Faculty:
Dr. Susheel Kharbanda - (Sr. Consultant – Urology)

PRESENTING / CHIEF COMPLAINTS:
26-year-old male patient presented with:

• Primary infertility
• Bilateral undescended testes
• Complete azoospermia

CLINICAL FINDINGS:

• Persistent Müllerian Duct Syndrome (PMDS)
• Bilateral intra-abdominal undescended testes
• Rudimentary uterus with bilateral Müllerian tubular structures
• Severe testicular atrophy
• Elevated FSH and LH with preserved testosterone levels
• Incidental Germ Cell Neoplasia In Situ (GCNIS) in the left testis

DIAGNOSIS:

• Persistent Müllerian Duct Syndrome (PMDS)
• Bilateral long-standing cryptorchidism
• Severe male-factor infertility with azoospermia
• Left testicular GCNIS

TREATMENT PERFORMED:

• Laparoscopic excision of Müllerian remnants
• Bilateral laparoscopic orchidectomy

HIGHLIGHTS OF THE CASE:

• Successfully managed a rare and challenging congenital condition presenting in adulthood with infertility.
• Laparoscopic exploration revealed a rudimentary uterus with bilateral Müllerian structures associated with bilateral intra-abdominal testes.
• Careful laparoscopic dissection and excision were performed while preserving critical pelvic structures.
• Histopathology unexpectedly revealed GCNIS in the left atrophic intra-abdominal testis, adding an important oncological dimension to the case.
• The case highlights that normal serum tumour markers do not exclude premalignant testicular pathology.

SPECIAL NOTE:
This case highlights Dr. Susheel Kharbanda’s expertise in managing a rare urological condition through Advanced Laparoscopic Surgery, with the significant oncological finding of GCNIS.