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de la Calle CM, Kim S, Baskin LS. Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes. J Pediatr Surg 2020; 55:2480-2491. [PMID: 32164982 DOI: 10.1016/j.jpedsurg.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/14/2020] [Accepted: 02/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE Pediatric surgical specialists are often confronted with the difficult task of identifying, diagnosing and managing intra-abdominal gonads in children. Ranging from the intra-abdominal cryptorchid testis to normal or pathologic ovaries and gonads in disorders of sexual development, all intra-abdominal gonads in the pediatric population pose different diagnosis and management challenges. Understanding the hormonal and fertility potential of the gonad and knowing its potential cancer risk is essential when deciding how to manage these patients. In addition, the ideal surgical management for each one of these patients is often debated. METHODS Descriptive literature review. RESULTS/CONCLUSION Herein, we reviewed gonadal formation, common etiologies, diagnosis and management of intra-abdominal testes, pathologic ovaries and gonads in disorders of sexual development. Fertility potential and cancer risk for each were also reviewed and how both affect surgical management of the gonad. TYPE OF STUDY/LEVEL OF EVIDENCE Review Article, Level V.
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Affiliation(s)
- Claire M de la Calle
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Sunghoon Kim
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
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52
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Abou El-Ella SS, Tawfik MA, Abd El-Aziz TF, Shalaby AMA, Barseem NF. The G178A polymorphic variant of INSL3 may be linked to cryptorchidism among Egyptian pediatric cohort. Pediatr Surg Int 2020; 36:1387-1393. [PMID: 32865613 DOI: 10.1007/s00383-020-04735-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
Cryptorchidism (CO) is a genital disorder of multifactorial etiology, with serious remote complications. Mutations in insulin-like 3 hormones (INSL3) G/A variant remain a matter of inquiry. We aimed to investigate the association between G178A-INSL3 polymorphism and undescended testis in a cohort of Egyptian children. In this study, a total of 160 children, including 80 cases with primary non-syndromic undescended testes and 80 healthy children with normal external genitalia as controls, both, were analyzed after detailed history, physical examination and imaging for mutations of G178A polymorphism of INSL3 gene by restriction fragment length polymorphism (RFLP) technique. We found most of the undescended testes were inside the inguinal canal mainly on the left side. Genetic analysis revealed that the mutant A allele of G178A INSL3 variant was significantly detected in the patient group with a frequency of 26.2% against 12.5% for control subjects, especially among cases with an evident family history of similar cases as shown by p value = 0.001 and odd's ratio (CI95%) of 0.13 (0.04-0.723). In conclusion, G178A-INSL3 gene polymorphism could be a susceptibility factor for testicular maldescent in Egyptian children. Also, family history of similar cases was considered as significant predictive risk for cryptorchidism, added to the shared genetic links to consanguinity in our locality.
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Affiliation(s)
- Sohier S Abou El-Ella
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Maha Atef Tawfik
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | | | - Naglaa Fathy Barseem
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
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Zitzmann M, Aksglaede L, Corona G, Isidori AM, Juul A, T'Sjoen G, Kliesch S, D'Hauwers K, Toppari J, Słowikowska-Hilczer J, Tüttelmann F, Ferlin A. European academy of andrology guidelines on Klinefelter Syndrome Endorsing Organization: European Society of Endocrinology. Andrology 2020; 9:145-167. [PMID: 32959490 DOI: 10.1111/andr.12909] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Knowledge about Klinefelter syndrome (KS) has increased substantially since its first description almost 80 years ago. A variety of treatment options concerning the spectrum of symptoms associated with KS exists, also regarding aspects beyond testicular dysfunction. Nevertheless, the diagnostic rate is still low in relation to prevalence and no international guidelines are available for KS. OBJECTIVE To create the first European Academy of Andrology (EAA) guidelines on KS. METHODS An expert group of academicians appointed by the EAA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS Clinical features are highly variable among patients with KS, although common characteristics are severely attenuated spermatogenesis and Leydig cell impairment, resulting in azoospermia and hypergonadotropic hypogonadism. In addition, various manifestations of neurocognitive and psychosocial phenotypes have been described as well as an increased prevalence of adverse cardiovascular, metabolic and bone-related conditions which might explain the increased morbidity/mortality in KS. Moreover, compared to the general male population, a higher prevalence of dental, coagulation and autoimmune disorders is likely to exist in patients with KS. Both genetic and epigenetic effects due to the supernumerary X chromosome as well as testosterone deficiency contribute to this pathological pattern. The majority of patients with KS is diagnosed during adulthood, but symptoms can already become obvious during infancy, childhood or adolescence. The paediatric and juvenile patients with KS require specific attention regarding their development and fertility. CONCLUSION These guidelines provide recommendations and suggestions to care for patients with KS in various developmental stages ranging from childhood and adolescence to adulthood. This advice is based on recent research data and respective evaluations as well as validations performed by a group of experts.
