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Aubert O, Zaidan H, Garnier H, Saxena AK, Cascio S. European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes. Eur J Pediatr Surg 2024; 34:452-457. [PMID: 38016641 DOI: 10.1055/s-0043-1777338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
INTRODUCTION The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT). MATERIALS AND METHODS An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA). RESULTS Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role. CONCLUSION Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.
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Affiliation(s)
- Ophelia Aubert
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Hind Zaidan
- Department of Pediatric Surgery, King Hamad University Hospital, Busaiteen, Bahrain
| | - Hanna Garnier
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland at Temple Street, Dublin, Ireland
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Siegal AR, Mbaye F, Chin CP, Ferrer FA, Malhotra NR, Makari JH. Contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database. J Pediatr Urol 2024; 20:821-828. [PMID: 38431462 DOI: 10.1016/j.jpurol.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION When evaluating the timeliness of orchiopexy for cryptorchidism, health disparities are apparent among Hispanic and African American males and those with public insurance. Since the publication of these data, the COVID-19 pandemic has stressed our healthcare system and significantly affected the provision of pediatric urology care. OBJECTIVE We sought to assess if certain groups were disproportionately affected in progression to orchiopexy after the diagnosis of cryptorchidism during and after the pandemic in US freestanding children's hospitals. STUDY DESIGN Using the PHIS database, pediatric patients ≤5 years who underwent orchiopexy between January 2018 and December 2022 were retrospectively analyzed. Exclusion criteria included prematurity, retractile testes, and testicular torsion. Primary outcomes were age at orchiopexy and the proportion of individuals undergoing timely orchiopexy for cryptorchidism. RESULTS Over the study period 3140 patients ≤5 years old underwent orchiopexy for cryptorchidism. Non-Hispanic Blacks and Hispanics were significantly less likely to have timely orchiopexy and underwent orchiopexy 2.13 and 3.60 months later compared to whites (p < 0.01). As compared to pre-COVID-19, during the pandemic the proportion of patients who had timely surgery was higher and the median age was significantly lower (p = 0.01 and p < 0.01, respectively) in white patients only. Over the study period, patients with public insurance were less likely to have timely orchiopexy and underwent orchiopexy 2.94 months later (p < 0.01) than patients with private insurance. Compared to during the pandemic, post-pandemic a significantly lower proportion of publicly insured patients have since undergone timely orchiopexy (p = 0.04). Patients in the West were less likely to have timely orchiopexy and had a higher age at time of orchiopexy (p < 0.01) than other regions. However, in the West during the pandemic, the proportion of children who had timely surgery was higher compared to pre-and post-COVID-19 (p < 0.01). DISCUSSION Overall, regardless of insurance status, race, or location, a significant proportion of patients did not undergo timely orchiopexy. During the pandemic white patients had a lower median age and an increased proportion underwent timely orchiopexy, despite the number of orchiopexies remaining constant. Disparities in the post-COVID-19 era have been further exacerbated for publicly insured patients, who a significantly lower proportion of have since undergone timely orchiopexy. Specific efforts are required across the United States to increase timely orchiopexy for all boys. CONCLUSIONS Progression to timely orchiopexy remains low for all boys in the era surrounding COVID-19; certain groups appear to be more adversely affected.
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Affiliation(s)
- Alexandra R Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Farimata Mbaye
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fernando A Ferrer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - Neha R Malhotra
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - John H Makari
- Department of Pediatric Urology, Children's Hospital and Medical Center, Omaha, NE, USA; Division of Urology, University of Nebraska Medical Center, Omaha, NE, USA
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Xu Y, Hu P, Chen W, Chen J, Liu C, Zhang H. Testicular fibrosis pathology, diagnosis, pathogenesis, and treatment: A perspective on related diseases. Andrology 2024. [PMID: 39330621 DOI: 10.1111/andr.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/10/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
Testicular fibrosis is a chronic and progressive condition characterized by the excessive deposition of extracellular matrix proteins. This process leads to fibrotic remodeling, damage to testicular tissue, and the irreversible loss of male reproductive function. However, there is currently a lack of comprehensive reviews systematically elucidating the pathology, diagnosis, pathogenesis, and treatment of testicular fibrosis from the perspectives of different related diseases. This review addresses these aspects of testicular fibrosis, with a particular emphasis on elucidating the underlying mechanisms of testicular cells. It provides insights that can be relevant for future research and clinical interventions.
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Affiliation(s)
- Ying Xu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Poyi Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanyi Chen
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Chen
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Liu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiping Zhang
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wachtmeister A, Tettamanti G, Nordgren I, Norrby C, Laurell T, Lu Y, Skarin Nordenvall A, Nordgren A. Cancer risk in individuals with polydactyly: a Swedish population-based cohort study. Br J Cancer 2024; 131:755-762. [PMID: 38951698 PMCID: PMC11333495 DOI: 10.1038/s41416-024-02770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Polydactyly is a feature of several cancer predisposition syndromes (CPS), however, cancer risk in individuals with polydactyly is largely unknown. METHODS We performed a matched cohort study using data from Swedish national registers. We included 6694 individuals with polydactyly, born in Sweden between 1970-2017. Polydactyly was categorised as thumb polydactyly, finger polydactyly, polydactyly+ (additional birth defects and/or intellectual disability) or isolated polydactyly. Each exposed individual was matched to 50 comparisons by sex, birth year and birth county. Associations were estimated through Cox proportional hazard models. FINDINGS An increased childhood cancer risk was found in males (HR 4.24, 95% CI 2.03-8.84) and females (HR 3.32, 95% CI 1.44-7.63) with polydactyly+. Isolated polydactyly was associated with cancer in childhood (HR 1.87, 95% CI 1.05-3.33) and young adulthood (HR 2.30, 95% CI 1.17-4.50) in males but not in females. The increased cancer risk remained after exclusion of two known CPS: Down syndrome and neurofibromatosis. The highest site-specific cancer risk was observed for kidney cancer and leukaemia. CONCLUSIONS An increased cancer risk was found in individuals with polydactyly, especially in males and in individuals with polydactyly+. We encourage future research about polydactyly and cancer associations and emphasise the importance of clinical phenotyping.
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Affiliation(s)
| | - Giorgio Tettamanti
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ida Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Christina Norrby
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Laurell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Yunxia Lu
- Department of Population Health and Disease Prevention & Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, CA, USA
| | - Anna Skarin Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Biomedicine, Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden
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Vespa E, Barchi A, Mandarino FV, Fasulo E, Fratto MC, Passaretti S, Azzolini F, Savarino EV, Danese S. Standard length of peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Dis Esophagus 2024:doae069. [PMID: 39214522 DOI: 10.1093/dote/doae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/11/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
Peroral endoscopic myotomy (POEM) is an established treatment for achalasia, yet there is still a lack of technical standardization. No clear definition of 'long', 'standard', or 'short' POEM exists to date. We conducted a systematic review with meta-analysis to analyze current POEM length standards. We included studies reporting technical details of POEM, in which no definite or comparative myotomy length was intentionally adopted (standard myotomy). The primary outcome was the pooled mean total myotomy length. Sub-group analyses were performed to explore heterogeneity across studies. From the initial 7172 records, 31 studies with 3023 patients were included. Pooled mean of total myotomy length was 10.39 cm (95% CI 10.06-10.71; I2 99.3%). Pooled mean of esophageal and gastric myotomy length, provided by 17 studies, was 7.11 cm (95% CI 6.51-7.71; I2 99.8%) and 2.81 cm (95% CI 2.41-3-22; I2 99.8%), respectively. On subgroup analysis for achalasia subtypes, pooled mean length in non-spastic achalasia (type I and II) was 10.17 cm (95% CI 9.91-10.43; I2 94.2%), while in type III it was 14.02 cm (95% CI 10.59-17.44; I2 98.9%). Pooled mean myotomy length for studies conducted between 2014-2020 was 10.53 cm (95% CI, 10.22-10.84; I2 99.1%) and 9.74 cm (95% CI, 7.95-11.54; I2 99.7%) in 2021-2022. Myotomy length during a 'standard' POEM is 10.4 cm, remaining over 10 cm in non-spastic achalasia. The high heterogeneity across studies confirms that the POEM technique needs further standardization. We found no significant time trend towards adopting short POEM, despite recent evidence supporting its use.
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Affiliation(s)
- Edoardo Vespa
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Barchi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Vito Mandarino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ernesto Fasulo
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Caterina Fratto
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sandro Passaretti
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Azzolini
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Azienda Ospedale Università di Padova, Padua, Italy
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
- Faculty of Medicine, Department of Gastroenterology and Endoscopy, Università Vita-Salute San Raffaele, Milan, Italy
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6
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Soto-Heras S, Reinacher L, Wang B, Oh JE, Bunnell M, Park CJ, Hess RA, Ko CJ. Cryptorchidism and testicular cancer in the dog: unresolved questions and challenges in translating insights from human studies†. Biol Reprod 2024; 111:269-291. [PMID: 38738783 DOI: 10.1093/biolre/ioae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024] Open
Abstract
Cryptorchidism, the failure of one or both testes to descend into the scrotum, and testicular cancer show a strong correlation in both dogs and humans. Yet, long-standing medical debates persist about whether the location of undescended testes directly causes testicular cancer in humans or if both conditions stem from a common origin. Although testicular cancer is a prevalent disease in dogs, even less is known about its cause and correlation with testicular descent in this species. This review investigates the relation between these two disorders in dogs, drawing insights from human studies, and examines key biomarkers identified thus far. In addition, it explores potential causal links, including the impact of temperature on maturing testicular cells and a potential shared genetic origin. Notably, this literature review reveals significant differences between men and dogs in reproductive development, histological and molecular features of testicular tumors, and the prevalence of specific tumor types, such as Sertoli cell tumors in cryptorchid dogs and germ cell tumors in humans. These disparities caution against using dogs as models for human testicular cancer research and underscore the limitations when drawing comparisons between species. The paper concludes by suggesting specific research initiatives to enhance our understanding of the complex interplay between cryptorchidism and testicular cancer in dogs.
