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Aksel S, Derpinghaus A, Cao M, Li Y, Cunha G, Baskin L. Neurovascular anatomy of the developing human fetal penis and clitoris. J Anat 2024; 245:35-49. [PMID: 38419143 PMCID: PMC11161816 DOI: 10.1111/joa.14029] [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: 09/21/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
The human penile and clitoral development begins from a morphologically indifferent genital tubercle. Under the influence of androgen, the genital tubercle forms the penis by forming a tubular urethra within the penile shaft. Without the effect of the androgen, the genital tubercle differentiates into the clitoris, and a lack of formation of the urethra within the clitoris is observed. Even though there are similarities during the development of the glans penis and glans clitoris, the complex canalization occurring along the penile shaft eventually leads to a morphological difference between the penis and clitoris. Based on the morphological differences, the main goal of this study was to define the vascular and neuronal anatomy of the developing penis and clitoris between 8 and 12 weeks of gestation using laser scanning confocal microscopy. Our results demonstrated there is a co-expression of CD31, which is an endothelial cell marker, and PGP9.5, which is a neuronal marker in the penis where the fusion is actively occurring at the ventral shaft. We also identified a unique anatomical structure for the first time, the clitoral ridge, which is a fetal structure running along the clitoral shaft in the vestibular groove. Contrary to previous anatomical findings which indicate that the neurovascular distribution in the developing penis and clitoris is similar, in this study, laser scanning confocal microscopy enabled us to demonstrate finer differences in the neurovascular anatomy between the penis and clitoris.
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Affiliation(s)
- Sena Aksel
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amber Derpinghaus
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mei Cao
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yi Li
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Gerald Cunha
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laurence Baskin
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
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López Soto Á, Velasco Martínez M, Ferrández Martínez M, Díaz García A, García Izquierdo O, Marín Sánchez P. Prenatal ambiguous/atypical genitalia: why are we still missing it and how can we improve diagnosis? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:581-585. [PMID: 37773980 DOI: 10.1002/uog.27507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Á López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - M Velasco Martínez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - M Ferrández Martínez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - A Díaz García
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - O García Izquierdo
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - P Marín Sánchez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Ding Y, Wang Y, Lyu Y, Xie H, Huang Y, Wu M, Chen F, Chen Z. Urogenital sinus malformation: From development to management. Intractable Rare Dis Res 2023; 12:78-87. [PMID: 37287654 PMCID: PMC10242390 DOI: 10.5582/irdr.2023.01027] [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: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Abstract
Urogenital sinus (UGS) malformation, also known as persistent urogenital sinus (PUGS), is a rare congenital malformation of the urogenital system. It arises when the urethra and vaginal opening fail to form properly in the vulva and fuse incorrectly. PUGS can occur as an isolated abnormality or as part of a complex syndrome, and is frequently associated with congenital adrenal hyperplasia (CAH). The management of PUGS is not well-established, and there are no standardized guidelines on when to perform surgery or how to follow up with patients over the long term. In this review, we discuss the embryonic development, clinical evaluation, diagnosis, and management of PUGS. We also review case reports and research findings to explore best practices for surgery and follow-up care, in hopes of increasing awareness of PUGS and improving patient outcomes.
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Affiliation(s)
- Yu Ding
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaping Wang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiqing Lyu
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yichen Huang
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Wu
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongzhong Chen
- Department of Urology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Clinical Research Center For Hypospadias Pediatric College, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Urogenital Development Research Center, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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4
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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Overland MR, Li Y, Derpinghaus A, Aksel S, Cao M, Ladwig N, Cunha GR, Himelreich-Perić M, Baskin LS. Development of the human ovary: Fetal through pubertal ovarian morphology, folliculogenesis and expression of cellular differentiation markers. Differentiation 2023; 129:37-59. [PMID: 36347737 DOI: 10.1016/j.diff.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 01/28/2023]
Abstract
A definition of normal human fetal and early postnatal ovarian development is critical to the ability to accurately diagnose the presence or absence of functional ovarian tissue in clinical specimens. Through assembling an extensive histologic and immunohistochemical developmental ontogeny of human ovarian specimens from 8 weeks of gestation through 16 years of postnatal, we present a comprehensive immunohistochemical mapping of normal protein expression patterns in the early fetal through post-pubertal human ovary and detail a specific expression-based definition of the early stages of follicular development. Normal fetal and postnatal ovarian tissue is defined by the presence of follicular structures and characteristic immunohistochemical staining patterns, including granulosa cells expressing Forkhead Box Protein L2 (FOXL2). However, the current standard array of immunohistochemical markers poorly defines ovarian stromal tissue, and additional work is needed to identify new markers to advance our ability to accurately identify ovarian stromal components in gonadal specimens from patients with disorders of sexual differentiation.