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Affiliation(s)
- Michael Zitzmann
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Lise Aksglaede
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Giovanni Corona
- Medical Department, Endocrinology Unit, Maggiore Bellaria Hospital, Azienda Usl, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Advanced Endocrine Diagnostics Unit, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Anders Juul
- Rigshospitalet, Department of Growth and Reproduction, University of Copenhagen, Copenhagen, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Sabine Kliesch
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Kathleen D'Hauwers
- Department of Urology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jorma Toppari
- Department of Pediatrics, Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology and Centre for Population Health Research, University Hospital, University of Turku, Turku, Finland
| | | | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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54
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Hori S, Aoki K, Nishimura N, Morizawa Y, Gotoh D, Fukui S, Nakai Y, Miyake M, Torimoto K, Fujimoto K. Trends in the Treatment Outcomes and Features of Cryptorchidism in Boys: A Single-Institute Experience. Res Rep Urol 2020; 12:373-381. [PMID: 32984085 PMCID: PMC7508029 DOI: 10.2147/rru.s271869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/29/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Cryptorchidism is one of the most common congenital abnormalities in pediatric urology, and orchiopexy is performed for the prevention of testicular damage and malignant transformation. We examined the distribution and outcomes of cryptorchidism under a single investigator at our institute. Patients and Methods This retrospective study included 283 boys diagnosed with cryptorchidism at our institute. Cryptorchidism was diagnosed based on the medical history and physical examination findings. Boys without spontaneous resolution after 6 months of age were indicated for orchiopexy. We investigated the 12-year trend in the distribution and outcomes of cryptorchidism at the institute. Results The mean age at diagnosis, gestational age, and birth weight were 2 years, 37 weeks, and 2740 g, respectively. A total of 170 boys underwent orchiopexy under 2 years of age, and 136 boys underwent orchiopexy under the age of 1 year, while 62 boys underwent orchiopexy over the age of 3 years. Abnormalities of the epididymis and disclosure of the processus vaginalis were observed in 44 (25%) and 72 boys (41%), respectively. Comparison of boys with or without hypospadias showed that the age at orchiopexy was higher in boys with hypospadias than in those without hypospadias (P=0.028). In addition, boys without hypospadias had a higher rate of abnormality of the epidermis than those with hypospadias (P=0.024). Conclusion Our findings suggest that most boys with cryptorchidism are treated under the age of 2 years and the incidence of epididymal abnormality is relatively high, especially in boys with hypospadias. An understanding of the natural features of cryptorchidism could lead to better management and outcomes. Further research is warranted to develop an appropriate treatment timeline in boys with cryptorchidism.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Katsuya Aoki
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Shinji Fukui
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara 634-8522, Japan
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Qadeer A, Quincey C, Gill K, Paddock M. Splenogonadal fusion: a radiologic-pathologic correlation and review of the literature. Radiol Case Rep 2020; 15:1817-1822. [PMID: 32793323 PMCID: PMC7413983 DOI: 10.1016/j.radcr.2020.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022] Open
Abstract
We present the case of a 29-year-old male who presented to his General Practitioner with a left testicular lump. Scrotal ultrasound examination revealed 4 well-defined, homogenous, mildly hypoechoic extratesticular mass lesions. He was referred for an urgent urological opinion and underwent local excision. Histologic analysis revealed splenic tissue resulting in the diagnosis of splenogonadal fusion.
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Affiliation(s)
- Amir Qadeer
- Department of Paediatrics, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Caroline Quincey
- Department of Pathology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Kanwar Gill
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Michael Paddock
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom.,Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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56
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Punjani N, Lamb DJ. Male infertility and genitourinary birth defects: there is more than meets the eye. Fertil Steril 2020; 114:209-218. [PMID: 32741459 PMCID: PMC10590568 DOI: 10.1016/j.fertnstert.2020.06.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
Abstract
Male factor infertility is a significant problem present in up to 50% of infertile couples. The relationship between male infertility and systemic disease is of significant interest, and emerging evidence suggests a relationship between male infertility and male genitourinary (GU) birth defects (cryptorchidism, hypospadias, ambiguous genitalia, and congenital anomalies of the kidney and urinary tract). Many of these birth defects are treated in isolation by busy urologists without acknowledgment that these may be related to more global syndromic conditions. Conversely, geneticists and nonurologists who treat variable systemic phenotypes may overlook GU defects, which are indeed related conditions. Many of these defects are attributed to copy number variants dosage-sensitive genes due to chromosome microdeletions or microduplications. These variants are responsible for disease phenotypes seen in the general population. The copy number variants described in this review are syndromic in some cases and responsible for both GU birth defects as well as other systemic phenotypes. This review highlights the emerging evidence between these birth defects, male infertility, and other systemic conditions.
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Affiliation(s)
- Nahid Punjani
- James Buchanan Brady Foundation Institute of Urology, Weill Cornell Medical College, New York, New York
| | - Dolores J Lamb
- James Buchanan Brady Foundation Institute of Urology, Weill Cornell Medical College, New York, New York; Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, New York; Center for Reproductive Genomics, Weill Cornell Medical College, New York, New York.
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57
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Jay MA, Arat A, Wijlaars L, Ajetunmobi O, Fitzpatrick T, Lu H, Lei S, Skerritt C, Goldfeld S, Gissler M, Gunnlaugsson G, Hrafn Jónsson S, Hjern A, Guttmann A, Gilbert R. Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study. BJS Open 2020; 4:1117-1124. [PMID: 32706149 PMCID: PMC7709362 DOI: 10.1002/bjs5.50329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.
