Transverse testicular ectopia: diagnostic and therapeutic algorithm

Abstract

Transverse testicular ectopia (TTE) is an uncommon anatomical anomaly where a testicle is mistakenly guided into the contralateral inguinal canal and may be associated with persistent Müllerian duct syndrome (PMDS).

Objective: To describe 2 cases of TTE and to propose a diagnostic and therapeutic algorithm.

Clinical Cases: Case 1: Term newborn, male, with bilateral non-palpable testicles. At one month of age, two structures with testicular consistency were palpated in the right inguinal canal. Ultrasound showed left TTE. Karyotype 46XY. At 8 months, he underwent bilateral open orchiopexy and resection of pelvic Müllerian remnants. Low anti-Müllerian hormone levels. Findings were consistent with PMDS. After 3 months, cystoscopy and laparoscopy were performed, ruling out Müllerian remnants and allowing for a new descent of the ascended left testicle. Postoperative recovery was favorable. Case 2: Term newborn, male, with a non-palpable right testicle and left inguinal volume increase at birth. Ultrasound at one month of age showed a left inguinal hernia and right TTE. Karyotype 46XY. Normal hormonal study. Pelvic ultrasound and exploratory laparoscopy showed no Müllerian remnants. At 9 months, cystoscopy was normal, and laparoscopic right orchiopexy and left inguinal hernioplasty were performed. Postoperative follow-up was without complications.

Conclusions: TTE is an infrequent condition that requires careful evaluation, including preoperative ultrasound, karyotype, and hormonal tests, as well as intraoperative cystoscopic and laparoscopic assessment to rule out the presence of Müllerian remnants. Treatment depends on the association with PMDS.