Congenital anomalies of the testis, vas epididymis, and inguinal canal.
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Adolescent↗
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Gubernacular discontinuity and abnormal distal fixation in cryptorchidism: Challenging the classical concept.
BACKGROUND: The gubernaculum is essential for testicular descent, but its detailed surgical anatomy remains poorly understood. We have previously identified an unrecognized anatomy of the round ligament in female patients with sliding inguinal hernias. OBJECTIVE: This study investigated whether comparable anatomical features exist in the gubernaculum of male cryptorchidism patients, as compared to those identified in female sliding hernias. MATERIALS AND METHODS: We retrospectively analyzed undescended testes located in the inguinal canal that underwent open inguinal orchidopexy between 2016 and 2025. Laparoscopically managed nonpalpable testes and those with suprascrotal testes were excluded. To ensure consistent anatomical evaluation, a standardized surgical protocol supervised by the senior author was applied to all cases. Findings were verified using operative reports and video recordings. After dissecting the processus vaginalis along the internal spermatic fascia (transversalis fascia), the pars infravaginalis gubernaculi were exposed. The relationship between the plica gubernaculi and pars infravaginalis gubernaculi, as well as the site of distal gubernacular fixation, was assessed. RESULTS: A total of 64 undescended testes of 56 patients were included. Video recordings were available for 45 of these 64 testes (70%). A patent processus vaginalis was observed in 60 out of 64 testes (94%), while it was obliterated in two ascending testes and unknown in two. In all 64 testes (100%), the pars infravaginalis gubernaculi was not continuous with the plica gubernaculi, with the transversalis fascia interposed between them. This configuration closely resembled that described previously for sliding inguinal hernias in women. Distal gubernacular fixation was located lateral to the scrotum in 49 testes (77%), at the upper scrotal border in 14 testes (22%), and absent in one testis (1.6%). DISCUSSION: Cryptorchidism is associated with a previously unrecognized discontinuity of the gubernaculi and common abnormal distal gubernacular fixation. These findings challenge the conventional views on gubernacular invagination and suggest that abnormal distal fixation may contribute to failed testicular descent. The study was limited by its single-center, retrospective design, small sample size, and lack of a control group. CONCLUSION: This study identified a previously unrecognized discontinuity of the gubernaculi in cryptorchidism. These findings deepen the understanding of the pathophysiology of testicular descent.
Humans↗
Anorchia and persistent Müllerian duct: a variant of the embryonic testicular regression syndrome.
A 20-yr-old phenotypical male with a 46, XY chromosome complement, a hernia uteri inguinale, and bilateral anorchia was studied. Eunochoidal body proportions, infantile type of male external genitalia with empty scrotum, underdeveloped sexual characteristics, and delayed bone age suggested the existence of inadequate testicular function. Extremely low levels of circulating testosterone and a lack of response to hCG stimulation was found. Persistently elevated blood levels of LH and FSH with an adequate pituitary response to an iv bolus of synthetic LRH was demonstrated, thus indicating inadequate endocrine gonadal function as well as functional integrity of the hypothalamic-pituitary unit. At the time of an inguinal hernioplasty, a small but well developed uterus was removed. No gonads were found within the true pelvis, inguinal canals, or along the anatomical pathways of testicular descent. A cord-like structure found in the left inguinal canal contained only fibrous tissue without gonadal elements. It is proposed that the occurrence of two altered events during embryogenesis, failure of Müllerian duct regression and late testicular regression, may explain the underlying defect in this unusual abnormality of sexual differentiation.
Adult↗
Luteinising hormone-releasing hormone nasal spray as therapy for undescended testicle.
Twenty-two prepubertal children with unilateral cryptorchidism were treated. None had undergone previous medical or surgical to modify the abnormal position of the testes, all of which were located inthe inguinal canal. Treatment was with luteinising hormone-releasing hormone (LH-RH) nasal spray given for 7 days. 9 boys insufflated 100 microgram LH-RH in each nostril 6 times per 24 hours (1200 microgram/24 h); the remaining 13 boys insufflated 500 microgram 12-hourly (1000 microgram/24 h). An LH-RH test (500 microgram IV) was carried out before and after therapy. Full descent of the testis into the scrotum was obtained in 7 out of the 22 cases; in a further 6 cases the testis moved down the inguinal canal. Basal values of luteinising hormone and follicle-stimulating hormone and those for pituitary reserve remained unchanged before and after therapy, and were similar to the values of a control group. No correlation was found between response to therapy and bone age, testosterone level in serum, basal values or pituitary reserve of luteinising hormone or follicle-stimulating hormone.
Administration, Intranasal↗
Testicular venography in the nonpalpable testis.
Localization and identification of a nonpalpable testis can be done accurately by testicular venography. The identification of the pampiniform plexus is essential to the localization of the testis by this method. We evaluated 15 patients 3-39 years of age with 21 nonpalpable testes. Fourteen successful testicular venograms were performed showing four retroperitoneal testes, four testes within the inguinal canal, and two testes located in the superficial inguinal pouch. Three nonpalpable testes were thought to be due to true agenesis, and one venogram was performed after prior surgical removal of the testis. Catheterization of the left testicular vein was accomplished with greater ease and accuracy (79%) to the right side (42%).
