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Fırat Tıp Dergisi
2016, Cilt 21, Sayı 2, Sayfa(lar) 096-098
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Perineal Ectopic Testis: An Unusual Cause of Perineal Pain and Empty Scrotum
Ali AKKOC1, Murat DIRAMALI2, Selcuk ALTIN1, Ramazan TOPAKTAS1, Cemil AYDIN1, Yasin ARIFOGLU3, Ahmet METIN4
1Gazi Yasargil Education and Research Hospital, Urology, Diyarbakir, Turkey
2Abant Izzet Baysal University, Faculty of Medicine, Department of Anatomy, Bolu, Turkey
3Bezmiale Foundation University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
4Abant Izzet Baysal University, Faculty of Medicine, Department of Urology, Bolu, Turkey
Keywords: Ektopik, Perineal, Testis, Ectopic, Perineal, Testis
Summary
Perineal ectopic testis is a rare congenital anomaly in which the testis is abnormally situated between the penoscrotal raphe and the genitofemoral fold. Etiopathogenesis of perineal ectopic testis is controversial. Perineal ectopic testis is frequently associated an inguinal hernia and can sometimes be associated with other disorder such as hypospadias and scrotal anomalies. Perineal ectopic testis is relatively rare but is easily recognized and treated by orchiopexy. Diagnosis is easily based on physical examination that reveals an empty scrotum and a soft tissue mass in perineal region. Histopathologically, the course of perineal ectopic testis is better than undescended testis. We report a 21 years old male with perineal pain and empty right scrotal sac. He was diagnosed to have perineal ectopic testis and was treated with orchiopexy.
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  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
    • Introduction
    Testicular maldescence is the most common anomaly of the genitalia with incidence of 1.5%. It is reported that 5 % of maldescended testes are ectopic1. Etiopathogenesis of perineal ectopic testis (PET) is controversial. The role of the gubernaculum is not well elucidated. For some authors this ectopy results from a gubernaculum failure and it's due to an anomaly of fixation of the distal extremity of the gubernaculum testis resulting in an abnormal position of the testis2,3.

    The five major sites of ectopic testes are the superficial inguinal pouch, femoral, suprapubic, transverse (contralateral hemiscrotum), and perineal3. PET is a rare congenital anomaly in which the testis is abnormally situated between the penoscrotal raphe and the genitofemoral fold4. For some authors this ectopic testis may be due to a mechanic obstruction of scrotal inlet or in the entrance of the testis in the scrotum (which become fibrous) that leads the gonad to an abnormal position5.
  • Top
  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
    • Case Presentation
    A 21-year-old man was admitted to the urology clinic because of perineal pain while he is walking and sitting and right empty scrotum. General and systemic examination revealed nothing abnormal. Perineal examination showed a right empty and less developed scrotum. The left testis was present in the scrotum but right testis was not present in the scrotum and inguinal region. An oval shaped soft mass was found in the perineal region. The diagnosis of right ectopic testis was made (Figure 1). By ultrasonography, a right PET that is 3.8x2.0x2.2 cm in diameter and normally echogenicity was demonstrated. Transrectal and urinary system ultrasound showed no pathology. His medical and family histories were unremarkable. The semen parameters, sex hormones and biochemically parameters were normal. Surgical exploration through inguinal incision revealed gubernaculum testis attached with perineal tissues. The testis was mobilized and gently delivered into the inguinal wound. It was found to be small in size with adequate length of the vas deferens and spermatic vessels; the testis was fixed in the ipsilateral scrotum using the standard dartos pouch technique (Figure 2). Follow-up revealed right testis present inside the scrotum (Figure 3).


    Click Here to Zoom    		 Figure 1: The right perineal testis that was observed by perineal examination.


    Click Here to Zoom    		 Figure 2: The right testis that fixed in the ipsilateral scrotum using the standard dartos pouch technique.


