, for which he was sent to hematology; subsequent evaluation was unremarkable. Over the years, he progressed to type 2 DM, for which he is receiving glucagon-like peptide-1 receptor agonist (GLP-1) and metformin. With the addition of the GLP-1, his BMI decreased from 41 to 31, and his most recent HbA1c was 6.2%. For hypogonadism, he continues on IM testosterone injections. RTS is a rare congenital condition linked to abnormalities in the CREBBP or EP300 genes as a result of microdeletion of chromosomes 16. 90% of cases survive to adulthood. Common endocrine conditions associated with RTS are congenital hypothyroidism, thyroid hypoplasia, growth hormone deficiency, and pituitary hypoplasia. Obesity is common, especially in adulthood; however, DM was not reported in the literature. Cryptorchidism is noted in over 70% of the cases. Of note, leukemia and lymphoma have also been linked to this syndrome; however, our patient's workup so far has been negative. The medical care for RTS patients is not standardized due to its incredibly rare nature. Our case is unique as there are no reported RTS patients with diabetes. These patients are at increased risk of obesity which will increase the risk of type 2 DM.

Acquired Undescended Testes: Immediate Surgery or Wait and See?

Undescended testes are a common urological pathology in boys. This condition is categorized according to the examination findings, palpable or non-palpable, and according to the time of diagnosis, congenital or acquired. Orchiopexy is recommended for congenital undescended testes as early as 6 months and up to 18 months at the latest. It is not certain when cases of acquired undescended testes first occur, and most will descend spontaneously into the scrotum. For this reason, when an acquired undescended testis is noticed, the question of whether orchiopexy should be performed immediately or if follow-up is an option becomes important. In this study, we aimed to examine studies on acquired undescended testes in light of the current literature in order to find an answer to this question.

Comparison of conventional Doppler imaging techniques and superb microvascular imaging in determination of vascularization in undescended testes.

Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes.

COMPLICATED INGUINAL HERNIA OR INGUINAL DERMOID: A DIAGNOSTIC DILEMMA

Simple or complicated inguinal hernias are the common inguinal lumps of any surgical emergency or outpatient settings. However, inguinal hematoma, abscess, enlarged inguinal lymph node, undescended testis, lipoma, or encysted hydrocele of the spermatic cord are few relatively less common entities seen in inguinal region whereas inguinal supernumerary pectineus bursa, preperitoneal lipoma, pedunculated uterine fibromyoma, angioma of uterine ligament, inguinal endometriosis, aneurysm of femoral artery, saphena varix, and thrombophlebitis are extremely uncommon entities of the groin region. We present an interesting case in which patient presented with painful firm lump in inguinal region and the history and clinical examination was consistent with the diagnosis of an incarcerated inguinal hernia but intraoperative findings amazed us and subsequently histopathological analysis labeled it a dermoid cyst.

PD06-11 LOSS OF WNT4 IN THE GUBERNACULUM CAUSES UNILATERAL CRYPTORCHIDISM AND FERTILITY DEFECTS DUE TO IMBALANCE OF MALE AND FEMALE GENES