Adolescent↗
[Results of the surgical treatment of direct and recurrent inguinal hernias using an autodermal implant].
The authors have developed the own method of inguinal herniotomy using an autodermal graft for the plasty of the posterior wall of the inguinal canal in direct and recurrent inguinal hernias. The technic of operation is described. The results of this modified method of herniotomy are analyzed.
Adult↗
Ultrasonographic demonstration of undescended testes.
Twelve cryptorchid patients had sonographic evaluation of the inguinal region prior to surgical orchiopexy. When the testis was within the inguinal canal, the gonad was localized preoperatively by sonography in eight of nine patients. One patient had an associated inguinal hernia in which loops of bowel concealed the gonad. There were no false positive cases. The authors were not able to show abdominal or pelvic maldescended testes.
Abdomen↗
[Morphological and structural variations of the human inguinal region (author's transl)].
In the inguinal region, numerous muscular and fibrous alterations are described. They are related to the unconstant position of the pubic tubercle in relation io the interspinous diameter (linea bi-spinalis). The pubic tubercle can be observed in two different locations: either high or low. The high location is characterized by the presence of the pubic tubercle at a distance of 5 to 7.5 cm below the interspinous diameter. It must be considered as normal and is found in 65% of the subjects. In the low locations, the distance between spinous tubercle and interspinous diameter reaches 7,5 to 12 cm. It is an important abnormality which interests 35% of the subjects. The lower the pubic tubercle are located, the more often morphological alterations are to be found in the following structures: obliquus externus, obliquus internus, transversus and cremaster muscles as well as fascia transversalis. Nevertheless, the pyramidalis muscle as well as the inguinal ligamentary formation, Hesselbach's interfoveolar ligament and Thompson's iliopubic tract do not follow that rule, since the important morphological variations of these deep fibrous components can never be related to the distance between pubic tubercle and interspinous diameter. The functional signification of the inguinal region and especially of the inguinal canal is modified by those ostelogical, muscular and ligamentary variations.
Humans↗
A reappraisal of the Pfannenstiel incision.
The postoperative morbidity of incisions used in retropublic prostatectomies was examined. 350 patients with vertical midline incisions were compared with 411 patients with transverse or Pfannenstiel incisions. There was a significantly increased incidence of postoperative inguinal hernias in the group of patients who had had transverse incisions. The possible reasons for this were discussed. It was concluded that the normal architecture of the inguinal canal was deformed and weakened by extra-wide transverse incisions.
Abdominal Muscles↗
Hormonal regulation of testicular descent: experimental and clinical observations.
Hormonal regulation of testicular descent has been investigated. Based on experimental studies using the rat and on a review of clinical material it has been determined that testicular descent is an androgen-mediated event directly under the regulation of pituitary gonadotropin. Furthermore, the active androgenic metabolite involved in this process appears to be dihydrotestosterone, which is synthesized by the testis and must be present in high local concentrations to be effective. In addition to these hormonal requirements the anatomy of the inguinal canal must provide unimpeded migration of the testis into the scrotum. Any imbalance or anomaly of these prerequisites may lead to cryptorchidism.
3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
Testicular feminization syndrome: a report of three Ethiopian patients and a brief review.
The clinical features of 3 Ethiopian patients presenting with the complete syndrome of testicular feminization are described. All 3 were seen because of primary amenorrhoea. At laparotomy, one patient had testes located intra-abdominally, a second lodged in the inguinal canals and a third as masses in the labia majora. Also, one of these patients had bilateral inguinal herniae, a usual feature of this syndrome. Since the incidence of malignancy is high among individuals with undescended testes, they were removed in 2 patients. In the third patient, however, the testes were not removed because of delay in development of secondary sex characteristics. The literature on testicular feminization is also briefly reviewed.
Adult↗
[Sex and type peculiarities of the topography of the anterior abdominal wall in adult persons of various ages].
In men and in "masculine" shape of the abdomen as compared with women and "feminine" shape of the abdomen the following features of the topography of the anterior-lateral abdominal wall were revealed: a narrower white line, wider straight muscles of the abdomen in their medial and upper parts, less square surface of the lateral muscle-free portions. The inguinal region of men and the "musculine" type of the abdomen are characterized by great dimensions of the superficial and profound rings, weaker aponeurosis of the external oblique abdominal muscle in formation of the anterior wall of the inguinal canal. In elderly and senile age there occur dilatation of the white line, the increase of the amount of chinks and apertures in it as well as of the length of aponeuroses. The superficial inguinal ring expands.
Abdominal Muscles↗
Inguinal herniorrhaphy: reduced morbidity, recurrences, and costs.