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Affiliation(s)
- Sandra Soto-Heras
- Epivara, Inc., 2109 S. Oak Street, Suite 100A, Champaign, IL 61820, USA
| | - Lindsey Reinacher
- Epivara, Inc., 2109 S. Oak Street, Suite 100A, Champaign, IL 61820, USA
| | - Bensen Wang
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Ji Eun Oh
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Mary Bunnell
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Chan Jin Park
- Epivara, Inc., 2109 S. Oak Street, Suite 100A, Champaign, IL 61820, USA
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - Rex A Hess
- Epivara, Inc., 2109 S. Oak Street, Suite 100A, Champaign, IL 61820, USA
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
| | - CheMyong Jay Ko
- Epivara, Inc., 2109 S. Oak Street, Suite 100A, Champaign, IL 61820, USA
- Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL 61802, USA
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Mamsen LS, Hildorf S, Ntemou E, Wang D, Cortes D, Fedder J, Thorup J, Andersen CY. Testis tissue cryopreservation may be considered in boys with cryptorchidism. Asian J Androl 2024:00129336-990000000-00212. [PMID: 39075793 DOI: 10.4103/aja202437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/06/2024] [Indexed: 07/31/2024] Open
Abstract
ABSTRACT This study assessed the feasibility of testis tissue cryopreservation (TTC) for fertility preservation in prepubescent boys with cryptorchidism. From January 2014 to December 2022, the University Hospital of Copenhagen (Rigshospitalet, Copenhagen, Denmark) implemented TTC for 56 boys with cryptorchidism to preserve their reproductive potential. Testis tissue samples were collected during orchiopexy (32 cases) or at subsequent follow-up procedures (24 cases), necessitated by an increased risk of infertility as indicated by hormonal assessments and/or findings from initial surgical biopsies. Testis samples were procured for TTC and pathological analysis. The cohort had an average age of 1.3 (range: 0.3-3.8) years at the time of orchiopexy, with 91.1% presenting bilateral cryptorchidism. The study revealed a median germ cell count of 0.39 (range: 0-2.88) per seminiferous tubule, with germ cells detected in 98.0% of the bilateral biopsies and 100% of the unilateral, indicating a substantial potential for fertility in these immature tissues. A dark spermatogonia (Ad) was detected in 37 out of 56 patients evaluated, with a median Ad spermatogonia count of 0.027 (range: 0.002-0.158) per seminiferous tubule. A total of 30.2% of the samples lacked Ad spermatogonia, indicative of potential gonadotrophin insufficiency. The median hormone levels measured were as follows: follicle-stimulating hormone (FSH) at 0.69 (range: 0.16-2.5) U l-1, luteinizing hormone (LH) at 0.21 (range: 0.05-3.86) U l-1, and inhibin B at 126 (range: 17-300) pg ml-1. Despite early orchiopexy, 20%-25% of boys with cryptorchidism remain at risk for future infertility, substantiating the necessity of TTC as a precaution. The study highlights the need for refined predictive techniques to identify boys at higher risk of future infertility.
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Affiliation(s)
- Linn Salto Mamsen
- Department of Gynaecology, Fertility, and Obstetrics, Laboratory of Reproductive Biology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen 2100, Denmark
| | - Simone Hildorf
- Department of Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen 2100, Denmark
| | - Elissavet Ntemou
- Department of Gynaecology, Fertility, and Obstetrics, Laboratory of Reproductive Biology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen 2100, Denmark
| | - Danyang Wang
- Department of Gynaecology, Fertility, and Obstetrics, Laboratory of Reproductive Biology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen 2100, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Jens Fedder
- Centre of Andrology and Fertility Clinic, Department D, Odense University Hospital, Odense 5000, Denmark
- Research Unit of Human Reproduction, Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark
| | - Jørgen Thorup
- Department of Pediatric Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
| | - Claus Yding Andersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark
- Fertility Clinic, University Hospital of Copenhagen, Herlev and Gentofte Hospital, Herlev 2730, Denmark
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Chen J, Jia Y, Zhong J, Zhang K, Dai H, He G, Li F, Zeng L, Fan C, Xu H. Novel mutation leading to splice donor loss in a conserved site of DMD gene causes Duchenne muscular dystrophy with cryptorchidism. J Med Genet 2024; 61:741-749. [PMID: 38621993 PMCID: PMC11287555 DOI: 10.1136/jmg-2024-109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND As one of the most common congenital abnormalities in male births, cryptorchidism has been found to have a polygenic aetiology according to previous studies of common variants. However, little is known about genetic predisposition of rare variants for cryptorchidism, since rare variants have larger effective size on diseases than common variants. METHODS In this study, a cohort of 115 Chinese probands with cryptorchidism was analysed using whole-genome sequencing, alongside 19 parental controls and 2136 unaffected men. Additionally, CRISPR-Cas9 editing of a conserved variant was performed in a mouse model, with MRI screening used to observe the phenotype. RESULTS In 30 of 115 patients (26.1%), we identified four novel genes (ARSH, DMD, MAGEA4 and SHROOM2) affecting at least five unrelated patients and four known genes (USP9Y, UBA1, BCORL1 and KDM6A) with the candidate rare pathogenic variants affecting at least two cases. Burden tests of rare variants revealed the genome-wide significances for newly identified genes (p<2.5×10-6) under the Bonferroni correction. Surprisingly, novel and known genes were mainly found on X chromosome (seven on X and one on Y) and all rare X-chromosomal segregating variants exhibited a maternal inheritance rather than de novo origin. CRISPR-Cas9 mouse modelling of a splice donor loss variant in DMD (NC_000023.11:g.32454661C>G), which resides in a conserved site across vertebrates, replicated bilateral cryptorchidism phenotypes, confirmed by MRI at 4 and 10 weeks. The movement tests further revealed symptoms of Duchenne muscular dystrophy (DMD) in transgenic mice. CONCLUSION Our results revealed the role of the DMD gene mutation in causing cryptorchidism. The results also suggest that maternal-X inheritance of pathogenic defects could have a predominant role in the development of cryptorchidism.
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Affiliation(s)
- Jianhai Chen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Ecology and Evolution, The University of Chicago, Chicago, Illinois, USA
| | - Yangying Jia
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Chemistry, The University of Chicago, Chicago, Illinois, USA
| | - Jie Zhong
- Institute of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Kun Zhang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongzheng Dai
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Guanglin He
- Institute of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Fuping Li
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Clinical Research Center for Birth Defects of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Zeng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanzhu Fan
- Department of Biological Sciences, Wayne State University, Detroit, Michigan, USA
| | - Huayan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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9
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Ma YL, Wang TX, Feng L, Hu CB, Sun JS, Zhang CF, Yu BH. Diagnoses and Treatment of Acquired Undescended Testes: A Review. Medicine (Baltimore) 2024; 103:e38812. [PMID: 38968470 PMCID: PMC11224853 DOI: 10.1097/md.0000000000038812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Acquired undescended testes were once considered a sporadic disease. In recent years, reports suggest that they are not uncommon, with an incidence rate about 3 times that of congenital undescended testes. The etiology of acquired undescended testes remains inconclusive, clinical diagnostic standards are unclear, and treatment approaches are still controversial. There is ongoing debate about the mechanism of testicular ascent. The prevailing view is that acquired undescended testes occur due to the partial absorption of the gubernaculum, which forms part of the parietal peritoneum. The residual gubernacular fibers continuously pull on the spermatic cord, preventing the spermatic cord from elongating proportionately to somatic growth, leading to a re-ascent of the testis. Acquired undescended testes may increase the risk of testicular cancer, but this is still debated. The preferred treatment method is also controversial. However, surgical fixation has an immediate effect; no studies have proven that early surgery improves fertility in patients. The etiology of acquired undescended testes is closely related to the continuous pull of the residual gubernacular fibers on the spermatic cord, which prevents the cord from extending proportionately to body growth. There are no clear diagnostic standards for acquired undescended testes yet, and spontaneous descent is possible, so testicular fixation surgery may not be the preferred treatment method.
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Affiliation(s)
- Ya-Long Ma
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Ti-Xue Wang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Lin Feng
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chuan-Bing Hu
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Jin-Song Sun
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chong-Fang Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Bao-Hua Yu
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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Li W, Chen Z, Xu W, Gao Y, Liu Z, Li Q, Dai L. Prevalence of congenital cryptorchidism in China: A nationwide population-based surveillance study, 2007-2021. Andrology 2024. [PMID: 38958226 DOI: 10.1111/andr.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/12/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Despite cryptorchidism being a common genital abnormality in male newborns with significant prevalence variations globally, there is a notable scarcity of epidemiological data on this condition in China. OBJECTIVE This study aimed to delineate the prevalence pattern of cryptorchidism in Chinese population over the past 15 years using nationwide surveillance data. MATERIALS AND METHODS Data from the China National Population-based Birth Defects Surveillance System (2007-2021) were analyzed to calculate the prevalence rates of cryptorchidism, stratified by birth year, maternal age, maternal residence, and geographic region. Adjusted prevalence rate ratios were computed using Poisson regression, while trends in prevalence and average annual percent change (AAPC) were assessed using the joinpoint regression model. RESULTS During the study period, a total of 1,833 cases of cryptorchidism were identified among 2,565,964 full-term male births, resulting in prevalence rates of 7.14, 5.60, and 1.54 per 10,000 births for overall, isolated, and associated cryptorchidism, respectively. The overall prevalence increased from 3.86 to 11.20 per 10,000 births, with an AAPC of 7.9% (95% confidence interval: 5.5-11.0). Significant variations were observed across maternal age (< 20 years, 7.62/10,000; 20-24 years, 6.14/10,000; 25-29 years, 6.96/10,000; 30-34 years, 7.48/10,000; ≥35 years, 9.22/10,000), maternal residence (urban vs. rural, 10.99/10,000 vs. 2.86/10,000), and geographic region (eastern, 12.38/10,000; central, 2.36/10,000; western, 2.63/10,000). Approximately one-third of cryptorchidism cases were bilaterally, while two-thirds were unilateral. Commonly observed associated abnormalities included congenital hydrocele testis, as well as anomalies in the genital organs, circulatory system, and musculoskeletal system. CONCLUSION Despite lower rates compared to other countries, the increasing trend in prevalence of cryptorchidism necessitates further investigation and intervention.
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Affiliation(s)
- Wenyan Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyu Chen
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuyang Gao
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Liu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- The Joint Laboratory for Pulmonary Development and Related Diseases, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
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11
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Moradi I, Finkelstein P, Paturi A, Shojai Rahnama B, O'Connor J. Bilateral Inguinal Hernias Masking Cryptorchidism: A Case Report. Cureus 2024; 16:e64103. [PMID: 39114228 PMCID: PMC11305693 DOI: 10.7759/cureus.64103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This case report discusses the uncommon occurrence of bilateral inguinal hernias masking cryptorchidism in a 47-year-old male, emphasizing the complexities and nuances of diagnosing and managing undescended testes in adults. Cryptorchidism is most often identified and treated during infancy; however, its rare adult manifestation presents significant diagnostic challenges and is fraught with serious implications for fertility and malignancy if left untreated. The subject presented with long-standing bilateral groin discomfort and was initially evaluated using clinical examination and CT imaging, which diagnosed bilateral inguinal hernias but did not initially detect cryptorchidism. During the staged surgical repairs, the testes were unexpectedly discovered within the hernia sacs, significantly altering the surgical approach and postoperative management. This necessitated an intraoperative consultation and collaboration between general surgery and urology, highlighting the critical role of multidisciplinary teamwork in managing complex surgical cases. The report underscores the importance of meticulous preoperative assessment and raises awareness about the potential for unusual findings in adult inguinal hernia repairs. This case report stresses the need for careful postoperative follow-up and regular urological surveillance to monitor for potential complications, including the development of testicular cancer. This case contributes valuable insights into the management strategies and long-term considerations for adult cryptorchidism, reinforcing the need for heightened clinical suspicion in similar presentations to ensure optimal patient outcomes.
