Perineal Ectopic Testis

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433 Vol. 9 | No. 1 | Winter 2012 | UROLOGY JOURNAL Keywords: testis, orchiopexy, abnormalities, diagnosis INTRODUCTION P erineal ectopic testis is a rare condition. The frst case was reported by John Hunter in 1786. (1) An undescended testis can be located anywhere in the pathway of testicular descent outside the scrotum. The testis can also be located in an ectopic position. The most common regions in descending order are the superfcial inguinal pouch (D
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  433 Vol. 9 | No. 1 | Winter 2012 | UROLOGY JOURNAL Keywords: testis, orchiopexy, abnormalities, diagnosis INTRODUCTION P  John Hunter in 1786. (1) An undescended testis can be located anywhere inthe pathway of testicular descent outside the scrotum. The testis can also be located in an ectopic position. The most common regions in descending order   canal, contralateral scrotum, and prepenile region. Perineal ectopic testis is seenapproximately in 1% of all cases of undescended testes. (2) An empty hemiscrotum with palpable perineal soft mass is suggestive of an ec-topic testis in the perineum. Antenatal diagnosis of perineal ectopic testis can bemade ultrasonographically. (3)  -agement. CASE REPORT A 19-year-old man presented to our outpatient clinic with a perineal mass anddiscomfort. Examination showed an empty and poorly developed left hemiscro-tum. The contralateral testis was in its normal location in the right hemiscrotum(Figure 1). An oval-shaped soft mass was detected in the perineum measuring 4× 5 × 6 cm. A clinical diagnosis of perineal ectopic testis was made.We recommended orchidectomy for the left perineal testis because of the pa- Gokhan Koc, Selim Yavuz Sural, Devrim Nihat Filiz, Yuksel Yilmaz Perineal Ectopic Testis Corresponding Author:Gokhan Koc, MDTepecik Teaching and Research Hospital, Izmir,Turkey Tel: +90 232 469 6969Fax: +90 232 433 0756E-mail: gokfekoc@gmail.comReceived January 2010 Accepted December 2010Tepecik Teaching and Research Hospital, Izmir,Turkey  Case Report   434 | tient’s age. However, the patient wanted his testis placed in the scrotum; hence, a left orchiopexywas performed. Surgical exploration was per-formed through inguinal skin crease incisions.  using the dartos pouch technique (Figure 2).Postoperative examination at one month revealeda normally located left testis in the scrotum (Fig-  of the surgery. DISCUSSION Descent of the testis is thought to occur in two phases; intra-abdominal migration and inguinalmigration. Testicular development and descentfrom the abdomen to the scrotum is a complex  hormonal, and certain mechanical factors. Theectopic testis completes normal transinguinal mi-gration, but is misdirected outside the normal pathof descent below external ring. Perineal testis isthe commonest form of true testicular ectopia,  testis is a rare congenital anomaly. (4) The etiology of testicular ectopia is unknown;however, some theories like gubernacular abnor-malities, genitofemoral nerve disorders, increasedintra-abdominal pressure, and endocrine disor-ders are the most prominent ones. (5) Lockwoodsuggested that distal part of the gubernaculum has  normal descent is seen and if another insertion isdominant, the insertion diverts the testis towarditself leading to ectopy. (6) Furthermore, it is pos-  the gubernaculum prohibits natural descent of thetestes. (7) Hutson suggested that abnormal positionof genitofemoral nerve leads to an abnormal mi-gration of the gubernaculum and pushes the testisto abnormal position. (8) Middleton and colleaguesalso reported that increased intra-abdominal pres- Figure 1. A left empty hemiscrotum and a mobile testicular massin the perineum. Figure 2. Surgical exploration of the left ectopic testis throughinguinal incision. Figure 3. Scrotum at one-month following surgery. Case Report  435 Vol. 9 | No. 1 | Winter 2012 | UROLOGY JOURNAL Perineal Ectopic Testis | Koc et al sure could facilitate testicular descent. (9) LozanoOrtega and associates stated that inadequate hor-monal stimulation may lead to ectopy.  The ectopic location of the testis is associatedwith a number of complications, such as trauma,torsion, and infertility in bilateral cases. (11) There-fore, treatment is warranted. Most authors recom-mend surgical correction at approximately 1 year    be demonstrated in the undescended testes. (12) Or-chiopexy is the treatment of choice under 2 yearsof age. But if an atrophic testis is detected, or-chidectomy should be performed.  -sition, all the possible sites for an ectopic testis  -cated that in cases of perineal ectopic testis, sur-gery should be performed before 6 months of ageeven if not associated with inguinal hernia. (2) Testicular cancer is more common in an ectopictestis than in a normally descended organ. There-fore, we recommended the patient an orchidec-tomy. However, he wanted his testis placed in thescrotum. Thus, we proceeded with orchiopexy;however, long-term follow-up was advised.We believe orchiopexy is the treatment of choicein selected patients with perineal ectopic testis.However, self testicular examination and long-term follow-up is mandatory. CONFLICT OF INTEREST  None declared. REFERENCES 1.Hunter J. Observations on certain parts of the animal econ-omy. London: Woellner; 1786.2.Celayir AC, Sander S, Elicevik M. Timing of surgery in per-ineal ectopic testes: analysis of 16 cases. Pediatr Surg Int.2001;17:167-8.3.Mazneikova V, Markov D. Antenatal ultrasound diagnosisof perineal ectopic testis--a case report. Eur J Ultrasound.2001;13:31-3.4.Murphy DM, Butler MR. Preperitoneal ectopic testis: a casereport. J Pediatr Surg. 1985;20:93-4.5.Heyns CF, Hutson JM. Historical review of theories on tes-ticular descent. J Urol. 1995;153:754-67.6.Lockwood CB. Development and Transition of the Testis,Normal and Abnormal. J Anat Physiol. 1888;22:505-41.7.Maidenberg M. [A case of an ectopic testis in the perineum].Prog Urol. 1993;3:268-71.8.Hutson JM. Undescended testis, torsion, and varicocele. In:Gross feld JL, O'Neil JAJ, Fonkalsrud EW, Coran AG, eds. Pedi-atric surgery. 6 ed. Philadelphia: Mosby; 2006:1193-214.9.Middleton GW, Beamon CR, Gillenwater JY. Two rare cases of ectopic testis. J Urol. 1976;115:455-8.10.Lozano Ortega JL, Escolano A, Rey A. [Perineal ectopic testi-cle]. Arch Esp Urol. 1983;36:289-92.11.Jlidi S, Echaieb A, Ghorbel S, Khemakhem R, Ben Khalifa S,Chaouachi B. [Perineal ectopic testis: report of four paediat-ric cases]. Prog Urol. 2004;14:532-3.12.Lugg JA, Penson DF, Sadeghi F. Early orchiopexy reverseshistologic changes in cryptorchid testes. J Urol. 1995153:235A.
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