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Abstract Hemolymphangioma is an uncommon benign tumor type that commonly occurs in the head and neck. Primary spermatic cord hemolymphangioma (SCH) with only several reported, however, is extremely rare. Clinical diagnosis can be challenging because of its rarity. Although spermatic cord hemolymphangiomas are benign tumors, there is still a high recurrence rate in postoperative. A 15-year-old boy presented to our hospital with complaints of scrotal for 15 days and did not have other associated symptoms. The male genital color Doppler ultrasound revealed that a cystic echo in the left spermatic cord region and above the testes was about 32 mm × 20 mm × 14 mm. He underwent left en bloc scrotum tumor resection under general anesthesia, and pathologic examination showed SCH. He was discharged from the hospital in the second postoperative day. After 1-month follow-up, the patient recovered well without recurrence. The patient is currently in follow-up phase. Up to date, only a few cases have been reported in the literature about SCH. So, we hope to raise the awareness of the diagnosis of SCH in clinical practice although this case.

Introduction and Objective: Penis enlargement through substance injection is common in many countries of Southeast Asia and Eastern Europe. The definitive therapy involves removing the entire skin and the subcutaneous tissue and resurfacing the penile shaft via a single-stage or multi-staged procedure. This study aimed to report the functional outcome and esthetics of treating penile paraffinoma patients using the scrotal tunnel + ventral inverted V incision + anastomosis inverted Y technique., Material and Methods: This study was a single-center retrospective descriptive analysis of patients who underwent one-stage scrotal tunnel + ventral inverted V incision and inverted Y-shaped anastomosis procedures from January 2013 to December 2023. The following data were collected: chief complaint, reason for the injection, type of fluid injected, duration of surgery, duration of hospitalization, length of follow-up, and results after surgery., Results: Of the 32 patients included in the study, 78% injected liquids in the form of oil and the goal of the majority of patients was penis enlargement (71%). The average age was 36.84 years, and the main complaint was pain in the penis during erection (53%). The average operation time was 130 minutes, hospitalization duration was 2.21 days, primary wound healing was 91%, patient satisfaction level was 97%, and Scale 4 erection hardness was 91%., Conclusion: One-stage surgery for penile paraffinoma produced promising results when the granuloma was limited to the penis and healthy scrotal skin was available to cover the penis.

Objective: Penoscrotal transposition (PST) is a rare anomaly of the external genitalia characterized by malposition of the penis in relation to the scrotum. This transposition may be partial or complete and may be associated with hypospadias, chordee, and other anomalies. We have reviewed our experience with the surgical repair of PST utilizing a modified Glenn-Anderson technique., Materials and Methods: Twenty-nine patients with a median age of 5.6 years (8 months -15 years) underwent surgical repair of PST at our institution between 2004-2022. Of those, 20 (69%) had complete PST, while 9 (31%) had partial PST. All children were divided into three groups. In the first group of 8 (28%) children, repair of PST was an integral part of one-stage male genitoplasty; in the second group of 18 (62%) children, repair of PST was an isolated last stage of the staged hypospadias repair and the remaining 3 (10%) children underwent PST repair without the presence of hypospadias. All patients underwent modification of the Glenn-Anderson technique involving utilization of bilateral rotational advancement scrotal flap, complete de-tethering of the testis from the internal part of the scrotum when indicated, and relocation of the scrotal compartment in a normal dependent position. The follow-up ranged from 6 months to 18 years., Results: In the first group, five children (62%) underwent Onlay Prepucial Island Pedicle Flap (OIF) hypospadias repair, and three (38%) underwent Long Tubularized Incised Plate Repair (TIP). In the second group, 8 (44%) underwent OIF hypospadias repair, 2 (12%) had Long TIP repair, and the remaining 8 (44%) underwent staged hypospadias repair. Post-operative Clavien Dindo grade III presented among three patients in group I and only one patient in group II. In the third group, no postoperative complications were observed., Conclusion: Our data show that penoscrotal transposition correction utilizing the Glenn-Anderson technique is a reliable and durable surgery in the pediatric population. These children require careful monitoring till adolescence to ensure that no re-operation is needed.

