Early diagnosis and aggressive treatment of testicular rhabdomyosarcomas including surgery and chemotherapy significantly reduce local recurrence and improve survival rates in young adults with metastases. Adjuvant chemotherapy is highly recommended to enhances prognosis and survival outcomes.

BACKGROUND: Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making.
METHODS: A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study\'s quality was conducted by utilizing the revised Cochrane risk-of-bias tool.
RESULTS: Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges.
CONCLUSIONS: Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.

Varicocele is the most common and treatable cause of male infertility. Therefore, surgical treatment of varicocele should be recommended for motivated patients and infertile couples who do not have other identified causes of infertility. Varicocelectomy has been proved to improve sperm parameters and improve chances of successful conception in most patients. However, surgical treatment is associated with certain risks, and therefore, the choice of the optimal treatment is under discussion. A total of 78 articles using a search in MEDLINE database (PubMed) were found and included in the review, dedicated to current concepts of functional anatomy of testicular arteries and veins. The current recommendations of professional communities regarding the selection of patients for varicocelectomy are described. The efficiency and safety of various surgical procedures for varicocele is analyzed. This review suggests high inconsistences in the literature. The available information on the indications for surgical treatment, as well as comparative data on the efficiency and safety of the inguinal, laparoscopic and microsurgical sub-inguinal approaches are presented. When urologist faces with a diagnosis of varicocele, individual approach should be applied, with a discussion of both benefits and possible complications of surgical treatment. Of the many existing techniques, microsurgical ligation of dilated veins is the most preferred.

Femoral hernia repair has various surgical methods. However, controversy still exists regarding the best method for management. This study aimed to compare the infrainguinal with the inguinal approach in the treatment of femoral hernias.
Eighty patients with primary unilateral femoral hernias were prospectively randomized to either the infrainguinal (n = 40) or inguinal approach groups (n = 40). Patient demographics, operative time, duration of hospital stay, postoperative complications, and recurrence rate were recorded.
There were no statistically significant differences between both study groups with respect to the patients\' demographics and associated comorbidities. Regarding inpatient outcomes, there were no differences between the infrainguinal and inguinal approach groups concerning the postoperative duration of stay (P = 0.248), urinary retention (P = 0.494), superficial wound infection (P = 0.494), seroma (P = 0.615), foreign body sensation (P = 0.615), and chronic pain (P = 0.359). However, total complications were encountered in 3 patients (7.5%) in the infrainguinal approach group compared to 11 patients (27.5 %) in the inguinal approach group (P = 0.037). Also, the mean operative time was significantly shorter in the infrainguinal approach group compared to that in the inguinal group (P < 0.001). Throughout the 15 mo median follow-up duration, there was no recurrence in the inguinal approach group and one (2.5%) recurrence in the infrainguinal approach group (P = 1.000).
In patients undergoing elective primary femoral hernia repair, the infrainguinal approach has a similar clinical curative effect to that of the inguinal approach. However, the former has the advantages of simple operation, short operation time, and fewer complications.

Single spinal anesthesia in transurethral resection of bladder tumor (TURBT) has been reported to be unable to prevent obturator nerve stimulation and adductor muscle contraction, which can cause complications like bladder perforation. The present study aimed to compare the effectiveness of the classic and inguinal approaches for obturator nerve block (ONB ). Seventy patients with cancers of the lateral wall of the bladder, scheduled to undergo TURBT at Imam Reza Hospital (Tabriz, Iran) during a 6-month period as of June 2016, were randomly allocated to groups of inguinal and classic methods (n=35). After the infusion of 500 mL of normal saline, spinal anesthesia was commenced using 3 mL (15 mg) of bupivacaine. Then ONB was performed using 10 mL of 1% lidocaine via the inguinal or classic approach in the inguinal group or the classic group, respectively. The success rate, defined as lack of post-block contraction with stimulation or during surgery, number of puncture attempts, time of block onset, and patient and surgeon satisfaction, was compared between the 2 methods using SPSS, version 19. The success rate of ONB was significantly higher in the inguinal group (97.1% vs. 71.4%; P=0.003). The number of puncture attempts in the classic group was more than that in the inguinal group (3.71±1.10 vs. 1.66±0.68, respectively; P<0.001). The block onset time was shorter in the inguinal group (1.5±0.66 min vs. 2.9±1.18 min; P<0.001). Dissatisfaction of the patient (19 cases vs. 2 cases) and the surgeon (10 cases vs. no case) was higher in the classic group (P<0.001). Compared to the classic approach, the inguinal approach for ONB appeared to be an easily performable, effective block with a high success rate, rapid onset, and good patient and surgeon satisfaction.
BACKGROUND: IRCT 201608171772N21.

