Effect of dilute Ethanol Intake on DEHP (di (2-ethylhexyl) phthalate)-induced Testicular Atrophy

Background: Di(2-ethylhexyl) phthalate (DEHP) is the most commonly used as a plasticizer for polyvinyl chloride (PVC), but recently, concern has arisen over the DEHP which may act as a reproductive toxicant to humans. On the other hand, ethanol is the most common supplement of beverages and foods, and so many persons ingest a large quantity of ethanol in daily life. However, interactions between ethanol and DEHP toxicity are not well known. Method: To investigate the effect of dilute ethanol ingestion on the DEHP induced testicular atrophy, rats were received a 1% (w/w) DEHP diet and 2.5 or 5% (v/v) ethanol water for 7 days. Result: The rats treated with DEHP-diet alone for 7 days were observed significant testicular weight loss. On the other hand, testicular weight loss was significantly suppressed in rats treated with DEHP diet and ethanol water. A significant negative correlation between relative testicular weight (as a percentage of body weight) and testicular MEHP concentration was found among rats treated with DEHP-free diet (Control) and DEHP diet alone. Most of the data plots for the DEHP diet plus ethanol water group were scattered above the regression line. Conclusion: These results suggest that dilute ethanol may be effective in preventing DEHP testicular atrophy. However, the mechanism of prevention is unknown and further research is needed.

P123 TAPP - THE BEST APPROACH FOR INGUINAL HERNIA ASSOCIATED WITH ADULT CRYPTORCHIDISM: CASE REPORT AND LITERATURE REVIEW

Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up. Results Cryptorchidism in adult is rare. The association with hernia is even more rare. The open management is not easy, often in pelvic/abdominal localization, the inguinal approach can be cumbersome. There is no standard of care for these cases, but we found the minimally invasive approach to be a good choice. Laparoscopic surgery has the advantage of enhanced exploration and orhidectomy can be easily performed. Associated with the orchidectomy, hernia cure can be facilitated by laparoscopic TAPP procedure. Conclusions In cases of concomitant hernia and cryptorchidism, we emphasize the idea of simultaneously cure hernia via laparoscopic TAPP procedure associated with orchidectomy as feasible and safe.

Single injection of very mild dose BOTOX in the vastus lateralis improves testicular spermatogenesis and sperm motility in ageing experimental mice

Acetylcholine (ACh), a key neurochemical messenger that plays key roles in neuroplasticity and muscle contraction. While ACh is important for the physiological function of the testis, abnormal levels of ACh cause testicular atrophy and male infertility. BOTOX is a therapeutic form of the botulinum neurotoxin that blocks the excessive release of ACh at the neuromuscular junction. Previously, repeated intracremasteric injections and slight overdose of BOTOX have been reported to induce adverse effects in the testicular parameter of experimental rodents. However, a mild dose of BOTOX is highly beneficial against skin ageing, neurological deficits, overactive urinary bladder problems, testicular pain and erectile dysfunctions. Considering the facts, the possible therapeutic benefit of BOTOX on the testis might be achieved via its minimal dose and indirect mode of action rather than repeated high quantity in the local supply. Therefore, we revisited the effect of BOTOX but with a trace amount injected into the vastus lateralis of the thigh muscle, and analyzed histological parameters of testis and quality of semen in ageing experimental mice. Experimental animals injected with 1 U/kg bodyweight of BOTOX showed enhanced spermatogenesis in associations with increased activities of key antioxidants in the testis, leading to increased total sperm count and motility. This study signifies that a mild intramuscular dose of BOTOX can be considered as a potential treatment strategy to manage and prevent male infertility.

Clinical and anatomical rationale for the use of simple methods of inguinal hernia repair

Despite significant advances in the field of surgical treatment of inguinal hernias, its results cannot be considered completely satisfactory. This is evidenced by the damage to the intestines, bladder, testicular atrophy and relapses arising from hernia repair.

Delayed Diagnosis and Treatment of Traumatic Testicular Dislocation: A Case Report and Literature Review

Traumatic testicular dislocation is a rare complication secondary to different kinds of accidents. A 61-year-old man, who was injured by wall collapse and was diagnosed as pelvic fracture and posterior urethral rupture 5 months ago, came to the urologic department to seek urethral reconstruction. However, thorough physical examination and imaging examination confirmed a round mass in the right inguinal region and an empty right scrotum, which support diagnosis of testicular dislocation. The patient did not take the initiative to complain about that because he thought the right testis had been destroyed by the accident already. So the patient underwent fiber cystourethroscopy, urethral reconstruction, and orchiopexy. No testicular atrophy was confirmed at follow-up. We reviewed previous reports about traumatic testicular dislocation and analyzed the cause of delayed diagnosis.