You have accessJournal of UrologyCME1 Apr 2023PD06-11 LOSS OF WNT4 IN THE GUBERNACULUM CAUSES UNILATERAL CRYPTORCHIDISM AND FERTILITY DEFECTS DUE TO IMBALANCE OF MALE AND FEMALE GENES Abhishek Seth, Hunter Flores, Ahmed Chahdi, and Carolina Jorgez Abhishek SethAbhishek Seth More articles by this author , Hunter FloresHunter Flores More articles by this author , Ahmed ChahdiAhmed Chahdi More articles by this author , and Carolina JorgezCarolina Jorgez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Undescended testis (UDT) is the most common urological birth defect affecting 6% of male births. Despite surgical correction, some men with unilateral UDT may experience infertility with the contralateral descended testis (CDT) showing no A-dark spermatogonia. We hypothesized that WNT4 plays a significant role in gonadal development since mutations in WNT4 are associated with ambiguous genitalia, and overexpression of WNT4 in mice deficient in E2F1 leads to infertility. METHODS: A Wnt4 gubernaculum-specific knock-out mouse was created and phenotyped by crossing RARß2-cre mice to Wnt4-flox mice. Fertility was determined by 6-month paired mating of a wild type (WT) female to a Wnt4f/f;cre+ (Wnt4-cKO) male. RESULTS: All Wnt4-cKO mice presented with a smaller left unilateral UDT, and an equal number of mice had inguinal vs. abdominal UDT. The abdominal UDT had a Sertoli cell-only phenotype. The inguinal UDT had a combination of normal and abnormal seminiferous tubules (ST), including maturation arrest. Half of the mice with inguinal UDT had no sperm in the left epididymis, and the ones with sperm had 33% fewer sperm with a 96% decrease in motility compared to those of WT mice. The left gubernaculum of Wnt4-cKO was longer and thinner with increased collagen and reduced muscle content compared to the right CDT. The fertility of the Wnt4-cKO male was significantly reduced as they produced 23 litters and 88 pups within the same time that 8 WT mice produced 48 litter and 395 pups. Wnt4-cKO mice with abdominal UDT had an increase in serum FSH and LH. Wnt4-cKO UDT and CDT had an increase in ER-a in Leydig cells. Wnt4-cKO CDT and inguinal UDT had an increase in the number of SOX9-positive cells in which SOX9 expression was high in both the cytoplasm and nucleus. Wnt4-cKO testes revealed an up-regulation of genes essential for female gonadal development and function, such as Rspo1, Wnt4,and Foxl2 in both CDT and UDT. Several WNT4 variants were identified in boys with UDT that could potentially cause or contribute to their condition. CONCLUSIONS: Conditional loss of Wnt4 in the gubernaculum leads to aberrant testicular decent and development unilaterally. Although these mice have one normal descended testis, the existence of fertility defects and molecular alterations in the CDT supports our hypothesis that unilateral UDT is a bilateral defect. Our results indicate that the androgen-estrogen imbalance affects both testes and suggest that estrogen impacts the ability of SOX9 to translocate into the nucleus to activate the male developmental pathway. Source of Funding: NIH grant 1R01HD100985 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e160 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Seth More articles by this author Hunter Flores More articles by this author Ahmed Chahdi More articles by this author Carolina Jorgez More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-03 THE NATURAL HISTORY OF RETRACTILE TESTES AND PROGRESSION TO ORCHIOPEXY

You have accessJournal of UrologyCME1 Apr 2023MP18-03 THE NATURAL HISTORY OF RETRACTILE TESTES AND PROGRESSION TO ORCHIOPEXY Cynthia A. Sharadin, Anthony J. Schaeffer, Glen A. Lau, M. Chad Wallis, Patrick C. Cartwright, and Deborah L. Jacobson Cynthia A. SharadinCynthia A. Sharadin More articles by this author , Anthony J. SchaefferAnthony J. Schaeffer More articles by this author , Glen A. LauGlen A. Lau More articles by this author , M. Chad WallisM. Chad Wallis More articles by this author , Patrick C. CartwrightPatrick C. Cartwright More articles by this author , and Deborah L. JacobsonDeborah L. Jacobson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aims to evaluate the incidence of 1) testicular ascent and 2) orchiopexy for any reason among boys with a history of retractile testicle(s). We hypothesized that incidence of both ascent and orchiopexy is higher than previously published rates. METHODS: A single-institution retrospective review of boys <18 years diagnosed with a retractile testis between 1/18-8/20 and followed until 10/22 was performed. Boys were identified by ICD9/10 codes for retractile testis and a manual chart review was performed. Exclusion criteria included absent/unreliable testicular exam, planned orchiopexy at diagnosis, and followup <6 months. Kaplan-Meier survival curves were generated for time to ascent and time to any orchiopexy. Cox regression was performed. RESULTS: 642 boys with a history of retractile testes were identified. 145 were excluded for unclear physical exam findings or planned intervention at diagnosis; 334 were excluded for followup <6 months. A total of 163 boys identified at median 4.3 years [SD 0.7-14] were followed with serial exams for >6 months (median 809 days [SD 511-1121]). 35 (21.5%) developed ascent at a median 792 days [SD 413-1034] of followup (Figure 1). Cox regression demonstrated no association between the likelihood of ascent and race (p=0.41), ethnicity (p=0.99), laterality (p=0.11), or age at diagnosis (p=0.12). There was an association between the likelihood of ascent and having a PCP in our system routinely examine the testes (n=51, HR 7.3 [1.69-31.15]) and with lower BMI (HR 0.72 [0.60-0.87]). A total of 29.4% of boys ultimately underwent orchiopexy for any reason: 6 (3.7%) for torsion of the retractile testis, 5 (3.1%) for difficult exam making diagnosis unclear, and 2 (1.2%) for pain with retraction (Figure 2). CONCLUSIONS: 21.5% of 163 boys with retractile testis followed for >6 months developed ascent at a median 792 days; 29.4% underwent orchiopexy for any reason. Future directions include expanding this study to include more recent patient data, given the time period to ascent, and accruing additional data years. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e223 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cynthia A. Sharadin More articles by this author Anthony J. Schaeffer More articles by this author Glen A. Lau More articles by this author M. Chad Wallis More articles by this author Patrick C. Cartwright More articles by this author Deborah L. Jacobson More articles by this author Expand All Advertisement PDF downloadLoading ...

