Testículo retrátil: estudo do músculo cremaster e de anomalias associadas

Abstract

This thesis aims to evaluate the incidence of anatomical anomalies in patients with retractile testicles and to analyze the structure of the cremaster muscle in patients with retractile testis (TR), comparing the distribution of nerves, elastic system and musculature with patients with cryptorchia and hernia inguinal (HI). Twenty patients (28 testicles) were used as materials and methods with truly retractile testicles and compared to 25 human fetuses (50 testicles) with the testicle in a scrotal position. The relationships between testis, epididymis and patency of the vaginal process (PV) were analyzed. To evaluate the relationship between the testis and the epididymis, a specific classification was used. To analyze the PV structure, two situations were considered: (a) obliteration of the PV between the inner inguinal ring and the upper pole of the testis; (b) patency of PV. The chi-square test was used to analyze the populations under study (p, <0.05). In continuation of the study, 31 patients were studied, 17 with TR (mean age = 5.17 years); nine with HI (mean age = 2.6 years) and five with cryptorchidism (mean age = 3 years). We performed a biopsy of the cremaster that was submitted to routine histological procedures and studied histochemical and immunohistochemical methods of smooth muscle, nerves, connective tissue and elastic fibers. The 25 fetuses were between 26 and 35 weeks after conception (SPC) and 20 patients with retractile testicles were aged between one and 12 years (mean 5.8). In the 50 fetal testicles, complete patency of the PV was observed in two cases (4%) and AEs in only one testicle (2%). Of the 28 retractile testicles we observed patency of PV in six cases (21.4%) and EAs in four patients (14.28%). When we compared the incidence of AEs and PV patency in the retractile testicles with the fetus, we observed a significantly higher prevalence of these abnormalities in the retractile testicles (p = 0.0116). In the comparative study between patients with retractile testicles, cryptorchidics and inguinal hérnia, we observed no difference (p = 0.08) in muscle fiber diameter, between the groups: TR (mean = 22.80μ, SD = 9.84), HI (mean = 22.76μ, SD = 3.01) and cryptorchidia (mean = 24.75μ, SD = 7.02). The muscle fiber density had a difference between the patients with TR and the group with HI (p = 0.02): Retractile (mean = 17.71%, SD = 16.67), HI (mean = 38.06%, SD = 14) and cryptorchidism (mean = 21.47%, SD = 16.18). There was no difference (p = 0.07) in elastic fiber density among the three groups: TR (mean = 8.9%, SD = 2), HI (mean = 8.92%, SD = 1.55) and cryptorchidism (mean = 10.47%, SD = 1.95). There was a lower concentration of nerve in the cremaster of patients with TR when compared to HI (p = 0.0362): TR (mean = 1.72%, SD = 0.58), HI (mean = 3.28%, SD = 0.94) and cryptorchidism (mean = 2.52%, SD = 0.53). Finally, the thesis concludes that the retractile testis is not a normal variant, with the risk of showing patency of the vaginal peritoneal canal and abnormalities of the epididymis. The retractile testis presented significant alterations in cremaster structure, with less musculature and nerves when compared to patients with inguinal hernia. The same is not a normal variant, presenting the structure of the cremaster muscle similar to the patients with cryptorchidism.