Objective: To evaluate the effectiveness of Eutectic Mixture of Local Anesthetic (EMLA), a topical anesthetic cream, in office-based invasive andrological procedures such as hydrocelectomy, spermatocelectomy, and others, aimed at minimizing pain perception and enhancing the overall patient experience., Methods: A double-blinded randomized controlled trial was conducted for patients undergoing scrotal andrology surgeries under LA. Power calculation was performed with an estimated sample size of 72. Participants were randomly assigned in a 1:1 ratio to topical EMLA + LA versus LA alone. In the post-operative recovery area, patient will be asked to complete a VAS questionnaire rating pain with LA administration and pain with procedure. Analysis comparing VAS pain scores of both groups was performed using the independent sample t-test method., Results: Seventy-two patients were included in our analysis, with 36 in the control and 36 in the intervention arm. For patient pain with administration of LA, the control arm reported an average VAS pain score of 4.31, compared to 3.72 in the intervention arm (P = .319). For patient pain with procedure, patients in the control arm reported a median VAS pain score of 3.47 compared to 3.03 (P = .432) in the intervention arm. Overall, 86% (62/72) of patients reported that they would either be "very likely" (4/5) or "highly likely" (5/5) to undergo future procedures under local anesthetic., Conclusion: While performing scrotal surgeries under LA appears to be well tolerated and a feasible option, the application of EMLA cream does not appear to significantly alter patient-reported outcomes., Competing Interests: Declaration of Competing Interest Premal Patel is a consultant for Boston Scientific Corporation; the remaining authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Circumcision is commonly performed but anatomic variants occur and can affect outcomes if not addressed properly. The combination of concealed penis and penoscrotal webbing is fairly common and presents across a spectrum of severity. If not repaired, this can result in a buried penis that can cause penile adhesions, wound healing concerns, and make the penis appear shorter secondary to a retracted position. We present our technique that is reproducible and highly successful in addressing both of these concerns. The paraphimotic band approach is performed more commonly and is able to reliably correct webbing and concealment without an incision at the penoscrotal junction. When more severe defect is present, a Y shaped incision is made at the penoscrotal junction to mobilize skin flaps to correct the deficit. In our cohort of 885 patients, 736 were corrected using the paraphimotic band technique while 149 underwent a complex scrotoplasty. None of the patients required a secondary surgery for complications., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Spina bifida is a congenital malformation of foetal neural structures which may present as a skin fold or sac containing cerebrospinal fluid and neural structures with a variety of neurological deficits. Surgical repairs of spina bifida may not ensure complete functions, neural improvement or recovery. We present this palliative report of an adult male in his early 40s with a medical history of meningocele repair in his infancy, with long-standing Marjolin ulcers, fractures, contractures, diverting ileostomy and urostomy and a fungating mass externally measuring 33×25 cm. The mass involved the buttocks, perineum and scrotum with a tumour overlying the meningocele and extending into the thigh through an internally draining tract. Factors such as immobility, pressure injuries and poor social support in the setting of chronic disability led to a conservative approach in the management of this unresectable carcinoma., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Neonatal myiasis is a rare condition, with few reports available on the subject. Surgical management is recommended in some cases. In this study, we present the case of a 7-day-old male neonate with larvae in his scrotum who underwent surgery., Case Presentation: A full-term 7-day-old male infant (Aryan race) was referred to a children's hospital. On the sixth day after birth, three 3-4 mm long larvae crawled out from his scrotum, with the number increasing over time. He was given intravenous antibiotics and topical mupirocin to combat secondary infections. The surgical treatment involved two steps: first, the larvae were extracted, and then the infection site was washed with betadine and hydrogen peroxide to help remove any possible remaining larvae., Conclusion: Scrotal myiasis is a rare disease that occurs in infants and requires immediate treatment. Surgical treatment is effective in removing dead or decaying larvae from a deep-seated location and washing the infection site to prevent secondary infection., (© 2024. The Author(s).)

Objective: To present our experience with a novel technique that combines the York-Mason transsphincteric approach with dartos muscle flap interposition to treat rectourethral fistulas., Methods: We extracted records from our prospectively kept database of 35 procedures conducted for treating rectourethral fistulas during 2002-2023; the York-Mason approach was combined with dartos muscle flap interposition in 5 cases, performed for treating rectourethral fistulas due to radical prostatectomy, all of which were referral cases., Results: All 5 patients were successfully treated and followed up for a median of 70.0 months without recurrence. Before the fistula repair, all had a diverting stoma. In all cases, the first voiding cystourethrogram revealed a healed fistula. The posterior and the scrotal incisions healed uneventfully. All patients reported normal voiding and no urinary incontinence. To date, the stoma has closed in 3 patients, all of whom had intact fecal continence and no postoperative anal stenosis., Conclusion: The transsphincteric modified York-Mason approach combined with dartos muscle flap interposition resulted in complete healing of rectourethral fistulas., Competing Interests: Declaration of Competing Interest The author has no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Varicocele is a prevalent vascular disorder affecting the male reproductive system, leading to scrotal pain and testicular dysfunction. Epidemiological studies have shown that varicocele occurs in approximately 10% to 15% of adult males, while scrotal pain affects 2% to 10% of the population. Currently, clinical treatment options for varicocele-induced scrotal pain include general therapy, medication, and surgery. Among these, surgical intervention is considered the most effective method, boasting a success rate of 80%. However, it carries risks such as postoperative bleeding, infection, and recurrence, making it less desirable for some patients. In recent years, transcutaneous neuromuscular electrical stimulation has gained wide acceptance for treating various andrological conditions, including erectile dysfunction and premature ejaculation, yielding positive outcomes. This non-invasive technique offers a promising alternative for managing varicocele-induced scrotal pain, potentially reducing the need for surgical intervention and its associated risks. Its growing popularity underscores the need for further research and clinical trials to validate its efficacy and safety in treating this condition.

