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Cryptorchid-Induced Changes in Spermatogenesis and Fertility
Published in Tom O. Abney, Brooks A. Keel, The Cryptorchid Testis, 2020
Clearly, evaluation of fertility in previously cryptorchid human subjects is difficult. In an attempt to circumvent these problems, a model using experimental cryptorchidism in rats was investigated.26,27 In these studies, Sprague-Dawley rats were treated within the first few days of life to create either mechanical cryptorchidism by suturing the testis to the abdominal wall or endocrinological cryptorchidism by estradiol administration. The ability to father offspring was assessed in these animals once maturity had been achieved. Using this model, it was observed that paternity was prevented by bilateral cryptorchidism and reduced to 45 to 60% by unilateral cryptorchidism compared to a paternity rate of 85 to 94% in shamtreated controls. Of interest was the finding that unilaterally orchiectomized rats had statistically increased paternity rates compared to the unilaterally cryptorchid group. These findings suggest that the unilateral ectopic testis may express an inhibitory influence on the contralateral scrotal testis, which may explain why many investigators have noted a reduced fertility in unilateral patients. The use of such an experimental model should shed more light on the deleterious effects of both bi- and unilateral cryptorchidism on subsequent patient fertility.
Urology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
A careful history and examination allows the testis palpated outside the scrotum to be categorised into: An undescended testis: a testicle that is found in the line of its normal path of descent but outside the scrotum.An ectopic testis: a testicle that lies outside the normal path of descent, for instance in the thigh or the perineum.An ascended testis: a previously normally descended testis that with growth has failed to retain its scrotal position.A retractile testis: a normal testis that on initial examination appears above the scrotum or in the inguinal canal but can be brought to the scrotum without tension once the cremasteric reflex has been overcome.
The external genitalia
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
Site An ectopic testis is nearly always palpable, although with difficulty in a fat child. A truly undescended testis lying in the inguinal canal or abdomen is not palpable. If the testis is not in the scrotum, you must carefully examine those sites where ectopic testes are known to settle: Superficial inguinal pouch. This is by far the most common site in which to find an ectopic testis. It is also the place to which the retractile testis retreats. An ectopic testis in this site has emerged through the external ring but, having failed to enter the scrotum, turns upwards and laterally to lie in a pouch deep to the superficial fascia. This may be caused by some obstruction at the neck of the scrotum from tight fascia. The testis can be palpated in the subcutaneous tissue just above and lateral to the crest of the pubis and the pubic tubercle.Femoral triangle. If the testis moves laterally after leaving the external inguinal ring, it can come to rest in the upper medial corner of the femoral triangle. A testis in this site is easy to feel, and is easily misdiagnosed as a lymph gland or even a femoral hernia, although the latter is very rare in children. This variety is sometimes termed crural, as it lies in the thigh.Base of the penis. If the testis moves medially, it will lie at the base of the penis, where it can be easily felt against the underlying pubic bone.Perineum. Occasionally, the testis passes over the pubis and then backwards, instead of downwards, to lie in the perineum just to one side of the corpus cavernosum of the penis (Fig. 18.23). An ectopic testis cannot be manipulated into the scrotum.
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
The majority of the cases studied were patients who presented as an emergency. Although there were a few cases where the finding was incidental during an elective procedure [16,17], patients generally presented with a short history typical for femoral hernia. A painful, irreducible lump in the groin was the cardinal finding. Short history with local inflammatory signs, such as skin erythema or abscess formation and systemic symptoms, high temperature and biochemical markers, must raise the suspicion of hernia strangulation. Most of the included patients in this study had either a CT or and USS, or both. However, the gold standard for hernia diagnosis is still history and clinical examination of the groin. The differential diagnosis should include palpable lymph nodes, saphena varix or even an ectopic testis in male patients. In cases where the diagnosis is uncertain such as, groin swelling of unclear origin, vague clinical symptoms or difficult cases like small hernias in obese patients, further diagnostic investigation is required [18]. Ultrasound is generally cost-effective, well-tolerated, delivers no ionising radiation and, as initial diagnostic modality, shows high sensitivity [19]. However, it is operator dependant and is not always available out of hours. CT, on the other hand, has great specificity and sensitivity in diagnosing acute abdominal pain and establishing a diagnosis. It has a range of 86.7 to 96% for specificity and 80.7 to 92% for sensitivity in detecting acute appendicitis [20,21]. It is generally widely and quickly available and is not operator dependant; however, it requires the administration of intravenous contrast and delivers ionising radiation. A correct preoperative CT diagnosis of acute appendicitis within the femoral hernia was found to be only 68%, whereas the number for diagnosing De Gangrenot’s hernia with a USS fell to 5.5% [6]. No randomised controlled trial, systematic review or meta-analyses have been conducted to examine which diagnostic imaging modality is superior and more appropriate in detection of strangulated groin hernias in adults [18].