V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY Andrew Carey, Arighnno Das, Madison Wi, Fardod O'kelly, Shannon Cannon, Vinaya Bhatia, and Walid Farhat Andrew CareyAndrew Carey More articles by this author , Arighnno DasArighnno Das More articles by this author , Madison WiMadison Wi More articles by this author , Fardod O'kellyFardod O'kelly More articles by this author , Shannon CannonShannon Cannon More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing circumcisions with concomitant inguinal pathologies currently require both a penile and inguinal incision. We have previously described performing inguinal procedures through a penile incision. Herein we extend on this minimally invasive approach by performing a hydrocelectomy through a circumcision incision. METHODS: Once the preputial skin is excised, the penopubic junction is bluntly dissected. An S-shaped retractor is placed on the pubic bone and retracted towards the ipsilateral shoulder. With the pubic bone as a key landmark, the cord structures are carefully identified and the hydrocele sac is dissected off. The circumcision is then completed in the usual fashion. RESULTS: To date, we have offered this approach to all children undergoing circumcision and who also have undescended testis (UDT), hydroceles, or hernias. We have found that this approach is best for children who are under 5 years of age. Notably, this approach does not affect the appearance of the circumcision in any way. CONCLUSIONS: Children with inguinal pathologies, such as UDT, hernias or hydroceles, who are also undergoing circumcision or any penile procedure are currently offered this approach. A single penile incision for circumcision and correction of inguinal pathology is feasible, safe, and provides similar surgical outcomes with shorter overall operative time. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Carey More articles by this author Arighnno Das More articles by this author Madison Wi More articles by this author Fardod O'kelly More articles by this author Shannon Cannon More articles by this author Vinaya Bhatia More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

MP43-11 EIGHT-YEAR FERTILITY PRESERVATION PROGRAM AT ATRIUM HEALTH WAKE FOREST BAPTIST FOCUSING ON SPERMATOGONIAL STEM CELL AND ROUND SPERMATID TECHNOLOGIES.