The mesothelium, which consists of a monolayer of mesothelial cells, extends over the surface of the serosal cavities (pleura, pericardium, peritoneum and tunica vaginalis). Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum. According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours (5th edition), mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour, well-differentiated papillary mesothelial tumour (WDPMT) and mesothelioma. Since WDPMT of tunica vaginalis was rare, there was no consensus concerning the treatment of it. In this case report, a 29-year-old man who had endured intermittent right scrotal pain for 8 months, aggravating scrotal pain for 2 weeks was admitted. No symptoms, such as frequent, urgent, or painful urination were shown. Physical examination revealed the enlargement and tenderness of right scrotum, with no signs of lifting pain. The most recent scrotal ultrasonography before surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis. Under the circumstance of patient' s chronic history of testicular hydrocele, he underwent an emergency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia. After opening the vagina tunic cavity, spot-like bleeding was observed on the right testicle, epididymis and vaginalis surface. The vaginalis was obviously thickened and the inner and outer walls were smooth. The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm, smooth inner and outer walls, and a suspected WDPMT with a diameter of 1. 5 cm. Immunohistochemical staining showed positive for Calretinin, BAP1, WT-1, CK5/6, D2-40 and P16，which confirmed the diagnosis of WDPMT. To sum up, the purpose of this case report was to raise awareness of a rare disease WDPMT, which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry. The disease should be differentiated from testicular torsion, epididymitis, orchitis and oblique inguinal hernia in symptoms, and from malignant mesothelioma and adenomatoid tumour in pathology. Because of the rarity of the cases, there was no unified standard for the treatment of WDPMT at present. The common treatment methods reported in literature included orchidectomy and vaginectomy. Due to the lack of understanding of this disease, postoperative follow-up was still recommended for at least 5 years.

Objectives: To describe a new penoscrotal reconfiguration technique, named "V-I penoscrotal reconfiguration" for the surgical reconstruction of a congenital webbed penis (CWP)., Methods: Twenty-one patients who underwent the "V-I penoscrotal reconfiguration technique" were included in this retrospective study. The CWP severity was assessed according to El-Koutby's classification. Demographic and clinical data, surgical data, and postoperative outcomes were scheduled and analyzed. Specifically, the postoperative follow-up included both physical and psychological assessments at 2 weeks, 1, 6, and 12 months after surgery. Parents' satisfaction degree was quantified by the Likert scale., Results: CWP was grade 3 in 11 (52%) patients, 2 in five (24%), and 1 (24%) in five. Five (24%) CWP were isolated malformations, 11 (52%) were associated with phimosis, three (14%) with hypospadias, and two (10%) with hypospadias and phimosis. There were no postoperative complications and no cases of redo surgery. The cosmetic outcomes were excellent in all cases: the parents' satisfaction score was 4 in 17 (81%) cases and 3 (9%) in the other four cases., Conclusions: CWP may cause psychological distress and functional problems, especially during sexual intercourse. Its correction in childhood is advocated to prevent psychological and sexual issues. The "V-I reconfiguration technique" is simple, and easy with excellent cosmetic and functional outcomes., (© 2024 The Japanese Urological Association.)

