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John M. Hutson - One of the best experts on this subject based on the ideXlab platform.
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the role of the gubernaculum in the descent and undescent of the testis
Therapeutic Advances in Urology, 2009Co-Authors: John M. Hutson, Adam Balic, Tamara R Nation, BRIDGET RAE SOUTHWELLAbstract:Testicular descent to the Scrotum involves complex anatomical rearrangements and hormonal regulation. The gubernaculum remains the key structure, undergoing the ‘swelling reaction’ in the transabdominal phase, and actively migrating out of the abdominal wall to the Scrotum in the inguinoscrotal phase. Insulin-like hormone 3 (Insl3) is the primary regulator of the first phase, possibly augmented by Mullerian inhibiting substance/anitmullerian hormone (MIS/AMH), and regression of the cranial suspensory ligament by testosterone. The inguinoscrotal phase is controlled by androgens acting both directly on the gubernaculum and indirectly via the genitofemoral nerve, and release of calcitonin gene-related peptide from its sensory fibres. Outgrowth of the gubernaculum and elongation to the Scrotum has many similarities to an embryonic limb bud. Cryptorchidism occurs because of both failure of migration congenitally, and failure of elongation of the spermatic cord postnatally. Germ cell development postnatally is disturbed in congenital cryptorchidism, but our current understanding of germ cell biology suggests that early orchidopexy, around 6 months of age, should provide a significant improvement in prognosis compared with a previous generation. Hormone treatment is not currently recommended. Acquired cryptorchid testes may need orchidopexy once they no longer reach the Scrotum, although this remains controversial.
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does the gubernaculum migrate during inguinoscrotal testicular descent in the rat
Anatomical Record-advances in Integrative Anatomy and Evolutionary Biology, 1998Co-Authors: Thomas D Clarnette, John M. HutsonAbstract:Background The role of the gubernaculum in descent of the testis is controversial. The mechanism of testicular descent has been studied in the rat, because inguino-scrotal descent occurs postnatally in this species. Several authors have claimed that the cremasteric sac forms by eversion of the gubernacular cone, whereby regression of the extra-abdominal part of the gubernaculum creates a space into which the gubernacular cone everts to form the processus vaginalis within the Scrotum. This postulated lack of any gubernacular migration phase contrasts with the situation in the human, where gubernacular migration appears to be an integral component of testicular descent. This study was designed to determine in the rat whether there is any gubernacular migration toward the Scrotum during testicular descent, or whether eversion of the cremasteric sac alone could account for the extension of this sac into the bottom of the Scrotum. Methods Oblique sagittal sections of the inguino-perineal region were taken from rats aged 21 days of gestation and days 1, 3, 4, 6, 8, and 10 days postnatally. Histological sections were examined and the following measurements were obtained: gubernacular cone height, gubernaculum-Scrotum distance, processus vaginalis length, and pubic symphysis-anus distance. Results The gubernaculum was not in close proximity to the developing Scrotum at any age. After 21 days of gestation, there was little evidence of a substantial gubernacular bulb distal to the processus vaginalis. At all ages the gubernacular cone height was significantly less than the distance from the gubernaculum to the Scrotum. Conclusions These results show that the gubernaculum does not develop in close proximity to the developing Scrotum. Even if complete eversion of the gubernaculum takes place, the gubernaculum would still fail to reach the bottom of the Scrotum. It is proposed that gubernacular eversion is more apparent than real and that some degree of gubernacular migration is needed for complete extension of the cremasteric sac to the bottom of the Scrotum. Anat. Rec. 250:159–163, 1998. © 1998 Wiley-Liss, Inc.
