Dataset Information

Asynchronous bilateral leiomyomata of tunica vaginalis: A case report.

ABSTRACT: Leiomyomata are smooth muscle tumours that are slow growing and benign. We report a case of bilateral leiomyomata arising from tunica vaginalis. A 65 year old presented with a 5-year history of a slow growing left testicular mass and underwent radical orchidectomy. He presented again 18 months later with a slow growing right testicular mass and underwent local surgical resection. In both the cases the diagnosis of tunica vaginalis leiomyoma was determined through subsequent histopathological analysis. We hope to inform urologists to be aware of this benign rare entity as it can be cured through a simple, organ preserving surgical excision.

SUBMITTER: Varma R

PROVIDER: S-EPMC6861614 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Asynchronous bilateral leiomyomata of tunica vaginalis: A case report.

Varma Raghav R Stitson Richard R Malki Manar M

Urology case reports 20191101

Leiomyomata are smooth muscle tumours that are slow growing and benign. We report a case of bilateral leiomyomata arising from tunica vaginalis. A 65 year old presented with a 5-year history of a slow growing left testicular mass and underwent radical orchidectomy. He presented again 18 months later with a slow growing right testicular mass and underwent local surgical resection. In both the cases the diagnosis of tunica vaginalis leiomyoma was determined through subsequent histopathological ana ...[more]

PMID: 31763172

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Project description:INTRODUCTION:In testicular torsion, ischemia time from pain onset impacts testicular salvage. A tunica albuginea fasciotomy to relieve compartment pressure followed by a tunica vaginalis flap (TVF) may enhance salvage. OBJECTIVE:To define the optimal window of ischemia time during which TVF may be most beneficial to avoid orchiectomy. STUDY DESIGN:A retrospective cohort study of males presenting with testicular torsion at a single tertiary-care institution from January, 2003 to March, 2017. Ischemia time was defined as duration of pain from onset to surgery. Because TVF would be an option to orchiectomy, and it was found that ischemia time was longer in testicles that underwent orchiectomy, matching was performed. Cases of torsion treated with TVF were matched 1:1 with cases treated with orchiectomy on age at surgery, and ischemia time. Outcomes included postoperative viability, defined as palpable testicular tissue with normal consistency, and atrophy, defined as palpable decrease in size relative to contralateral testicle. Sensitivity analyses were performed restricting to the subgroups with postoperative ultrasound, >6 months' follow-up, and additionally matching for degrees of twist. RESULTS:A total of 182 patients met eligibility criteria, of whom 49, 36, and 97 underwent orchiectomy, TVF, and septopexy alone, respectively. Median follow-up was 2.7 months; 26% of patients had postoperative ultrasound (61% of TVF group). In the orchiectomy, TVF, and septopexy groups, respectively, median ischemia times were 51, 11, and 8 h, postoperative viability rates were 0, 86, and 95%, and postoperative atrophy rates were 0, 68, and 24%. After matching, 32 patients with TVF were matched to 32 patients who underwent orchiectomy. In the TVF group, postoperative viability occurred in 95% (19/20) vs 67% (8/12) of patients with ischemia times ?24 and >24 h, respectively. Atrophy occurred in 67% (12/18) vs 83% (10/12) of these same respective patients. Sensitivity analysis by ultrasound and longer follow-up found similar viability results, although atrophy rates were higher. Additional matching for degrees of twist showed lower viability and higher atrophy rates for increasing ischemia times. DISCUSSION:Patients who presented with testicular torsion with ischemia times ?24 h and who were being considered for orchiectomy may have benefitted most from TVF, albeit at high risk of atrophy. However, for ischemia times >24 h, TVF may still have preserved testicular viability in two-thirds of cases. A limitation was short follow-up. CONCLUSION:A TVF was a valid alternative to orchiectomy for torsed testicles, albeit with high testicular atrophy rates.

Dataset Information

Asynchronous bilateral leiomyomata of tunica vaginalis: A case report.

Publications

Asynchronous bilateral leiomyomata of tunica vaginalis: A case report.

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