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Affiliation(s)
- M. A. Jay
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - A. Arat
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - L. Wijlaars
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - O. Ajetunmobi
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - S. Lei
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
| | - C. Skerritt
- Bristol Royal Hospital for ChildrenBristolUK
| | - S. Goldfeld
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - M. Gissler
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Information Services DepartmentFinnish Institute for Health and WelfareHelsinkiFinland
| | - G. Gunnlaugsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - S. Hrafn Jónsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - A. Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - A. Guttmann
- Child Health Evaluative SciencesCanada
- Division of Paediatric Medicine, Hospital for Sick ChildrenCanada
- ICESCanada
- Dalla Lana School of Public HealthCanada
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - R. Gilbert
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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Axelsson J, Scott K, Dillner J, Lindh CH, Zhang H, Rylander L, Rignell-Hydbom A. Exposure to polychlorinated compounds and cryptorchidism; A nested case-control study. PLoS One 2020; 15:e0236394. [PMID: 32702712 PMCID: PMC7377911 DOI: 10.1371/journal.pone.0236394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background Maldescended testes or cryptorchidism is a genital birth defect that affects 2–9% of all male new-borns. Over the last 40 years there have been reports of increased prevalence in countries like the US, the UK and the Scandinavian countries. This possible increase has in some studies been linked to a foetal exposure to chemical pollutants. In this matched case-control study, we analysed maternal serum samples in early pregnancy for three different organochlorine compounds, to investigate whether the levels were associated with the risk of cryptorchidism. Method Maternal serum samples taken during the first trimester of pregnancy from 165 cases (boys born with cryptorchidism) and 165 controls, matched for birth year and maternal age, parity and smoking habits during the pregnancy, were retrieved from the Southern Sweden Maternity Biobank. The samples were analysed for 2,2’,4,4’,5,5’-hexachlorobiphenyl (PCB-153), dichlorodiphenyltrichloroethane (p,p’-DDE) and hexachlorobenzene (HCB), using gas chromatography mass spectrometry. Associations between exposure and cryptorchidism were evaluated by conditional logistic regression. Results We found no statistically significantly associations between exposure to these compounds and cryptorchidism, either when the exposure variables were used as a continuous variable, or when the exposure levels were divided in quartiles. Conclusion We found no evidence of an association between maternal levels of PCB-153, p,p’-DDE or HCB during the pregnancy and the risk of having cryptorchidism in the sons.
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Affiliation(s)
- Jonatan Axelsson
- Reproductive Medicine Centre, Skåne University Hospital, Malmö, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Kristin Scott
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Joakim Dillner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - He Zhang
- Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
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de Vasconcelos RAL, Ximenes RAA, Calado AA, Martelli CMT, Gonçalves AV, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Cryptorchidism in Children with Zika-Related Microcephaly. Am J Trop Med Hyg 2020; 102:982-984. [PMID: 32157994 PMCID: PMC7204599 DOI: 10.4269/ajtmh.19-0753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The genitourinary tract was recently identified as a potential site of complications related to the congenital Zika syndrome (CZS). We provide the first report of a series of cryptorchidism cases in 3-year-old children with Zika-related microcephaly who underwent consultations between October 2018 and April 2019 as part of the follow-up of the children cohort of the Microcephaly Epidemic Research Group, Pernambuco, Brazil. Of the 22 males examined, eight (36.4%) presented with cryptorchidism. Among 14 undescended testis cases, 11 (78.6%) could be palpated in the inguinal region. Seven of the eight children had severe microcephaly. Conventional risk factors for cryptorchidism were relatively infrequent in these children. We hypothesize that cryptorchidism is an additional manifestation of CZS present in children with severe microcephaly. As in our cases, for most of the children, the testes were located in the inguinal region, and the possible mechanisms for cryptorchidism were gubernaculum disturbance or cremasteric abnormality.
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Affiliation(s)
| | - Ricardo A A Ximenes
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
| | | | | | - Andreia V Gonçalves
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
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Ather A, Zhong S, Rosenbaum AJ, Quinonez RB, Khan AA. Pharmacotherapy during Pregnancy: An Endodontic Perspective. J Endod 2020; 46:1185-1194. [PMID: 32590023 DOI: 10.1016/j.joen.2020.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/27/2022]
Abstract
Odontogenic pain affects up to 54.9% of pregnant women1-3. This pain is often associated with pulpal and/or periapical infections that pose risks to women and their fetus. The American Dental Association in collaboration with the American College of Obstetricians and Gynecologists developed a consensus statement to affirm the importance of timely and appropriate oral health care as a critical component of a healthy pregnancy4. However, limited knowledge of endodontic procedure safety and related medication use often result in the avoidance of treatment during pregnancy. This article, a collaborative effort by specialists from endodontics, pediatric dentistry, and obstetrics, reviews the current evidence on the safety of medications commonly used in endodontics including local anesthetics, analgesics, anxiolytics, and antibiotics.