Purpose: Management of scrotal hernias presents as a common challenge, with operative interventions to address these hernias associated with higher rates of morbidity compared to those of less-complex pathology. Surgeons have advocated for the use of techniques such as primary abandonment of the distal sac as a potential means to reduce complications for operative intervention, with preliminary findings demonstrating feasibility. We sought to assess outcomes related to primary sac abandonment among patients undergoing minimally invasive (MIS) repair of scrotal hernias., Methods: A review of prospectively maintained databases among two academic hernia centers was conducted to identify patients who underwent MIS inguinal hernia repairs with primary sac abandonment. Patient demographics, hernia risk factors, intraoperative factors, and postoperative outcomes were evaluated. Short-term outcomes related to patient-reported experiences and surgical-site occurrences requiring procedural intervention were queried., Results: Sixty-seven male patients [median age: 51.6 years; interquartile range (IQR): 45-65 years] underwent inguinal hernia repair with primary sac abandonment. Anatomic polypropylene mesh was used in 98.5% cases. Rates of postoperative complications were low and included postoperative urinary retention (6%), clinically identified or patient-reported seromas/hematomas within a 30-day follow-up period (23.9%), deep venous thrombosis (1.5%), and pelvic hematoma (1.5%). No seromas or hematomas necessitated procedural interventions, with resolution of symptoms within three months of their operation date., Conclusion: We report a multi-center experience of patients managed with primary abandonment of the sac technique during repair of inguinoscrotal hernias. Utilization of this technique appears to be safe and reproducible with a low burden of short-term complications., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Objective: To contribute to the literature by sharing the clinical presentation, surgical approach, postoperative complications management, and follow-up protocols of the patients we operated on due to intrascrotal extratesticular mass., Methods: Thirty-two patients admitted due to intrascrotal extratesticular mass were included in the study. Demographic and clinical characteristics of the patients such as age, initial clinical presentation, physical examination, radiological imaging findings, such as scrotal Doppler ultrasonography and magnetic resonance imaging, mass size, and characteristics, surgical treatment procedures, operation notes, and patient follow-up visits were retrospectively examined and evaluated from the patient files., Results: The median age of the 32 individuals included in the study was 52 (interquartile range: [45.0-60.5]) years. The primary reason for initial presentation was a palpable mass in 25 (78.1%) patients, pain in 13 (40.6%) patients, and scrotal swelling in 8 (25%) patients. The median mass diameter was 4.4 (interquartile range: [3.1-5.7]) cm. Surgical treatment involved inguinal excision in 29 cases (90.6%) and inguinoscrotal excision in 3 cases (9.4%). All patients were treated with testicle-sparing surgery. The most common tumor location, observed in 27 cases (84.3%), was the epididymis. The most frequent histopathological diagnosis was epididymal cyst, identified in 13 patients (40.6%). Pathology results showed that the mass was removed with negative margins in all patients., Conclusion: Testicular-sparing surgery through the inguinal approach is one of the surgical methods that can be preferred for intrascrotal extratesticular masses. This approach can both preserve the testicle and achieve successful surgical results. Studies with larger samples are needed on this subject., Trial Registration: This study was approved by the Erzurum Medicine Faculty University Local Ethics Committee (approval number: BAEK 2023/08-105)., Competing Interests: Declaration of Competing Interest All authors declare no potential conflict of interest with this publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Injection of exogenous material into the penis and scrotum has been performed for augmentation purposes. Complications include cosmetic dissatisfaction, penile necrosis and lymphoedema. We report the complications and outcomes from a single centre with an updated systematic review of the literature. A retrospective review of all cases presenting with foreign substance injection into the genitalia, over a 10-year period was performed. Thirty-five patients with a mean (standard deviation (SD); range) age of 36.9 (±9.1; 22-61) years at presentation were included. The mean (SD; range) time between injection and presentation was 7.8 (±5.8; 1 day-20 years) years. The most common injected substance was silicone (n = 16, 45.7%) and liquid paraffin (n = 8, 22.9%). The penile shaft (94.3%) was the most injected site. The most common presentations were cosmetic dissatisfaction (57.1%) and pain and/or swelling (45.7%). Surgery was required in 32 (91.4%) cases. Primary procedures included local excision and primary closure (n = 19, 59.4%), circumcision (n = 5, 15.6%), excision with a split skin graft or a scrotal flap reconstruction (n = 5, 15.6%). Three (8.6%) patients presented with necrosis and required acute debridement. Overall, 18 patients had more than 1 procedure, and 8 patients required 3 or more procedures. A systematic search of the literature identified 887 articles of which 68 studies were included for analysis. The most common substance injected was paraffin (47.7%), followed by silicone (15.8%). The majority of patients (77.9%) presented with pain, swelling or penile deformity. 78.8% of the patients underwent surgical treatment, which included excision and primary closure with or without the use of skin grafts (85.1% of all procedures), the use of flaps (12.3%) and penile amputation (n = 2). Complications of foreign body injection into the male genitalia can be serious resulting in necrosis and autoamputation. Surgical intervention is often required to excise abnormal tissue to manage pain and improve cosmesis., (© 2023. The Author(s).)

Ventriculoperitoneal shunt (VPS) is the most common procedure done for hydrocephalus in the paediatric population. While shunt infection and shunt malfunction remain the most common complications, shunt migration is not frequently observed. Being present in a large peritoneal cavity, theoretically, a shunt can travel to a variety of locations. Even among these, scrotal migration is quite uncommon. This case highlights the significance of keeping this possibility in mind while evaluating a case of shunt malfunction. It also discusses various nuances of surgically managing scrotal migration., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to compare the clinical outcomes of two surgical approaches, laparoscopic-assisted scrotal incision and conventional inguinal-scrotal incision, for treating cryptorchidism with unobliterated processus vaginalis. Methods: Clinical data from 60 pediatric patients with inguinal cryptorchidism who were admitted to our institution between January 2018 and January 2022 were retrospectively analyzed. Depending on the surgical technique used, the patients were split into two groups: the laparoscopic group ( n  = 30) underwent a laparoscopic-assisted scrotal incision, whereas the conventional group ( n  = 30) underwent a conventional inguinal-scrotal incision for testicular descent and fixation. The length of the procedure, intraoperative blood loss, and the typical hospital stay following the procedure were compared between the two groups. Also assessed was the frequency of postoperative complications including wound infection and hematoma development. Results: The laparoscopic group demonstrated a notably shortened average surgical duration compared with the traditional group, and this discrepancy held statistical significance ( P  = .017). Moreover, the laparoscopic approach resulted in a reduced volume of intraoperative blood loss, with a statistically significant distinction ( P  = .002), along with a decreased average length of hospital stay after surgery, also statistically significant ( P  = .009). Testicular retraction, atrophy, inguinal hernias, or hydrocele were not present in any group. Although the difference between the laparoscopic and open groups was not statistically significant ( P  > .05), the laparoscopic group saw a reduced frequency of scrotal hematoma. The frequency of wound infection was also decreased in the laparoscopic group compared with the open group, although there was no statistically significant difference ( P  > .05). Conclusion: The laparoscopic-assisted scrotal incision approach for testicular descent and fixation offers precise localization of cryptorchidism, reduced surgical trauma, shorter postoperative recovery time, and results in smaller scars with minimal tissue damage. The procedure showcases enhanced overall clinical effectiveness, fewer postoperative complications, heightened safety, and superior cosmetic outcomes.

Introduction: Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap., Case Report: A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect., Discussion: The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour., Conclusion: The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.

