Laparoscopy and Transseptal Orchiopexy in the Management of Transverse Testicular Ectopia

Abstract

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes descend through the same inguinal canal. The most frequent clinical presentation is undescended testis (UDT) with ipsilateral inguinal hernia and contralateral non-palpable testis. This condition is often diagnosed during surgery and is frequently associated with other anomalies. There is controversy in the surgical management of TTE. Considerations for TTE repair include avoiding damage to the testes or vas deferens and detection of other congenital anomalies. Frequently, the vas deferens and testicular tissues are joined, and dissection of these structures can cause damage. In this article, we report four patients with TTE, describe the surgical approach made in each case, and provide a review of the literature.

Management of Transverse Testicular Ectopia with Persistent Mullerian Duct Syndrome

“…Because of the presentation with undescended testis or symptomatic inguinal hernia, TTE is detected during the surgery in many patients [1, 2, 5, 7]. Sometimes, both testes may be palpated on the same side with ipsilateral inguinal hernia and contralateral unpalpable testis, as in our patient.…”

“…Type II is accompanied by PMDS (20%–30%). Type III is accompanied by other anomalies such as DSD, hypospadias, scrotal abnormalities, seminal vesicle cysts, common deferent duct, and horseshoe kidney [2, 3, 5–7]. Based on this information, it can be said that our patient is type II TTE.…”

“…Development of both testes from the same germinal ridge, early fusion of Wolffian ducts, testicular adherence to mullerian structures, and obstruction of the inguinal ring are suggested as causative in failure of testicular descent. The most widely accepted theory is abnormal attachment of gubernaculum which was proven by experimental studies [3–5, 7,10].…”

“…Preoperative diagnosis requires a high level of suspicion. If necessary, imaging methods should be used to support diagnosis [1, 3, 5, 7].…”

“…Transverse testicular ectopia (TTE) is a rare anomaly in boys in which both testes pass through the same inguinal canal, and it is usually accompanied by an inguinal hernia [1–5]. The majority of patients present with ipsilateral inguinal hernia and contralateral nonpalpable testis [1–4, 6–8].…”