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Affiliation(s)
- Amber Ather
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sheng Zhong
- Private Practice, Endodontics Associates Limited, Roseville, Minnesota
| | - Alan J Rosenbaum
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, Texas
| | - Rocio B Quinonez
- Department of Pediatric Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, Texas
| | - Asma A Khan
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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Gabrielson AT, Gearhart JP, Herati AS. Correspondence: The spectrum of testicular-epididymal fusion anomalies in children with cryptorchidism: Personal experience, systematic review and meta-analysis. J Pediatr Urol 2020; 16:406-407. [PMID: 32430209 DOI: 10.1016/j.jpurol.2020.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew T Gabrielson
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions 600 N. Wolfe Street/Park 217 Baltimore, 21287, MD, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions 600 N. Wolfe Street/Park 217 Baltimore, 21287, MD, USA
| | - Amin S Herati
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions 600 N. Wolfe Street/Park 217 Baltimore, 21287, MD, USA.
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Wang YJ, Chen L, Zhang QL, Lin Y, Cui X, Chen JC, Zhou CM. Transscrotal transverse incision for the treatment of middle and low cryptorchidism in children: experience from 796 cases. BMC Surg 2020; 20:51. [PMID: 32183767 PMCID: PMC7079498 DOI: 10.1186/s12893-020-00710-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to summarize our clinical experience with transscrotal transverse incision in the treatment of low and middle cryptorchidism in children. METHODS A total of 796 children with low or middle cryptorchidism participated in this study from March 2012 to May 2018. Transscrotal transverse incision was used to treat low and middle cryptorchidism. Symptoms and signs were followed up at 1 week, 1 month, 3months and every six to 12 months thereafter. RESULTS Testicular descent fixation through transverse scrotal incision was successfully performed in all 796 children. All patients were discharged 1-2 days after the operation. During hospitalization and follow-up, 35 patients had complications, including 7 cases of cryptorchidism recurrence, 5 cases of poor scrotal incision healing, and 23 cases of scrotal haematoma. There were no complications, such as bladder injury, testicular atrophy, inguinal hernia or hydrocele. CONCLUSION Transscrotal transverse incision is a safe and feasible method for the treatment of middle and low cryptorchidism. It has the advantages of less trauma and an aesthetic scar after operation.
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Affiliation(s)
- Yun-Jin Wang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Qi-Liang Zhang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Jian-Cai Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China
| | - Chao-Ming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People's Republic of China.
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Berklite L, Witchel SF, Yatsenko SA, Schneck FX, Reyes-Múgica M. Early Bilateral Gonadoblastoma Associated With 45,X/46,XY Mosaicism: The Spectrum of Undifferentiated Gonadal Tissue and Gonadoblastoma in the First Months of Life. Pediatr Dev Pathol 2019; 22:380-385. [PMID: 30646821 DOI: 10.1177/1093526618824469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
45,X/46,XY mosaicism is one of a heterogenous group of congenital conditions known as differences (disorders) of sex development (DSD) that results in abnormal development of internal and external genitalia. Patients with DSD, particularly those with segments of the Y chromosome, are at increased risk for germ cell tumors including gonadoblastoma. Gonadoblastoma is a neoplasm comprised of a mixture of germ cells and elements resembling immature granulosa or Sertoli cells with or without Leydig cells or lutein-type cells in an ovarian type stroma. Gonadoblastoma has an increased prevalence of 15% to 40% in patients with 45,X/46,XY mosaicism and has been previously reported in patients as young as 5 months of age with that karyotype. Herein, we describe a 3-month-old child with 45,X/46,XY karyotype who was referred for the evaluation of asymmetric labia majora. Additional evaluation revealed left streak gonad and right dysplastic/dysgenetic testis. Both gonads contained foci of cells typical for gonadoblastoma as well as undifferentiated gonadal tissue, underscoring the potential for very early infantile gonadoblastoma and the spectrum of developmental anomalies associated with this karyotype.
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Affiliation(s)
- Lara Berklite
- 1 Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Selma F Witchel
- 2 Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Svetlana A Yatsenko
- 3 Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X Schneck
- 2 Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Miguel Reyes-Múgica
- 2 Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Zhou Y, Zhang D, Hu D, Liu B, Peng J, Shen L, Long C, Yu Y, Zhang Y, Liu X, Tao X, Timashev P, Lin T, He D, Wei G. Retinoic acid: A potential therapeutic agent for cryptorchidism infertility based on investigation of flutamide-induced cryptorchid rats in vivo and in vitro. Reprod Toxicol 2019; 87:108-117. [PMID: 31170451 DOI: 10.1016/j.reprotox.2019.05.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/07/2019] [Accepted: 05/25/2019] [Indexed: 11/27/2022]
Abstract
Cryptorchidism is a common disorder in children and may cause infertility in adults. The BTB is essential for maintaining the microenvironment necessary for normal spermatogenesis. This study investigated whether retinoic acid (RA) may regulate the proteins that are essential for integrity of the BTB in cryptorchidism. Female Sprague-Dawley rats were administrated flutamide during late pregnancy to induce a model of cryptorchidism in male offspring. The concentrations of RA and BTB tight and gap junction protein levels were significantly lower in untreated cryptorchid pups compared with normal pups, but almost normal in cryptorchid pups given RA. Studies in vitro corroborated these findings. The sperm quality of RA-treated model pups was better compared with the untreated model. RA treatment may have therapeutic potential to restore retinoic acid and proteins associated with integrity of the BTB in cryptorchid testis.