Acute genital diseases can occur at any age and are characterized by complaints of various kinds of the external genitalia. Pain, swelling, and redness of the scrotum, adjacent groin region, and immediate surroundings are the leading symptoms, the severity of which may vary. In addition, peritonitic symptoms such as nausea, vomiting, and circulatory sensations may be present and are comparable to symptoms of an acute abdomen. The term "acute scrotum" encompasses various clinical entities, where scrotal symptoms are predominant and represent a urological emergency situation. Immediate and comprehensive diagnostics are necessary to ensure timely management in case of necessary surgical intervention., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: To analyze the effectiveness of scrotal flaps' use for skin deficit correction in re-operative cases to improve hypospadias' treatment results in children., Methods: In the Urology Department of the Russian Children's Clinical Hospital (from 2013 to 2019) 46 patients were treated with hypospadias who underwent 3 to 7 failed repairs before being admitted to the clinic. Patients were divided into two groups: Group I - 24 patients with ventral skin deficit and proximal hypospadias; Group II - 22 patients with circumferential skin deficit and mid-shaft hypospadias. Scrotal flaps were used in both groups to cover the skin defect. The results were analyzed in short- and long-term follow-up of 2-8 years. Cosmetic results according to Hypospadias Objective Penile Evaluation scale, as well as functional results (recovery of independent free urination, lack of complications) were assessed., Results: In long term follow-up, there is no statistically significant difference between Group I and Group II in number of fistulas and cases of glans dehiscence. Total number of complications in Group I - 6 (25%) vs 6 (27.3%) in Group II. Good cosmetic results were obtained in most patients of both groups, and satisfactory cosmetic results in 1 patient (4.1%) from Group I, and 2 patients (9.1%) from Group II (Table)., Conclusion: In re-operative cases of midshaft and proximal hypospadias repairs, scrotal flaps allow to obtain good cosmetic and functional results, correcting ventral and circumferential skin deficit., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: After 5 years experience with the GUD (glandular urethral disassembly) technique for distal hypospadias, we present the GUDplay technique, incorporating Thiersch-Duplay tubularization of the plate till the coronal area, disassembling the glans aggressively and refurbishing the glans., Methods: We defined the urethral plate and designed an inverted Y incision to open the glans in two wings. The glans was entirely detached from the corpora to gain a great mobility that allowed minor cranial mobilization of the urethra and caudal rotation of the wings. In sequence, there are well-known steps: Duplay urethroplasty, spongioblasts and a Dartos flap to cover the neourethra. The glans was connected to the urethra by 6.0 PDS sutures except in the ventral meatus and the glans wings are joined in the midline., Results: The 5-year-old patient had midshaft hypospadias without previous surgery. The catheter was removed after a week and the healing appears to be good., Discussion: We combined principles of total glans deconstruction in association to Duplay tubularization and then lifted it up to the tip of the glans divided in two wide and mobile wings. We have treated a small series of 6 cases without complications and mean follow-up of 6.2 months., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent., Methods: A retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent., Results: A total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis., Conclusion: The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias., (© 2024. The Author(s).)

Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. The objective of this systematic review is to provide a thorough overview of scrotal BCC, including a summary of its clinical characteristics, and microscopic subtypes. It also seeks to discuss the many techniques used in the management of this uncommon clinical presentation. Utilizing data from 1957 to October 2023, a systematic review of PubMed and Wiley Online Library was conducted to identify all cases of scrotal BCC with various presentations and managements. A total of 73 patients were included. The median patient age was 65.9 years (range 42 to 87). All studies were either case reports or case series. Our review shows that treatment with Mohs micrographic surgery (MMS), leads to a superior patient outcome based on anecdotal evidence in select cases. To deepen our understanding of Mohs surgery's efficacy in treating scrotal BCC, it is imperative to conduct more robust research in the form of randomized clinical trials., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The patient was a 71-year-old male whose chief complaint was a scrotum mass. The mass had gradually increased in size without any associated symptoms. The physical examination revealed a pedunculated, radish brown, and elastic soft tumor (4. 5×3. 5×3. 0 cm) in the right scrotum. Blood chemical analysis of HbA1c and squamous carcinoma antigen were 8. 3% and 38. 4 ng/ml (≦1. 5), respectively. This tumor was successfully treated with surgical resection. Histopathological examination showed condyloma acuminatum without malignant findings. Giant condyloma acuminatum commonly affects the genital and perianal areas. An immunocompromised state generally exists in the background of the patients.

Extramammary Paget disease (EMPD) is a rare malignant neoplasm arising in apocrine gland-rich skin, which may be classified as either of primary or secondary origin. Management of this condition is predominantly surgical, and is often characterised by lengthy diagnostic delays. Complete surgical excision is challenging, and local recurrence is common. Herein, we discuss a subtle presentation of recurrent scrotal EMPD in a 77-year-old male and review the available literature. Although relatively rare, the indistinct nature of this pathology merits special attention from treating surgeons, who are frequently responsible for initial management and follow-up. The risk of distant metastasis and concomitant prognostic implications necessitate a high clinical index of suspicion, and low threshold for definitive biopsy in similar cases.