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Affiliation(s)
- Iman Moradi
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Paige Finkelstein
- General Surgery, Columbia University Business School, New York City, USA
| | - Akil Paturi
- Orthopaedics, St. George's University School of Medicine, St. George's, GRD
| | | | - James O'Connor
- General Surgery, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, USA
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12
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Salvi NB, Ghassabian A, Brubaker SG, Liu H, Kahn LG, Trasande L, Mehta-Lee SS. Prenatal phthalate exposure and fetal penile length and width. Pediatr Res 2024; 95:1587-1595. [PMID: 38057576 PMCID: PMC11127776 DOI: 10.1038/s41390-023-02939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Phthalates are endocrine-disrupting chemicals with anti-androgenic qualities and studies reported associations between prenatal phthalate exposure and infant genitalia. This study investigated whether increased prenatal phthalate exposure is associated with decreased fetal penile measures. METHODS Data was from the New York University Children's Health and Environment Study (2016-2019). Maternal urinary concentrations of 16 phthalate metabolites were quantified at <18 weeks gestation as a proxy for fetal exposure (n = 334 male pregnancies). We retrospectively measured penile length and width using ultrasounds conducted 18-24 weeks gestation (n = 173 fetuses). Associations of maternal urinary levels of phthalates with fetal penile length and width were determined using linear regression models. RESULTS 57.2% of women were Hispanic, 31.8% Non-Hispanic White, 6.4% Asian, 2.3% Non-Hispanic Black, and 2.3% multiple races. Mean maternal age was 32 years (standard deviation [SD] = 5.7). Mean penile length was 7.13 mm (SD = 1.47) and width was 6.16 mm (SD = 0.87). An inverse relationship was observed between maternal levels of mono-ethyl phthalate and fetal penile length, and mono-(7-carboxy-n-heptyl) phthalate and penile width, though estimates were small and not significant when considering correction for multiple comparisons. CONCLUSIONS In our cohort we found no clinically meaningful associations between early pregnancy phthalate exposure and fetal penile length or width. IMPACT First-trimester phthalate metabolites were assessed in pregnant women in New York City. Penile length and width were retrospectively measured on clinically assessed ultrasounds conducted ≥18 weeks and <24 weeks of gestation. In this cohort, no clinically meaningful associations were observed between first-trimester prenatal phthalate exposure and fetal penile length. This study contributes to the limited but growing research on the impact of prenatal phthalate exposure on male fetal genital development. The results emphasize that there may not be a clear association between prenatal phthalate exposure and fetal penile length and width, and further research on this topic may be required.
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Affiliation(s)
- Nicole B. Salvi
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY
| | - Sara G. Brubaker
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
| | - Hongxiu Liu
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei, P.R. China
| | - Linda G. Kahn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY
| | - Shilpi S. Mehta-Lee
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY
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13
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AlSahli L, Alabdulsalam A, Mahfouz A, Alnamshan M. Outcomes of Early vs. Late Surgical Intervention in Children With Undescended Testis. Cureus 2024; 16:e56430. [PMID: 38638732 PMCID: PMC11024666 DOI: 10.7759/cureus.56430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background Undescended testis (UDT) is one of the most common urogenital abnormalities. International guidelines recommend performing orchidopexy no later than 18 months to decrease the risk of complications associated with UDT such as infertility and testicular malignancy. The aim of the study is to evaluate the outcomes of early versus late surgical intervention of UDT and to assess if the optimal age of orchidopexy is met. Methods This is a retrospective cross-sectional study that included 258 pediatric patients' testes with no prior UDT intervention from January 2016 to December 2020. A chart review was used to collect the patients' data. Children included were categorized into two groups based on their age at the time of surgery (group A ≤ 18 months and group B > 18 months). Statistical differences were explored using Pearson's chi-squared test or Fisher's exact test for categorical variables or a Wilcoxon rank sum test for numerical variables. A p-value of <0.05 indicated statistical significance. Results The median age at the presentation among the overall cohort was 14 months. The median age at the presentation for group A was six months and group B was 35 months. Group A included 109 children and group B included 149 children. At the time of the surgery, the median age of patients was 23 months. The median age at orchidopexy for group A was 12 months and the median age for group B was 38 months. The time between diagnosis and surgery was significantly shorter among older children with a median duration of one month versus a median of five months among patients in the ≤18 months group (p = 0.003). The follow-up interval was at three and 12 months. The change in testicular size before and after surgeries was statistically significant, as most small testicles before surgeries had become normal in size after surgeries among the overall cohort (76.6%), patients aged ≤18 months (72.4%), and those aged >18 months (79.2%) (p < 0.001). Conclusion Most of the patients included in this study did not undergo orchidopexy at the optimal age recommended by the international guidelines. However, there was a statistically significant improvement in testicular size following orchidopexy in children with small UDT regardless of age at the time of surgery.
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Affiliation(s)
- Lama AlSahli
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdulaziz Alabdulsalam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Arwa Mahfouz
- Pediatric Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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14
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Rodríguez F, Godoy MJ, Ortiz E, Benítez-Filselcker A, López MT, Cassorla F, Castro A. CAG and GGN repeat polymorphisms in the androgen receptor gene of a Chilean pediatric cohort with idiopathic inguinal cryptorchidism. Andrology 2024; 12:289-296. [PMID: 37377277 DOI: 10.1111/andr.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/02/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Cryptorchidism is one of the most common congenital disorders in boys and it is associated with a higher risk of sub-fertility and testicular cancer. Testicular descent occurs during embryo-fetal development in two phases, transabdominal and inguino-scrotal. In the latter process, androgens play a leading role. The androgen receptor has in its N-terminal domain, two aminoacidic repeats encoded by polymorphic nucleotide repetitions: (CAG)nCAA and GGN. The number of repetitions of these trinucleotides has been associated with different transactivation capacities and sensitivities of the androgen receptor response. OBJECTIVE To determine whether pediatric Chilean individuals with idiopathic inguinal cryptorchidism have a different number of CAG and/or GGN repeats polymorphisms compared with controls. MATERIALS AND METHODS A total of 109 cases with idiopathic inguinal cryptorchidism (26 bilateral and 83 unilateral) were studied by polymerase chain reaction amplification from DNA extracted from peripheral blood, followed by fragment size analysis by capillary electrophoresis, which were compared with 140 controls. RESULTS The CAG26 repeats allele was increased in the total cases (8.3% vs. 1.4%; p = 0.012; odds ratio = 6.21, 95% confidence interval 1.31-29.4), and in bilateral cases compared to controls (11.5% vs. 1.4%; p = 0.028; odds ratio = 9 CI 95% 1.43-56.8). Similarly, CAG > 22 alleles were increased in the total cases (62.4% vs. 49.3%, p = 0.041), and more significantly in bilateral cases (73.1% vs. 49.3%; p = 0.032; odds ratio = 2.79, 95% confidence interval 1.1-7.1). In addition, CAG < 18 alleles were not observed among cases, but were present in 5.7% of controls (p = 0.01). Regarding the GGN repeats, no differences were observed between cases and controls either when analyzing separately unilateral and bilateral cryptorchidism. The joint analysis of the distribution of CAG and GGN alleles showed that the CAG26 allele was present with GGN23, hence the combination CAG26/GGN23 alleles was equally increased in bilateral cases compared with controls (11.5% vs. 1.4%). In contrast, CAG < 18 was preferably observed in the combination CAG < 18/GGN≠23 and was absent in the total cases (4.3% vs. 0%; p = 0.037). DISCUSSION These results suggest that greater lengths of CAG alleles may contribute to a diminished androgen receptor function. The CAG26 allele alone or in combination with GGN23 was associated with a higher risk of bilateral cryptorchidism. On the other hand, CAG < 18 and the CAG < 18/GGN≠23 allele combination may reduce the probability of cryptorchidism.
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Affiliation(s)
- Fernando Rodríguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - María José Godoy
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Eliana Ortiz
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Andrés Benítez-Filselcker
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - María Teresa López
- Pediatric Urology Department, San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Fernando Cassorla
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
| | - Andrea Castro
- Institute of Maternal and Child Research, School of Medicine, University of Chile Santiago, Santiago, Chile
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15
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Borkar NB, Tiwari C, Mohanty D, Vepakomma D, Nagdeve N. Techniques of staged laparoscopic orchidopexy for high intra-abdominal testes in children: A systematic review and meta-analysis. Urol Ann 2024; 16:64-70. [PMID: 38415237 PMCID: PMC10896330 DOI: 10.4103/ua.ua_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/21/2023] [Indexed: 02/29/2024] Open
Abstract
Background Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis. Materials and Methods The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy. Results The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures. Conclusion Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.
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Affiliation(s)
| | - Charu Tiwari
- Department of Paediatric Surgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Deepti Vepakomma
- Department of Paediatric Surgery, AIIMS, Manglagiri, Andhra Pradesh, India
| | - Nilesh Nagdeve
- Department of Paediatric Surgery, AIIMS, Nagpur, Maharashtra, India
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16
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Kikkawa K, Ueda Y, Yamashita S, Kohjimoto Y, Hara I. The Importance of Follow-Up and Evaluation of Intraoperative Findings to Determine Surgical Indications for Retractile Testis. Adv Urol 2023; 2023:8764631. [PMID: 37720542 PMCID: PMC10504044 DOI: 10.1155/2023/8764631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/03/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis. Methods We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery. Results A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment. Conclusion Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate.