You have accessJournal of UrologyCME1 Apr 2023MP43-11 EIGHT-YEAR FERTILITY PRESERVATION PROGRAM AT ATRIUM HEALTH WAKE FOREST BAPTIST FOCUSING ON SPERMATOGONIAL STEM CELL AND ROUND SPERMATID TECHNOLOGIES. Adam Cohen, Janmejay Hingu, Nima Pourhabibi Zarandi, Guillermo Galdon, Omar Abdelaal, Banafsheh Nickmehr, Kimberly Stogner-Underwood, Stanley Kogan, Steve Hodges, Stuart Howards, Thomas McLean, Anthony Atala, and Hooman Sadri-Ardekani Adam CohenAdam Cohen More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Nima Pourhabibi ZarandiNima Pourhabibi Zarandi More articles by this author , Guillermo GaldonGuillermo Galdon More articles by this author , Omar AbdelaalOmar Abdelaal More articles by this author , Banafsheh NickmehrBanafsheh Nickmehr More articles by this author , Kimberly Stogner-UnderwoodKimberly Stogner-Underwood More articles by this author , Stanley KoganStanley Kogan More articles by this author , Steve HodgesSteve Hodges More articles by this author , Stuart HowardsStuart Howards More articles by this author , Thomas McLeanThomas McLean More articles by this author , Anthony AtalaAnthony Atala More articles by this author , and Hooman Sadri-ArdekaniHooman Sadri-Ardekani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male infertility has been associated with many disease processes, including chemotherapy and radiotherapy for cancer, undescended testis (UDT), and genetic conditions such as Klinefelter Syndrome (KS). Preservation of human spermatogonial stem cells (SSC) may be a suitable option for young male patients at risk of losing fertility. With optimal cryopreservation, cell viability can be retained to reestablish spermatogenesis in the future through in vitro germ cell differentiation or round spermatid injection. METHODS: Urology and hematology-oncology patients at Atrium Health Wake Forest Baptist with malignancy, UDT, or KS were approached for consent and assent (if ≥seven years old) for the fertility preservation program. If participation was accepted, patients were given the option to undergo a fertility-preserving testicular biopsy, preferably during general anesthesia for other procedures such as Port-a-Cath placement, orchidopexy, or lymph node biopsy. They were also allowed to enroll as a registry participant (non-biopsy control). Histological and microbiological analyses were performed on biopsies before being cryopreserved. Further data were obtained retrospectively via chart review. RESULTS: Over eight years of banking, a total of 202 patients were approached for the study, with 125 (61.8%) undergoing a biopsy, 39 (19.3%) enrolling as non-biopsy control, and 38 (18.8%) declining participation. The mean age at which biopsy was performed across all diagnoses was 8.39 years (range 0.61 to 37.39). Of the 125 biopsy patients, 73% opted to donate a portion (up to 20%) of the tissue for basic research with no direct benefit to the donor. Of the biopsied patients, 76 (60.8%) were performed for cancer, 38 (30.4%) for unilateral or bilateral UDT, and 11 (8.8%) for KS. Based on PRM1 immunofluorescence, 48.3% of specimens had round spermatids. Short-term complications for testicular biopsy, primarily pain and swelling, were typically mild to moderate. CONCLUSIONS: A multidisciplinary approach can accommodate patients at risk for reduced future fertility due to various pathologies. The preservation of testicular tissue at present can aid in future fertility restoration through techniques such as in vitro SSC differentiation or round cell spermatid injection (ROSI). Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e605 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Cohen More articles by this author Janmejay Hingu More articles by this author Nima Pourhabibi Zarandi More articles by this author Guillermo Galdon More articles by this author Omar Abdelaal More articles by this author Banafsheh Nickmehr More articles by this author Kimberly Stogner-Underwood More articles by this author Stanley Kogan More articles by this author Steve Hodges More articles by this author Stuart Howards More articles by this author Thomas McLean More articles by this author Anthony Atala More articles by this author Hooman Sadri-Ardekani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-05 INHIBIN B/FSH RATIO AS A PREDICTOR OF ABNORMAL SEMEN ANALYSIS IN ADOLESCENT BOYS WITH PALPABLE VARICOCELE

You have accessJournal of UrologyCME1 Apr 2023MP18-05 INHIBIN B/FSH RATIO AS A PREDICTOR OF ABNORMAL SEMEN ANALYSIS IN ADOLESCENT BOYS WITH PALPABLE VARICOCELE Karl Godlewski, Sameer Mittal, Juliana Arenas, Nathan Hyacinthe, Emily Ai, Tyler Gaines, Katherine Fischer, Jason van Batavia, and Thomas Kolon Karl GodlewskiKarl Godlewski More articles by this author , Sameer MittalSameer Mittal More articles by this author , Juliana ArenasJuliana Arenas More articles by this author , Nathan HyacintheNathan Hyacinthe More articles by this author , Emily AiEmily Ai More articles by this author , Tyler GainesTyler Gaines More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Jason van BataviaJason van Batavia More articles by this author , and Thomas KolonThomas Kolon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fertility potential in adolescent boys with varicocele is best assessed with semen analysis (SA), however a SA can be difficult to obtain in some patients. Surrogates for abnormal SA, such as FSH and Inhibin B, have been investigated to potentially circumvent the barriers related to boys obtaining SA. Recent reports note the Inhibin B/FSH ratio may have good predictive value of testis health in adult varicoceles and infantile undescended testes. We hypothesize that Inhibin B/FSH ratio is a better predictor than FSH or Inhibin B alone in identifying abnormal SA in adolescent boys with left varicocele. METHODS: We queried our IRB-approved varicocele registry to identify Tanner V boys with palpable varicocele, SA and serum hormonal labs (FSH, Inhibin B) within 12 months of the SA. Abnormal SA was defined as TMC<9 million. ROC analysis was used to determine how well hormone levels (FSH, Inhibin B and Inhibin B/FSH ratio) could predict abnormal SA. Optimal cutoffs were calculated using the Youden index (J). RESULTS: Of 2158 patients in our registry, 192 Tanner V boys with palpable varicocele, SA, and hormone labs were included. Overall mean age was 17.2 years. Significant differences were noted in mean Inhibin B (226 vs 173; p=0.001), median FSH (3.3 vs 4.9; p=0.001), median TMC (37 vs 3.1; p=0.001), and median Inhibin B/FSH ratio (69 vs 32; p=0.001) between boys with normal and abnormal SA, respectively [Table 1]. ROC curves were generated to determine optimal cutoffs for FSH, Inhibin B, and Inhibin B/FSH ratio to predict abnormal SA [Figure 1]. Inhibin B/FSH ratio showed the highest AUC (0.66, sensitivity 71% specificity 61%.) overall at a cutoff of 53. CONCLUSIONS: In our analysis of adolescent patients with palpable varicocele, Inhibin B/FSH ratio does appear to be a better predictor of abnormal SA (TMC<9mil) than FSH or Inhibin B alone. Despite there being a clear correlation between all three markers and abnormal SA, the mediocre AUC’s of 0.65 – 0.66 for each respective cutoff, make clinical decision making solely on markers difficult. Source of Funding: - © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e224 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karl Godlewski More articles by this author Sameer Mittal More articles by this author Juliana Arenas More articles by this author Nathan Hyacinthe More articles by this author Emily Ai More articles by this author Tyler Gaines More articles by this author Katherine Fischer More articles by this author Jason van Batavia More articles by this author Thomas Kolon More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluation of Scrotal Pathologies by Ultrasound and Color Doppler.

