Search

Splenogonadal fusion (SGF) is a rare congenital anomaly of an aberrant accessory spleen-gonad connection. We present a rare case of continuous splenogonadal fusion in a full-term male with a left undescended testis, multiple congenital limb anomalies, and syndromic facies. Diagnostic laparoscopy revealed the "Echidna Splenule," a snake-like intraperitoneal splenule coursing from the spleen along the left paracolic region and engulfing an atrophic intra-abdominal testis preventing spontaneous descent and distally herniating into the left open internal inguinal ring. The atrophic testis and Echidna Splenule were resected. Splenogonadal fusion should be considered in children with left undescended testis and concomitant limb and facial anomalies., Competing Interests: Declaration of Competing Interest We have no declarations of conflict of interest or support and no financial disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Infertility is common among individuals with differences in sex development (DSD), and affected individuals and families desire fertility counseling. This survey sought to assess fertility knowledge and experiences with fertility counseling among DSD specialists for DSD conditions excluding congenital adrenal hyperplasia., Design, Setting, Participants, and Measures: A survey was iteratively developed by members of the DSD-Translational Research Network (DSD-TRN) Fertility Preservation Workgroup and disseminated to 5 clinician groups: the DSD-TRN, the Society for Pediatric Psychology DSD Special Interest Group (SIG), the Pediatric Endocrine Society DSD-SIG, the Societies for Pediatric Urology, and the North American Society for Pediatric and Adolescent Gynecology., Results: Completed surveys (n = 110) were mostly from pediatric urology (40.3%), gynecology (25.4%), and endocrinology (20.9%) specialists. Most (73/108, 67.6%) respondents reported discussing fertility potential. Sixty-seven responded to questions regarding fertility potential. Many participants answered questions about the presence of a uterus in individuals with 46,XY complete gonadal dysgenesis and about the potential for viable oocytes in individuals with 46,XY partial gonadal dysgenesis incorrectly. Comments acknowledged the need for further education on fertility in individuals with DSD., Conclusions: Many DSD providers have some knowledge of fertility potential, but knowledge gaps remain. Experts expressed a desire for education and accessible resources to counsel effectively about fertility potential for individuals with DSD., (Copyright © 2022. Published by Elsevier Inc.)

Crossed testicular ectopia (CTE) is an extremely rare anomaly of urogenital development. The etiopathogenic mechanism is unknown. Medical records of two biological siblings with a confirmed diagnosis of CTE being managed at our center were collected. The first patient was born with a non-palpable left testis. An exploratory laparoscopy was performed and a CTE was found. The second patient had an incarcerated left inguinal hernia and a mesopenile hypospadias. During surgery a CTE was observed. The parents were consanguineous. This is the first reported case of CTE in siblings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

A supernumerary testis is a rare finding with limited description in the literature. Presentations of supernumerary testes vary and often involve initial discovery intraoperatively or in association with a separate condition. In this case report, we describe our experience of a patient with ultrasound imaging concerning for a left paratesticular mass. The patient was taken to the operating room where the mass was found to be an atrophic, supernumerary testis. We also address the specific anatomy encountered in our case and discuss both the intraoperative and post-operative management that resulted, in addition to reviewing relevant literature., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Splenogonadal fusion (SGF) is a rare congenital anomaly in which there is abnormal adhesion between splenic tissue and gonads. Several patients with cryptorchidism associated with this anomaly have undergone orchiectomy because of the suspicion of tumors. Preoperative computed tomography (CT) is useful in differentiating between SGF and tumors, and in evaluating the vasculature of the SGF. We report a boy with an abdominal testis associated with SGF. Based on the CT findings, we successfully performed Fowler-Stephens orchiopexy. To the best of our knowledge, no SGF cases in which Fowler-Stephens orchiopexy could salvage the testis without testicular atrophy have been previously reported., (Copyright © 2021 Elsevier Inc. All rights reserved.)