    Click Here to Zoom    		 Figure 3: The right testis that replaced inside the scrotum

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  • Summary
  • Introduction
  • Case Presentation
  • Disscussion
  • References
    • Discussion
    The cause of testicular ectopia is unknown but it is thought to be due to abnormal position of genito-femoral nerve which leads to an abnormal migration of gubernaculum and thus takes testis to abnormal position6. Ectopic testis can be found at opposite side of the scrotum, suprapubic region, femoral canal, perineum, and anterior abdominal wall7. Perineal testicular ectopia is seen very rarely and bilaterality is even more scarce8. The perineal ectopic testes have been reported in the literature and 80% of these cases are unilateral4. An empty scrotum with a soft perineal mass on ipsilateral side is very suggestive of perineal testis as was the case in this patient9. As this case, perineal pain may be a symptom of PET, too. Some cases of ectopic testis diagnosed on ultrasound, antenataly at 38 weeks and confirmed in postnatal period by clinical examination, are also reported2.

    Ectopic location of the testes is associated with a number of complications like trauma, torsion and infertility4. It is generally accepted that undescended testis should not be operated before 6 months of age, but surgery for ectopic testes should be carried out before the age of 6-months even if not associated with inguinal hernia1.

    Perineal ectopic testes are usually explored through standard inguinal skin-crease incision; some surgeons use a low scrotal approach due to the low incidence of concomitant hernia9. Perineal ectopic testis is frequently associated an inguinal hernia and can sometimes be associated with other disorder such as hypospadias and scrotal anomalies10. The hernia sac and other anomalies weren't noted in this patient. Gubernaculum is usually found fixed to the perineum as was noted in this case. The testes can be placed in ipsilateral hemiscrotum easily because the spermatic cord and vessels will be sufficiently long1. The functional outcome of ectopic testis is difficult to define, but has been found to be similar to other forms of maldescended testis9. Histopathologically, the course of perineal ectopic testis is better than undescended testis5. Consequently, PET is certainly kept in mind in differential diagnosis of perineal pain and empty scrotum and also all of the cases should be researched in terms of PET.

    Conflict of Interest
    No conflict of interest was declared by the authors
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  • Summary
  • Introduction
  • Case Presentation
  • Discussion
  • References
    • References

    1) Celayir AC, Sander S, Elicevik M. Timing of surgery in perineal ectopic testis: analysis of 16 cases. Pediatr Surg Int 2001; 17: 167-8.

    2) Middleton GW, Beamon CR, Gillenwater JY. Two rare cases of ectopic testis. J Urol 1976; 115: 455-8.

    3) Maidenberg M. A case of an ectopic testis in the perineum. Prog Urol 1993; 3: 268-71.

    4) Jlidi S, Echaieb A, Ghorbel S, Khemakhem R, Ben Khalifa S, Chaouachi B. Perineal ectopic testis: Report of four pediatric cases. Prog Urol 2004; 14: 532-3.

    5) Nouira F, Ben Ahmed Y, Jlidi S, et al. Management of perineal ectopic testes. Tunis Med 2011; 89: 47-9.

    6) Hutson JM. Undescended testis, torsion, and varicocele. In: Gross feld JL, O'Neil JA Jr, Fonkalsrud EW, Coran AG (eds): Pediatric surgery. 6th edition, Philadelphia: Mosby Elsevier, 2006: 1193-214.

    7) Rao PL, Gupta V, Kumar V. Anterior abdominal wall: An unusual site for ectopic testis. Pediatr Surg Int 2005; 21: 687-8.

    8) Kuyumcuoglu U, Erol D, Matay E, Ozen H. Bilateral perineal ectopic testes. Int Urol Nephrol 1990; 22: 271-3.

    9) Soomro S, Mughal SA. Perineal ectopic testis - a rare encounter in paediatric surgical practice. J Coll Physicians Surg Pak 2008;18:386-7.

    10) Dogruyol H, Balkan E. Perineal ectopic testis. Br J Urol 1992; 69: 547.
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  • Summary
  • Introduction
  • Case Presentation
  • Discussion
  • References
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