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Affiliation(s)
- Maya R Overland
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Yi Li
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Sena Aksel
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Mei Cao
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Nicholas Ladwig
- Department of Pathology, University of California, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Marta Himelreich-Perić
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, 10000, Zagreb, Croatia
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
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6
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Cunha GR, Cao M, Aksel S, Derpinghaus A, Baskin LS. Mouse-human species differences in early testicular development and its implications. Differentiation 2023; 129:79-95. [PMID: 35667976 DOI: 10.1016/j.diff.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/16/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023]
Abstract
The mouse has been used as a model of human organogenesis with the tacit assumption that morphogenetic and molecular mechanisms in mice are translatable to human organogenesis. While many morphogenetic and molecular mechanisms are shared in mice and humans, many anatomic, morphogenetic, and molecular differences have been noted. Two critical gaps in our knowledge prevent meaningful comparisons of mouse versus human testicular development: (a) human testicular development is profoundly under-represented in the literature, and (b) an absence of a detailed day-by-day ontogeny of mouse testicular development from E11.5 to E16.5 encompassing the ambisexual stage to seminiferous cord formation. To address these deficiencies, histologic and immunohistochemical studies were pursued in comparable stages of mouse and human testicular development with a particular emphasis on Leydig, Sertoli and myoid cells through review of the literature and new observations. For example, an androgen-receptor-positive testicular medulla is present in the developing human testis but not in the developing mouse testis. The human testicular medulla and associated mesonephros were historically described as the source of Sertoli cells in seminiferous cords. Consistent with this idea, the profoundly androgen receptor (AR)-positive human testicular medulla was shown to be a zone of mesenchymal to epithelial transition and a zone from which AR-positive cells appear to migrate into the human testicular cortex. While mouse Sertoli and Leydig cells have been proposed to arise from coelomic epithelium, Sertoli (SOX9) or Leydig (HSD3B1) cell markers are absent from the immediate coelomic zone of the developing human testis, perhaps because Leydig and Sertoli cell precursors are undifferentiated when they egress from the coelomic epithelium. The origin of mouse and human myoid cells remains unclear. This study provides a detailed comparison of the early stages of testicular development in human and mouse emphasizing differences in developmental processes.
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Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Mei Cao
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Sena Aksel
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
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Li Y, Overland M, Derpinghaus A, Aksel S, Cao M, Ladwig N, Cunha GR, Baskin LS. Development of the human fetal testis: Morphology and expression of cellular differentiation markers. Differentiation 2023; 129:17-36. [PMID: 35490077 DOI: 10.1016/j.diff.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/25/2023]
Abstract
A comprehensive immunohistochemical ontogeny of the developing human fetal testis has remained incomplete in the literature to date. We collected human fetal testes from 8 to 21 weeks of fetal age, as well as postnatal human testes at minipuberty, pre-pubertal, and pubertal stages. Immunohistochemistry was performed with a comprehensive panel of antigens targeting gonadocytes, Sertoli cells, fetal Leydig cells, peritubular myoid cells, and other hormonal and developmental targets. Testicular cords, precursor structures to seminiferous tubules, developed from 8 to 14 weeks of fetal age, separating the testis into the interstitial and intracordal compartments. Fetal gonadocytes were localized within the testicular cords and evaluated for Testis-Specific Protein Y, Octamer-binding transcription factor 4, Sal-like protein 4, and placental alkaline phosphatase expression. Fetal Sertoli cells were also localized in the testicular cords and evaluated for SRY-box Transcription Factor 9, inhibin, and anti-Mullerian hormone expression. Fetal Leydig cells were present in the interstitium and stained for cytochrome p450c17 and calretinin, while interstitial peritubular myoid cells were examined using smooth muscle α-actin staining. Androgen receptor expression was localized close to the testicular medulla at 8 weeks and then around the testicular cords in the interstitium as they matured in structure. Postnatal staining showed that Testis-Specific Protein Y remained positive of male gonadocytes throughout adulthood. Anti-Mullerian hormone, SRY-box Transcription Factor 9, and Steroidogenic factor 1 are expressed by the postnatal Sertoli cells at all ages examined. Leydig cell markers cytochrome p450c17 and calretinin are expressed during mini-puberty and puberty, but not expressed during the pre-pubertal period. Smooth muscle α-actin and androgen receptor were not expressed during mini-puberty or pre-puberty, but again expressed during the pubertal period. The ontogenic map of the human fetal and postnatal testicular structure and expression patterns described here will serve as a reference for future investigations into normal and abnormal testicular development.
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Affiliation(s)
- Yi Li
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Maya Overland
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Sena Aksel
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Mei Cao
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Nicholas Ladwig
- Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, USA.