A 12-year-old otherwise healthy boy presents to a local emergency room with sudden onset, sharp, continuous left testicular pain for 9 hours, associated with nausea and vomiting. Exam and ultrasound is consistent with testicular torsion. During scrotal exploration, a bell-clapper deformity of the left testicle is appreciated, with a normal gubernacular attachment of the right testicle. Bell-clapper deformity is a congenital failure of the posterior attachment of the gubernaculum to the testis, which increases testicular mobility within the tunica vaginalis and predisposes individuals to testicular torsion., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The coexistence of persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE) is extremely rare. Due to a lack of distinctive clinical features in the early stages, PMDS coexists with TTE is usuallydiagnosed when patients are examined for other diseases,including cryptorchidism and inguinal hernia. We present a case of a 51-year-old man who presented with a recurrent left indirect inguinal hernia for 2 years and right congenital cryptorchidism. The patient was diagnosed as PMDS with TTE by preoperative magnetic resonance imaging and underwent laparoscopic resection of the right transverse ectopic testis and Mullerian duct residues., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To query the current contralateral testis fixation (CTF) practice patterns among pediatric urologists in different clinical situations that could result in monorchism., Methods: An online survey was sent to members of the Urology Section of the American Academy of Pediatrics. The survey included questions addressing CTF practice patterns in 14 clinical scenarios. Responses were anonymously submitted, blindly reviewed, and analyzed., Results: Among 53 respondents, 62.3% had academic appointments and 73.6% had an exclusive pediatric urology practice. All participants agreed on CTF necessity in testicular torsion beyond the neonatal period. CTF was advocated by 84.9% in prenatal torsion, 96.2% in postnatal torsion, and 94.3% in delayed torsion presentation. Emergent intervention was favored by 64.4% in prenatal and 98% in postnatal torsion. Only 1 participant (1.9%) preferred CTF with a unilateral testicular tumor and 5 (9.4%) in trauma substantiating an orchiectomy. There was less consensus on CTF in torsed undescended testis (79.3% in prepubertal and 81.13% in postpubertal), testicular nubbin in a child (40.4%), palpable atrophic undescended testis (13.2%), and unilateral bell-clapper anomaly (47.2%). In situations other than torsion, lack of strong evidence was the commonest reason not to perform CTF., Conclusion: The majority of responding pediatric urologists currently performs CTF in neonatal torsion. Although there is a general consensus on CTF in testicular torsion outside the neonatal period, CTF remains controversial in other clinical situations, warranting further research. The decision for CTF should involve patients, parents, and treating physicians., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Polyorchidism is a rare anomaly of testicular development. Particularly, a bilobed testis is an extremely rare congenital malformation, which is thought to be a variant expression of polyorchidism. Only 5 cases of bilobed testis have been reported in the literature to date. This report is of bilateral, undescended, bilobed testes in a 15-month-old boy who has multiple other malformations of possible genetic etiology., (Copyright © 2017 Elsevier Inc. All rights reserved.)