Introduction Due to its ease of use, lack of ionizing radiation exposure, noninvasive nature, reproducibility, low cost, and ease of accessibility, ultrasound (US) is the preferred imaging modality for evaluating scrotal disease. High-resolution US and color Doppler better highlight scrotal and testicular diseases because of the scrotum's superficial anatomy. The genital organs are subjected to damaging ionizing radiation during CT, while MRI is both costly and uncommon. Aims and objectives The aim of this study is to use ultrasonography (USG) to examine various scrotal diseases and to diagnose and identify different disorders utilizing high-resolution US and color Doppler. Materials and methods The study was done on 60 patients who were referred to theDepartment of Radiodiagnosis by the General Surgery and Urology departments for the scrotal US and Doppler study. This study was conducted between October 2021 and March 2022 at the Indira Gandhi Institute of Medical Sciences, Patna, India. Results Out of 60 patients, hydrocele was seen in 25 cases, scrotal hernia in 12 cases, undescended testis in eight cases, varicocele and epididymal cysts in seven cases, etc. In acutely painful scrotal disorders, high-frequency US with color Doppler sonography successfully distinguishes between testicular ischemia/torsion and acute inflammatory illnesses. Eighteen cases of inflammatory scrotal pathologies and one case of testicular torsion were seen. Conclusion In detecting and assessing scrotal diseases, high-frequency USG and color Doppler sonography have good sensitivity and specificity. Furthermore, the lack of ionizing radiation, simplicity, wide availability, cost-efficiency, and reproducibility make it a highly important method for scrotal diseases.

Comparison of clinical outcomes between laparoscopic orchiopexy and open orchiopexy in the treatment of palpable undescended testes.

To compare the clinical effects of laparoscopic orchiopexy (LO) and open orchiopexy (OO) in the treatment of palpable undescended testes. Seventy-six children with palpable undescended testes treated in Zaozhuang Municipal Hospital from June 2019 to January 2021 were selected in this observational retrospective study. Patients were grouped according to their different surgical methods, 33 patients received OO (Open-group) and 43 patients received LO (Laparoscopic-group). The clinical outcomes of the two groups were compared, including surgical-related indicators, near and long-term surgical complications and postoperative testicular growth. Operation time, intraoperative bleeding, first ambulation time and hospitalization time in the Laparoscopic-group were lower than those in the Open-group (p<0.05). The short-term complication rate in the Laparoscopic-group was lower than that in the Open-group (2.27% vs 15.15%; p<0.05), but the long-term complication rate in the Laparoscopic-group was not significantly different from the Open-group (4.65% vs 3.03%; p>0.05). Follow-up was up to 18 months post-operation, with the rate of testicular growth (97.67% vs 96.97%; p>0.05) and testicular volume (0.59 ± 0.14ml vs 0.58 ± 0.12ml p>0.05) not significantly different between the Laparoscopic-group or Open-group respectively. LO is as clinically effective as OO in the treatment of palpable undescended testes, however, shorter operation time, less intraoperative bleeding and rapid recovery time have been noted with LO.