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Baskin LS. Response to: Letter to Editor - Utility of Genetic Work-Up for 46, XY Patients with Severe Hypospadias. J Pediatr Urol 2022:S1477-5131(22)00583-6. [PMID: 37005195 DOI: 10.1016/j.jpurol.2022.12.007] [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: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Laurence S Baskin
- UCSF Benioff Children's Hospitals, University of California, San Francisco, USA.
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Srivastava P, Tenney J, Lodish M, Slavotinek A, Baskin L. Utility of genetic work-up for 46, XY patients with severe hypospadias. J Pediatr Urol 2022:S1477-5131(22)00537-X. [PMID: 36496321 DOI: 10.1016/j.jpurol.2022.11.023] [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: 08/15/2022] [Revised: 10/25/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hypospadias is a common congenital abnormality that has been increasing in prevalence over the last decades. Historically, 46, XY patients with severe hypospadias and descended scrotal testes at birth have frequently lacked a genetic diagnosis. Platforms for molecular genetic testing have become more readily available and can offer an insight into underlying genetic causes of severe hypospadias. The goal of this study was to define the anatomical characteristics of severe hypospadias that can accurately define patients with 46, XY severe hypospadias and determine the practical utility of performing molecular genetic testing in this group of patients. METHODS Patients who met the criteria for 46, XY severe hypospadias were offered a molecular genetic work-up in consultation with pediatric genetics. Patients were identified through chart review. Data extracted included karyotype, hypospadias phenotype including stretched penile length at diagnosis, age at genetic diagnosis, molecular genetic testing, pathogenic gene variant(s), gender identity, and clinical course. All patients underwent clinical genetic testing via 46, XY Disorders of Sexual Development (DSD) panels offered by Invitae®, GeneDx®, or Blueprint Genetics®. RESULTS Of the 14 patients that underwent genetic testing, there were 5 previously 27 published and 3 novel pathogenic or likely pathogenic variants in genes associated with 28 46, XY severe hypospadias Table. Pathogenic variants were identified in AR (3), 29 SRD5A2 [1], NR5A1 [2], WT1 [1], and ARTX [1]. Two patients had a variant of unknown significance, one in FREM2 and another in CEP41. Four had negative gene panels. The patient with the WT1 pathogenic variant was subsequently found to have developed a Wilms tumor and the patients with NR5A1 pathogenic variants are now undergoing adrenal insufficiency surveillance. DISCUSSION/CONCLUSION Patients with 46,XY severe hypospadias and descended testes in the scrotum at birth can benefit from molecular genetic testing as their underlying disorders may reveal pathogenic variants that could have potentially life-altering consequences and change surveillance and monitoring.
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Affiliation(s)
- Priya Srivastava
- University of California San Francisco, Division of Pediatric Endocrinology, USA
| | - Jessica Tenney
- University of California San Francisco, Division of Pediatric Genetics and Metabolism, USA
| | - Maya Lodish
- University of California San Francisco, Division of Pediatric Endocrinology, USA
| | - Anna Slavotinek
- University of California San Francisco, Division of Pediatric Genetics and Metabolism, USA
| | - Laurence Baskin
- University of California San Francisco, Division of Pediatric Urology, USA.
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Stancampiano MR, Suzuki K, O'Toole S, Russo G, Yamada G, Faisal Ahmed S. Congenital Micropenis: Etiology And Management. J Endocr Soc 2022; 6:bvab172. [PMID: 35036822 PMCID: PMC8754418 DOI: 10.1210/jendso/bvab172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 01/23/2023] Open
Abstract
In the newborn, penile length is determined by a number of androgen dependent and independent factors. The current literature suggests that there are interracial differences in stretched penile length in the newborn and although congenital micropenis should be defined as a stretched penile length of less than 2.5 SDS of the mean for the corresponding population and gestation, a pragmatic approach would be to evaluate all boys with a stretched penile length below 2 cm, as congenital micropenis can be a marker for a wide range of endocrine conditions. However, it remains unclear as to whether the state of micropenis, itself, is associated with any long-term consequences. There is a lack of systematic studies comparing the impact of different therapeutic options on long-term outcomes, in terms of genital appearance, quality of life, and sexual satisfaction. To date, research has been hampered by a small sample size and inclusion of a wide range of heterogeneous diagnoses; for these reasons, condition-specific outcomes have been difficult to compare between studies. Lastly, there is a need for a greater collaborative effort in collecting standardized data so that all real-world or experimental interventions performed at an early age can be studied systematically into adulthood.