A looping vas deferens may be present in up to 20% of undescended testes located within or proximal to the inguinal canal. This associated abnormality is vulnerable to transection during orchidopexy. We present an example of a very long looping vas to emphasize the importance of inspection for this anomaly, and demonstrate the extreme extent that a looping vas may extend. Identification of the vas among cord structures may provide false reassurance of normal ductal anatomy. Examination for a looping vas by inspecting structures caudal to the testis should occur at an early opportunity during orchidopexy to avoid inadvertent transection., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Polyorchidism is a rare congenital anomaly with less than 200 case reports in literature. Triorchidism, the condition of having 3 testicles, is the most common presentation. We present an unusual case of a patient who was diagnosed with 5 testicles by magnetic resonance imaging. To the best of our knowledge, this rare presentation has not previously been reported in the medical literature., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To determine if vanishing testis could result from a fault in embryological development as a result of an arrest in endothelial cell migration rather than secondary to just a random physical torsion/twist. A testicular nubbin or vanishing testis is considered to be secondary to a neonatal torsion and is usually associated with a hemosiderin deposit., Materials and Methods: Cases of vanishing testis excision were compared with age-matched controls from cadaveric testes without known genitourinary pathology. To assess the testis microvasculature, we performed immunohistochemistry using an automated staining platform with controlled and standardized conditions and positive and negative controls. We used cluster of differentiation (CD) 34 to stain blood vessel endothelium, stem cells, and interstitium; CD31 (all endothelium); and D2-40 for lymphatic endothelium. Morphometric analysis was carried out, % of the total tissue with CD31 and CD34 positive stain was assessed, and the number of the lymphatic vessels (D2-40) per mm 2 was counted., Results: Of the 10 cases, 7 had evidence of hemosiderin deposit and calcification. The % distribution of CD34 in controls was higher, 13.4 ± 3.1 (mean ± standard deviation), compared to nubbin cases, 4.5 ± 2.9 (P ≤ .001). The % distribution of CD31 was 2.8 ± 0.83 in controls compared to 1.31 ± 0.60 in cases (P ≤ .001). The lymphatic distribution was similar in both groups, cases (6.4 ± 4.3 n/mm 2 ) and controls (6.4 ± 1.7 n/mm 2 ) (P = .99) CONCLUSION: This histopathological study suggests that disturbances in endothelial development may be a contributing factor leading to testicular hypoplasia and a resultant nubbin testis, independent of a physical torsion event., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Transverse testicular ectopia (TTE) is a rare form of ectopic testis observed in boys with a normal 46, XY karyotype. TTE can be associated with persistent Müllerian duct syndrome or other genital anomalies such as hypospadias. However, TTE concomitant with both persistent Müllerian duct remnants and hypospadias has never been reported in the literature. A case of chromosomal disorders of sex development with TTE and persistent Müllerian duct remnants, which was initially presumed to represent mixed gonadal dysgenesis, is presented., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We present a rare case of cystic dysplasia of the testes in an adolescent boy who presented with testicular pain and found to have a palpable intratesticular mass. Ultrasound revealed an avascular cystic dilation of the testicle. Usually, a palpable intratesticular mass is malignant unless proven otherwise. However, on computed tomography scan, he was found to have agenesis of the ipsilateral kidney and dilation of the ipsilateral seminal vesicle. These findings were consistent with a congenital abnormality, suggesting that the testicular finding was likely cystic dysplasia of the testes, with low malignant potential. Thus, the patient did not undergo radical orchiectomy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Sex development depends on the synchronous interaction of complicated genetic and hormonal events. Sex differentiation begins with sex determination, which is the assignment of the embryonic bipotential gonads as either testes or ovaries on the basis of transcriptional regulation. Hormonal regulation then directs the development of the male or female phenotype. Disruptions of this intricate cascade of events result in disorders of sexual development., Case: A 16-year-old female adolescent presented with primary amenorrhea. Evaluation revealed female external genitalia, XY karyotype, absent gonadal tissue, and rudimentary Müllerian structures. On the basis of her constellation of findings, the most logical diagnosis was the rare embryonic testicular regression syndrome., Summary and Conclusion: A careful understanding of embryonic sexual development is critical to the evaluation of patients with disorders of sexual development., (Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Ovotesticular disorders of sexual development result in the presence of both testis and ovarian tissue. Most commonly, gonadal structures in the scrotum or inguinal canal are comprised of testis tissue. The presence of a uterus within an inguinal hernia sac in a phenotypically male patient is referred to as hernia uteri inguinalis. This condition has rarely been reported in patients with ovotesticular disorders of sexual development. We present a patient with rare mosaicism in combination with an unusual location of Müllerian duct structures within an inguinal hernia sac., (Published by Elsevier Inc.)