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Affiliation(s)
- Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yuko Ueda
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
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Sadeghinezhad J, Yarmahmoudi F, Dehghan MM, Mohajeri SF, Roomiani E, Bojarzadeh H, Asl MA, Saeidi A, Silva MD. Stereological study of testes following experimentally-induced unilateral cryptorchidism in rats. Clin Exp Reprod Med 2023; 50:160-169. [PMID: 37643829 PMCID: PMC10477409 DOI: 10.5653/cerm.2023.06058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 06/17/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Cryptorchidism is one of the main causes of infertility and can result in testicular cancer. This study aimed to present quantitative data on the damage caused by cryptorchidism using stereological analysis. METHODS Thirty newborn rats were randomly divided into control and experimental groups. The experimental group underwent surgery to induce unilateral cryptorchidism in the left testis, whereas the control group underwent a sham surgical procedure 18 days after birth. The testes were removed at designated time points (40, 63, and 90 days after birth) for stereological evaluation and sperm analysis. Total testicular volume, interstitial tissue volume, seminiferous tubule volume and length, and seminiferous epithelium volume and surface area were measured. Other parameters, such as sperm count, sperm morphology, and sperm tail length, were also examined. RESULTS Statistically significant differences (p<0.05) were observed between the experimental and the control groups at different ages regarding the volumes of various parameters, including the surface area of the germinal layer, the length of the seminiferous tubules, sperm count, and sperm morphology. However, no significant differences were observed in the epithelial volume and the sperm tail length of the groups. CONCLUSION Given the substantial effect of cryptorchidism on different testicular parameters, as well as the irreversible damage it causes in the testes, it is important to take this abnormality seriously to prevent these consequences.
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Affiliation(s)
- Javad Sadeghinezhad
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Fatemeh Yarmahmoudi
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mohammad Mehdi Dehghan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeed Farzad Mohajeri
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ehsan Roomiani
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Hadis Bojarzadeh
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mahdi Aghabalazadeh Asl
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ava Saeidi
- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Margherita De Silva
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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18
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Cull JN, Jacobson DL, Schaeffer AJ. Spontaneous and rapid transcanalicular translocation of a previously retractile testicle into the abdomen of a post-pubertal, teenage male. Urol Case Rep 2023; 48:102397. [PMID: 37089195 PMCID: PMC10119880 DOI: 10.1016/j.eucr.2023.102397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023] Open
Abstract
We describe a case of spontaneous, rapid, atraumatic transcanalicular translocation of a previously retractile testis into the abdomen of a post-pubertal 16-year-old male. The testis was lowered back into the inferior scrotum laparoscopically, through a patent processus vaginalis, and was under no tension in that location without lengthening of cord structures. At 7 months postoperative, the patient reported bilateral intrascrotal testicles with no further complications. This exceptional case demonstrates that post-pubertal males with a history of retractile testis may be at risk for developing testicular translocation into the abdomen.
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Affiliation(s)
- Jennison N. Cull
- University of Utah, Department of Surgery (Pediatric Urology), Salt Lake City, UT, USA
| | - Deborah L. Jacobson
- University of Utah, Department of Surgery (Pediatric Urology), Salt Lake City, UT, USA
| | - Anthony J. Schaeffer
- University of Utah, Department of Surgery (Pediatric Urology), Salt Lake City, UT, USA
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19
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Japan's comprehensive undescended testis screening program: incidence of ascending testis after screening. Pediatr Surg Int 2022; 39:35. [PMID: 36469123 DOI: 10.1007/s00383-022-05331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Screening for undescended testis (UDT) in Japan is performed as a neonate, then at 1, 3, 10, and 18 months old, and 3 years old. Incidence of ascending testis (AT) after screening was reviewed. METHODS All orchiopexy/orchiectomy at a single institute between July 2005 and June 2022 were reviewed retrospectively. RESULTS 376 boys had 422 procedures; 54/422 (12.8%) were in 48 boys ≥ 4 years old (mean age: 6.7 years; range: 4-13); testes were normal (n = 22; 40.7%), small (n = 25; 46.2%), or atrophied (n = 7; 1.3%). There were 47 orchiopexies and 7 orchiectomies for atrophy. Incidence of AT in boys ≥ 4 years old was 24/422 (5.7%). Of these, 16/422 (3.8%) developed after normal descent and 8/422 (1.9%) were associated with retractile testis (AT + RET). Other indications included delayed treatment for UDT (n = 13), late referral by pediatricians (n = 10), and iatrogenic UDT (n = 6). Surgical intervention in boys ≥ 4 years old (12.8%) was less than that reported in the West (range: 30-50%) as was AT: (5.7% versus 15.4%) and AT + RET (1.9% versus 13.8%). CONCLUSIONS Comprehensive UDT screening probably contributed to the lower incidence of surgery and AT (especially AT + RET) in boys ≥ 4 years old.
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Boehm K, Fischer ND, Qwaider M, Haferkamp A, Schröder A. Contralateral testicular hypertrophy is associated with a higher incidence of absent testis in children with non-palpable testis. J Pediatr Urol 2022; 19:214.e1-214.e6. [PMID: 36460587 DOI: 10.1016/j.jpurol.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020. STUDY DESIGN We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org). RESULTS A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p = 0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17 mm (16-19.2)) as compared to patients with a viable testis (median length 15 mm (14-17), p = 0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p < 0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p = 0.007]. CONCLUSION Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.
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Affiliation(s)
- Katharina Boehm
- Department of Urology, University Medical Center, Carl-Gustav-Carus University, Dresden.
| | - Nikita Dhruva Fischer
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohammad Qwaider
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany; Department of Urology, Klinikum Darmstadt, Darmstadt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Annette Schröder
- Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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21
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Elias FM, Nishi MY, Sircili MHP, Bastista RL, Gomes NL, Ferrari MTM, Costa EMF, Denes FT, Mendonca BB, Domenice S. Elevated plasma miR-210 expression is associated with atypical genitalia in patients with 46,XY differences in sex development. Mol Genet Genomic Med 2022; 10:e2084. [PMID: 36369742 PMCID: PMC9747552 DOI: 10.1002/mgg3.2084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/09/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Differences of sex development (DSD) is a term used for conditions in which the chromosomal, gonadal or phenotypical sex is atypical. 46,XY DSD patients frequently present undervirilized external genitalia. The expression of different miRNAs in many organs of the male genital system has been reported, and these miRNAs have been associated with testicular function and its disorders, but no description has been related to DSD conditions. This study aimed to evaluate the plasma expression of miR-210 in 46,XY DSD patients who presented atypical genitalia at birth. METHODS Eighteen 46,XY DSD patients who presented atypical genitalia (undescended testis and/or hypospadias, bifid scrotum or micropenis) at birth and 36 male control individuals were selected. Plasma levels of miR-210 and reference miR-23a were measured using RT-qPCR and the data were analysed by the 2-ΔCt method. RESULTS MiR-210 plasma levels were significantly higher in 46,XY DSD patients with atypical genitalia than in male control subjects (p = 0.0024). A positive association between miR-210 levels and the presence of cryptorchidism and hypospadias (p = 0.0146 and p = 0.0223) was found in these patients. Significantly higher levels of miR-210 were observed in patients with 46,XY DSD and cryptorchidism than in control subjects (p = 0.0118). These results are in agreement with previous literature reports, in which increased levels of miR-210 expression were observed in human testicular tissue from adult males with undescended testes in comparison with samples of descended testes. CONCLUSION Our study showed a positive association between the presence of atypical genitalia and plasma levels of miR-210 expression in the group of patients with 46,XY DSD of unknown aetiology studied. These findings contribute to reveal a new perspective on the role of miRNAs in the development of male external genitalia and the broad spectrum of phenotypes presented by patients with 46,XY DSD.
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Affiliation(s)
- Felipe Martins Elias
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Mirian Yumi Nishi
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Maria Helena Palma Sircili
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil,Departamento de Urologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Rafael Loch Bastista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Nathalia Lisboa Gomes
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Maria Tereza Martins Ferrari
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Elaine Maria Frade Costa
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Francisco Tibor Denes
- Departamento de Urologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | - Sorahia Domenice
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM‐42Hospital das Clinicas da Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
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22
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Prevalence of Posttraumatic Stress Disorder Symptoms Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis. Harv Rev Psychiatry 2022; 30:271-282. [PMID: 36103682 DOI: 10.1097/hrp.0000000000000340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limited evidence is currently available on the prevalence of posttraumatic stress disorder (PTSD) following traumatic spinal cord injury (SCI). This systematic review and meta-analysis aims to assess the prevalence and geographic distribution of PTSD symptoms after SCI. METHODS After a search in the MEDLINE, Embase, Scopus, and Web of Science databases, two reviewers independently summarized relevant studies published through 20 October 2021. Observational studies were included. The studies were eligible if they assessed PTSD symptoms using standard self-report or clinician-based instruments. Data and results were reported using the overall prevalence and the odds ratio (OR), with 95% confidence intervals (CIs). RESULTS 24 articles (5646 patients) met the inclusion criteria. The prevalence of PTSD symptoms ranged from 6.33% (95% CI, 2.73-13.97) to 61.76% (95% CI, 52.07-70.61). Pooled analysis demonstrated that the overall prevalence of PTSD symptoms in SCI patients was significantly higher in developing countries (41.64%; 95% CI, 31.11-52.55) than in developed countries (19.35%; 95% CI, 14.66-24.51) (OR = 1.24; 95% CI, 1.08-1.42; p = .003). The highest prevalence of PTSD symptoms was reported in South Africa (56.25%; 95% CI, 47.01-65.08), followed by Sri Lanka (45.71%; 95% CI, 30.47-61.81), and Greece (43.55%; 95% CI, 31.94-55.91). By contrast, Norway (6.33%; 95% CI, 2.73-13.97), Switzerland/Germany (8.65%; 95% CI, 4.8-13.42), and Denmark (10.71%; 95% CI, 6.89-16.30) were found to have the lowest prevalence of PTSD symptoms after SCI. CONCLUSION Many traumatic SCI patients suffer from PTSD symptoms, and their prevalence seems to be higher in developing countries than in developed countries. These findings underscore the need to consider the psychological aspects of traumatic SCI.
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23
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Annick ET, Ko J, Baker ZG, Hannallah A, De Filippo RE, Chang AY. Continued use of scrotal ultrasounds for the workup of undescended testes: Confirmation bias and inaccuracies. J Paediatr Child Health 2022; 58:1384-1389. [PMID: 35478367 DOI: 10.1111/jpc.15998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022]
Abstract
AIM Scrotal ultrasounds are utilised in some primary care settings for suspected cryptorchidism, despite inaccuracies. We aim to identify the correlation between ultrasound and primary care provider (PCP) findings of undescended testicles (UDTs) as a potential source of confirmation bias. METHODS Males referred for suspected UDT by PCPs who underwent scrotal ultrasound and paediatric urologist examination from 2014 to 2019 were included. Correlation between PCP and ultrasound findings and diagnostic accuracy were evaluated. Logistic regression was utilised to determine associations between patient factors and UDT misdiagnosis. RESULTS Out of 145 testes, ultrasound corroborated PCPs' UDT diagnoses 87.6% of the time, 49.6% of which were confirmed as UDT by paediatric urologists. Ultrasound had a false positivity rate of 81.0% and specificity of 19.0%. Ultrasound versus paediatric urologist findings regarding testicle location were significantly different (P < 0.0001). Patients aged ≥8 years old had 5.2 times greater odds of being misdiagnosed with UDT than patients <8 years old (95% confidence interval: 1.6-16.7; P < 0.002) by PCP and ultrasound. CONCLUSION Scrotal ultrasound highly corroborated PCPs' UDT diagnoses. Older patients were more likely to be misdiagnosed with UDT by PCP and ultrasound. As ultrasounds rarely refute PCP examinations for suspected UDTs and are highly inaccurate, confirmation bias may explain the use of ultrasound in the workup of UDT.
