Transverse testicular ectopia with penoscrotal transposition

Transverse testicular ectopia is a condition in which both testes lie in the same hemiscrotum. Associated congenital genitourinary anomalies are found in about 20% of such cases. A new case of transverse testicular ectopia associated with penoscrotal transposition is presented.     

Transverse testicular ectopia: case report and review of the literature

A rare case of transverse testicular ectopia in a 2-year-old child presented as bilateral undescended, nonpalpable testes at the Children's Hospital, Banaras Hindu University, Varanasi. Because of its rarity and other interesting features, it is reported with a brief review of the literature. Offprint requests to: A. N. Gangopadhyay     

Scrotoshisis,bilateral extra-corporeal testicular ectopia and testicular torsion

Although anomalies of testicular descent are common, scrotoschisis and extracorporeal testicular ectopia is rare with only 3 reported cases in literature. This is a report of a neonate presenting with scrotoschisis and bilateral extracorporeal testicular ectopia. The right testis underwent torsion before presentation, resulting in gangrene of that testis, requiring orchidectomy. The scrotum was explored and the viable left testis placed in the scrotum and fixed in that position. The left testis has remained normal at 9 months of follow up. The possible embryology and management of this curious anomaly is discussed.     

Transverse testicular ectopia: preoperative diagnosis by ultrasonography

Transverse testicular ectopia (TTE) is a rare anomaly. We report the first case of TTE described in Taiwan. The physical examination, ultrasonography (US), and laparoscopy revealed both testes in the left hemiscrotum, and surgical correction was performed. This case was diagnosed preoperatively by US, which can offer an easy, safe, and convenient alternative in the preoperative diagnosis of TTE. The possible mechanism for this anomaly and the literature are reviewed. Accepted: 17 June 1999     

Crossed intra-abdominal testicular ectopia and true hermaphroditism

Crossed testicular ectopia (CTE), also known as transverse testicular ectopia, is a rare congenital anomaly characterized by the presence of two testes of contralateral origin at a single location. Associated genitourinary abnormalities have been reported in 20% of cases. CTE has also been noted together with disorders of sexual differentiation in a few cases.We have reviewed the clinical assessment and surgical management in an uncommon case in which both crossed intra-abdominal testicular ectopia and true hermaphroditism were present.     

Transverse testicular ectopia: correlation of embryology with laparoscopic findings

Two patients with unilateral transverse testicular ectopia (TTE) without the persistence of Mullerian duct structures are described. Each presented with unilateral impalpable testis and a contralateral inguinal hernia. The diagnosis of unilateral TTE was made during laparoscopic evaluation for undescended testis. The first patient had unilateral TTE on the right side and the second on the left. In both patients, a long thin band resembling the round ligament of the uterus was seen extending from the region of the internal inguinal ring (IIR) on the side of the undescended testis to the opposite inguinal canal. In both patients, there was no patent processus vaginalis on the side of the undescended testis and on the contralateral side the inernal rings were widely patent with large hernial sacs. In the second patient, the right vas was seen extending from the right IIR towards the right side of the pelvis. The right vas showed a short segment of discontinuity at the level of the right IIR while its proximal end extended into the left inguinal canal in close relation to the right spermatic vessels. The vasal anomaly was probably ischemic in origin, resulting from excessive mobility of the ectopic testis and its vas in TTE. Correlation of the current hypotheses on the embryology of TTE with the above mentioned laparoscopic findings is discussed.     

Persistent müllerian duct associated with transverse testicular ectopia

A rudimentary uterus and Fallopian tubes, persistent Müllerian duct syndrome (PMDS), associated with transverse testicular ectopia (TTE) was found in a phenotypically normal boy with 46, XY karyotype who presented with bilateral undescended testes. Catheterization of the uterus confirmed its connection to the urethra. Because of the close vicinity of the rudimentary uterus to the vas deferens and bladder neck in PMDS, in spite of infertility in the majority of these patients, hysterectomy should be avoided to prevent iatrogenic damage to the vas and bladder neck. In TTE associated with bilateral and sometimes unilateral maldescent, abdominal exploration may be justified to exclude the possibility of PMDS and to facilitate orchiopexy.     

Persistent müllerian duct syndrome with transverse testicular ectopia

A patient with the combined anomalies of persistent müllerian ducts and testicular ectopia presented with a right inguinal hernia. He represents the 14th case to be documented outside Japan. A review of the literature on persistent müllerian duct syndrome has permitted a new classification of the anatomical variants to be determined. It is proposed that the testes have prolapsed into the hernial sac rather than descending in the normal way. Furthermore, the high frequency of transverse ectopia in patients with persistent müllerian ducts may be caused by the absence of round ligaments to immobilize the genital tract.     

Testicular growth from birth to two years of age, and the effect of orchidopexy at age nine months: a randomized, controlled study

AIM: To study whether surgical treatment at age 9 mo in boys with congenital unilaterally palpable undescended testes (cryptorchidism) is followed by improved growth of the previously retained testes compared to non-treatment. METHODS: At the age of 6 mo, 70 boys were randomized to surgical treatment at 9 mo and 79 boys to treatment at 3 y of age. The boys were then followed at 12 and 24 mo. Ultrasonography was used to determine testicular volume. RESULTS: After orchidopexy, the previously retained testes resumed growth and were significantly larger than the non-operated testes at 2 y (0.49 ml vs 0.36 ml, p<0.001). Testicular growth after orchidopexy was also demonstrated by a higher mean ratio between the previously retained and the scrotal testes of the individual boys at 2 y: 0.84 for the surgically treated group, compared to 0.63 for the untreated group (p<0.001). CONCLUSION: Surgery at 9 mo has a beneficial effect on the growth of previously undescended testes.     