We report a case of testicular torsion in an adolescent with polyorchidism, specifically quadorchidism. Sonographic and intraoperative images are provided to describe the presentation and management of this case, while the challenges and pitfalls with this clinical scenario are discussed., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. We present a case of TTE in a 33-year-old man. Laparoscopy showed the left spermatic vessels, accompanied by parietal peritoneum, which formed a septum that divided the pelvic space into two, were extending transversely from the left lateral side of the descending colon toward the right internal inguinal ring over the sigmoid colon. A panoramic laparoscopic view of the spermatic vessels in TTE can clearly demonstrate the descending pathway and partly contribute to our understanding of the etiologic mechanisms of TTE., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

A 35-year-old man presented with a painless left scrotal mass. Pathologic examination after orchiectomy revealed splenogonadal fusion. Splenogonadal fusion is an exceptionally rare, typically benign, congenital anomaly. Splenogonadal fusion should be included in the differential diagnosis of a left-sided testicular mass., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Polyorchidism is a rare congenital anomaly, with only 140 pathologically proven cases reported. Bilateral polyorchidism is far less common than triorchidism. Most cases present as a painless scrotal mass or are found incidentally during evaluation of other inguinoscrotal pathologies. We report a case of bilateral polyorchidism with 4 testes, 2 in each hemiscrotum that presented as left-sided testicular pain and hydrocele., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To discuss the classification systems and pose a rationale for a flexible approach. We also propose our surgical approach for vasoepididymal or epidymo-epididymal approximation. Polyorchidism is a rare congenital anomaly with about 200 cases reported., Methods: We present 8 cases of polyorchidism treated at our institute from 1992 to 2010. To our knowledge, this is the most numerous single-center experience. We performed vasoepididymal or epidymo-epididymal approximation to restore near-normal anatomy plus stabilization of the testicular and ductal system to facilitate possible future reconstructive surgery., Results: In the case of contralateral anorchia or an atrophic testis, a supernumerary testis can fairly replace the contralateral counterpart. The reproductive potential of the supernumerary testis must not be ignored. Also, the malignant potential of the supernumerary testis should not be overestimated., Conclusion: A careful pursuit of the vessel and vasal route during surgery for an undescended testis, judicious use of laparoscopy, and a lower threshold for diagnosis both on imaging studies and during surgery might result in a greater number of cases of polyorchidism in the daily practice of pediatric urology., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Hypogonadism affecting the male pediatric population is uncommon, with that attributed to multiple unrelated etiologies being exceedingly rare. We report a case of septo-optic dysplasia, an atypical cause of delayed puberty, with subsequent workup unveiling 2 coexistent conditions: hypogonadotropic hypogonadism and anorchia. Primary and secondary etiologies must be considered in patients with undescended testes. Thorough evaluation is mandatory to ensure proper diagnosis and care, because Occam's razor can, on unique occasions, be double-edged., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Scrotoschisis, the congenital extrusion of the testis through the scrotal wall, is very rare. We describe a new case and review the pertinent published data. A male neonate presented with left scrotoschisis that was repaired successfully with a Denis-Browne trans-scrotal orchiopexy, with antibiotic coverage. The testes were intrascrotal and symmetric after 2 years of follow-up. Most cases of scrotoschisis are unilateral and affect normal males. The immediate prognosis is good, but long-term results are not available. The etiology of the disease is unknown, but it might be related to spontaneous healed fetal intestinal perforations with meconium peritonitis., (Copyright © 2012 Elsevier Inc. All rights reserved.)