Single Median Raphe Scrotal incision Orchiopexy: A safe & feasible approach for fixation of Palpable Undescended testes

Background: We wish to share our outcome of single median raphe scrotal incision orchiopexy (SMRSO) regarding safety & feasibility of technique by evaluating ease of access, conversion rate, duration of surgery, success rate, complications, and the need for redo-surgery. Methods: We retrospectively analyzed data of 277 orchiopexies performed in our department on 224 patients operated on between June 2016 to June 2019. SMRSO was considered for palpable testes that can be brought to the upper limit of the scrotum under anesthesia. The conventional inguinoscrotal approach was used for high lying testes. A median raphe incision was made to access & mobilize the testis on either side, ligation of processus vaginalis performed, and the testes secured in the scrotal pouch. The approach was utilized for both unilateral and bilateral orchiopexies. Follow-up done at one week, one month & six months to evaluate the outcome. Results: A total of 277 orchiopexies were performed in 224 patients. 237 (86%) orchiopexies were via the median raphe scrotal approach in 184 patients. Out of these, 53 cases had bilateral orchiopexies. 30 (11%) performed via a conventional inguinoscrotal approach and 10 (4%) by laparoscopic approach. The mean duration of surgery for SMRSO was 24 minutes for unilateral and 42 minutes for bilateral cases. Immediate postoperative complications included scrotal hematoma in three (1.6%) cases, Hematoma of the abdominal wall in one case, and scrotal edema in 4 (2%) patients. All complications were treated conservatively & resolved. No wound infection or testicular atrophy was reported. Long-term complications included testicular ascend in three cases [1.6%]. Conclusion: Single-incision Median Raphe Scrotal orchiopexy is an attractive alternative to the standard inguinoscrotal orchiopexy for palpable low lying undescended testes with a better cosmetic outcome. doi: https://doi.org/10.12669/pjms.37.7.4261 How to cite this:Jan IA, Hassan M, Shalaan I, Alshehhi MA. Single Median Raphe Scrotal incision Orchiopexy: A safe & feasible approach for fixation of Palpable Undescended testes. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4261 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

668 Inguinal Hernia Repair: Are We Compliant with The Recommended Consent Process?

Aim Inguinal hernia repairs are one of the most commonly performed operative procedures in the UK. An adequate consent process gives the patient the autonomy in making decisions related to their care and treatment. In this project, we were auditing whether hernia patients have gone through a standardised consent process from time clinic presentation up to the day of surgery. Method This was a retrospective audit based on the Royal College of Surgeons’ (Good Surgical Practice) guidelines and trust local policy. We assessed 50 case notes for patients who had inguinal hernia repair between November 2019 and November 2020 in two of the busy district general hospitals in the UK. Results We found that our practice was fully compliant with documenting patient demographics, signatures, and the name of the procedure in the consent forms. Documented discussion prior to surgery was found only on79% of clinic letters. Poor compliance was noted in documenting some of the possible risks in the consent form including testicular atrophy (59%), injury to vas, vessels, and nerves (56%), wound complications (49%), chest infection (24%). Zero compliance was noted in documentation missed hernia and mortality as potential risks to the procedure. Conclusions A detailed documented discussion with the patient in relation to benefits, risks, and alternatives of surgery should take place on clinic presentation as well as on the day of surgery to ensure compliance with the consent process.

Treatment of diabetes insipidus with extracts from the pituitary gland

Prof. D. M. Rossiyskiy (Nauchi. Izv. NKP, 1923, No. 5) observed a case of diabetes insipidus, which developed after a skull injury and was accompanied by stuttering, nocturnal urinary incontinence and testicular atrophy, where pituitary therapy gave a brilliant and persistent therapeutic the effect.

Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis

Background: Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism. Methods: Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery. Results: The final meta-analysis included five studies involving 705 children; LO, n = 369 (52.3%) and CO, n = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03–1.88, p = 0.17), early complications (RR = 0.66, 95% CI 0.21–2.08, p = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03–3.88, p = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies. Conclusion: LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.