Transverse testicular ectopla: report of three cases

Two patients who presented with a history of right inguinal hernia and a third with an impalpable left testis were found to have transverse testicular ectopia. Both testes were fixed in their own scrotum, through a modified Ombredanne operation in two patients and a subdartos pouch in one.     

Transverse testicular ectopia detected by MR imaging and MR venography

Crossed testicular ectopia is a rare anomaly, characterised by migration of one testis towards the opposite inguinal canal. In most reported cases, the correct diagnosis was not made pre-operatively. We report a case of transverse testicular ectopia diagnosed pre-operatively with MRI. MRI and MR venography demonstrated unilateral location of both testes in the right inguinal canal, which was confirmed by surgery. We provide a brief literature review of transverse testicular ectopia and the imaging of undescended testis.     

Balloon inflation-created subdartos pouch during orchiopexy: a new simplified technique

Purpose  Creation of subdartos pouch is an integral part of orchidopexy. The objective of this study was to describe and evaluate the results that can be achieved by using a new simplified technique (creation of subdartos pouch by balloon inflation of small sized Foley’s or Fogarty catheter during orchiopexy). Materials and methods  Seventy-five boys with undescended testicle had been operated upon at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia in the period from April 2007 to April 2008. The technique will be described in detail. All patients were followed up for 12 months on average, range (2–12) months. Results  They were 75 boys with undescended testicle, 53(71%) palpable cases [48(64%) unilateral, 5(7%) bilateral] and 22(29%) impalpable cases [20(26%) unilateral, 2(3%) bilateral]. Mean age of 13 ± 1.47 months (range, 9–36 months). The mean operative time was 11.5 ± 1.12 min. (range, 10–15 min) for each orchiopexy; whereas, the mean operative time for creation of subdartos pouch was 23.7 ± 1.12 s (range, 20–30 s). There were no intraoperative or early postoperative complications (hematoma or infection). There was no evidence of testicular atrophy by testicular ultrasound among cases of palpable testes. Only two testes among the cases of impalpable testes became smaller in size but viable after 12 months. However, almost all families were happy with good esthetic appearance of the scrotum. Conclusion  The new technique of balloon inflation-created subdartos pouch during orchiopexy is an easy, safe bloodless and quick technique with good cosmetic outcome.     

Crossed renal ectopia in children

Five cases of crossed ectopic kidneys are presented, four in males and one in female, four fused and one unfused. All were on the right side; in four cases the kidneys were positioned inferiorly and in one superiorly. Urological malformations and accompanying anomalies were observed in most of our cases. Vesicoureteral reflux was demonstrated in the three children in whom cystography was performed. In the presence of anorectal malformations and vertebral anomalies or on diagnosis of crossed ectopic kidneys, early and thourough urological investigation is indicated.     

Crossed testicular ectopia

Crossed testicular ectopia is characterized by the presence of both testes in one hemiscrotum. A 7-month-old boy with this condition is described and the relevant literature reviewed. Although this anomaly has been recognized for over 100 years, its etiology is not yet established. The advent of ultrasonography has allowed early diagnosis and therapy in recent years.     

Transverse testicular ectopia: three additional cases and a review of the literature

Purpose

Transverse testicular ectopia (TTE) is a well described, rare congenital abnormality of testicular descent, in which both testes migrate through one inguinal canal. The objective of this work was to present three cases of TTE, one of them with a common vas deferens. To our knowledge, a fused vas deferens has only been reported four times in previously published reports.

Methods

Three patients presented with inguinal hernia and contralateral cryptorchidism. In case 1, the diagnosis of TTE was made preoperatively by palpating two testes in one hemiscrotum. The diagnosis of case 2 was made intraoperatively and was found to be of a rare form in which the two vasa deferentia fused in the inguinal canal to form a common vas deferens. The diagnosis of case 3 was also done intraoperatively and a laparoscopy was performed to document the anatomy of TTE and to rule out the presence of Müllerian duct remnants. We also performed a literature search for other reports of TTE.

Results

The three cases were operated with trans-septal orchidopexy. In addition, laparoscopy was performed in case 3 to clarify the anatomy. Biopsy revealed normal testicular tissue from both testes in the first two patients. Follow-up with ultrasound, 6?months after operation showed normal size and blood flow of both testes.

Conclusion

Transverse testicular ectopia should be suspected in a boy with an inguinal hernia and contralateral non palpable testis. Trans-septal orchidopexy is recommended when vasa deferentia are fused. Laparoscopy is useful to document the anatomy and to rule out the presence of Müllerian remnants.     

Age at orchidopexy as an indicator of the quality of regional child health services

Early treatment for primary undescended testis (UDT) is necessary to prevent testicular degeneration and improve fertility. The general recommended age for orchidopexy is before 2 years of age. Comparing the age distribution of orchidopexy between different services may give an indirect indication of the quality of the child health services, since timely diagnosis and referral will lead to boys undergoing orchidopexy at the optimal age. This paper reviews the age distribution of boys having orchidopexies for UDT between 1997 and 2006 in the South Island of New Zealand and the state of Victoria, Australia: 64.2% of boys on the South Island and 48.0% of boys in Victoria had orchidopexies before the age of 5. There was a considerable difference in the proportions of children from 0 to 4 years and from 10 to 14 years between the two regions. No distinct trend in age was seen in either population during the period reviewed. These results show that many boys do not receive treatment for UDT at the optimal age. Age at orchidopexy may be an indicator of the quality (in terms of diagnosis, access and timeliness) of a region's paediatric surgical service and may identify where attention should be paid if earlier diagnosis and referral is to be achieved.