Introduction: Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture., Case: Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis., Discussion: The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap., Conclusion: The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Acquired penile defects can be secondary to various pathologic conditions, including infection, scar, or complications following urologic procedures. Penis defects with skin deficit carry a distinct challenge for reconstructive surgeons. Scrotal flaps can provide reliable coverage and can restore distinct qualities of native penile skin., Methods: A series of patients presented with a variety of acquired penile defects. Each of these patients underwent staged bipedicle scrotal flap surgery for coverage by the senior author., Results: Eight patients underwent bipedicle scrotal flap reconstruction for penile defects with a skin deficit. All eight patients had satisfactory outcomes postoperatively. Only two of the eight patients had minor complications., Conclusions: For select patients presenting with underlying deficit of penile skin, bipedicle scrotal flaps prove to be a safe, reproducible, and reliable reconstructive technique for penile resurfacing., Clinical Question/level of Evidence: Therapeutic, V., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Abnormalities of the bovine scrotum and testes are an important cause of infertility. Proper evaluation of the male reproductive system is a critical first step in screening for such abnormalities. Excessive periscrotal fat, cutaneous scrotal defects, and unilateral scrotal swelling are common deformities that warrant further investigation. Early diagnosis and surgical intervention are often needed to restore reproductive soundness. This article reviews these conditions and provides therapeutic modalities., Competing Interests: Disclosure The authors declare no conflicts of interest or sources of funding., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Schwannomas originate from the peripheral nerve sheaths and are mainly detected in the head, neck, or extremities. They are rarely encountered in the penoscrotal region., Case Presentation: Herein, we present a case of a penoscrotal schwannoma diagnosed and successfully treated in our center. A 40-year-old patient with a history of resection of a dorsal penile schwannoma presented with multiple nodular lesions at the scrotum, penile shaft, and radix, which were first noticed 5 years before his current presentation. He complained about penile pain and dyspareunia. Magnetic resonance imaging was performed for preoperative diagnosis. All nodular lesions were resected while preserving the neurovascular structures. The histopathological examination revealed benign lesions. The patient's complaints were resolved, and there was no recurrence during the 1-year follow-up., Conclusion: The primary treatment is surgical excision. The patients need close follow-up regarding the risks of recurrence and malignant transformation., (© 2024 S. Karger AG, Basel.)

Penoscrotal elephantiasis (PSE) is defined as an increase, sometimes considerable, in the volume of the external genitalia, which will be responsible for an unsightly appearance, a sexological impact and a psychological harm. The cause may be primary or secondary to a parasitic disease (filarsiosis) or to intrinsic or extrinsic lymphatic obstruction. The diagnosis is essentially clinical, with penoscrotal involvement being the most frequent. The etiological research implies the realization of certain complementary examinations according to the circumstances. Surgical treatment ideally consists of excising the mass. followed by reconstruction using grafts or local flaps of healthy skin, which is an important way of restoring comfort to the patient. We report two cases of penoscrotal elephantiasis treated surgically with good functional and aesthetic results. We update, through our own experience, aspects of the diagnostic and therapeutic care of penoscrotal elephantiasis., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objective: The incidence of scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is rare and may lead to life-threatening visceral complications. Management requires prompt removal of the migrated portion of the shunt and closure of the scrotal sac. We report an interesting case of a young child who presented with asymptomatic unilateral swelling of his scrotum secondary to a migrated VPS catheter. A repeat X-ray prior to his surgery to remove the migrated catheter showed that the entire length of the distal VPS catheter was back in the peritoneal cavity. In view of this unusual phenomenon, the case is discussed in corroboration with published literature., Methods and Results: A systematic search of publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 49 reported cases (including our patient) of scrotal migration of shunt catheters in patients less than 18 years old. There is only 1 other case of spontaneous resolution of shunt catheter from the scrotum. Favoured management of choice is repositioning the distal shunt catheter back into the peritoneal cavity and herniotomy in the same setting, if possible. Overall, the literature suggests this is a shunt-related complication that has a good prognosis if intervention is timely., Conclusion: Scrotal migration of a VPS catheter is a rare but potentially life-threatening complication in children. Our case report highlights the role of updated preoperative imaging and the need for consistent long-term shunt surveillance in children., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Extramammary Paget's disease of the scrotum and penis is a relatively rare cutaneous malignant tumor. At present, its pathogenesis, and clinical and pathological characteristics are not very clear. This is controversial regarding surgical margin width to decrease the high recurrence rate. This paper aimed to report the case and review the literature of extramammary Paget's disease of scrotum and penis., Case Presentation: We presented the case of a 74-year-old male patient with the patchy erythema and pruritus in the perineum who was admitted to our department. Biopsy of the large plaque revealed Paget disease. Under the condition of ensuring negative surgical margins by rapid frozen pathology, a wide local excision of the lesion, bilateral orchiectomy, and adnexectomy were performed on the patient. Pathology revealed that many scattered vacuolated Paget cells were observed in the epidermal layer, and the diagnosis was Paget's disease of the scrotum and penis. The 2 cm outside the skin lesion was used as the initial surgical margin, and free skin flap transplantation was used to repair the surgical wound. The patient recovered well and was discharged 1 week after surgery., Conclusion: Currently, histopathologic biopsy is the most important diagnostic method for EMPD. Once confirmed, for patients eligible for surgical intervention, wide local excision of the lesion and rapid intraoperative frozen pathological examination should be performed as soon as possible. The skin flap transplantation is the first choice for the repair of large-scale wound after surgery., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Epididymal cysts are benign cystic formations of the epididymis that usually appear in adolescence or early adulthood. Their frequency doubles after the age of 14-15. Obstruction in the epididymal efferent ductules with subsequent prostenotic dilatation of them, as well as dysgenesis due to hormonal disorders during fetal or postnatal life, are possible. At the 1st Department of Pediatric Surgery of A.U.Th. we treated 11 cases of boys at the age of 11-16 who presented with acute scrotum because of an epididymal cyst. The diagnosis was confirmed by ultrasound scanning . Due to persistent symptomatology, patients underwent surgical exploration and removal of the cyst. The postoperative care of the patients was uncomplicated with immediate remission of symptoms. In one case, ipsilateral acute epididymitis occurred after 10 days, which was successfully treated with antibiotic therapy. It is reported that approximately 50% of epididymal cysts involute within an average of 17 months. In conclusion, using the data obtained from the review, of the small in number of international bibliography studies, it is proposed conservative treatment of asymptomatic cysts with diameter smaller than 1 cm and surgical excision [1] of large asymptomatic cysts with diameter greater than 1 cm, which do not regress after a follow-up of 24-48 months, cysts, regardless of their diameter, responsible for persistent symptoms and in the manifestation of acute scrotal symptoms due to inflammation, intravesical bleeding or secondarily torsion of the epididymis.

