Transverse Testicular Ectopia and Persistent Müllerian Duct Syndrome in Pediatric Patients: A Multicentric Study with Ultrasound Insights

Transverse Testicular Ectopia (TTE) is an uncommon form of undescended testicle, and its occurrence alongside Persistent Müllerian Duct Syndrome (PMDS) is even rarer. TTE involves one testicle crossing the scrotal septum or descending into the opposite inguinal canal, resulting in both testes residing in the same hemiscrotum. In some cases, this condition is associated with persistent Müllerian structures. This report presents six cases of TTE, detailing their surgical management and proposing recommendations for handling such cases. Medical records from six different centers were reviewed, with all patients having at least one year of post-operative follow-up. Diagnoses were made using clinical assessments and ultrasound imaging, and all six cases were managed with a laparoscopic approach. Two patients underwent a two-stage Fowler-Stephens procedure, one incorporating the Prentiss maneuver for optimal testicular positioning, while the other utilized transseptal repositioning. Two patients had their testes repositioned in a single-stage laparoscopic Fowler-Stephens surgery. The final two patients, after laparoscopic exploration revealed both testicles passing through one inguinal ring, underwent an open inguinal orchiopexy with midline scrotal septum repositioning. Notably, three out of six patients had PMDS, but the Müllerian remnants were not resected as they were closely related to the blood supply of the testes or vas deferens. Post-operative ultrasounds after one year showed homogeneous testicular echogenicity, with adequate gonadal volume and proper scrotal positioning. TTE is a rare condition that should be considered in cases of undescended testicle or inguinal hernia. The approach to each case should be based on the individual anatomy, with laparoscopic exploration as the preferred method, followed by surgical correction of cryptorchidism. While removing Müllerian remnants is typically recommended, it may not always be possible when these structures are intimately connected with the testes.