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histologic evaluation of inguinoscrotal migration of the gubernaculum in rodents during testicular descent and its relationship to the genitofemoral nerve
Pediatric Surgery International, 1992Co-Authors: Mary E Fallat, Martyn P L Williams, Pamela J Farmer, John M. HutsonAbstract:This study was designed to readdress the role of mechanical factors in testicular descent in rodents, with specific attention to the role of the genitofemoral nerve in this process. In a group of newborn rats, the genitofemoral nerve was divided unilaterally and a histologic comparison done of gubernacular and scrotal growth and development and testicular movement between sides. In all animals at birth, the gubernaculum and Scrotum were poorly developed bilaterally and the distal gubernaculum was located in the groin and was not attached to the Scrotum. The testis was located at or above the inguinal ring. With post-natal maturation, the processus vaginalis and gubernaculum advanced beyond the groin into the Scrotum, and the Scrotum developed to accomodate the testis on the control or normal side only. The testis started to descend into the Scrotum only after these anatomic events occurred. Sectioning of the genitofemoral nerve aborted this process. This study suggests that inguinoscrotal testicular descent is an active process requiring gubernacular migration that is dependent on the genitofemoral nerve.
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Fluorescent anterograde labelling of the genitofemoral nerve shows that it supplies the scrotal region before migration of the gubernaculum
Pediatric Surgery International, 1991Co-Authors: Sarah L. Larkins, John M. HutsonAbstract:The genitofemoral nerve (GFN) contains a sexually dimorphic neuropeptide transmitter, calcitonin generelated peptide (CGRP). It has been proposed that release of CGRP from the nerve may mediate testicular descent. The aim of this study was to determine the course of the GFN in order to see if CGRP-containing fibres reached the future Scrotum before gubernacular migration occurs, since this arrangement would be expected if the nerve controls gubernacular migration by CGRP release. Fluorescent anterograde labelling of the cut GFN in young rats using diamidinophenyl indole (DAPI) or Fast Blue was performed to determine the distal course of the nerve. On frozen serial sections, the nerve was found running posterolateral to the developing spermatic cord in the inguinal canal, then distally on the surface of the cremaster muscle. It then turned cranially to enter the gubernaculum from its distal attachment while some branches continued past the gubernaculum to end in the skin of the future Scrotum. Immunoperoxidase staining for CGRP showed labelling in all GFN fibre bundles, including those reaching the Scrotum. The course of the nerve with its sexually dimorphic neurotransmitter, CGRP, suggests that the nerve may influence the direction of gubernacular migration from the groin into the Scrotum.
BRIDGET RAE SOUTHWELL - One of the best experts on this subject based on the ideXlab platform.
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the role of the gubernaculum in the descent and undescent of the testis
Therapeutic Advances in Urology, 2009Co-Authors: John M. Hutson, Adam Balic, Tamara R Nation, BRIDGET RAE SOUTHWELLAbstract:Testicular descent to the Scrotum involves complex anatomical rearrangements and hormonal regulation. The gubernaculum remains the key structure, undergoing the ‘swelling reaction’ in the transabdominal phase, and actively migrating out of the abdominal wall to the Scrotum in the inguinoscrotal phase. Insulin-like hormone 3 (Insl3) is the primary regulator of the first phase, possibly augmented by Mullerian inhibiting substance/anitmullerian hormone (MIS/AMH), and regression of the cranial suspensory ligament by testosterone. The inguinoscrotal phase is controlled by androgens acting both directly on the gubernaculum and indirectly via the genitofemoral nerve, and release of calcitonin gene-related peptide from its sensory fibres. Outgrowth of the gubernaculum and elongation to the Scrotum has many similarities to an embryonic limb bud. Cryptorchidism occurs because of both failure of migration congenitally, and failure of elongation of the spermatic cord postnatally. Germ cell development postnatally is disturbed in congenital cryptorchidism, but our current understanding of germ cell biology suggests that early orchidopexy, around 6 months of age, should provide a significant improvement in prognosis compared with a previous generation. Hormone treatment is not currently recommended. Acquired cryptorchid testes may need orchidopexy once they no longer reach the Scrotum, although this remains controversial.
Philip R. Cohen - One of the best experts on this subject based on the ideXlab platform.
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A Case Report of Scrotal Rejuvenation: Laser Treatment of Angiokeratomas of the Scrotum.