Background: Accessory splenic tissue is a commonly encountered phenomenon in medical literature. Typically, these accessory spleens are found in close proximity to the main spleen, either in the hilum or within the surrounding ligaments. Nevertheless, it is noteworthy that they can also be located in unusual sites such as the jejunum wall, mesentery, pelvis, and, exceptionally rarely, the scrotum. The first documented case of accessory splenic tissue in the scrotum was reported by Sneath in 1913 and is associated with a rare congenital anomaly called splenogonadal fusion. This report describes an infant who presented with a scrotal mass noted by his mother and after examination, investigations, and surgical exploration, it was revealed to be splenogonadal fusion., Case Description: An 8-month-old Caucasian male patient presented with a mass in the left testicle and bluish discoloration of the scrotum, which had been incidentally noticed in the previous 2 months. The general physical examination was unremarkable. Other than a palpable scrotal mass that was related to the upper pole of the testis, the rest of examination was unremarkable. Imaging revealed that this mass originated from the tail of the epididymis without infiltrating the testis and tumor markers were normal. On inguinal exploration, a reddish brown 2 × 2 cm mass was found attached to the upper pole and was completely excised without causing any harm to the testis, vessels, or epididymis. Histopathological evaluation confirmed the presence of intratesticular ectopic splenic tissue., Conclusion: Although uncommon, splenogonadal fusion can be included in the differential diagnosis of a testicular swelling. Accurate diagnosis allows for appropriate treatment planning which helps to avoid unnecessary radical orchiectomy, which can have a significant impact on the patient's reproductive and psychological wellbeing., (© 2023. The Author(s).)

Objective: This study aimed to compare the outcome of undescended testicle patients with and without transparenchymal sutures., Patients and Methods: Patients were divided into two distinct groups for evaluation: Group 1 (Testicular Fixation +): this group comprised 41 patients who underwent a procedure that involved testicular fixation. Group 2 (Testicular Fixation -): this group included 47 patients who had not undergone any testicular fixation., Results: The age difference between these groups was not statistically meaningful (p>0.05). As for the presence of hypospadias, 2 patients (4.8%) in Group 1 and 3 patients (6.4%) in Group 2 were affected, showing no significant difference (p>0.05). Post-surgical local infection was evident in 9.8% of Group 1 and 8.5% of Group 2 patients, showcasing no significant difference (p>0.05). When assessing recurrence, both groups bore almost identical rates, 7.3% for Group 1 and 6.4% for Group 2 (p>0.05). Atrophy was observed in 2.4% of Group 1 and 2.1% of Group 2, with no marked distinction (p>0.05)., Conclusions: Both groups exhibited similar outcomes, suggesting that no fixation method was also a good option.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ovotesticular (OT) disorder of sex development (DSD) is a rare condition that affects the development of reproductive organs and manifests in a wide range of phenotypic presentations. The clinical diagnosis of this condition is challenging because of its atypical nature, and the variability of presentation in 46,XX OT-DSD cases makes it a complex issue in medical practice. We report a case of a 13-year-old boy who presented with left scrotal pain. Further exploration revealed a tunica rupture without testicular torsion of the left testis, whereas the histopathological analysis of a nodule excised from the right testis indicated the presence of ovotestis tissues. A second nonemergent surgery preserved the testicular tissues as the ovarian tissue in both gonads was excised. After 22 months of follow-up, the patient's testes produced normal testosterone levels sustained over time without any exogenous supplementation. This case reveals that, in male children who present with an acute scrotal disease as adolescents, the gonads should be retained until the etiology is confirmed, and the possibility of OT-DSD should be considered., (Copyright © 2023 by the American Academy of Pediatrics.)