The objective of the study was to determine whether a less-invasive surgical technique used in cryptorchid horses, dogs and cats can be used successfully to remove retained testicles in pigs on farm. In total, 284 monolateral cryptorchid pigs underwent surgery on-farm condition, during which an incision was made over the inguinal ring and the undescended testicle was located for removal via identification of the vaginal process and the embryonic gubernaculum. A traction of these structures allowed the testis to pass through the deep and the superficial rings up to its exteriorisation outside the abdominal wall through the inguinal canal. The undescended testicle was located in the abdomen in 258 cases (90.8 per cent) and in the inguinal region in the remaining 26 cases (9.1 per cent). In none of the pigs was the abdominal cavity breached or the inguinal rings enlarged. However, in 23 pigs (8.1 per cent) the gubernaculum testis was thin and it frayed and ruptured when traction was applied, requiring a recovering by inserting a finger and Kelly curved forceps into the abdomen through the inguinal ring. In two pigs (0.7 per cent), the undescended testicle was not found. All surgical procedures were completed within 6-12 minutes. Four pigs died within two days after surgery (1.4 per cent). Major intraoperative or long-term complications did not occur. Results suggested that this surgical method is highly effective and could be used as a primary surgical approach in cryptorchid pigs as it is in cryptorchid dogs, cats and horses.

BACKGROUND: The single scrotal incision orchidopexy was described by Bianchi in 1989. Despite its popularity, the place of this technique in the treatment of cryptorchidism in children is still unclear.
OBJECTIVE: To evaluate and compare the outcomes of the conventional inguinal approach and the scrotal approach for the treatment of palpable undescended testis in children.
METHODS: A prospective study for all patients with palpable undescended testis undergoing orchidopexy between January 2011 and December 2013 was conducted. Totally 200 patients were randomly divided into two groups: group 1: two incisions inguinal approach (80 patients, 100 testis); group 2: single scrotal incision approach (89 patients, 100 testis).
RESULTS: The patients\' mean age was 53.9±13 months in group 1 and 45.8±9 months in group 2. There was no statistical difference between the two groups in terms of patient age (P=0.8) and location of the undescended testis (P=0.359). Operative time was statistically significantly lower in the scrotal group (P<0.05). There was a significant difference in the complications rates between the two groups.
CONCLUSIONS: The single scrotal incision orchidopexy is safe and effective for undescended testicles palpable in the inguinal canal or in high scrotal position.

OBJECTIVE: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia.
METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB.
RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032).
CONCLUSIONS: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

BACKGROUND: The inguinal approach to the distal part of the ureter allows the surgeon to perform various types of procedures and is considered to be one of the minimally invasive techniques in pediatric surgery. We aim to describe our initial experience with the surgery of the distal ureter performed through an inguinal mini-incision.
METHODS: Between March 2012 and June 2013, 8 patients were treated using a minimally invasive inguinal technique. The indications for surgical correction were single system primary obstructive megaureter, obstructive megaureter of the upper pole in a duplex kidney and distal ureteral stones. In all patients with single system obstructive megaureter and significant hydronephrosis, ureterocutaneostomy was performed. In one patient with duplex system primary obstructive megaureter and significant hydronephrosis of the upper pole, ureteroureterostomy of the dilated ureter to the normal caliber ureter in the distal part was performed. In the second patient with duplex system primary obstructive megaureter and reduced marker excretion of the upper pole in renal scintigraphy, ureterocutaneostomy was performed. In both cases of distal ureteral stones, deposits were removed by a simple incision.
RESULTS: We did not observe any perioperative or postoperative complications. The imaging studies have shown that ureteral dilatation decreased in all but one child in whom the upper pole and the ureter were resected due to lack of function.
CONCLUSIONS: The inguinal approach allows for the adequate visualization of the distal ureter, creating the conditions for implementation of the various procedures, reduces the risk of retrovesical plexus injury and minimizes visible scars.

BACKGROUND: Selective obturator nerve blockade (ONB) is an effective option to prevent adductor spasm during transurethral resection of bladder tumors (TURBT) involving the lateral wall under spinal anesthesia (SA). The classic approach is less popular as the obturator nerve is deep seated and associated with vascular injury. The inguinal approach was described as a safer alternative. This randomized clinical study was undertaken to compare the ease of block, the success rate and complications of the classic pubic and superficial inguinal approach for ONB.
METHODS: A total of 30 patients scheduled to undergo TURBT under SA were administered bilateral ONB. Inguinal approach recently described by Choquet was performed on one side and classic approach described by Labat was performed on the other side in random order using a nerve stimulator. The ease of block, success rate (number of attempts to accomplish the block) and complications were noted and compared between both the approaches. Chi-square analysis was performed to compare the ease of approach of the two techniques. Non-parametric analyses using Mann Whitney test was used to compare the number of attempts to accomplish the block in each approach. A value of P < 0.05 was considered statistically significant.
RESULTS: The ease of block (P = 0.09) and the median number of attempts to accomplish the block (P = 0.45) were comparable between the two approaches. The incidence of vascular injury was higher in classic approach (P = 0.056).
CONCLUSIONS: Inguinal approach is a useful alternative to classic approach block for patients undergoing TURBT under SA.