Dermatologic Therapy, 2018Co-Authors: Philip R. CohenAbstract:Scrotal rejuvenation encompasses not only the functional quality but also the aesthetic appearance of the Scrotum. It includes medical therapy and procedural interventions to improve scrotal conditions that require morphologic restoration and/or aesthetic alteration. Rejuvenation of the Scrotum may be appropriate for aging-related and non-aging-related changes concerning the hair (alopecia and hypertrichosis), the morphology (laxity and wrinkles), and/or the vascularity (angiokeratoma) of the Scrotum. Angiokeratomas—typically small, asymptomatic, purple papules—may occur on the Scrotum. However, these benign vascular lesions may be of cosmetic concern to the affected individuals; in addition, the angiokeratomas can become an issue of medical importance if they begin to bleed. Multiple locally destructive modalities are available for the treatment of scrotal angiokeratomas; indeed, several lasers have effectively been used to treat angiokeratomas of the Scrotum. A 70-year-old man with numerous scrotal angiokeratomas experienced scrotal bleeding in the absence of prior trauma to the area or sexual activity. He presented for treatment to prevent future episodes of spontaneous bleeding from his scrotal angiokeratomas, but he also had not liked the aesthetic appearance of the previously asymptomatic angiokeratomas on his Scrotum. His angiokeratomas were successfully treated with three sequential 532-nm potassium titanyl phosphate (KTP) laser sessions, which led to not only functional but also cosmetic improvement of his Scrotum. In conclusion, men can develop scrotal changes due to either intrinsic (aging) or extrinsic (trauma) causes, but nonsurgical interventions and surgical procedures are available for the management of these conditions in individuals who desire to rejuvenate their Scrotum.
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Scrotal Rejuvenation.
Cureus, 2018Co-Authors: Philip R. CohenAbstract:Genital rejuvenation is applicable not only to women (vaginal rejuvenation) but also to men (scrotal rejuvenation). There is an increased awareness, reflected by the number of published medical papers, of vaginal rejuvenation; however, rejuvenation of the Scrotum has not received similar attention in the medical literature. Scrotal rejuvenation includes treatment of hair-associated scrotal changes (alopecia and hypertrichosis), morphology-associated scrotal changes (wrinkling and laxity), and vascular-associated scrotal changes (angiokeratomas). Rejuvenation of the Scrotum potentially may utilize medical therapy, such as topical minoxidil and oral finasteride, for scrotal alopecia and conservative modalities, such as depilatories and electrolysis, for scrotal hypertrichosis. Lasers and energy-based devices may be efficacious for scrotal hypertrichosis and scrotal angiokeratomas. Surgical intervention is the mainstay of therapy for scrotal laxity; however, absorbable suspension sutures are postulated as a potential intervention to provide an adequate scrotal lift. Hair transplantation for scrotal alopecia and injection of botulinum toxin into the dartos muscle for scrotal wrinkling are hypothesized as possible treatments for these conditions. The interest in scrotal rejuvenation is likely to increase as men and their physicians become aware of both the conditions of the Scrotum that may warrant rejuvenation and the potential treatments of the Scrotum for these individuals.
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cutaneous scrotal metastasis origins and clinical characteristics of visceral malignancies that metastasize to the Scrotum
International Journal of Dermatology, 2013Co-Authors: Brian S Hoyt, Philip R. CohenAbstract:Cutaneous metastases occur in about 10% of patients with cancer, occasionally presenting as the initial sign of internal malignancy. Most often cutaneous metastases are an indicator of advanced cancer and are associated with a poor prognosis. The Scrotum is a rare site of cutaneous metastasis, and metastatic tumor to the Scrotum can be mistaken for other skin lesions. We reviewed the published literature regarding patients who developed cutaneous metastasis to the Scrotum. We summarized the clinical characteristics of these men, including primary tumor sites, age at diagnosis, treatment regimens, interval between diagnosis of primary tumor and subsequent metastasis, and outcomes. We extensively searched the PubMed medical database for papers on visceral malignancies with metastasis to the Scrotum. We limited our definition to solid organ tumors; thus lymphomas, sarcomas, and melanomas of the Scrotum were excluded. We identified 29 patients who developed scrotal metastases from visceral cancers. The colon/rectum (34%), prostate (28%), and lung (14%) were the most frequent sites of tumor origin. The prognosis for these patients is poor: mean patient survival was only four months after diagnosis of metastatic skin lesions. Cutaneous metastasis to the Scrotum is a rare manifestation of internal malignancies that most often represents an advanced and/or progressive cancer associated with a poor prognosis. Treatment is often unsuccessful, and the mean patient survival following scrotal metastasis is <4 months.
