Infertility Diagnosis and Treatment
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
In cold weather the testes are drawn up by the action of the cremaster muscle and in hot weather they hang at a lower position. This behavior has been hypothesized to be a physiological control mechanism to maintain the testicular temperature constant presumably because testicular function are optimal over a small range of temperature. Further indirect evidence supporting the view arose from the observation that patients having varicocele, a pathology which raises the scrotal temperature, had poor semen quality and the incidence of infertility was high amongst these patients. A strong correlation between wearing of tight scrotal supports which keep the testes near the high temperature regions of the perineum and infertility has also been noted. Temperature wise a somewhat equivalent congenital condition of undescended testes also is associated with reproductive failure.
The external genitalia
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Testicular torsion can occur at any age, and is of two distinct types, intra- and extravaginal. Intravaginal torsion. The testis twists within the tunica vaginalis itself. This is the most common type, predisposed to by the ‘bell clapper’ abnormality in which the testis lies horizontally (Fig. 18.27) and is more mobile because of a longer length of the vessels. This process can be aided by contraction of the spiral fibres of the cremaster muscle.Extravaginal torsion. The entire testis and tunica vaginalis twists on the spermatic cord itself. This is seen rarely in neonates and infants.
Complications of Abdominal Wall Surgery and Hernia Repair
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
The nerves at risk of injury during open inguinal hernia repair are the ilioinguinal nerve, iliohypogastric nerve, and genital and femoral branches of the genitofemoral nerve. The ilioinguinal nerve lies beneath the external oblique aponeurosis along the surface of the spermatic cord. Injury most commonly occurs when the external oblique is opened for exposure of the inguinal canal. It results in loss of sensation to the base of the penis, upper scrotum, and inner thigh. The iliohypogastric nerve can be injured by relaxing incisions in the rectus sheath or by medial dissection during preperitoneal hernia repair. Such injury usually causes sensory loss to the suprapubic area. The genitofemoral nerve perforates the internal oblique muscle at the origin of the cremaster muscle. Injury to this nerve causes motor weakness of the cremaster muscle and cutaneous sensory loss in the penis and scrotum. The femoral branch of this nerve lies deep to the inguinal canal; injury to this branch causes sensory loss to the lateral thigh. Injury to any of these nerves usually produces only temporary symptoms that characteristically resolve within 6 months. Reports indicate that as many as 18%–20% of patients with hernias experience neurapraxia and hyperesthesia.41
Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele
Published in Systems Biology in Reproductive Medicine, 2020
Yu Yang, Xiaoqiang Wu, Qu Leng, Wei Su, Shuo Wang, Rongwei Xing, Xumin Zhou, Daojun Lv, Bingkun Li, Xiangming Mao
After staining, the histological transverse sections clearly displayed the microstructures of the spermatic cord (Figure 1). The fascia was clearly observed in the polarimicroscope images of the sections after sirius red staining which showed typical characteristics of type II collagen (Figure 1D). Under stereo microscopy, we observed that the outermost layer of the irregular cylindrical spermatic cord was the external spermatic fascia and the cremaster muscle inside which were two thin and translucent sheaths (Figure 2). The large sheath which wrapped the internal spermatic vessels was identified as the well-known internal spermatic fascia while the smaller sheath which wrapped the vas deferens and its associated vessels was termed as the vas deferens fascia. Most of the two delicate circular sheaths with different contours and sizes were stuck laterally to the inner contour of the cremaster or the external spermatic fascia. They connected closely at the middle, with each other leaving little space between them. The two sheaths and their contents ran in parallel inside the external spermatic fascia and the cremaster muscle. The existence of two separate sheaths was also confirmed by the 3D reconstruction images (Figure 3).
Review of the role of robotic surgery in male infertility
Published in Arab Journal of Urology, 2018
Mohamed Etafy, Ahmet Gudeloglu, Jamin V. Brahmbhatt, Sijo J. Parekattil
A subinguinal approach is used to access the spermatic cord beyond the external inguinal ring. The cord is then brought up to the skin and held in place using a tongue blade platform. The cremasteric muscle layer is then separated and dilated veins are found and ligated with 3-0 silk ties using robotic microsurgical instruments [12].The Black diamond micro-forceps are used in the right arm, the micro-bipolar forceps in the left arm, and the curved monopolar scissors in the fourth arm. Previous studies have shown that 75% of patients have multiple testicular arteries in the spermatic cord and at the subinguinal level 95% of these arteries are surrounded by adherent veins [27]. Thus, to avoid any accidental injury to the testicular arteries during the varicocelectomy, we routinely use a micro-Doppler US probes to assess the location of the arteries and veins. The use of the robotic platform allows surgeons to use this probe real-time with the additional arm to sense the flow in the artery whilst performing vein ligation simultaneously with the other two arms. Currently, there are two available micro-Doppler US probes: VTI (Vascular Technology Inc., Nashua, NH, USA) provides an easy to use, audible so disposable micro-Doppler probe (Fig. 5 ) and Aloka (Hitachi-Aloka, Tokyo, Japan) has a micro-Doppler US probe (Fig. 5) that provides full depth US imaging of the spermatic cord with Doppler flow sensing as well. The output from this probe can be sent directly to the surgeon console to provide real-time simultaneous imaging whilst the surgeon is operating.
The voltage-gated K+ channel Kv1.3 modulates platelet motility and α2β1 integrin-dependent adhesion to collagen
Published in Platelets, 2022
Joy R Wright, Sarah Jones, Sasikumar Parvathy, Leonard K Kaczmarek, Ian Forsythe, Richard W Farndale, Jonathan M Gibbins, Martyn P Mahaut-Smith
Thrombosis was measured in mouse cremaster arterioles as described previously[19]. Briefly, under general anesthesia the cremaster muscle was exteriorized and connective tissue removed. DyLight® 649-conjugated anti-GPIbβ antibody (0.2 µg/g mouse weight) was introduced into the carotid artery via a cannula. Injury to the vessel wall was made with a MicroPoint ablation laser (Andor Technology, Belfast, UK) and thrombus formation recorded using a digital camera with a charge-coupled device (C9300, Hamamatsu Photonics, Welwyn Garden City, UK). Data were analyzed using SlideBook 6 software (Intelligent Imaging Innovations, Denver, USA).