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Affiliation(s)
- Erin T Annick
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Joan Ko
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Zoë G Baker
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Arthi Hannallah
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Roger E De Filippo
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
| | - Andy Y Chang
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California, United States
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24
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Hildorf SE. Clinical aspects of histological and hormonal parameters in boys with cryptorchidism: Thesis for PhD degree. APMIS 2022; 130 Suppl 143:1-58. [PMID: 35822689 PMCID: PMC9542020 DOI: 10.1111/apm.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Engmann Hildorf
- Department of Pediatric Surgery and Department of PathologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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25
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Echeverría Sepúlveda MP, Yankovic Barceló F, Lopez Egaña PJ. The undescended testis in children and adolescents. Part 1: pathophysiology, classification, and fertility- and cancer-related controversies. Pediatr Surg Int 2022; 38:781-787. [PMID: 35298712 DOI: 10.1007/s00383-022-05110-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
Undescended testis (UDT) is defined as failure of a testis to descend into the scrotum. It is one of the most common reasons for consultation in pediatric surgery and urology with an incidence of 3% in live-born male infants. Decades ago, classical studies established that the failure of a testis to descend alters the development of its germ cells increasing the risk of infertility and testicular cancer in adulthood. More recent publications have rebutted some of the myths and raised controversies regarding the management of these patients, which, far from being limited to surgical treatment, should include pathophysiological and prognostic aspects for a comprehensive approach to the condition. Therefore, here we present an updated review divided into two parts: the first assessing the pathophysiological aspects and risks of these patients focused on fertility and cancer, and the second addressing the different treatment options for UDT.
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Affiliation(s)
- María Pilar Echeverría Sepúlveda
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clinica Alemana, Barros Luco, San Miguel, 3300, Santiago, Chile
| | - Francisca Yankovic Barceló
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clinica Alemana, Barros Luco, San Miguel, 3300, Santiago, Chile.,Pediatric Urology Service, Clinica Santa Maria, Santiago, Chile.,Departments of Pediatrics and Pediatric Surgery, Universidad de Chile, Santiago, Chile
| | - Pedro-Jose Lopez Egaña
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clinica Alemana, Barros Luco, San Miguel, 3300, Santiago, Chile. .,Pediatric Urology Service, Clínica Alemana, Santiago, Chile. .,Departments of Pediatrics and Pediatric Surgery, Universidad de Chile, Santiago, Chile.
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26
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Akinsola B, Farthing H. A case of torsion of the undescended testes. J Am Coll Emerg Physicians Open 2022; 3:e12666. [PMID: 35252971 PMCID: PMC8886185 DOI: 10.1002/emp2.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 10/26/2022] Open
Abstract
Abdominal pain and vomiting are common presenting symptoms in young children, and there are a myriad of differential diagnoses ranging from benign to life-threatening. We present the case of a 20-month-old boy who came to the emergency department with abdominal pain, fever, and vomiting. Initially, he was thought to have intussusception with a necrotic lead point based on clinical signs, laboratory findings, and ultrasonography, but was taken to the operating room after air enema failed to demonstrate an intussusceptum. He was ultimately diagnosed with torsion of an undescended testicle. Few cases of torsion of the undescended testes are reported in literature.
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Affiliation(s)
- Bolanle Akinsola
- Department of Pediatric Emergency MedicineChildren's Healthcare of AtlantaAtlantaGeorgiaUSA
- Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Heather Farthing
- Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
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27
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Robinson CH, Albury C, McCartney D, Fletcher B, Roberts N, Jury I, Lee J. The relationship between duration and quality of sleep and upper respiratory tract infections: a systematic review. Fam Pract 2021; 38:802-810. [PMID: 33997896 PMCID: PMC8656143 DOI: 10.1093/fampra/cmab033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Upper respiratory tract infections (URTIs) are common, mostly self-limiting, but result in inappropriate antibiotic prescriptions. Poor sleep is cited as a factor predisposing to URTIs, but the evidence is unclear. OBJECTIVE To systematically review whether sleep duration and quality influence the frequency and duration of URTIs. METHODS Three databases and bibliographies of included papers were searched for studies assessing associations between sleep duration or quality and URTIs. We performed dual title and abstract selection, discussed full-text exclusion decisions and completed 50% of data extraction in duplicate. The Newcastle-Ottawa Quality Assessment Scale assessed study quality and we estimated odds ratios (ORs) using random effects meta-analysis. RESULTS Searches identified 5146 papers. Eleven met inclusion criteria, with nine included in meta-analyses: four good, two fair and five poor for risk of bias. Compared to study defined 'normal' sleep duration, shorter sleep was associated with increased URTIs (OR: 1.30, 95% confidence interval [CI]: 1.19-1.42, I2: 11%, P < 0.001) and longer sleep was not significantly associated (OR: 1.11 95% CI: 0.99-1.23, I2: 0%, P = 0.070). Sensitivity analyses using a 7- to 9-hour baseline found that sleeping shorter than 7-9 hours was associated with increased URTIs (OR: 1.31, 95% CI: 1.22-1.41, I2: 0%, P < 0.001). Sleeping longer than 7-9 hours was non-significantly associated with increased URTIs (OR: 1.15, 95% CI: 1.00-1.33, I2: 0%, P = 0.050, respectively). We were unable to pool sleep quality studies. No studies reported on sleep duration and URTI severity or duration. CONCLUSIONS Reduced sleep, particularly shorter than 7-9 hours, is associated with increased URTIs. Strategies improving sleep should be explored to prevent URTIs.
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Affiliation(s)
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David McCartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin Fletcher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Imogen Jury
- Department of Medical Sciences, University of Oxford, Oxford, UK
| | - Joseph Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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28
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Dinkelbach L, Lehnick D, Shavit S, Szavay P, Zundel S. Acquired undescended testis: When does the ascent occur? J Pediatr Surg 2021; 56:2027-2031. [PMID: 33248683 DOI: 10.1016/j.jpedsurg.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the timeframe in which acquired undescended testes occur. To guide recommendations for screening examinations, we aimed to (1) specify the ratio of acquired undescended testes in orchiopexy cases and to (2) identify a predisposing age for the development of acquired undescended testis. METHODS Three-hundred-forty cases of orchiopexy were retrospectively analyzed and classified as congenital or acquired cases of undescended testis. In acquired cases, the time of the last documented physiological testicular position was obtained. The time of testicular ascent was approximated by calculating the mean between the last physiological finding and orchiopexy. RESULTS In 151 cases (44.4%) prior physiological position of testes was documented and acquired undescended testis was assumed. In 115 of these cases (76.2%) details on the age at last physiological position were available. Ascent occurred between the age of one and fourteen. The 50th, 75th, 85th, 90th and 95th percentile for the estimated age at ascent was 5.8, 7.3, 8.4, 8.7 and 11.1 years, respectively. CONCLUSIONS Acquired undescended testes are a common cause of cryptorchidism. Ascent occurs throughout all prepubertal ages, emphasizing the need to regular follow-up of testicular position until puberty. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Lars Dinkelbach
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225 Duesseldorf, Germany; Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland.
| | - Dirk Lehnick
- Clinical Trial Unit Central Switzerland / Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Sandra Shavit
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
| | - Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
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29
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Saber-Khalaf M, Ali AF, Elsoghier OM. Predictive factors of successful testicular sperm extraction for non-obstructive azoospermia with a history of bilateral cryptorchidism and normal testosterone. Andrologia 2021; 54:e14284. [PMID: 34664297 DOI: 10.1111/and.14284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022] Open
Abstract
This study aimed to assess the predictive factors of successful sperm retrieval in non-obstructive azoospermia with a history of bilateral cryptorchidism. This retrospective study included 103 patients with azoospermia who had micro-dissection testicular sperm extraction between January 2010 and January 2020. The median (range) age of the patients and their wives in the study group was 33 (21-44) and 24 (19-33) years, respectively. The patients with low testosterone level (<3 ng/dl) were prescribed with human chorionic gonadotropin 5,000 IU injection every 3 days for 3 months. Those with persistent low testosterone even after hormonal stimulation were excluded. Sperms were retrieved from 64 (62%) patients, whilst failed in 39 (38%) patients. On univariate analysis, the median testicular volume was significantly larger in the successful group versus the failed group (p < .001), serum FSH and serum LH were significantly lower in the successful group (p = .001), serum testosterone was significantly higher in the successful group compared to the failed group (p < .001) and the age of orchidopexy was lower in the successful group versus the failed group (p = .016). On multivariate analysis, the average testicular volume and the serum testosterone levels were independent factors for successful sperm retrieval.
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Affiliation(s)
- Mohammed Saber-Khalaf
- Department of Urology, Sohag University Hospital, Faculty of medicine, Sohag University, Sohag, Egypt
| | - Atef F Ali
- Department of Urology, South Valley University, Qena, Egypt
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30
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Hori S, Aoki K, Tachibana A, Nishimura N, Tomizawa M, Morizawa Y, Gotoh D, Fukui S, Nakai Y, Miyake M, Torimoto K, Yoneda T, Tanaka N, Fujimoto K. Usefulness of clinical factors for diagnosing and differentiating types of testicular malposition in boys: A retrospective study. Int J Urol 2021; 29:57-64. [PMID: 34655119 DOI: 10.1111/iju.14715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate useful objective variables and factors supporting the diagnosis of retractile testis and cryptorchidism by primary care providers, including urologists. METHODS This retrospective study included 512 boys diagnosed with retractile testis or cryptorchidism at our institute. Boys with retractile testis were followed up and underwent orchiopexy once the testis became undescended, while boys with cryptorchidism underwent orchiopexy immediately. We investigated trends in the prevalence of testicular malposition and explored useful diagnostic factors for retractile testis and cryptorchidism. RESULTS Of 512 boys, 199 were diagnosed with retractile testis and 313 were diagnosed with cryptorchidism. Comparison of clinical information between retractile testis and cryptorchidism showed that age at diagnosis, laterality, and location of the testis were significantly different between the groups (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The comparison of surgical information also showed that epididymal abnormality and state of processus vaginalis is patency or closure were significantly different between the groups (P = 0.0088 and P = 0.0003, respectively). Multivariate analysis showed that diagnosis at age 0-1 years, unilaterality, and canalicular testis were predictive factors for cryptorchidism (P = 0.001, P < 0.0001, and P < 0.0001, respectively). CONCLUSIONS Age at diagnosis, laterality, and location of the testis could be factors to aid the diagnosis of retractile testis and cryptorchidism.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Akira Tachibana
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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31
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Shreyas K, Rathod KJ, Sinha A. Management of high inguinal undescended testis: a review of literature. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Undescended testis is one of the most common paediatric surgical diagnoses. A lot of research has been done to date, to standardise the surgical management of intra-abdominal and extra-abdominal undescended testis. High inguinal undescended testis is a unique clinical encounter which demands additional surgical measures over conventional orchidopexy for better surgical results.