Vikram S Dogra - One of the best experts on this subject based on the ideXlab platform.
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mri of the Scrotum recommendations of the esur scrotal and penile imaging working group
European Radiology, 2018Co-Authors: Athina C Tsili, Michele Bertolotto, Ahmet Tuncay Turgut, Vikram S Dogra, Simon Freeman, L Rocher, Jane Belfield, Michal Studniarek, Alexandra Ntorkou, Lorenzo E DerchiAbstract:The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the Scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were ‘magnetic resonance imaging’, 'testis or testicle or testicular', 'Scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute Scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the Scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. • This report presents recommendations for magnetic resonance imaging (MRI) of the Scrotum. • Imaging acquisition protocols and clinical indications are provided. • MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.
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Acute painful Scrotum.
Radiologic Clinics of North America, 2004Co-Authors: Vikram S Dogra, Shweta BhattAbstract:The acute painful Scrotum, which is the most common urologic emergency, may present a diagnostic challenge even to experienced clinicians. Imaging is used mainly to identify patients requiring surgical treatment to reduce the rate of unnecessary testicular exploration. Gray-scale ultrasound combined with color and pulsed Doppler modes is the method of choice for patients presenting with acute scrotal pain. This article describes the ultrasound features of scrotal pathologies associated with a painful Scrotum and the pitfalls of a relevant scrotal ultrasound examination.
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Sonography of the Scrotum
Radiology, 2003Co-Authors: Vikram S Dogra, Ronald H. Gottlieb, Mayumi Oka, Deborah J. RubensAbstract:Ultrasonography (US) with a high-frequency (7.5–10-MHz) transducer has become the imaging modality of choice for examination of the Scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the Scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the Scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed. © RSNA, 2003
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Ultrasonography of the Scrotum.
Journal of Ultrasound in Medicine, 2002Co-Authors: Vikram S Dogra, Martin I. ResnickAbstract:Objective. To review the ultrasonographic technique, anatomy, and pathologic entities found in the Scrotum during evaluation of scrotal masses, acute scrotal pain, and male infertility. Method. A pictorial review of cases with diagrams of pertinent anatomic features and findings is presented. Results. Ultrasonography in conjunction with color and pulsed Doppler imaging has supplanted other imaging modalities in the evaluation of scrotal diseases and disorders. Ultrasonography is valuable in the evaluation of the acutely painful Scrotum in addition to scrotal masses and male infertility. Advances in ultrasonographic spatial and low-contrast resolution have improved our ability to more clearly define diagnoses for the referring urologist and have led to new observations that are currently being investigated and have yet to be fully understood. Microlithiasis and the mottled appearance of seminiferous tubule sclerosis and atrophy are 2 such entities. This article reviews the pertinent normal scrotal anatomy and the use of ultrasonography in the evaluation and classification of acute scrotal pain, scrotal masses, male infertility, and trauma. This review article also discusses pitfalls of color Doppler imaging in assessment of the Scrotum and how to avoid them. Conclusion. The use of ultrasonography in the evaluation of the Scrotum benefits from an understanding of scrotal anatomy and familiarity with potential pitfalls of color Doppler and pulsed Doppler evaluation.
Lorenzo E Derchi - One of the best experts on this subject based on the ideXlab platform.
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mri of the Scrotum recommendations of the esur scrotal and penile imaging working group
European Radiology, 2018Co-Authors: Athina C Tsili, Michele Bertolotto, Ahmet Tuncay Turgut, Vikram S Dogra, Simon Freeman, L Rocher, Jane Belfield, Michal Studniarek, Alexandra Ntorkou, Lorenzo E DerchiAbstract:The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the Scrotum. The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were ‘magnetic resonance imaging’, 'testis or testicle or testicular', 'Scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute Scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary). The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the Scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented. • This report presents recommendations for magnetic resonance imaging (MRI) of the Scrotum. • Imaging acquisition protocols and clinical indications are provided. • MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.
