Macroscopic demonstration of the male urogenital system with evidence of a direct inguinal hernia utilizing room temperature plastination

Abstract

The male urogenital system represents a morphologically complex region that arises from a common embryological origin. However, it is typically studied separately as the excretory system is dissected with the posterior wall of the abdomen while the reproductive features are exposed with the pelvis and perineum dissection. Additionally, the reproductive structures are typically dissected following pelvic and perineal hemisection obviating a comprehensive and holistic examination. Here, we performed a dissection of the complete male urogenital system utilizing a 70-year-old donor and room temperature silicon plastination. Identification of a direct inguinal hernia during the dissection facilitated a unique opportunity to incorporate a common abdominal wall defect into the plastination requiring a novel approach to retain patency of relevant structures. Results showed that the typical structures identified in medical gross anatomy were retained in addition to the hernia. Thus, the described approach and the resulting specimen provide valuable and versatile teaching tools for male urogenital anatomy.

Keywords

• direct inguinal hernia
• genital
• male
• reproductive
• urogenital

References

1. 1. Larsen WJ, Sherman LS. Human embryology: development of the urogenital system. New York (NY): Elsevier Churchill Livingstone; 1993. p. 245.
2. 2. Sadler TW. Third to eighth weeks: the embryonic period; Urogenital system. In: Langman's medical embryology. 11th ed. Philadephia (PA): Wolters Kluwer/Lippincott Williams and Wilkins; 2010. p. 77, 246–8, 260–1.
3. 3. du Bois AM. The embryonic kidney. In: Rouiller C, Muller AF, editors. The kidney: morphology, biochemistry, physiology. Vol. 1. New York (NY): Academic Press; 1969. p. 8–11, 48.
4. 4. Gubbay J, Collignon J, Koopman P, Capel B, Economou A, Münsterberg A, Vivian N, Goodfellow P, Lovell-Badge R. A gene mapping to the sex-determining region of the mouse Y chromosome is a member of a novel family of embryonically expressed genes. Nature 1990;346:245–50.
5. 5. Rotondi M, Valenzano F, Bilancioni E, Spano G, Rotondi M, Giorlandino C. Prenatal measurement of testicular diameter by ultrasonography: development of fetal male gender and evaluation of testicular descent. Prenat Diagn 2001;21:112–5.
6. 6. Chen H, Midzak A, Luo L-d, Zirkin BR. Aging and the decline of androgen production. In: Payne AH, Hardy MP, editors. The Leydig cell in health and disease. Totowa (NJ): Humana Press; 2007. p. 117–31.
7. 7. Sanford EJ, Paulson DF, Rohner TJ, Jr., Santen RJ, Bardin CW. The effects of castration on adrenal testosterone secretion in men with prostatic carcinoma. J Urol 1977;118:1019–21.
8. 8. Georgiadis EI, Matzoros C, Aliferis C, Batrinos M. Are adrenal and testicular androgen levels correlated? Horm Metab Res 1992;24:488–91.