This report describes laparoscopic Fowler-Stephens orchidopexy for cryptorchidism resulting from orchidogastric fusion in an infant born with gastroschisis. At 11 months of age, the left testicle remained impalpable, and diagnostic laparoscopy was performed. Intraoperatively, a normal-appearing testicle was found attached to the stomach. The testicle was dissected, mobilized down to the left inguinal ring, exteriorized through a transscrotal trocar, and subsequently fixated in the lower left scrotum. On follow-up 5 months later, both testicles were normal in size and location. Single-stage laparoscopic Fowler-Stephens orchidopexy is easily accomplished in cases of orchidogastric fusion resulting from a long vas deferens., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To investigate the accuracy of contralateral testicular hypertrophy in Japanese boys with a nonpalpable testis and to determine the optimal cutoff value of the contralateral testicular size to predict the absence of the testis., Methods: From December 2003 to November 2009, we evaluated 55 boys <60 months old (mean age 19.4) with a unilateral nonpalpable testis and compared their findings with those of a control group. The control group included 20 age-matched boys with 40 testes. The nonpalpable status of the testes was diagnosed by physical examination, and the contralateral testis was measured with calipers before surgery. A sensitivity and specificity analysis were performed using computer software., Results: At surgery, the testis was found in 22 of the 55 boys and was absent in 33. Of the 33 boys with an absent testis, 4 had a blind-ending vessel and 29 had an atrophic cord and testicular nubbin in the canal or scrotum. The mean contralateral testicular length and volume in the boys with an absent testis was 22.4 mm and 2.20 cm(3) compared with 16.6 mm and 1.10 cm(3) in the boys with the testis present and 16.6 mm and 1.18 cm(3) in the controls, respectively (P < .01). The predictive accuracy, sensitivity, and specificity for an absent testis was 87.3%, 81.8%, and 95.5% for the length and 85.5%, 84.8%, and 86.4% for the volume, respectively, at the optimal cutoff value of 21 mm in length and 1.6 cm(3) in volume., Conclusions: Our data have shown that contralateral testicular hypertrophy strongly indicates an absent testis in Japanese boys. The optimal cutoff for contralateral testicular hypertrophy with calipers was 21 mm and 1.6 cm(3). This result has provided valuable information for preoperative counseling and treatment planning., (Copyright 2010 Elsevier Inc. All rights reserved.)

We report a case of fused testes in a patient with transverse testicular ectopia and persistent Mullerian duct syndrome. A laparoscopy performed to confirm the diagnosis showed a single vas deferens on the left side. Treatment included excision of the Mullerian remnant through a left inguinal incision and orchidopexy of the fused testes via the left inguinal canal after sectioning of the right internal spermatic vessels. Follow-up ultrasound has so far confirmed viability of both testes., (Copyright 2010 Elsevier Inc. All rights reserved.)

Persistent Müllerian duct syndrome with transverse testicular ectopia is a rare pathologic association. A 7-month-old boy was admitted to the emergency department with a right testicular swelling. Physical examination revealed a tender right testis, the upper limits of which could not be palpated. The left testis was impalpable. An ultrasound revealed a normal right testis with an evident blood flow, overcome by a similar mass but avascular. At surgery, the right hernial sac contained both testes with an infantile uterus and fallopian tubes. The left testis was viable after manipulation. Proximal-salpingectomy with corporeal hysterectomy was performed to allow bilateral scrotal orchiopexy., (Copyright 2010 Elsevier Inc. All rights reserved.)

Splenogonadal fusion is a rare congenital malformation characterized by intrauterine fusion of the spleen and gonad. We present a 13-year-old boy referred to our clinic, with left scrotal mass and impalpable testis on the right. The scrotal mass was diagnosed histologically as discontinuous-type splenogonadal fusion and intra-abdominal displaced right testis as germ cell aplasia (Sertoli cell only)., (2010 Elsevier Inc. All rights reserved.)

Crossed testicular ectopia is an extremely rare congenital disorder in which both testes descend toward the same hemiscrotum. Twenty percent of cases with crossed testicular ectopia are accompanied by urogenital anomalies such as hypospadias, seminal vesicle cysts, renal anomalies associated with obstruction of the ureteropelvic junction, and testicular tumors. In the case reported here, we describe a patient with ganglioneuroblastoma and crossed testicular ectopia.

Scrotoschisis is a rare congenital defect of the scrotal sac associated with extrusion of one or both testicles. Only 9 cases have been reported in the literature. The exact mechanism causing this rare congenital defect is unknown. We describe a case of unilateral scrotoschisis in a 35-week preterm infant delivered by cesarean section. The defect was repaired under local anesthesia within a few hours after birth, with good healing noted on follow-up. Scrotoschisis in an infant after delivery by cesarean section has been reported only once before. Although a laceration of scrotum during cesarean section was considered, it seemed unlikely.

