The male reproductive system and hernias
Peter Kopelman, Dame Jane Dacre in Handbook of Clinical Skills, 2019
The male external genitalia comprise the penis, scrotum and scrotal contents. The most common penile condition is phimosis, which may be caused by, and predispose to, infection, and may cause pain on erection and difficulty with micturition. The cremasteric fascia is muscular, and contraction of this muscle may cause the testicles to retract into the groins, especially in children. This may lead to a mistaken diagnosis of undescended testicle. Adult hydrocoeles and epididymal cysts develop over months to years and present as painless scrotal swellings. The patient is concerned either that the swelling may be sinister or by the inconvenience it causes. Palpation of the penis may identify areas of fibrosis in the shaft in Peyronie’s disease, but is of little value in most conditions. Palpation of the scrotal contents aims to identify the normal structures and the relationship of any abnormality to these. Using both hands, each testicle is picked up in turn.
Inguinal hernia repair
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
Complications following an inguinal hernia repair are best classified as wound, scrotal, operative, nerve injury and general. An attempt should be made to identify indirect hernial sac on the cord and, if present, it should be secured with clips and separated from the spermatic cord structures as far as the deep inguinal ring. An appropriately sized Prolene mesh is placed on the posterior wall of the inguinal canal, making a suitably sized slit in the lateral end of the mesh to accommodate the spermatic cord. Preperitoneal laparoscopic hernia repair (TEP) is indicated for bilateral and recurrent inguinal hernias only. This procedure is performed under a general anaesthetic, with the patient in a supine position, after informed consent has been obtained. The patient is prepared and draped so that two-thirds of the lower abdomen is exposed. A direct hernial sac can then be identified and its contents carefully separated from the overlying weakened transversalis fascia.
Genital surgery
James Barrett in Transsexual and Other Disorders of Gender Identity, 2017
Genital surgery in male-to-female transsexuals may consist of several components, not all of which are requested by any individual patient. These are: bilateral orchidectomy, amputation of the penis, labioplasty, vaginoplasty, clitoroplasty. Bilateral orchidectomy is often requested by patients as a first stage prior to continuing to further genital surgery at a later date, but may in some patients be the only operation desired. Amputation of the penis is normally performed as part of labioplasty with or without vaginoplasty. Even if some of the skin is used for vaginoplasty, there is normally sufficient scrotal skin available after orchidectomy to permit the construction of labia. The penile skin may also be used in some areas, especially if it is not being used for a neovagina. Creation of a neovagina has two components: firstly the creation of a cavity for the vagina within the male pelvis/perineum, and secondly providing an epithelial lining for that cavity.
The interscrotal approach to inguinoscrotal pathologies
Published in Arab Journal of Urology, 2015
Zineddine Soualili, Djelloul Achouri, Assia Haif, Souhem Touabti, Smain Ait Yahia, Mahmoud Benmahmoud, Hichem Choutri, Sameh Nedjar, Malika Mimoune, Sayah Chouaib
Objective:To determine the efficiency of the interscrotal approach to inguinoscrotal pathologies. Patients and methods:We report the use of the interscrotal approach in 21 boys, from September 2012 to November 2013, operated using an interscrotal access through a vertical incision on the median raphe. Results:The approach was used for bilateral inguinal hernia (48%), bilateral ectopic testis (19%), torsion of the spermatic cord (19%), testicular biopsy (10%) and webbing of the penis (5%). Conclusion:Inter-scrotal access is an option for inguinoscrotal pathologies, with the advantages of a single incision, much less dissection and disruption of tissue, and greater comfort for the ‘day-case’ child.
Accessory Scrotum
Published in Fetal and Pediatric Pathology, 2020
Fatma Fitouri, Nesrine Chebil, Sabrine Ben Ammar, Sondes Sahli, Mourad Hamzaoui
Introduction: An accessory scrotum is characterized by a characteristic skin appearance in addition to a normal scrotum in the anatomically normal position. Case report: We report an accessory inguinal left hemiscrotum in a 15-day-old male infant. There was a normal scrotum and penis. The testes were descended and normally located within the normal scrotum. Additional scrotal skin was located anterior and lateral to the normal scrotum. Conclusion: The accessory ectopic scrotum is readily observed by physical examination. Cosmetic excision is the treatment of choice.
Scrotal cooling and its benefits to male fertility: A systematic review
Published in Journal of Obstetrics and Gynaecology, 2013
I. Nikolopoulos, W. Osman, Z. Haoula, K. Jayaprakasan, W. Atiomo
The aim of this study was to systematically review the evidence for the impact of scrotal cooling on spermatogenesis. EMBASE (1980–2010) and MEDLINE (1950–Sept. 2010) databases were searched using the terms ‘male infertility or subfertility or fertility’, combined with a separate search of ‘scrotal cooling’, without any limits or restrictions. A total of eight articles met the criteria for inclusion in the study. There was insufficient evidence to draw any firm conclusions about the impact of scrotal cooling on male fertility. A positive trend of improved male fertility was however observed. There is therefore a need for well designed randomised controlled trials.