Costs, morbidity, and recurrences have been reduced in the repair of inguinal hernias. In 18 months 135 repairs were done using local anesthetics, prompt ambulation, and minor variations in the Shouldice technic. Men and women aged 22 to 84 years were operated upon. No recurrences have been reported, and urinary catheterization has not been necessary. Significant savings are available by abbreviated hospital stay. The majority of patients require only 24 hours for repair of a unilateral inguinal hernia and the observation period following it. The same basic repair is used for direct and indirect sliding hernias. Rebuilding the floor of the inguinal canal is essential. Postoperative pain has been minimal. Use of long-acting local anesthetics has proven helpful.
Adult↗
[Tractional diverticulum of the urinary bladder as a component in recurring inguinal hernias].
The tractonal diverticulum as contained in recidivating inguional hernia occur rather often. They are created most often during plastic surgical treatment most frequently in inguinal hernia repairs in which a suture partially or completely passes through the urinary bladder and fixes it to the layers of inguinal canal when it is being sutured. They also occur when the bladder is accidentally pinched while the sutures are being pulled taught. The diverticulum so created almost never yields characteristic symptoms, and for this reason it is most often diagnosed intraoperatively. Because of this, the surgeon must keep in mind the possible existence of such a diverticulum when reoperating a recidivating hernia localized in the lower abdomen especially those near the bladder. It is important that such a diverticulum be carefully dissected and that the bladder be adequately closed with a layers of catgut sutures. An accidental -- overlooked lesion of the urinary bladder during operation can have a fatal outcome. For this reason such lesions must never be overlooked, and should be resolved during the hernioplasty itself.
Diverticulum↗
Venographic localization of the non-palpable undescended testis in children.
In cases of bilateral non-palpable undescended testes in which human chorionic gonadotropin stimulation has shown the presence of testicular tissue and in cases of unilateral non-palpable undescended testes selective transfemoral gonadal venography with a modified Seldinger technique has been used for the preoperative localization of the non-palpable testis. since the undescended testis may be located anywhere along the course of its embryologic descent, that is from the level of the renal fossa to its exit from the inguinal canal, preoperative localization will aid in the surgical management. Gonadal venography has proved to be accurate and safe, and has aided in the determination of the extent of surgical exploration in 9 children with 12 non-palpable undescended testes (6 right and 6 left).
Abdomen↗
[Pendulum testes: a degraded from of cryptorchism].
In 22 cases of sterility we have been able to single out under the name of "pendulum testes" a syndrome showing the following features: --clinically, testes that are often small and soft and normally found in the lower part of the scrotum, but with a tendency to ride up toward the inguinal canal and stay there so that an attempt to bring them down manually into the scrotum in unsuccessful; --cytologically, often accompanied by very poor sperm formation, and; --histologically, showing tubule pathology. We approach this picture as that of crytorchidism for in our opinion pendulum testis is a degraded form of latter. This leads us to discuss for both conditions problems of classification and indications for treatment.
Adult↗
Response of scrotal and non-scrotal vertebrate testis to the male antifertility agent alpha-chlorohydrin.
Effect of single oral dose (90 mg/kg body weight), multiple doses (90 mg/kg body weight for 7 days) or even higher doses (180-300 mg/kg body weight) of alpha-chlorohydrin on the testis-epididymis complex of dog, rat, cryptorchid rat, hedgehog, domestic fowl, lizard, frog, and toad has been studied. alpha-chlorohydrin treatment, at any dose, did not induce lesions in the testis-epididymis complex of dog and hedgehog having testis in scrotum and inguinal canal respectively. Abdominal testis of cryptorchid rat, domestic fowl, lizard, frog and toad also did not respond to alpha-chlorohydrin treatment. Lesions in normal rat testis-epididymis complex, after single oral dose of alpha-chlorohydrin, were quite prominent. Non-sensitivity of alpha-chlorohydrin to these animal species may be due to the absence of the pampiniform plexus complex in hedgehog and sub-mammalian animal species. Absence of conventional epididymis in the sub-mammalian animal species may be the additional reason of the non-sensitivity of the drug. Prominence of collateral blood vasculature in dog testis-epididymis complex and some alterations in the blood supply due to cryptorchidity in cryptorchid rat testis seems to be the reason of non-sensitivity of alpha-chlorohydrin to dog and cryptorchid rat testis. These observations confirm the hypothesis that the action of a single oral dose of alpha-chlorohydrin is associted with the blood vasculature of the testis-epididymis complex.
Animals↗
Reconstruction of intraoral defects with the free groin flap.
A free flap has been defined as an island flap that has been completely detached from the body and transferred to a distant recipient site, where microvascular anastomoses are done to reestablish its essential intravascular circulation. The groin flap, based on its superficial circumflex iliac artery and venae comitantes, was utilized as a free flap to close large intraoral defects in six patients following ablative cancer operations. All patients received preoperative or postoperative irradiation therapy. Four of the six free groin flap operations were clinically successful. One flap became necrotic unexpectedly after 3 1/2 weeks. Infection played a major part in necrosis of the other flap. The use of the free flap in oral cavity reconstruction offers certain advantages over regional vascular flaps but definite limitations exist.
Adult↗