9. 9. Tank PW. The abdomen; the pelvis and perineum. In: Grant’s dissector. 15th ed. Philadelphia (PA): Lippincott Williams and Wilkins; 2013: 89–163. 10. Walter T. Body Worlds: clinical detachment and anatomical awe. Sociol Health Illn 2004;26:464–88.
10. 11. von Hagens G, Tiedemann K, Kriz W. The current potential of plastination. Anat Embryol (Berl) 1987;175:411–21.
11. 12. Labrash S, Lozanoff S. Standards and guidelines for willed body donations at the John A. Burns School of Medicine, 2007. Hawaii Med J 2007;66:72,74–5.
12. 13. Clark RK. Your reproductive system; Your urinary system. In: Anatomy and physiology: understanding the human body. Sudbury (MA): Jones and Bartlett Publishers; 2005. p. 267-72, 371–88.
13. 14. Moore KL, Dalley AF, Agur AMR. Abdomen; pelvis and perineum. In: Clinically oriented anatomy. 6th ed. Philadelphia (PA): Wolters Kluwer/Lippincott Williams and Wilkins; 2010. p. 181–438.
14. 15. Schünke M, Schulte E, Schumacher U. Abdomen and pelvis. In: Gilroy AM, MacPherson BR, Ross LM, editors. Atlas of anatomy. 2nd ed. Stuttgart: Thieme; 2012. p. 124–48.
15. 16. Setchell BP, Maddocks S, Brooks DE. Anatomy, vasculature, innervation, and fluids of the male reproductive tract. In: Knobil E, Neill JD, Greenwald GS, Markert CL, Pfaff DW, editors. The physiology of reproduction. 2nd ed. Vol. 1. New York (NY): Raven Press; 1994. p. 1063–175.
16. 17. Benson GS. Male sexual function: erection, emission, and ejaculation. In: Knobil E, Neill JD, Greenwald GS, Markert CL, Pfaff DW, editors. The physiology of reproduction. 2nd ed. Vol. 1. New York (NY): Raven Press; 1994. p. 1489–506.
17. 18. Henry RW. Silicone plastination of Biological tissue: Room-temperature technique – North Carolina technique and products. Journal of the International Society for Plastination 2007;22:26–30.
18. 19. Saypol DC, Lipshultz LI, Howards SS. Varicocele. In: Lipshultz LI, Howards SS, editors. Infertility in the male. New York (NY): Churchill Livingstone; 1983. p. 299–313.
19. 20. Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 2003; 83:1045–51.
20. 21. Evers BM. Small Bowel. In: Sabiston DC, Townsend CM, editors. Sabiston textbook of surgery: the biological basis of modern surgical practice. 18th ed. Philadelphia (PA): Saunders/Elsevier; 2008. p. 873– 916.
21. 22. McIntosh A, Hutchinson A, Roberts A, Withers H. Evidence-based management of groin hernia in primary care - a systematic review. Fam Pract 2000;17:442–7. 23. Ruhl CE, Everhart JE. Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 2007;165:1154–61.
22. 24. Conze J, Klinge U, Schumpelick V. Part XIII. Abdominal wall - hernias. In: Holzheimer RG, Mannick JA, editors. Surgical treatment – Evidence-based and problem-oriented. München: Zuckschwerdt Verlag; 2001. p. 611–8.
23. 25. Holzheimer RG. Inguinal hernia: classification, diagnosis and treatment – classic, traumatic and Sportsman's hernia. Eur J Med Res 2005;10:121–34.
24. 26. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, Dunlop DD, Reda DJ, McCarthy M Jr, Neumayer LA, Barkun JS, Hoehn JL, Murphy JT, Sarosi GA Jr, Syme WC, Thompson JS, Wang J, Jonasson O. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006;295:285–92.
25. 27. Ein SH, Njere I, Ein A. Six thousand three hundred sixty-one pediatric inguinal hernias: a 35-year review. J Pediatr Surg 2006;41:980– 6.
26. 28. Nehme AE. Groin hernias in elderly patients. Management and prognosis. Am J Surg 1983;146:257–60.
27. 29. van Wessem KJ, Simons MP, Plaisier PW, Lange JF. The etiology of indirect inguinal hernias: congenital and/or acquired? Hernia 2003;7:76–9.
28. 30. Nano M. Technique for inguinal hernia repair in the elderly patient. Am J Surg 1983; 146:373–5.
29. 31. Gianetta E, de Cian F, Cuneo S, Friedman D, Vitale B, Marinari G, Baschieri G, Camerini G. Hernia repair in elderly patients. Br J Surg 1997;84:983–5.
30. 32. Jenkins JT, O'Dwyer PJ. Inguinal hernias. BMJ 2008;336:269-72. 33. Ralphs DN, Brain AJ, Grundy DJ, Hobsley M. How accurately can direct and indirect inguinal hernias be distinguished? Br Med J 1980;280:1039–40.
31. 34. Sanjay P, Fulke JL, Shaikh IA, Woodward A. Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era? Clin Anat 2010;23:848–50.
32. 35. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg 2004;91:1372–6.
33. 36. Tamura K, Stickley CD, Labrash SJ, Lozanoff S. Effectiveness of Plastinated anatomical specimens depicting common sports injuries to enhance musculoskeletal injury evaluation education. Athletic Training Education Journal 2014;9:174–81.