Objectives: To describe the embryologic, clinical, and therapeutic features of transverse testicular ectopia (TTE) and to review the literature on similar cases., Methods: Three cases of TTE were discovered accidentally during surgery for inguinal hernia and undescended testes; a persistent Müllerian duct syndrome (PMDS) was associated in 1 case. We also performed a literature search for other reports of TTE., Results: A conservative surgical approach was chosen: transseptal orchiopexy was preferred in 2 cases and the Müllerian remnant was preserved in the first case., Conclusions: TTE is a rare anomaly that usually presents as a unilateral cryptorchidism and a contralateral descendent testis with an associated hernia. In suspected cases, laparoscopy and ultrasonographic evaluation may be helpful in diagnosing this condition before surgery. Surgery, transseptal orchiopexy, is highly recommended to manage TTE especially when vasa deferentia are fused. In case of PMDS, the authors preferred preserving Müllerian remnants because of the risk of vas deferens and testicular blood supply damage. Recently, laparoscopy is useful for both diagnosing and management of TTE and associated anomalies.

Crossed testicular ectopia/transverse testicular ectopia is an extremely rare anomaly, in which both gonads migrate toward the same hemiscrotum. About 100 cases of transverse testicular ectopia have been reported in published studies. We report a case of transverse testicular ectopia in an 8-year-old boy who presented with right inguinal hernia and nonpalpable left testis. On exploration, both testes were present in the right inguinal region. Bilateral orchiopexy was performed by crossing the left testis in the preperitoneal space. The diagnosis could not be made preoperatively in most of reported cases. Magnetic resonance imaging, magnetic resonance venography, and laparoscopy are useful for diagnosis and management.

Transverse testicular ectopia (TTE) is an extremely rare congenital anomaly in which both testes descend through the same inguinal canal. We report an 8-month-old male with TTE and hypospadias. To help manage the patient, we conducted laparoscopy to elucidate the anatomy of the spermatic cord of the ectopic testis. On laparoscopy, we clearly identified the spermatic cord of the right ectopic testis. In addition, the laparoscopic guide was helpful when doing the trans-septal orchidopexy, in that the ectopic testis could be precisely discriminated without confusion as to the laterality of the testes. Long-term follow-up at 32 months confirmed that both testes were properly positioned in the scrotum and had a good consistency.

Objectives: There is controversy surrounding the optimal management of the testicular remnant associated with the vanishing testes syndrome. Some urologists advocate the need for surgical exploration, whereas others believe this is unnecessary. These differing opinions are based on the variable reports of viable germ cell elements found within the testicular remnants. To better understand the pathology associated with this syndrome and the need for surgical management, we reviewed our experience regarding the incidence of viable germ cell elements within the testicular remnant., Methods: An institutional review board-approved, retrospective review was performed of all consecutive patients undergoing exploration for a nonpalpable testis at Eastern Virginia Medical School and Geisinger Medical Center between 1994 and 2006. Patients who were found to have spermatic vessels and a vas deferens exiting a closed internal inguinal ring were included in this analysis., Results: Fifty-six patients underwent removal of the testicular remnant. Patient age ranged from 11 to 216 months. In 8 of the specimens (14%), we identified viable germ cell elements. In an additional 4 patients (7%), we identified seminiferous tubules without germ cell elements., Conclusions: In our review, we identified that a significant number of testicular remnants associated with the vanishing testes syndrome can harbor viable germ cell elements or seminiferous tubules. The exact fate of these residual elements remains unknown; however, there may exist the potential for malignant transformation. Given the potential for malignant degeneration, we believe that these remnants should be removed.

Abdominoscrotal hydrocele and transverse testis ectopia are rare clinical conditions. This case report describes the combination of these two rare entities. An azoospermic and infertile adult man presented with left abdominoscrotal hydrocele and a right impalpable testis. He was treated with left orchiopexy, right orchiectomy, and excision of the abdominoscrotal hydrocele. We discuss the diagnosis and treatment of this combination, which has not been previously reported.