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Affiliation(s)
- Yu Zhou
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; Chongqing Key Laboratory of Pediatrics, China
| | - Deying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China.
| | - Dong Hu
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China
| | - Bo Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; Chongqing Key Laboratory of Pediatrics, China
| | - Jinpu Peng
- Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Lianju Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China
| | - Chunlan Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China
| | - Yihang Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China
| | - Xu Tao
- Biomanufacturing Center, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China.
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Dave S, Liu K, Clark R, Garg AX, Shariff SZ. A retrospective population-based cohort study to evaluate the impact of an older sibling with undescended testis and hypospadias on the known maternal and fetal risk factors for undescended testis and hypospadias in Ontario, Canada, 1997-2007. J Pediatr Urol 2019; 15:41.e1-41.e9. [PMID: 30459092 DOI: 10.1016/j.jpurol.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are several reported risk factors for undescended testis (UDT) and hypospadias (HYP). Also, a family history of UDT or HYP has not been accounted for in prior studies, and doing so may influence these independent risk estimates. STUDY DESIGN A population-based retrospective cohort study was conducted using linked administrative databases in Ontario, Canada, to identify all live male newborns born between 1997 and 2007, and it was determined whether they underwent an orchidopexy or HYP repair within 5 years of birth. Baseline maternal and fetal risk factors were obtained using appropriate ICD codes. A statistical analysis using a generalized estimating equation with a logit link was performed, adjusting for clustering in mothers with a previous child born in the 5 years before the proband with UDT or HYP, to evaluate the adjusted risk factors of UDT and HYP. RESULTS A total of 709,968 male infants were followed up from birth for 5 years, of which 5830 underwent an orchidopexy and 2722 had an HYP repair. On multivariable analysis, factors associated with a higher risk of UDT included prematurity, small for gestational age (SGA), associated HYP, gestational hypertension, use of assisted fertility techniques, increased maternal age, Cesarean section, previous sibling with UDT, and disorders of sexual differentiation (DSDs). After adjusting for clustering in mothers with a previous baby with UDT, DSD, associated HYP (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1), and a previous sibling with UDT (OR, 3.6; 95% CI, 2.5-5.2) remained significant risk factors. The risk factors on multivariable analysis predicting the risk of HYP included SGA, prematurity, higher income families, and associated anomalies such as UDT. After adjusting for clustering in mothers with a previous sibling with HYP, SGA (OR, 1.8; 95% CI, 1.0-3.1), higher income families (OR, 1.5-1.6), associated UDT (OR, 7.1; 95% CI, 4.9-10.0), and a previous sibling with HYP (OR, 12.8; 95% CI, 9.1-18.1) remained significant risk factors. DISCUSSION Studies estimating risk factors for UDT and HYP have used variable methodologies to identify index cases and perform statistical analysis. This study suggests that having an older sibling with UDT or HYP is a significant independent risk factor. Performing an analysis adjusting for clustering in mothers with a previous child with UDT or HYP leads to loss of statistical significance for other described risk factors. CONCLUSION Underlying genetic or similar environmental exposures may be a key risk factor for UDT and HYP, which confounds known maternal and fetal risk factors for these anomalies.
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Affiliation(s)
- S Dave
- Department of Surgery and Paediatrics, Division of Urology, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
| | - K Liu
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - R Clark
- Department of Surgery and Paediatrics, Division of Urology, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - A X Garg
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada; Arthur Labatt Family School of Nursing, Western University, London Ontario Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - S Z Shariff
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada; Arthur Labatt Family School of Nursing, Western University, London Ontario Canada; Lawson Health Research Institute, London, Ontario, Canada; Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Rocca MS, Di Nisio A, Sabovic I, Ghezzi M, Foresta C, Ferlin A. E2F1 copy number variations contribute to spermatogenic impairment and cryptorchidism by increasing susceptibility to heat stress. Andrology 2019; 7:251-256. [PMID: 30659775 DOI: 10.1111/andr.12583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Copy number variations (CNVs) play an important role in the onset of several diseases, and recently research focused on the relationship between these structural variants and diseases of the reproductive tract, including male infertility and cryptorchidism. OBJECTIVES To evaluate the contribution of copy number variations of E2F1 gene to idiopathic male infertility and the factors influencing expression of this gene. MATERIALS AND METHODS We performed a retrospective study on 540 subjects recruited from September 2014 to February 2015. TaqMan CNV assay was used to analyze E2F1 CNV. Real-time PCR was used to assess E2F1 and HSP70 expression level in heat stressed and transfected cells with three E2F1 copies. RESULTS We found a significant difference in the frequency of altered E2F1 copies in patients (12/343, 3.5%) compared with controls (0/197) (p = 0.005). Six patients with E2F1 CNV had history of cryptorchidism, but the prevalence between men with idiopathic infertility (6/243, 2.5%) and infertile men with history of cryptorchidism (6/100, 6.0%) was not statistically different (p = 0.1). E2F1 expression increased under heat stress conditions, especially in cells carrying more copies of gene and this was associated with increased expression of HSP70. DISCUSSION Our data suggest that an abnormal E2F1 expression caused by multiple copies of E2F1 gene predisposes to the onset of infertility and that the risk further increases if subjects with altered E2F1 copies have stressful conditions, such as heat stress or history of cryptorchidism. CONCLUSION This study shows a link between E2F1 CNV and male infertility, suggesting that the increased risk of spermatogenic impairment associated with higher E2F1 copies might be due to higher susceptibility to stressful conditions.
