A reevaluation of the structures accepted to represent the postnatal gubernaculum

The round ligament of the uterus: Questioning its distal insertion

PURPOSE

Classically, the round ligament of the uterus (RLU) attaches distally in the ipsilateral labia majora. This attachment has rarely been described in adults. That is why we have performed an anatomical study focused on this distal ending.

PATIENTS

We performed in 2015 the cadaveric dissection of 19 RLU.

METHODS

In all cases, the RLU was individualized on its entire length from its uterine origin to the inguinal canal. Then this canal was open from its internal orifice to its external orifice. We described the distal attachment of the RLU according four areas: before the internal inguinal ring, after the external inguinal ring, under the pubic bone and in labia majora.

RESULTS

We found 3 types of distal attachments with first an attachment after the external inguinal ring in more than half of cases (52.6%). Then, before the internal inguinal ring (26.3%) and under the pubic bone (22.1%). No RLU was found inlabia majora. However, the proximal attachment seems constant at the antero-superior face of uterus, near the tubo-uterine junction like its pelvic path under the broad ligament.

CONCLUSION

In adult, the RLU is a structure, which begins at the cranio-ventral part of the uterine bottom near the tubo-uterine junction. Then it passes under the broad ligament and reaches the inguinal canal, that it crosses in more half of cases. However, 3 distal attachment areas have been identified but never in the labia majora. Indeed, some anatomical information available in anatomical treaties seems not correct and should be amended.

Anatomy and histology of the scrotal ligament in adults: inconsistency and variability of the gubernaculum testis

PURPOSE

The anatomy of gubernaculum testis (GT) is often discussed; however, the postnatal anatomy of the GT or scrotal ligament (SL) is rarely described. Hence, we performed an anatomical and histological study to analyze histologically the structures between testis and scrotum.

METHODS

We performed anatomical dissections on 25 human fresh cadavers' testes. Each testis was removed with its envelopes and macroscopically analyzed. Then samples were included for histological study. Finally, they were analyzed under microscope, looking for attachments between testis, epididymis and scrotal envelopes.

RESULTS

The absence of proximal and distal attachment was found in 56.0% of cases. Looking at the proximal attachment of the SL, the main one found is the epididymal attachment (28.0%), whereas no cases of testis attachment was found. Distally, there are more variations with scrotal attachment (12%) and cremaster attachment (12.0%). We found a significant prevalence of multiple adherences in 16.0% of cases too. Finally, in 15 cases (57.7%) an attachment is present between testis and epididymis, as it is commonly described.

CONCLUSIONS

In the majority of cases there is no attachment of the lower pole of the testis and epididymis and these structures remain free. So it seems that the SL disappears with aging. Moreover, there is not only one kind of ligamentous attachment, but a high variability of attachments at the lower pole of the testiculo-epididymal structure. When it exists, this structure is never a real ligament and it seems more appropriate to use the term "attachments".

Tissue calcium content in piglets with inguinal or scrotal hernias or cryptorchidism

Scrotal and inguinal hernias are of great economic importance to the pig industry. These lesions are thought to result from incomplete closure of the inguinal ring and/or a patent processus vaginalis. Impairment of programmed cell death (PCD) may be involved in these abnormalities. As tissue Ca(2+) overload may be used as a measure of cell death, the aim of this study was to determine the tissue Ca(2+) content in samples of hernia sac, peritoneum, cremaster muscle and aqueous fluid from newborn piglets with scrotal or inguinal hernias (n=18) or cryptorchidism (n=18). Control samples from healthy piglets (n=20) were also evaluated. Tissue Ca(2+) content was determined by atomic absorption spectrophotometry. Significantly less Ca(2+) was found in the sacs (0.005 mg/g wt), peritoneal tissue (0.100 mg/g wt) and cremaster muscles (0.008 mg/g wt) of piglets with inguinal or scrotal hernias compared with control tissues (0.184, 0.144 and 0.048 mg/g wt for sacs, peritoneal tissue and cremaster muscles, respectively). These findings suggest that there may be perturbation of the apoptotic pathway in the urogenital tissues of affected piglets.

Testicular descent, cryptorchidism and inguinal hernia: the Melbourne perspective

Cryptorchidism is the commonest congenital genitourinary anomaly in males and results when the testis does not descend into its normal intrascrotal position during development. In full-term infants, the incidence is approximately 3% at birth. Cryptorchidism results in several abnormalities, including attenuated spermatogenesis, infertility and a greater risk of malignancy. The normal mechanism of testicular descent appears to be multi-staged, with various anatomical factors and hormonal influences, but the exact process is still unclear. In this article we review the current theories of normal testicular descent, with a focus on the hormones and anatomical factors, and current treatments for undescended testis.