Korean J Obstet Gynecol.  2012 Mar;55(3):209-212. 10.5468/KJOG.2012.55.3.209.

Laparoscopic gonadectomy of streak gonads within the inguinal canals in a patient with XY partial gonadal dysgenesis

• Song MH
• Ahn BN
• Kim HK
• Oh HK
• Lee TS
• Choi YS

• KMID: 2274130
• DOI: http://doi.org/10.5468/KJOG.2012.55.3.209

Abstract

A 33-year-old phenotypic female presented with primary amenorrhea. The physical examination revealed no breast development, scanty axillary and pubic hair, normal female external genitalia, and a short blind vagina. The findings of magnetic resonance imaging, karyotyping, and hormonal examinations supported the diagnosis of XY partial gonadal dysgenesis. Laparoscopic surgery showed that spermatic cords, including the bilateral streak gonads and epididymes, were within the inguinal canals. After opening the spermatic cords and identifying the lower borders of the streak gonads, the spermatic cords were transected at the level of the vas deferens. A prophylactic herniorrhaphy using polyprophylene mesh was performed due to weakening of the internal inguinal ring. Pathologic evaluation of the gonads confirmed the diagnosis of partial gonadal dysgenesis without evidence of malignancy. A laparoscopic approach is feasible for treatment of XY gonadal dysgenesis, even if the streak gonads are present within the inguinal canal.

Keyword

Laparoscopy; Gonadectomy; Gonadal dysgenesis; Inguinal canal; Streak gonad

MeSH Terms

Adult
Amenorrhea
Breast
Female
Genitalia
Gonadal Dysgenesis
Gonads
Hair
Herniorrhaphy
Humans
Inguinal Canal
Karyotyping
Laparoscopy
Magnetic Resonance Imaging
Physical Examination
Spermatic Cord
Vagina
Vas Deferens

Figure

• 

  Fig. 1 Laparoscopic findings during surgery. (A) Left gonadal vessel (arrow) was identified lateral to the left external iliac artery (arrow head), and the distal ends of the gonadal vessel entered into the internal inguinal ring. (B) After peritoneal incision was made along the gonadal vessel, further dissection in the direction of the inguinal area revealed a spermatic cord (asterisk) and internal inguinal ring (arrow). (C) The spermatic cord (arrow head) was opened with monopolar scissors. A streak gonad (arrow), as a white band-like structure and epididymis (asterisk) was found in the spermatic cord. (D) Identifying the distal end (arrow) of the streak gonad (asterisk) (E) Vas deferens distal to the gonad was transected with LigaSure. Asterisk, spermatic cord.

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