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Affiliation(s)
- M S Rocca
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - A Di Nisio
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - I Sabovic
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - M Ghezzi
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - A Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology, University of Brescia, Brescia, Italy
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Rodprasert W, Virtanen HE, Mäkelä JA, Toppari J. Hypogonadism and Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:906. [PMID: 32010061 PMCID: PMC6974459 DOI: 10.3389/fendo.2019.00906] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- *Correspondence: Wiwat Rodprasert
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Kojima Y, Yokoya S, Kurita N, Idaka T, Ishikawa T, Tanaka H, Ezawa Y, Ohto H. Cryptorchidism after the Fukushima Daiichi Nuclear Power Plant accident:causation or coincidence? Fukushima J Med Sci 2019; 65:76-98. [PMID: 31915325 PMCID: PMC7012587 DOI: 10.5387/fms.2019-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 01/20/2023] Open
Abstract
Cryptorchidism (undescended testes) is among the most common congenital diseases in male children. Although many factors have been linked to the incidence of cryptorchidism, and testicular androgen plays a key role in its pathogenesis, the cause remains unknown in most cases. Recently, a Japanese group published a speculative paper entitled, "Nationwide increase in cryptorchidism after the Fukushima nuclear accident." Although the authors implicated radionuclides emitted from the Fukushima accident as contributing to an increased incidence of cryptorchidism, they failed to establish biological plausibility for their hypothesis, and glossed over an abundance of evidence and expert opinion to the contrary. We assessed the adequacy of their study in terms of design setting, data analysis, and its conclusion from various perspectives. Numerous factors must be considered, including genetic, environmental, maternal/fetal, and social factors associated with the reporting of cryptorchidism. Other investigators have established that the doses of external and internal radiation exposure in both Fukushima prefecture and the whole of Japan after the accident are too low to affect testicular descent during fetal periods;thus, a putative association can be theoretically and empirically rejected. Alternative explanations exist for the reported estimates of increased cryptorchidism surgeries in the years following Japan's 2011 earthquake, tsunami, and nuclear crisis. Data from independent sources cast doubt on the extent to which cryptorchidism increased, if at all. In any case, evidence that radionuclides from the Fukushima Daiichi Nuclear Power Plant could cause cryptorchidism is lacking.
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Affiliation(s)
- Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University School of Medicine
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University
| | - Takayuki Idaka
- Medical Research Center, Fukushima Medical University School of Medicine
| | - Tetsuo Ishikawa
- Department of Radiation Physics and Chemistry, Fukushima Medical University
| | - Hideaki Tanaka
- Department of Pediatric Surgery, Fukushima Medical University Hospital
| | - Yoshiko Ezawa
- Medical Affairs Division, Fukushima Medical University Hospital
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University
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Wang Y, Wei Y, Tang X, Liu B, Shen L, Long C, Lin T, He D, Wu S, Wei G. Association between androgen receptor polymorphic CAG and GGC repeat lengths and cryptorchidism: A meta-analysis of case-control studies. J Pediatr Urol 2018; 14:432.e1-432.e9. [PMID: 29914823 DOI: 10.1016/j.jpurol.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Previous studies have revealed the relationship between androgen receptor (AR) CAG and/or GGC polymorphisms and risk of cryptorchidism, yet the results have been elusive and controversial. AIM To determine whether AR polymorphic CAG and/or GGC repeats are related to cryptorchidism. STUDY DESIGN The relevant studies were obtained from PubMed, Embase, China National Knowledge Infrastructure, and Wanfang. The pooled odds ratios with 95% confidence intervals (CIs) were used to assess the strength of associations. Subgroup analyses were performed based on ethnicity and source of controls. Moreover, Begg's funnel plots and Egger's linear regression test were conducted to determine publication bias. RESULTS Eight case-control studies containing 321 patients and 784 normal controls were included. There was a significant association between longer CAG repeats and cryptorchidism risk (weighted mean difference (WMD) = 0.62; 95% CIs 0.06, 1.18; P = 0.031). Moreover, there was a significant association between the longer GGC repeats and cryptorchidism risk (WMD = 0.87; 95% CIs 0.04, 1.74; P = 0.040). There was significant association between the longer CAG repeats and bilateral cryptorchidism (WMD = 0.88; 95% CIs -0.18, 1.94; P = 0.011), while there was no significant association between the longer CAG repeats and unilateral cryptorchidism (WMD = -0.09; 95% CIs -0.50, 0.31; P = 0.554). There were significant associations between the longer GGC repeats and unilateral cryptorchidism (WMD = 0.88; 95% CIs -0.30, 2.05; P = 0.005) and bilateral cryptorchidism (WMD = 1.35; 95% CIs -0.52, 3.21; P = 0.000). Stratifying analysis revealed an association between longer CAG/GGC repeats and cryptorchidism in Caucasian populations from Europe (WMD = 0.73; 95% CIs 0.00, 1.46; P = 0.017), while there was no association with Asian populations. DISCUSSION This meta-analysis found that CAG/GGC repeats in the AR gene were longer in cryptorchidism patients compared to controls. Both the longer CAG repeats and GGC repeats in the AR gene were associated with cryptorchidism risk. The longer CAG repeats were associated with bilateral cryptorchidism, whereas the longer GGC repeats were associated with unilateral and bilateral cryptorchidism. Stratifying analysis revealed an association between longer CAG/GGC repeats and cryptorchidism in Caucasian populations from Europe, while there was no association between longer CAG/GGC repeats and cryptorchidism in Asian populations. CONCLUSION The CAG/GGC repeats in the AR gene were longer in cryptorchidism than in controls. Longer CAG repeats may play a role in determining bilateral cryptorchidism, and longer GGC repeats may play a role in determining unilateral and bilateral cryptorchidism. These observations were more applicable to Caucasian populations.