Main body of abstract
Open inguinal orchidopexy is a routine and quite straightforward operation for the majority of extra-abdominal undescended testis. However, there are instances in which the testis, even though situated in the inguinal region, poses a challenge for surgeons, to bring it in the scrotum by routine open inguinal orchiopexy. High inguinal testis can be defined as “any intra-canalicular testis present higher up in the inguinal canal and cannot be brought down easily to the scrotum by routine surgery as in standard orchiopexy (open or laparoscopy) and require additional lengthening manoeuvres”. It needs additional surgical lengthening manoeuvres like Prentiss, along with the steps of routine orchiopexy to bring it down in the scrotum. This review article describes the various nomenclatures of undescended testis, appropriate investigations and also various additional surgical measures in the management of difficult high inguinal testis.
Conclusion
High inguinal undescended testis poses a unique technical challenge even to well-experienced surgeons. It is very important that surgeons dealing with this condition are well aware of the anatomy in this region and also various different manoeuvres described to date to bring the testis down in the scrotum.
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Tang MY, Wong Y, Pang KK, Tam Y. Orchidopexy for congenital and acquired undescended testes ‐ Long‐term follow up needed. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Yeuk‐lam Tang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin Hong Kong
| | - Yuen‐shan Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin Hong Kong
| | - Kristine Kit‐yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin Hong Kong
| | - Yuk‐him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin Hong Kong
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Dong LH, Hildorf S, Clasen-Linde E, Kvist K, Cortes D, Thorup J, Andersen CY. Postnatal germ cell development in cryptorchid boys. Asian J Androl 2021; 22:258-264. [PMID: 31274480 PMCID: PMC7275797 DOI: 10.4103/aja.aja_48_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cryptorchidism is associated with infertility in adulthood. Early orchiopexy is suggested to reduce the risk. Information is lacking on the potential link between infant germ cell maturation and the risk of future infertility. The objective of the study was to evaluate age-related germ cell development in cryptorchidism. Immunostaining for markers of germ cell development (octamer-binding transcription factor 3/4 [OCT3/4], placental alkaline phosphatase [PLAP], KIT proto-oncogene [C-KIT], podoplanin [D2-40], Lin-28 homolog A [LIN28], and G antigen 7 [GAGE-7]) was performed in testicular biopsies from 40 cryptorchid boys aged 4-35 months. Germ cell numbers and distributions were evaluated in cross sections of seminiferous tubules, with and without immunostaining. OCT3/4, D2-40, and LIN28 were generally expressed in the early stages of germ cell development, as shown by positive expression in germ cells in the central region of seminiferous tubules. In contrast, PLAP and GAGE-7 were expressed in both central and peripheral parts of the tubules in the early stages of development and expressed mainly in a peripheral position with advancing age. Germ cell maturation was delayed in this study population as compared with that observed in our previous study on germ cell markers in a healthy population. The number of GAGE-7-positive germ cells per tubular cross section obtained by immunostaining was significantly higher than that obtained by standard hematoxylin and eosin staining. Double immunostaining revealed heterogeneity in germ cell development in cryptorchid testes. These results shed light on the pathophysiology of germ cell development in boys with cryptorchidism.
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Affiliation(s)
- Li-Hua Dong
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Simone Hildorf
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Kolja Kvist
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark
| | - Jørgen Thorup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark.,Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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Le Moal J, Goria S, Guillet A, Rigou A, Chesneau J. Time and spatial trends of operated cryptorchidism in France and environmental hypotheses: a nationwide study from 2002 to 2014. Hum Reprod 2021; 36:1383-1394. [PMID: 33728432 DOI: 10.1093/humrep/deaa378] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is there an evolution in the risk of operated cryptorchidism in France and does local geographical environment appear as an important trigger for this defect? SUMMARY ANSWER We observed an increase of the risk of operated cryptorchidism in boys under the age of 7 years during the period 2002-2014 and a strong spatial heterogeneity, with the detection of spatial clusters suggesting environmental factors. WHAT IS KNOWN ALREADY Epidemiologic data on cryptorchidism are scarce and its etiology is poorly understood. As part of the testicular dysgenesis syndrome, cryptorchidism is suspected to be a male genital developmental disorder caused by endocrine disruptor chemical (EDC) exposure during the prenatal period. STUDY DESIGN, SIZE, DURATION This was a retrospective and descriptive study using data from the French national hospital discharge database, in the 2002-2014 study period. We built an indicator to reflect incident cases of operated cryptorchidism in boys under the age of 7 years in metropolitan France, with an algorithm using specific codes for diseases (ICD-10 codes) and surgical acts (CCAM codes). PARTICIPANTS/MATERIALS, SETTING, METHODS The study population was composed of 89 382 new cases of operated cases of cryptorchidism in boys under the age of 7 years. We estimated the temporal evolution of the incidence rate. We fitted a spatial disease-mapping model to describe the risk of cryptorchidism at the postcode scale. We used Kulldorff's spatial scan statistic and Tango's flexibly shaped spatial scan statistic to identify spatial clusters. MAIN RESULTS AND THE ROLE OF CHANCE The estimated increase in the incidence of operated cryptorchidism from 2002 to 2014 was equal to 36.4% (30.8%; 42.1%). Cryptorchidism displayed spatial heterogeneity and 24 clusters (P < 0.0001) were detected. The main cluster was localized in a former coal mining and metallurgic area in northern France, currently an industrial area. The cluster analysis suggests the role of shared socio-economic and environmental factors that may be geographically determined and intertwined. The industrial activities identified in the clusters are potentially the source of persistent environmental pollution by metals, dioxins and polychlorinated biphenyls. LIMITATIONS, REASONS FOR CAUTION The indicator we used reflects operated cases of cryptorchidism, with an under-evaluation of the health problem. We cannot exclude a possible role of the evolution and local differences in surgical practices in the observed trends. Our inclusion of boys under 7 years of age minimized the biases related to differences in practices according to age. Regarding the environmental hypothesis, this is an exploratory study and should be considered as a hypothesis-generating process for future research studies. WIDER IMPLICATIONS OF THE FINDINGS To our knowledge, this is the first descriptive study to address nationwide trends of operated cryptorchidism with detection of spatial clusters, with a very large sample allowing great statistical power. Our results generate plausible environmental hypotheses, which need to be further tested. STUDY FUNDING/COMPETING INTEREST(S) This study was entirely funded by Santé publique France, the French National Public Health Agency. All authors declare they have no actual or potential competing financial interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J Le Moal
- DATA Science Department, Santé publique France, Saint Maurice 94415, France
| | - S Goria
- DATA Science Department, Santé publique France, Saint Maurice 94415, France
| | - A Guillet
- DATA Science Department, Santé publique France, Saint Maurice 94415, France
| | - A Rigou
- Non-Transmissible Diseases and Injury Department, Santé publique France, Saint Maurice 94415, France
| | - J Chesneau
- DATA Science Department, Santé publique France, Saint Maurice 94415, France
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Hayes M, Patel A, Seideman C. Staged Fowler Stephens, Who Requires a Third Procedure? Curr Urol Rep 2021; 22:32. [PMID: 34009488 DOI: 10.1007/s11934-021-01049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The two-stage Fowler-Stephens orchiopexy is a well-described surgical approach for most pediatric urologists tackling the high intra-abdominal testis. Testicular ascent is a well-reported outcome of the surgery and a problem that could be fixed with a repeat procedure. The purpose of this review is to determine the rate of subsequent testicular ascent and repeat surgery after a two-stage Fowler-Stephens using best available evidence. RECENT FINDINGS/RESULT We selected 16 studies that pertained to our topic. 0-13% of testicles were deemed to be in an inappropriate position on follow-up (6-37 months). The definition of appropriate postoperative position varied between studies and rates of repeat procedures were sparsely available. Available data reports a repeat orchiopexy rate of 2.6-7.5% after two-stage Fowler-Stephens. Two-stage Fowler-Stephens orchiopexy is a highly successful surgical technique to manage high intra-abdominal testes. Rates of testicular ascent are difficult to ascertain due to varying definitions and small sample sizes. While repeat procedures are typically indicated, the actual rate of repeat orchiopexy is rarely reported and long-term outcomes following a third procedure is sparse.
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Affiliation(s)
- Mitchell Hayes
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
| | - Amir Patel
- Department of Urology, Oregon Health & Science University, Portland, OR, USA. .,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA.
| | - Casey Seideman
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
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Batra NV, DeMarco RT, Bayne CE. A narrative review of the history and evidence-base for the timing of orchidopexy for cryptorchidism. J Pediatr Urol 2021; 17:239-245. [PMID: 33551366 DOI: 10.1016/j.jpurol.2021.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Consensus recommendations for surgical management of cryptorchidism recommend orchidopexy between 6 and 18 months of age. The COVID-19 pandemic has impacted elective surgical scheduling. OBJECTIVE In response to the COVID-19 pandemic, we sought to review the available data regarding the natural history, surgical management, and infertility- and cancer-related risks associated with cryptorchid testes. The purpose of this review is to provide parents, referring providers, and surgeons with information to inform their decisions to proceed with or delay orchidopexy. METHODS A retrospective review and analysis of all available articles relevant to the natural history, surgical management, and infertility- and cancer-related risks of cryptorchidism present on PubMed, SCOPUS, and Cochrane Library was conducted. RESULTS The quality of historic literature pertaining to the effect of cryptorchidism on fertility and malignancy differ, with poorer data available on fertility. Cryptorchid testes may show histologic differences as early as birth, and some of these changes may have prognostic value in future fertility. Formerly unilateral cryptorchid men have slightly but not significantly reduced paternity rates compared to the general population. Cryptorchid testes have an increased risk of germ cell carcinogenesis, and robust data suggest the risk for malignancy in cryptorchid testes increases substantially after puberty. CONCLUSION The current body of evidence regarding the risks for future infertility and testicular cancer support the consensus recommendations for surgical correction of cryptorchidism between 6 and 18 months of age. During the uncertain time of the COVID-19 pandemic, decision for orchidopexy is a shared-decision between physician and parent. For an infant or young boy with a unilateral undescended testes, delaying orchidopexy several months until a time of decreased exposure risk is unlikely to result in substantial or sustained fertility or malignant risks.
