Surgical findings in cryptorchidism in children with Zika-related microcephaly: a case series
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CASE REPORT
Surgical findings in cryptorchidism in children with Zika‑related microcephaly: a case series Rômulo A. L. de Vasconcelos3* , Ricardo A. A. Ximenes3,4, Adriano A. Calado3, Celina M. T. Martelli1, Andreia V. Gonçalves3,4, Elizabeth B. Brickley2, Thalia V. B. de Araújo4, Maria A. W. Rocha3 and Demócrito de B. Miranda‑Filho3*
Abstract Background: Complications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Per‑ nambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zikarelated microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent. Methods: A total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchi‑ dopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate. Results: We found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testisepididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic guber‑ nacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac. Conclusions: We herein describe the surgical findings of these children’s orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume. Keywords: Congenital Zika syndrome, Cryptorchidism, Microcephaly, Zika virus, Orchiopexy, Surgery, Case series Background Although neurodevelopmental impairments and structural brain defects are amongst the most common features in children with Zika-related microcephaly (ZRM), the condition has also been increasingly associated with *Correspondence: [email protected]; [email protected] 3 Universidade de Pernambuco, Rua Arnóbio Marques, 310 – Santo Amaro, Recife, PE 50100‑130, Brazil Full list of author information is available at the end of the article
abnormalities across a range of organ systems [1]. It is now recognized that a high frequency of children with ZRM may present with cryptorchidism [2]. Cryptorchidism is known to be associated with testicular cancer, infertility, and hypogonadism [3]. Here, we provide the first report on the findings of
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