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Affiliation(s)
- Y Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - Y Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - X Tang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China
| | - B Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - L Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China
| | - C Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics Chongqing, China
| | - T Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - D He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
| | - S Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China.
| | - G Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children's Urogenital Development and Tissue Engineering, China; Ministry of Education Key Laboratory of Child Development and Disorders, China
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70
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Hua XG, Hu R, Hu CY, Li FL, Jiang W, Zhang XJ. Associations between hypospadias, cryptorchidism and anogenital distance: Systematic review and meta-analysis. Andrologia 2018; 50:e13152. [PMID: 30251425 DOI: 10.1111/and.13152] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/27/2018] [Accepted: 08/10/2018] [Indexed: 01/22/2023] Open
Abstract
Hypospadias and cryptorchidism are potential manifestations of testicular dysgenesis syndrome (TDS) at birth. Anogenital distance (AGD) has been presumed as an indicator related to endocrine disruptors proposed as one of the pathogenetic mechanisms underlying male reproductive disorders. In humans, recent studies have correlated AGD in boys to testicular anomalies. However, the associations between hypospadias, cryptorchidism and AGD remain inconsistent and have not been combined. Hence, we conducted a meta-analysis to assess gradations in the severity of the endocrine disruption in cryptorchidism or hypospadias by using AGD. A total of 2,119 boys from five birth cohort studies and two cross-sectional studies were subjected to meta-analysis. Random-effect model was used to calculate the standardised mean difference (SMD) of AGD. Our results reveal that boys with hypospadias or cryptorchidism have shorter AGD ([SMD, -2.63; 95% CI, -4.65 to -0.62] and [SMD, -0.69; 95% CI, -1.36 to -0.02]) respectively. There was no indication of a publication bias either from the result of Egger's test or Begg's test for hypospadias and cryptorchidism.
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Affiliation(s)
- Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Rui Hu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Feng-Li Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Gurney JK, Stanley J, McGlynn K, Richiardi L, Shaw C, Edwards R, Merriman TR, Robson B, Koea J, McLeod M, Kennedy MA, Sarfati D. Testicular Cancer in New Zealand (TCNZ) study: protocol for a national case-control study. BMJ Open 2018; 8:e025212. [PMID: 30082371 PMCID: PMC6078234 DOI: 10.1136/bmjopen-2018-025212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Testicular cancer (TC) is by far the most common cancer to affect young men; however, the exposures that cause this disease are still poorly understood. Our own research has shown that Māori men have the highest rates of this disease in New Zealand-a puzzling observation, since internationally TC is most commonly a disease of men of European ancestry. These trends provide us with a unique opportunity: to learn more about the currently unknown exposures that cause TC, and to explain why Māori have the highest rates of this disease in New Zealand. Using epidemiology and genetics, our experienced research team will conduct a nationwide study which aims to answer these internationally important questions. AIM OF STUDY The overall aim of the current national case-control study is to identify the key exposures in the development of TC in New Zealand, and explore which factors might explain the difference in the incidence of TC between Māori and non-Māori. METHODS AND ANALYSIS Outside of our own investigations into cryptorchidism, we still do not know which exposures are driving the significant incidence disparity between ethnic groups in NZ. The aim of the proposed research is to use a population-based case-control study to identify the key exposures in the development of TC in New Zealand. We will recruit 410 TC cases and 410 controls, and collect (1) environmental exposure data, via interview and (2) genetic information, via genome-wide genotyping. ETHICS AND DISSEMINATION Ethical approval for this study was sought and received from the New Zealand Ministry of Health's Health and Disability Ethics Committee (reference # 17/NTA/248). Following a careful data interpretation process, we will disseminate the findings of this study to a wide and varied audience ranging from general academia, community groups and clinical settings, as well as to the participants themselves.