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Affiliation(s)
- Nikhil V Batra
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA.
| | - Romano T DeMarco
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA
| | - Christopher E Bayne
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA
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Yang Z, Li S, Yin J, Bao J, Zeng H, Xu W, Zhang X, Xing Z, Zhao W, Liu C. A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis. Transl Pediatr 2021; 10:882-892. [PMID: 34012837 PMCID: PMC8107851 DOI: 10.21037/tp-20-473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables. METHODS We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018. RESULTS A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851. CONCLUSIONS In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.
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Affiliation(s)
- Zhilin Yang
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianchun Yin
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiming Bao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Wanhua Xu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Xuan Zhang
- Department of Pediatric Surgery, Shenzhen Pingshan District Woman's and Children's Hospital, Southern Medical University, Shenzhen, China
| | - Zhihao Xing
- Clinical laboratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Weiguang Zhao
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Cundong Liu
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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Hildorf S, Cortes D, Clasen-Linde E, Fossum M, Thorup J. The impact of early and successful orchidopexy on hormonal follow-up for 208 boys with bilateral non-syndromic cryptorchidism. Pediatr Surg Int 2021; 37:339-345. [PMID: 33423103 DOI: 10.1007/s00383-020-04820-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Inhibin-B is produced by Sertoli cells and decreased values might be associated with impaired fertility potential. The aim of the study was to evaluate the impact of bilateral orchidopexy on serum inhibin-B and follicle-stimulating hormone (FSH). METHODS A cohort study including 208 bilateral cryptorchid boys (median age: 1.7 year) was evaluated with serum inhibin-B and FSH in relation to histological parameters. Based on the fertility potential, the boys were divided into three subgroups. At follow-up (median age: 2.7 years) the boys were evaluated with FSH and in case of inhibin-B using multiple of the median (MoM). RESULTS Inhibin-B MoM improved significantly at follow-up. In 32 boys with high FSH at orchidopexy 63% normalized FSH and 59% increased MoM inhibin-B, but 31% had impaired inhibin-B at follow-up. In 105 boys with transient hypogonadotropic hypogonadism, 52% increased inhibin-B MoM but 31% had impaired inhibin-B at follow-up. In 71 boys with normal FSH, inhibin-B, and G/T, 54% increased inhibin-B MoM and 15% had impaired inhibin-B at follow-up. The effect of the surgery was best in patients younger than 1 year. CONCLUSION Orchidopexy, especially before 1 year of age, improves the fertility potential in bilateral cryptorchidism. At follow-up, 26% (54/208) had a risk of infertility based on inhibin-B.
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Affiliation(s)
- Simone Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Gu S, Wang Y, Luo H. Comparison of Laparoscopic Orchiopexy and Traditional Inguinal Incision Orchiopexy for Palpable Undescended Testes in Cryptorchidism. J Laparoendosc Adv Surg Tech A 2021; 31:598-603. [PMID: 33595353 DOI: 10.1089/lap.2020.0832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic orchiopexy (LO) has become a standard procedure for the treatment of nonpalpable undescended testes (UDT). LO for palpable UDT is still controversial. The aim of this study is to explore the method and effect of LO procedure for palpable UDT in children suffering from cryptorchidism. Methods: A retrospective study was performed for LO and traditional inguinal incision orchiopexy (TIO) for palpable UDT. A total of 291 children were enrolled, and they were aged 9-96 months with either left- or right-side palpable inguinal canalicular testes. Patients with testes that were nonpalpable, ectopic, and retractable were excluded. One hundred seventy patients received LO and 121 patients received TIO. Patient age, operative time, and clinical outcomes were reviewed. Independent t-test and Fisher's exact test were performed by SPSS 25.0 software. Results: The mean operative time (30.77 ± 6.02 minutes versus 44.76 ± 6.70 minutes) and postoperative normal activity time (1.25 ± 0.43 days versus 2.48 ± 0.68 days) of LO were significantly shorter than those of TIO group (P < .05). Forty-seven of 49 cases (95.9%) aged <1 year successfully achieved LO. Conclusion: LO is an appropriate choice for palpable UDT, especially in younger children aged <2 years. The success rate of LO decreased with age.
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Affiliation(s)
- Shaodong Gu
- Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Lianyungang, China.,The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, China.,The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, China
| | - Yingxun Wang
- Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Lianyungang, China.,The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, China.,The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, China
| | - Hong Luo
- Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Lianyungang, China.,The Affiliated Lianyungang Hospital of Xuzhou Medical University/The First People's Hospital of Lianyungang, Lianyungang, China.,The First Affiliated Hospital of Kangda College of Nanjing Medical University/The First People's Hospital of Lianyungang, Lianyungang, China
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Obayashi J, Wakisaka M, Tanaka K, Furuta S, Ohyama K, Kitagawa H. Risk factors influencing ascending testis after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Pediatr Surg Int 2021; 37:293-297. [PMID: 33388952 DOI: 10.1007/s00383-020-04789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the risk factors influencing ascending testis following laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia or hydrocele. METHODS Boys undergoing LPEC between 2014 and 2018 had their medical records and operative movies reviewed. Group A patients required orchiopexy after LPEC. Group B patients did not. Their baseline characteristics were reviewed. The path of the LPEC needle (not crossing the spermatic duct at first circuit [Not Crossing]), whether the second entry of the LPEC needle was different from the first hole (Different Hole), peritoneal injury requiring re-ligation (Re-ligation), and hematoma (Hematoma) were evaluated. The quantitative factors of significant difference were set as a cut-off value. RESULTS There were 5 patients (7 sides) in Group A and 162 patients (237 sides) in Group B. Birth weight was lower in Group A (p = 0.035). Not Crossing was 7 sides (100%) in Group A and 97 sides (41%) in Group B (p = 0.002). Hematoma was 2 sides (29%) in Group A and 11 sides (5%) in Group B (p = 0.047). Cut-off value of birth weight was 932 g (AUC 0.78). CONCLUSION Birth weight < 932 g and operative findings (not crossing over the spermatic duct on the first circuit and hematoma) indicated an increased risk of ascending testis after LPEC.
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Affiliation(s)
- Juma Obayashi
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Munechika Wakisaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Kunihide Tanaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
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Jorgez CJ, Seth A, Wilken N, Bournat JC, Chen CH, Lamb DJ. E2F1 regulates testicular descent and controls spermatogenesis by influencing WNT4 signaling. Development 2021; 148:dev191189. [PMID: 33441379 PMCID: PMC7823160 DOI: 10.1242/dev.191189] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/26/2020] [Indexed: 12/14/2022]
Abstract
Cryptorchidism is the most common urologic birth defect in men and is a predisposing factor of male infertility and testicular cancer, yet the etiology remains largely unknown. E2F1 microdeletions and microduplications contribute to cryptorchidism, infertility and testicular tumors. Although E2f1 deletion or overexpression in mice causes spermatogenic failure, the mechanism by which E2f1 influences testicular function is unknown. This investigation revealed that E2f1-null mice develop cryptorchidism with severe gubernacular defects and progressive loss of germ cells resulting in infertility and, in rare cases, testicular tumors. It was hypothesized that germ cell depletion resulted from an increase in WNT4 levels. To test this hypothesis, the phenotype of a double-null mouse model lacking both Wnt4 and E2f1 in germ cells was analyzed. Double-null mice are fertile. This finding indicates that germ cell maintenance is dependent on E2f1 repression of Wnt4, supporting a role for Wnt4 in germ cell survival. In the future, modulation of WNT4 expression in men with cryptorchidism and spermatogenic failure due to E2F1 copy number variations may provide a novel approach to improve their spermatogenesis and perhaps their fertility potential after orchidopexy.
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Affiliation(s)
- Carolina J Jorgez
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Abhishek Seth
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nathan Wilken
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Juan C Bournat
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ching H Chen
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dolores J Lamb
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
- Brady Urology Department, Center for Reproductive Genomics and Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Muncey W, Dutta R, Terlecki RP, Woo LL, Scarberry K. Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports. Andrology 2021; 9:781-791. [PMID: 33354918 DOI: 10.1111/andr.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/05/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT. METHODS A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult" AND "bilateral orchidopexy" OR "bilateral cryptorchidism." Relevant referenced articles from non-indexed journal were identified by Google Scholar search and additionally included. RESULTS Fifty-seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3). CONCLUSION Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.
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Affiliation(s)
- Wade Muncey
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rahul Dutta
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | - Lynn L Woo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Kyle Scarberry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Zhao T, Deng F, Jia W, Gao X, Li Z, Tang X, Li D, Zhou R, Shu F, Zhang J, Zhang Z, Fu W, Liu G. Ambulatory Orchidopexy Is a Potential Solution to Improve the Rate of Timely Repair in Cryptorchid Boys: An 8 Year Retrospective Study of 4,972 Cases. Front Pediatr 2021; 9:671578. [PMID: 34017811 PMCID: PMC8129512 DOI: 10.3389/fped.2021.671578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cryptorchidism is the most common congenital anomaly in pediatric urology. Although early surgery on cryptorchid boys is recommended by pediatric urologists worldwide, the actual age at orchidopexy is often older than the recommended age. Our medical center has started performing ambulatory orchidopexy since March 2016 at the ambulatory surgery center. We aimed to investigate whether ambulatory orchidopexy can improve the timely repair rate. Methods: A retrospective analysis was conducted from 2012 to 2019 at our medical center. Ambulatory orchidopexy was started at our medical center on March 24, 2016. Boys born on or after September 24, 2015 were classified into the "with ambulatory medical resource" group, and boys born before September 24, 2014, were classified into the "without ambulatory medical resource" group. The timely repair rates were calculated and compared. Results: A total of 4,972 cryptorchidism cases were included in the final study. Approximately 33.0% of cryptorchid boys received timely surgery (orchidopexy by the age of 18 months), and only 6.8% of all cryptorchid boys underwent surgery before the age of 1 year. After the performance of ambulatory orchidopexy, the timely repair rate increased from 25.7 to 37.0% (P < 0.001), and the percentage of patients receiving surgery before the age of 1 year increased significantly from 3.5 to 8.6% (P < 0.001). The proportion of timely repair in patients with ambulatory medical resources was significantly higher than that in patients without ambulatory medical resources (15.6% vs. 58.2%, P < 0.001). Significant changes in the rate of surgery before 12 months of age were also found between the two groups (2.4% vs. 14.8%, P < 0.001). Conclusions: After the performance of ambulatory orchidopexy in our medical center, the rates of both timely repair and receiving surgery before the age of 1 year increased significantly. Ambulatory orchidopexy is a potential solution to improve the rate of timely repair in cryptorchid boys, and it is worthy of promotion in developing countries and regions.