Endocrine disrupting alkylphenolic compounds have been found in the aquatic environment, and concern has arisen over the ability of these compounds to affect the reproductive system of fish. In this study, the effects of exposure to an environmentally relevant concentration of octylphenol or 17beta-estradiol on the gonad structure of fish were examined. Viviparous guppies (Poecilia reticulata) were exposed as adults via the water or as embryos via the mother to 26 microg/l octylphenol or 0.85 microg/l 17beta-estradiol (mean measured water concentrations). Histological examinations revealed effects of the exposures on the gonads of the fish exposed as adults. Indications of blocked spermatogonial mitosis were seen in the testis structure of adult males after exposure to octylphenol or 17beta-estradiol. The post-parturition ovaries of adult females exposed to 17beta-estradiol showed effects suggesting an inhibited yolk deposition. At the tested concentrations, exposure to octylphenol or 17beta-estradiol via the mother fish did not significantly affect the weight, length, gonopodium index or sex distribution of the offspring. However, histology revealed effects on the liver structure, suggesting some effect of maternal exposure to octylphenol or 17beta-estradiol. These findings indicate that although octylphenol and 17beta-estradiol affect the gonad structure of adult male and female guppies, these substances have no significant effects on the sexual differentiation of the embryos at the tested concentrations.

Polyorchidism is an uncommon congenital anomaly of the genital tract defined as the presence of more than two testes. Polyorchidism is associated with maldescent testis, inguinal hernia, torsion, and an increased risk of malignancy. However, if a neoplasm is ruled out by ultrasonography, surgical exploration is not needed. We report a case of multiple testicular glands.

A localized Gleason score 6 (3 + 3) prostate cancer was found in a 56-year-old man with bilateral cryptorchidism. Radical laparoscopic prostatectomy was performed. However, at the beginning of the procedure, a uterus, two fallopian tubes, and two intra-abdominal gonads were endoscopically identified. The müllerian rests were excised and the gonads biopsied. The histologic examination showed testicular tissue. The association of prostate cancer and persistent müllerian duct syndrome to our knowledge has not previously been reported. Prostate cancer is an androgen-dependent neoplasm, and patients with male pseudohermaphroditism have poor androgen production that should provide protection against it.

A case of transverse testicular ectopia with supernumerary vas deferens and cyst of the ejaculatory duct is reported. The reports relevant to these malformations were reviewed and their embryologic etiology discussed.

Persistent müllerian duct syndrome (PMDS) is a rare form of male pseudohermaphroditism. We present 5 cases with PMDS (2 cases associated with testicular malignancy) and discuss the diagnosis and management. Management strategies of PMDS have changed. Whereas in the past, removal of the müllerian remnants was targeted together with orchidopexy or -ectomy, this is no longer recommended. However, testicles that cannot be descended at an early stage are at a high risk of malignancy and should, therefore, be removed. If this is necessary on both sides, there is the additional problem of lifelong testosterone substitution which requires efficient patient monitoring and good patient compliance. In cases where this cannot be achieved, compromises, such as temporarily delayed orchidectomy, may be considered.

Objectives: To review anatomical and histological findings in 105 vanishing testes., Methods: Records of 2,509 boys with 3,064 cryptorchid testes treated at our hospital between 1969 and 1995 were reviewed., Results: 691 (23%) testes were clinically impalpable. Exploration in 691 impalpable testes revealed absent testis in 144 (21%). In 39 (27%) of the 144 absent testes, there was complete agenesis of testis along with the epididymis and vas deferens whereas 105 (73%) were associated with blind-ending cord structures-the vanishing testis. The site of blind-ending cord structures in 105 vanishing testes was intra-abdominal in 22 (21%), inguinal canal in 62 (59%), superficial inguinal ring in 19 (18%) and scrotum in 2 (2%). Histological information was available in 47 vanishing testes and revealed vas, epididymis, or both in 32 (68%), fibrous/vascular tissue in 11 (23%) and testicular cords in 4 (9%). Dystrophic calcification and/or haemosiderin were present in 7 (15%)., Conclusions: Our data show that the incidence of vanishing testis in boys with non-palpable testes is over twice the incidence of testicular agenesis. The most common site of blind-ending cord structures is distal to the internal inguinal ring. The finding of viable testicular tissue at the end of the attenuated cord structures in 4 of our patients, and also reported in other series, suggests that inguinal exploration should be carried out in all patients who on laparoscopy are found to have cord structures entering the internal ring.