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Affiliation(s)
- Jason K Gurney
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Katherine McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Maryland, USA
| | | | - Caroline Shaw
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Bridget Robson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, Waitemata District Health Board, Auckland, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Martin A Kennedy
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
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PRDM Histone Methyltransferase mRNA Levels Increase in Response to Curative Hormone Treatment for Cryptorchidism-Dependent Male Infertility. Genes (Basel) 2018; 9:genes9080391. [PMID: 30071651 PMCID: PMC6116052 DOI: 10.3390/genes9080391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022] Open
Abstract
There is a correlation between cryptorchidism and an increased risk of testicular cancer and infertility. During orchidopexy, testicular biopsies are performed to confirm the presence of type A dark (Ad) spermatogonia, which are a marker for low infertility risk (LIR). The Ad spermatogonia are absent in high infertility risk (HIR) patients, who are treated with a gonadotropin-releasing hormone agonist (GnRHa) to significantly lower the risk of infertility. Despite its prevalence, little is known about the molecular events involved in cryptorchidism. Previously, we compared the transcriptomes of LIR versus HIR patients treated with and without hormones. Here, we interpreted data regarding members of the positive regulatory domain-containing (PRDM) family; some of which encoded histone methyltransferases that are important for reproduction. We found there were lower levels of PRDM1, PRDM6, PRDM9, PRDM13, and PRDM14 mRNA in the testes of HIR patients compared with LIR patients, and that PRDM7, PRDM9, PRDM12, and PRDM16 were significantly induced after GnRHa treatment. Furthermore, we observed PRDM9 protein staining in the cytoplasm of germ cells in the testes from LIR and HIR patients, indicating that the mRNA and protein levels corresponded. This result indicated that the curative hormonal therapy for cryptorchidism involved conserved chromatin modification enzymes.
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Rodríguez F, Vallejos C, Ponce D, Unanue N, Hernández MI, Célis S, Arcos K, Belmar F, López MT, Cassorla F. Study of Ras/MAPK pathway gene variants in Chilean patients with Cryptorchidism. Andrology 2018; 6:579-584. [DOI: 10.1111/andr.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F. Rodríguez
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - C. Vallejos
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - D. Ponce
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - N. Unanue
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - M. I. Hernández
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - S. Célis
- Pediatric Urology Department; Hospital Clínico San Borja - Arriarán; Santiago Chile
| | - K. Arcos
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - F. Belmar
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
| | - M. T. López
- Pediatric Urology Department; Hospital Clínico San Borja - Arriarán; Santiago Chile
| | - F. Cassorla
- Institute of Maternal and Child Research; School of Medicine; University of Chile; Santiago Chile
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Barthold JS, Wintner A, Hagerty JA, Rogers KJ, Hossain MJ. Cryptorchidism in Boys With Cerebral Palsy Is Associated With the Severity of Disease and With Co-Occurrence of Other Congenital Anomalies. Front Endocrinol (Lausanne) 2018; 9:151. [PMID: 29713311 PMCID: PMC5911456 DOI: 10.3389/fendo.2018.00151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cryptorchidism is reported in 40-50% of small case series of cerebral palsy (CP) and attributed to hypothalamic-pituitary-gonadal axis abnormalities, intellectual disability (ID), or cremaster spasticity. We collected demographic and clinical data to define the frequency of cryptorchidism and clinical comorbidities in a large CP population. METHODS Electronic health record data were collected for all male patients ≥7 years of age seen in a large, multidisciplinary CP clinic between 2000 and 2016. Variables including age, testicular position, surgical findings, CP severity, birth history, and comorbidities were tested for association using univariable and stepwise backward logistic regression analyses. RESULTS Of 839 established patients, testis position was scrotal in 553, undescended in 185 (24%), retractile in 38 (5%), and undocumented in 63 cases. Cryptorchidism were diagnosed at a mean age of 5.8 years, with 20% documented as acquired, and testes were most commonly in the superficial inguinal pouch (41%) and associated with an inguinal hernia (56%). Severity was bilateral in 114/166 (69%) undescended and 24/36 (66%) retractile cases, respectively. Mean birth weight and the frequency of prematurity (55, 58, and 54%) and multiple birth (14, 13, and 9%) were not significantly different among the three groups. We observed a strong ordinal trend in the frequency of comorbidities, including quadriplegia, syndromic features/known genetic disease, intrauterine growth restriction (IUGR), death, brain malformations, seizures, gastrostomy, absent continence, ID and hearing, speech or visual impairment, with the retractile group holding the intermediate position for the majority. The stepwise multivariable analysis showed independent positive associations of cryptorchidism with quadriplegia, syndromic features/known genetic disease, hearing loss, and absent continence, and inverse associations with gestational age and multiple birth. CONCLUSION These data suggest that cryptorchidism is less common than previously reported in CP cases, but most strongly associated with quadriplegia. Delayed diagnosis may be related to an acquired condition or to the multiple additional functional deficits that occur in this population. Our data suggest that UDT and CP may both be components of malformation syndromes occurring in singleton births whose clinical features are more likely to include earlier delivery, IUGR, hearing loss, and/or global spasticity.
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Wang Q, Ge X, Wang HX, Shi QM, Ding Z, Xu LC. Association of androgen receptor gene CAG and GGN repeat polymorphism with cryptorchidism: A meta-analysis. Andrologia 2017; 50. [DOI: 10.1111/and.12909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Qi Wang
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
| | - Xing Ge
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
| | - Heng-Xue Wang
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
| | - Qiao-Mei Shi
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
| | - Zhen Ding
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
| | - Li-Chun Xu
- School of Public Health; Xuzhou Medical University; Xuzhou Jiangsu China
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