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Affiliation(s)
- Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fuming Deng
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Jia
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Gao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhongmin Li
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangliang Tang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dian Li
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fangpeng Shu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhengtao Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Fu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guochang Liu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Hori S, Aoki K, Nishimura N, Morizawa Y, Gotoh D, Fukui S, Nakai Y, Miyake M, Torimoto K, Yoneda T, Tanaka N, Fujimoto K. Trends in treatment outcomes for retractile testis in Japanese boys: A single-center study. Int J Urol 2020; 28:327-332. [PMID: 33302323 DOI: 10.1111/iju.14458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the natural course of retractile testis by analyzing its prevalence and outcomes. METHODS This retrospective study included 215 boys in whom retractile testis was diagnosed after reviewing the medical history and physical examinations of the patients. Orchiopexy was performed once the testis became undescended. We investigated the trends in the prevalence and outcomes of retractile testis and compared clinical factors between cases that resolved spontaneously and those that required orchiopexy. RESULTS Of 215 boys, 145 were finally evaluated. The mean age at diagnosis was 2 years, and 100 boys were aged ≤2 years when they were hospitalized. Seventy-three boys were referred to our institution through health examinations as babies. The condition improved spontaneously in 89 boys, while 43 boys underwent orchiopexy, and 13 boys remained under follow-up. The follow-up period between diagnosis and resolution was significantly longer in the spontaneous resolution group than in the surgical intervention group (P = 0.011). Bilateral retractile testis improved spontaneously in significantly more boys compared to unilateral retractile testis (P = 0.0010). Spontaneous resolution was observed in boys of all ages, but those diagnosed at ≤3 years of age had a significantly higher rate of spontaneous resolution compared to those who were diagnosed at >3 years of age (P = 0.0019). CONCLUSIONS Our findings suggest that retractile testis cannot be affirmed as a variant of normal testis. Performing examinations at a young age is critical for preventing misdiagnosis, screening failures, and unnecessary surgery.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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45
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Gul M, Hildorf S, Dong L, Thorup J, Hoffmann ER, Jensen CFS, Sønksen J, Cortes D, Fedder J, Andersen CY, Goossens E. Review of injection techniques for spermatogonial stem cell transplantation. Hum Reprod Update 2020; 26:368-391. [PMID: 32163572 DOI: 10.1093/humupd/dmaa003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the prognosis of childhood cancer survivors has increased dramatically during recent years, chemotherapy and radiation treatments for cancer and other conditions may lead to permanent infertility in prepubertal boys. Recent developments have shown that spermatogonial stem cell (SSC) transplantation may be a hope for restoring fertility in adult survivors of childhood cancers. For this reason, several centres around the world are collecting and cryopreserving testicular tissue or cells anticipating that, in the near future, some patients will return for SSC transplantation. This review summarizes the current knowledge and utility of SSC transplantation techniques. OBJECTIVE AND RATIONALE The aim of this narrative review is to provide an overview of the currently used experimental injection techniques for SSC transplantation in animal and human testes. This is crucial in understanding and determining the role of the different techniques necessary for successful transplantation. SEARCH METHODS A comprehensive review of peer-reviewed publications on this topic was performed using the PubMed and Google Scholar databases. The search was limited to English language work and studies between 1994 (from the first study on SSC transplantation) and April 2019. Key search terms included mouse, rat, boar, ram, dog, sheep, goat, cattle, monkey, human, cadaver, testes, SSC transplantation, injection and technique. OUTCOMES This review provides an extensive clinical overview of the current research in the field of human SSC transplantation. Rete testis injection with ultrasonography guidance currently seems the most promising injection technique thus far; however, the ability to draw clear conclusions is limited due to long ischemia time of cadaver testis, the relatively decreased volume of the testis, the diminishing size of seminiferous tubules, a lack of intratesticular pressure and leakage into the interstitium during the injection on human cadaver testis. Current evidence does not support improved outcomes from multiple infusions through the rete testes. Overall, further optimization is required to increase the efficiency and safety of the infusion method. WIDER IMPLICATIONS Identifying a favourable injection method for SSC transplantation will provide insight into the mechanisms of successful assisted human reproduction. Future research could focus on reducing leakage and establishing the optimal infusion cell concentrations and pressure.
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Affiliation(s)
- Murat Gul
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark.,Department of Urology, Selcuk University School of Medicine, 42250 Konya, Turkey
| | - Simone Hildorf
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Lihua Dong
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Eva R Hoffmann
- DNRF Center for Chromosome Stability, Department of Molecular and Cellular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Jens Sønksen
- Department of Urology, Herlev and Gentofte University Hospital, 2930 Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Jens Fedder
- Centre of Andrology & Fertility Clinic, Department D, Odense University Hospital, 5000 Odense, Denmark.,Research Unit of Human Reproduction, Institute of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ellen Goossens
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
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46
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Kim SJ. Undescended testis: importance of a timely referral to a surgical specialist. Clin Exp Pediatr 2020; 63:429-430. [PMID: 32252146 PMCID: PMC7642139 DOI: 10.3345/cep.2020.00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Su Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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47
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Zvizdic Z, Islamovic B, Milisic E, Jonuzi A, Vranic S. Changing Trends in the Referral and Timing of Treatment for Congenital Cryptorchidism: A Single-Center Experience from Bosnia and Herzegovina. J Pediatr Surg 2020; 55:1965-1968. [PMID: 31500876 DOI: 10.1016/j.jpedsurg.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cryptorchidism is the most common male urogenital tract disorder identified at birth. Treatment delays of cryptorchidism may be associated with significant complications such as subfertility and testicular cancer. The currently recommended age for performing orchidopexy is between 6 and 12 months of age and no later than 18 months. The aim of this study was to investigate the trends in the pattern of referral and age of boys at the time of operative treatment of congenital cryptorchidism at the largest tertiary care center in Bosnia and Herzegovina. METHODS The study included all boys who underwent orchidopexy for congenital cryptorchidism during two equivalents periods: 2008-2010 and 2015-2017. We assessed the referral age of patients, the age of patients at the time of orchidopexy, laterality of cryptorchidism, position of cryptorchidic testes palpated before surgery, the intraoperative position of cryptorchidic testis, a clinical position of the testis at follow up, and risk factors for late orchidopexy. RESULTS In total, 324 patients with 386 testes underwent orchidopexy for congenital cryptorchidism during the study periods. Of these patients, 62 received a bilateral orchidopexy (19.1%). Total referral age of patients with congenital cryptorchidism was 23 months (range, 4-74.5 months). Total median age at surgery was 24 months (range, 6-74 months). One hundred and eleven patients (28.8%) underwent surgery at less than the age of 12 months, 136 (35.2%) at less than the age of 18 months, and 250 (64.8%) patients underwent surgery after the age of 18 months. The analysis of the observed two periods (2008-2010 and 2015-2017) showed a statistically significant decrease in the mean referral age and the mean age at surgery over the last 5 years (2015-2017) (p = 0.007 and p = 0.003, respectively). CONCLUSIONS Current guidelines for timely operative treatment for congenital cryptorchidism have not been fully implemented in Bosnia and Herzegovina but a gradual improvement is evident. The main factor contributing to delays in orchidopexy was delayed or neglected referral by referring physicians. Optimizing the time of orchidopexy will require an improved coordination at all levels of pediatric health care to diminish the long-term consequences of cryptorchidism. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Belma Islamovic
- Public Medical Center Visoko, Visoko, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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48
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Barbotin AL, Dauvergne A, Dumont A, Ramdane N, Mitchell V, Rigot JM, Boitrelle F, Robin G. Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes. Asian J Androl 2020; 21:445-451. [PMID: 30880688 PMCID: PMC6732891 DOI: 10.4103/aja.aja_2_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l−1vs 19.3 IU l−1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.
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Affiliation(s)
- Anne-Laure Barbotin
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Anaïs Dauvergne
- CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Agathe Dumont
- CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Nassima Ramdane
- CHU Lille, Department of Biostatistics, EA2694, Lille University, F-59000 Lille, France
| | - Valérie Mitchell
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Jean-Marc Rigot
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Florence Boitrelle
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303 Poissy, France
| | - Geoffroy Robin
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France.,CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
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49
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Saka R, Tazuke Y, Ueno T, Watanabe M, Nomura M, Masahata K, Deguchi K, Okuyama H. Laparoscopy-Assisted Transscrotal Orchidopexy for Palpable Undescended Testis: Initial Results. J Laparoendosc Adv Surg Tech A 2020; 30:1131-1136. [PMID: 32746698 DOI: 10.1089/lap.2020.0360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Undescended testis (UDT) is one of the most common congenital genital malformations in boys. However, orchidopexy carries a risk of injuring the testicular vessels and vas deferens. We therefore developed a novel approach to manage palpable UDT. Materials and Methods: We analyzed the medical records of patients who underwent orchidopexy at our institute between January 2017 and April 2020. This study was approved by the Institutional Review Board of our hospital. The age, body weight, laterality, testicular position, length of operation, and complications were investigated. The patients were classified into two groups depending on the surgery received: laparoscopy-assisted transscrotal orchidopexy (LATO) or conventional inguinal orchidopexy (CO). In brief, LATO involves preceding laparoscopic closure of the patent processus vaginalis (PPV) followed by transscrotal orchidopexy. Dissection of the PPV from the testicular vessels and vas deferens was minimized through this procedure. The chi-squared test and t-test were used to analyze the significance of the data. Results: Among a total of 49 patients, 24 (33 testes) underwent LATO, and 25 (30 testes) underwent CO. There was no significant difference in patients' age, body weight, or laterality. The length of operation was similar between the groups in both unilateral and bilateral cases. The contralateral PPV was confirmed in 80% of unilateral cases of LATO (12/15). No complications, including testicular atrophy and postoperative ascent, were noted in either group. Conclusions: There were no significant differences between the groups in the surgical results. However, the confirmation and ligation of the PPV were easier in LATO, and peeling of the testicular vessels and vas deferens was minimized. LATO may be safe and effective for managing palpable UDT.
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Affiliation(s)
- Ryuta Saka
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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50
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Molinaro F, Fusi G, Aglianò M, Volpi N, Franci D, Lorenzoni P, Messina M, Galgano A, Grasso F, Plessi C, Messina M, Angotti R. Clinically Differentiated Abnormalities of the Architecture and Expression of Myosin Isoforms of the Human Cremaster Muscle in Cryptorchidism and Retractile Testis. Urol Int 2020; 104:891-901. [PMID: 32674099 DOI: 10.1159/000508432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). BACKGROUND The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. SUBJECTS AND METHODS Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. RESULTS AND CONCLUSIONS The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.
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Affiliation(s)
- Francesco Molinaro
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Fusi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
| | - Margherita Aglianò
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniela Franci
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Paola Lorenzoni
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maddalena Messina
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Angela Galgano
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Grasso
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rossella Angotti
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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