Background: Squamous cell carcinoma (SCC) of the scrotum is a rare and aggressive cancer. There are no established guidelines on the management of scrotal SCC., Objective: To analyze the clinical management and outcomes of scrotal SCC., Patients and Methods: A retrospective analysis of patients diagnosed with primary scrotal SCC over a 10-year period was performed. The type of surgery, tumor stage and histological subtypes, recurrence rate and metastases, cancer-specific mortality (CSM), and other-cause mortality (OCM) were analyzed., Results: Between 2012 and 2022, a total of 10 men were identified with primary scrotal SCC. The median (interquartile, IQR) age was 65.5 (55-77) years. Wide local excision was performed in 9 patients and 1 patient underwent a total scrotectomy. The pathological T-stage was: pT1, n = 3; pT2, n = 1; pT3, n = 5 (50%); pT4, n = 1. Four patients had pathologically positive inguinal lymph nodes and 2 had distant metastatic disease at presentation. At a median (IQR) follow-up of 10.5 (4-31) months 5 patients died, of which 3 died from scrotal SCC., Conclusion: Scrotal SCC is extremely rare in the UK with only 10 primary cases identified in our center over the past 10 years. Surgical resection of the tumor and appropriate inguinal node staging are required due to a high proportion of cases which metastasize to the inguinal lymph nodes., Patient Summary: Scrotal cancer is rare. 10 cases were diagnosed over 10 years at a single center. Around half had disease spread to the groin nodes or distant organs at presentation. Surgical resection was required in all patients. At the time of analysis, half of the patients are alive. Due to the rarity and aggressiveness of the cancer, management should be carried out within a specialist center., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Spontaneous scrotal enterocutaneous fistulas (ECFs) are rare and more common in countries with poor access to medical care. Our patients represent the first two reported adult cases of scrotal ECFs in the United States. Both patients were 83-year-old males who presented from assisted living facilities with past medical histories of prostate cancer. The first patient had an ECF from his cecum to right scrotum and the second patient had an ECF from his sigmoid colon to left scrotum. These are the first recorded cases describing spontaneous scrotal ECFs in adults in the United States. They are also the seventh and eighth reported cases worldwide. Both patients had delayed presentations of their incarcerated hernias because their scrotal ECFs decompressed their incarcerated bowels and attenuated the development of obstructive symptoms. Each patient underwent a successful orchiectomy by urology and bowel resection with ligation of their scrotal ECFs, and herniorrhaphy by general surgery., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To describe the surgical technique and evaluate the safety, feasibility, and preliminary outcomes of perineal closure with fasciocutaneous flaps as an alternative to scrotoplasty for large genital wounds., Methods: Cases of perineal closure with fasciocutaneous flaps and thigh pouch creation for patients having undergone scrotectomy from January 2015 until August 2022 were reviewed for operative details and surgical outcomes., Results: Twenty patients were identified undergoing this procedure. Patients had a median age of 64 (Inter-quartile range [IQR] 58-70), body mass index of 34 (IQR 29-40) and Charlson comorbidity index of 5 (IQR 4-8). Median total wound area was 443 cm 2 (IQR 225-600). Operative technique in all cases included testicular thigh pouch and fasciocutaneous flap creation for perineal closure; these flaps were raised from the thigh in 18 patients and abdominal wall in 8. This technique resulted in 100% closure rate of the perineum with 3 patients required abdominal split thickness skin grafting (STSG) to complete closure. Complication occurred in 3 patients (15%) with 1 wound infection and 2 episodes of bleeding. Forty percent of patients were discharged home. Median follow-up was 9 months with only 1 patient reporting pain related to thigh pouches and none desiring elective scrotoplasty., Conclusions: Despite large defects, perineal closure was completed in all patients with minimal use of STSG. Complication rates were comparable to other methods despite significant patient frailty and no patients desired staged scrotoplasty. This method of closure adds an option for the complex perineal reconstruction patient., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism, a randomized controlled trial was conducted involving boys who were 6-12 months old at surgery and were diagnosed with clinically palpable, inguinal undescended testis. Between June 2021 and December 2021, these boys at Fujian Maternity and Child Health Hospital (Fuzhou, China) and Fujian Children's Hospital (Fuzhou, China) were enrolled. Block randomization with a 1:1 allocation ratio was employed. The primary outcome was testicular function assessed by testicular volume, serum testosterone, anti-Müllerian hormone (AMH), and inhibin B (InhB) levels. Secondary outcomes included operative time, amount of intraoperative bleeding, and postoperative complications. Among 577 screened patients, 100 (17.3%) were considered eligible and enrolled in the study. Of the 100 children who completed the 1-year follow-up, 50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy. The testicular volume, serum testosterone, AMH, and InhB levels in both groups increased markedly after surgery (all P < 0.05), but there were no apparent differences between groups at 6 months and 12 months after operation (all P > 0.05). No differences between the scrotal and inguinal groups were noted regarding the operative time ( P = 0.987) and amount of intraoperative bleeding ( P = 0.746). The overall complication rate (2.0%) of the scrotal group was slightly lower than that of the inguinal group (8.0%), although this difference was not statistically significant ( P > 0.05). Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism, with similar operative status and postoperative complications. Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism., (Copyright © 2023 Copyright: © The Author(s)(2023).)