PDF-524.pdf 433Vol. 9 | No. 1 | Winter 2012 |U R O LO G Y J O U R N A L Keywords: testis, orchiopexy, abnormalities, diagnosis INTRODUCTION PJohn Hunter in 1786.(1) An undescended testis can be located anywhere in the pathway of testicular descent outside the scrotum. The testis can also be located in an ectopic position. The most common regions in descending order canal, contralateral scrotum, and prepenile region. Perineal ectopic testis is seen approximately in 1% of all cases of undescended testes.(2) An empty hemiscrotum with palpable perineal soft mass is suggestive of an ec- topic testis in the perineum. Antenatal diagnosis of perineal ectopic testis can be made ultrasonographically.(3) - agement. CASE REPORT A 19-year-old man presented to our outpatient clinic with a perineal mass and discomfort. Examination showed an empty and poorly developed left hemiscro- tum. The contralateral testis was in its normal location in the right hemiscrotum (Figure 1). An oval-shaped soft mass was detected in the perineum measuring 4 × 5 × 6 cm. A clinical diagnosis of perineal ectopic testis was made. We recommended orchidectomy for the left perineal testis because of the pa- Gokhan Koc, Selim Yavuz Sural, Devrim Nihat Filiz, Yuksel Yilmaz Perineal Ectopic Testis Corresponding Author: Gokhan Koc, MD Tepecik Teaching and Research Hospital, Izmir, Turkey Tel: +90 232 469 6969 Fax: +90 232 433 0756 E-mail: gokfekoc@gmail. com Received January 2010 Accepted December 2010 Tepecik Teaching and Research Hospital, Izmir, Turkey Case Report 434 | tient’s age. However, the patient wanted his testis placed in the scrotum; hence, a left orchiopexy was performed. Surgical exploration was per- formed through inguinal skin crease incisions. using the dartos pouch technique (Figure 2). Postoperative examination at one month revealed a normally located left testis in the scrotum (Fig- of the surgery. DISCUSSION Descent of the testis is thought to occur in two phases; intra-abdominal migration and inguinal migration. Testicular development and descent from the abdomen to the scrotum is a complex hormonal, and certain mechanical factors. The ectopic testis completes normal transinguinal mi- gration, but is misdirected outside the normal path of descent below external ring. Perineal testis is the commonest form of true testicular ectopia, testis is a rare congenital anomaly.(4) The etiology of testicular ectopia is unknown; however, some theories like gubernacular abnor- malities, genitofemoral nerve disorders, increased intra-abdominal pressure, and endocrine disor- ders are the most prominent ones.(5) Lockwood suggested that distal part of the gubernaculum has normal descent is seen and if another insertion is dominant, the insertion diverts the testis toward itself leading to ectopy.(6) Furthermore, it is pos- the gubernaculum prohibits natural descent of the testes.(7) Hutson suggested that abnormal position of genitofemoral nerve leads to an abnormal mi- gration of the gubernaculum and pushes the testis to abnormal position.(8) Middleton and colleagues also reported that increased intra-abdominal pres- Figure 1. A left empty hemiscrotum and a mobile testicular mass in the perineum. Figure 2. Surgical exploration of the left ectopic testis through inguinal incision. Figure 3. Scrotum at one-month following surgery. Case Report 435Vol. 9 | No. 1 | Winter 2012 |U R O LO G Y J O U R N A L Perineal Ectopic Testis | Koc et al sure could facilitate testicular descent.(9) Lozano Ortega and associates stated that inadequate hor- monal stimulation may lead to ectopy. The ectopic location of the testis is associated with a number of complications, such as trauma, torsion, and infertility in bilateral cases.(11) There- fore, treatment is warranted. Most authors recom- mend surgical correction at approximately 1 year be demonstrated in the undescended testes.(12) Or- chiopexy is the treatment of choice under 2 years of age. But if an atrophic testis is detected, or- chidectomy should be performed. - sition, all the possible sites for an ectopic testis - cated that in cases of perineal ectopic testis, sur- gery should be performed before 6 months of age even if not associated with inguinal hernia.(2) Testicular cancer is more common in an ectopic testis than in a normally descended organ. There- fore, we recommended the patient an orchidec- tomy. However, he wanted his testis placed in the scrotum. Thus, we proceeded with orchiopexy; however, long-term follow-up was advised. We believe orchiopexy is the treatment of choice in selected patients with perineal ectopic testis. However, self testicular examination and long- term follow-up is mandatory. CONFLICT OF INTEREST None declared. REFERENCES 1. Hunter J. Observations on certain parts of the animal econ- omy. London: Woellner; 1786. 2. Celayir AC, Sander S, Elicevik M. Timing of surgery in per- ineal ectopic testes: analysis of 16 cases. Pediatr Surg Int. 2001;17:167-8. 3. Mazneikova V, Markov D. Antenatal ultrasound diagnosis of perineal ectopic testis--a case report. Eur J Ultrasound. 2001;13:31-3. 4. Murphy DM, Butler MR. Preperitoneal ectopic testis: a case report. J Pediatr Surg. 1985;20:93-4. 5. Heyns CF, Hutson JM. Historical review of theories on tes- ticular descent. J Urol. 1995;153:754-67. 6. Lockwood CB. Development and Transition of the Testis, Normal and Abnormal. J Anat Physiol. 1888;22:505-41. 7. Maidenberg M. [A case of an ectopic testis in the perineum]. Prog Urol. 1993;3:268-71. 8. Hutson JM. Undescended testis, torsion, and varicocele. In: Gross feld JL, O'Neil JAJ, Fonkalsrud EW, Coran AG, eds. Pedi- atric surgery. 6 ed. Philadelphia: Mosby; 2006:1193-214. 9. Middleton GW, Beamon CR, Gillenwater JY. Two rare cases of ectopic testis. J Urol. 1976;115:455-8. 10. Lozano Ortega JL, Escolano A, Rey A. [Perineal ectopic testi- cle]. Arch Esp Urol. 1983;36:289-92. 11. Jlidi S, Echaieb A, Ghorbel S, Khemakhem R, Ben Khalifa S, Chaouachi B. [Perineal ectopic testis: report of four paediat- ric cases]. Prog Urol. 2004;14:532-3. 12. Lugg JA, Penson DF, Sadeghi F. Early orchiopexy reverses histologic changes in cryptorchid testes. J Urol. 1995153: 235A.