Intrascrotal Incision: An Alternative Technique for the Management of Inguinoscrotal Pathologies, Experience from 76 Cases

Abstract Introduction The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies. Materials and Methods A total of 76 male patients, between 2 and 16 years, underwent surgical treatment through a mid raphe intrascrotal incision, for a wide range of inguinoscrotal diseases, including torsion of the spermatic cord, torsion of the testicular appendages, non-communicating hydrocele, communicating hydrocele, ectopic testis, retractile testicles, palpable undescended testis, testicular trauma and testicular prosthesis placement. Results All the patients had an uneventful postoperative recovery, with none mentioned complication, and none of them required convention to the traditional inguinal method. The follow-up examination ranged from 6 months to 3 years, with no surgical complication highlighted. Conclusions We recommend that the intrascrotal incision through the mid raphe may be considered as an alternative technique to inguinoscrotal pathologies, instead of other approaches. The ability to treat a variety of pathologies regarding both two hemi-scrotums and the inguinal region at the same time, the provision of adequate surgical site, while succeeding much less dissection and disruption of tissue, the excellent cosmetic result, the greater comfort for the ‘day-case’ child, the ability to use the scrotal septum in order to fix the testis in the scrotum and the avoidance of an extra incision are the main advantages of the intrascrotal incision.

Management of testicular tumours in patients with undescended testes- a challenging but rewarding task: experience from a tertiary care cancer centre in India.

Primary objective: To study patients' clinical profile and outcomes with germ cell tumours developing in undescended testes. Case records of patients enlisted in the prospectively maintained 'testicular cancer database' at our tertiary cancer care hospital from 2014 to 2019 were retrospectively reviewed. Any patient who presented with testicular germ cell tumour with a documented history/diagnosis of undescended testes, whether surgically corrected or not, was considered for this study. The patients were managed along the standard lines of treatment for testicular cancer. We evaluated clinical features, difficulties and delays in diagnosis and complexities in management. We evaluated event-free survival (EFS) and overall survival (OS) using the Kaplan-Meier Method. Fifty-four patients were identified from our database. The mean age was 32.4 years (median age 32, range: 15-56 years). Seventeen (31.4%) had developed cancer in orchidopexy testes, and 37 (68.6%) presented with testicular cancer in uncorrected cryptorchid testes. The median age at orchidopexy was 13.5 years (range: 2-32 years). The median time from symptom onset to diagnosis was 2 months (1-36 months). There was a delay in the initiation of treatment of more than 1 month in 13 patients, with the longest delay being 4 months. Two patients were initially misdiagnosed as gastrointestinal tumours. Thirty-two (59.25%) patients had seminoma, and 22 (40.7%) patients had non-seminomatous germ cell tumours (NSGCT). Nineteen patients had metastatic disease at presentation. Thirty (55.5%) patients underwent orchidectomy upfront while in 22 (40.7%) patients, orchidectomy was done after chemotherapy. The surgical approach included high inguinal orchidectomy, exploratory laparotomy or laparoscopic surgery per the clinical situation. Post-operative chemotherapy was offered as clinically indicated. At a median follow-up of 66 months (95% CI: 51-76), there were four relapses (all NSGCT) and one death. The 5-year EFS was 90.7% (95% CI: 82.9-98.7). The 5-year OS was 96.3% (95% CI: 91.2-100). The tumours in undescended testes, particularly those without prior orchiopexy, often presented late and with bulky masses, requiring complex multidisciplinary management. Despite the complexity and challenges, our patient's OS and EFS matched that of patients with tumours in normally descended testes. Orchiopexy may help in earlier detection. In the first such series from India, we show that testicular tumours in the cryptorchid are also as curable as the germ cell tumours developing in the descended testis.A multidisciplinary disease management group with expertise in managing complex cases is crucial for a favourable outcome in these groups of patients. We also found that orchiopexy done even later in life confers an advantage in terms of early detection in a subsequently developing testicular tumour.