Ascent of the intrascrotal testis to an undescended position has been described, but it remains controversial. A case of a 1-year-old with bilateral ascended testes is presented. These testes were documented by a pediatric urologist to have been intrascrotal on two prior occasions. The right testis was intra-abdominal, and the left was peeping at the internal ring. Ascent has generally been seen in older children with a history of retractile testis and has never been reported to result in a testis located in an intra-abdominal position. This represents a rarely reported early testicular ascent, the mechanism of which is different than that of older children.

An infant with a left hydrocele and nonpalpable right testis had an antenatal ultrasonogram showing a left hydrocele and normal right testis. When left inguinal hydrocelectomy was performed, extravaginal torsion of the spermatic cord and a normal testis was discovered. The right spermatic cord ended in a testicular remnant. We propose that this was a case of bilateral antenatal torsion that would have resulted in bilateral vanishing testis syndrome had the left hydrocele not prevented vascular compromise when antenatal testicular torsion occurred. This case gives visible support to the theory that testicular remnants are the result of antenatal torsion.

Abdominoscrotal hydrocele (ASH) in infancy is a rarely reported condition. We present an 11-week-old infant who was born with massive scrotal enlargement. At exploration, he was found to have large bilateral ASHs and bilateral fusiform testes. Gross morphologic testicular changes associated with hydrocele have previously only been reported in adults. Our patient is the youngest to be reported with ASHs.

Transverse testicular ectopia (TTE) is a rare genitourinary anomaly. We report a case of TTE in a 14-year-old boy diagnosed and managed laparoscopically. The clinical features and etiology of this rare testicular anomaly are reviewed.

Objectives: Testicular torsion is seen in all age groups. The bell-clapper deformity (BCD) when present predisposes the patient to torsion. This study was undertaken to determine the incidence of the BCD., Methods: An autopsy series of 51 males with 101 testes was dissected by the senior author to determine the incidence of the BCD., Results: The manner of testicular investment by the tunica vaginalis was classified as normal, intermediate, or absent (BCD). Seventy-six testes were normal, 13 were intermediate, and 12 were of the bell-clapper type., Conclusions: The incidence of the BCD in this autopsy series was 12%. Because the incidence of testicular torsion in the general population is far less than 12%, other factors in addition to anatomic predisposition must be involved.

Objective: To show the reliability of laparoscopic procedures in case of cryptorchidism. It also shows the growing possibilities of laparoscopic manipulations of the cryptorchid testis obviating in a great percentage the need for open operative procedures., Methods: Starting from the standard diagnostic laparoscopic procedure we gradually extended its use to a full operative procedure. The standard procedure is extensively elucidated in the way we used it in sixty-one laparoscopic procedures for seventy-four non-palpable testes., Results: All laparoscopies were technically successful. Forty testes (60.3%) were found intra-abdominally. Four testes (5.5%) were found lying in the inguinal canal or in an ectopic position. Twenty-five testes were absent. The diagnosis of a vanishing testis could be established in most of these cases. In the beginning period the following open procedures were done after the diagnostic laparoscopy: sixteen open explorations, ten formal standard orchidopexies; nine orchiectomies, nine autotransplantations, and three Fowler-Stephens procedures. In recent years we proceeded with laparoscopic manipulation, performing eleven laparoscopically assisted orchidopexy procedures (LAOPs), six extended laparoscopic explorations, and two laparoscopic orchiectomies., Conclusions: Laparoscopy is not only a safe and reliable method in diagnosing the presence of a nonpalpable testis, but also thanks to more sophisticated instruments allows us more and more to perform the complete treatment. It can facilitate the placement of surgical incisions or obviate the need for further open intervention if no spermatic vessels are visualized in the abdomen.

We report on a case of polyorchidism that presented as testicular torsion. A brief history and review of the literature is also presented. Of the 47 cases reported, this patient is the youngest.