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General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Testicular torsion is an emergency condition where one testicle rotates in the scrotal sac, occluding the testicular artery. The resulting testicular ischemia produces extreme pain of rapid onset on the affected side. Swelling may also be present, making the diagnosis of acute epididymitis a possible diagnosis. Since the arterial occlusion stops warm blood from entering the scrotum, the involved testicle should appear cool to thermography, as opposed to the warm appearance of epididymitis. Experimental torsion of the testicular artery in animals has confirmed this, testicular torsion results in significant testicular cooling as measured by thermography; rewarming occurs quickly upon reduction of the experimental torsion.184 Thermography utilized in the emergency department may be extremely useful in the diagnosis of testicular torsion as well as in confirmation of its correction.
Hernias
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Complications of inguinal hernia repair➢ Scrotal haematoma.➢ Wound infection.➢ Urinary retention.➢ Chronic pain / paraesthesia in the scrotum (or labium majora in females) from damage to the ilio-inguinal nerve.➢ Testicular atrophy caused by inadvertent damage to the testicular artery.➢ Recurrence rates less than 1%.Infection most important risk for recurrence.Poor operative technique.Avoidance of mesh for reinforcement of weak musculature.Conditions such as chronic cough, constipation or bladder outlet obstruction also contribute to recurrence.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The testis is supplied by the testicular artery which arises directly from the descending abdominal aorta at the level of approximately L2. Although at first glance this may seem illogical, when the testis is in closer proximity to other blood vessels such as the internal iliac, the explanation lies in the fact that the testis develops high up on the posterior abdominal wall early in embryonic life. As it descends into the scrotum during development, the testis carries with it the same blood supply that it received whence it was positioned on the posterior abdominal wall (i.e., from the aorta).
Microscopic subinguinal varicocelectomy in 100 consecutive cases: Spermatic cord vascular anatomy, recurrence and hydrocele outcome analysis
Published in Arab Journal of Urology, 2018
Ahmed M. Al-Kandari, Abdulnasser Khudair, Abdelghaffar Arafa, Fouad Zanaty, Ahmed Ezz, Mohamed El-Shazly
The arterial supply to the testis is derived from three sources: the internal spermatic artery, the deferential (vasal) artery, and the external spermatic (or cremasteric) artery [22]. The internal spermatic artery is intimately associated with the pampiniform plexus of veins. The testicular artery is consistently the largest calibre arterial vessel, with a diameter equal to or greater than the sum of the vasal and cremasteric arteries in >50% of the spermatic cords. This suggests that although the vasal and cremasteric arteries combined contribute significantly to the testicular blood supply, the testicular artery provides most of the blood flow to the human testes. Preservation of the testicular arteries is recommended for optimal testicular blood flow [23]. There is evidence showing deleterious effects of its ligation on germinal epithelium and spermatogenesis from testicular ischaemia in both human and animal models [24].
Impact of body mass index on semen parameters and reproductive hormones among men undergoing microsurgical subinguinal varicocelectomy
Published in Arab Journal of Urology, 2023
Mohammed Mahdi, Ahmad Majzoub, Haitham Elbardisi, Mohamed Arafa, Kareim Khalafalla, Sami Al Said, Walid El Ansari
Varicocelectomy was performed using the microsurgical subinguinal approach. All cases were done by the same urology team using a standardized approach [25]. Procedures were done under general anesthesia, utilizing a 2–3 cm subinguinal incision. After delivery of the spermatic cord, any dilated external spermatic veins were ligated. Following dissection of the external spermatic fascia, a surgical microscope (Pentero 900, Carl Zeiss Meditec, Jena, Germany) was used under × 18 magnification to explore the cord and dissect, separate, ligate (using titanium clips) and divide the internal spermatic veins. A micro Doppler probe was also used during the procedure to identify and preserve the testicular artery. Vas deferens and lymphatic vessels were preserved.
Conservative treatment of partial testicular artery injury during transabdominal preperitoneal hernioplasty (TAPP)
Published in Acta Chirurgica Belgica, 2022
Goran Augustin, Lucija Brkic, Maja Hrabak Paar
With the TAPP inguinal hernioplasty, vascular injuries are possible at multiple operational steps. Injury may occur with the introduction of the Veress needle, the first trocar insertion, and during insertion of other trocars. During dissection of the preperitoneal space and the hernia sac, injuries to deep inferior epigastric arteries, testicular arteries, deferential arteries, and both external iliac arteries and veins are possible. All these vascular injuries are can occur during the mesh and peritoneum fixation with tacks. In our case, after TAPP, bilateral retroperitoneal hematoma developed. CT showed that both deep inferior epigastric arteries and right testicular artery had a normal flow up to periphery. The contrast of the left testicular artery was visible up to the hematoma, but without active extravasation. A left testicular vein was visible up to the left renal vein. The assumption was that the most likely cause of bleeding is a small injury of the left testicular artery, which did not actively bleed intraoperatively due to stretch from manipulation, raised intraabdominal pressure, and reflex vasoconstriction. Postoperatively, a large hematoma possibly compressed the injured artery resulting in cessation of extravasation. Another exclusion of the testicular vein injury is that it would not result in such a massive hematoma. Iatrogenic injury of the testicular artery is very rare and is most commonly encountered during orchiectomy [6]. With such injuries, the vitality of the testis could be an issue. These represent high testicular artery injuries and other uninjured arteries contributing to testicular blood supply are sufficient for adequate testicular perfusion.