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Affiliation(s)
| | - Kentaro Suzuki
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Stuart O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, Scientific Institute San Raffaele, Milan 20132, Italy
| | - Gen Yamada
- Department of Developmental Genetics, Institute of Advanced Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Syed Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow G51 4TF, UK
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Cunha GR, Cao M, Derpinghaus A, Baskin LS. Human urogenital sinus mesenchyme is an inducer of prostatic epithelial development. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:329-336. [PMID: 34541031 PMCID: PMC8446767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine whether human fetal urogenital sinus mesenchyme (UGM) can induce prostatic development in a responsive mouse epithelium. METHOD Male and female human fetal UGM was combined with mouse urinary bladder epithelium (BLE), and the resultant human UGM + mouse BLE tissue recombinants were grown under renal capsules of male athymic mice. Human male and female UGM was derived from reproductive tracts 9 and 14 weeks of gestation obtained following elective termination of pregnancy. At these ages prostatic ducts had already emerged from the urogenital sinus epithelium, and the human UGM remained contaminated with human prostatic epithelium. This unavoidable problem was tolerated because the induced mouse prostatic epithelium could be distinguished from contaminating human prostatic epithelium. RESULTS The simple columnar epithelium induced from mouse bladder epithelium by human male and female UGM resembled mouse prostatic epithelium by: (a) histology, (b) the pattern of basal cell distribution, (c) Hoechst dye nuclear staining, (d) expression of NKX3.1, (e) the pattern of androgen receptor expression and (f) the expression of probasin, a mouse prostatic secretory protein. Summary/Interpretation: These findings provide validation for mouse as a model of human prostatic development as the molecular dialogue involved in mesenchymal-epithelial interactions are sufficiently conserved that human UGM can induce mouse bladder epithelium to undergo prostatic development.
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Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Mei Cao
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California 400 Parnassus Avenue, San Francisco, CA 94143, USA
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Abstract
Cloacal malformations are characterized by the confluence of the lower urinary tract, the female reproductive tract, and the rectum to create a common channel with a single opening on the perineum. The presence of a cloaca is a normal phase of early human embryological development. Between the 4th and 7th weeks of gestation, the cloaca undergoes subdivision to form the hindgut and urogenital sinus. Failure of this process results in the congenital anomaly termed persistent cloaca (PC). The term urorectal septum malformation sequence (URSMS) is also used to describe this anomaly. The classic description of this process which is still cited in many standard textbooks dates from the 19th century. However, this has been increasingly called into question by the findings of studies using modern scientific methodology. Urogenital sinus anomalies are defined by the confluence of the urethra and vagina to form a common channel of varying length with a single perineal opening. In this condition, the anorectal canal opens separately on the perineum. The presence of a urogenital sinus represents a transient phase of the normal development of the lower genital tract in the female fetus. However, the form of urogenital sinus most commonly encountered in the developed world is a feature of disordered sexual differentiation and does not arise simply from the persistence of the anatomical structure which is a feature of normal fetal development.
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13
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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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Cunha GR, Li Y, Mei C, Derpinghaus A, Baskin LS. Ontogeny of estrogen receptors in human male and female fetal reproductive tracts. Differentiation 2020; 118:107-131. [PMID: 33176961 DOI: 10.1016/j.diff.2020.10.001] [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: 08/02/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022]
Abstract
This paper reviews and provides new observations on the ontogeny of estrogen receptor alpha (ESR1) and estrogen receptor beta (ESR2) in developing human male and female internal and external genitalia. Included in this study are observations on the human fetal uterine tube, the uterotubal junction, uterus, cervix, vagina, penis and clitoris. We also summarize and report on the ontogeny of estrogen receptors in the human fetal prostate, prostatic urethra and epididymis. The ontogeny of ESR1 and ESR2, which spans from 8 to 21 weeks correlates well with the known "window of susceptibility" (7-15 weeks) for diethylstilbestrol (DES)-induced malformations of the human female reproductive tract as determined through examination of DES daughters exposed in utero to this potent estrogen. Our fairly complete mapping of the ontogeny of ESR1 and ESR2 in developing human male and female internal and external genitalia provides a mechanistic framework for further investigation of the role of estrogen in normal development and of abnormalities elicited by exogenous estrogens.
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Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Yi Li
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Cao Mei
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Amber Derpinghaus
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
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15
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Baskin L, Sinclair A, Derpinghaus A, Cao M, Li Y, Overland M, Aksel S, Cunha GR. Estrogens and development of the mouse and human external genitalia. Differentiation 2020; 118:82-106. [PMID: 33092894 DOI: 10.1016/j.diff.2020.09.004] [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: 08/15/2020] [Accepted: 09/18/2020] [Indexed: 01/02/2023]
Abstract
The Jost hypothesis states that androgens are necessary for normal development of the male external genitalia. In this review, we explore the complementary hypothesis that estrogens can elicit abnormal development of male external genitalia. Herein, we review available data in both humans and mice on the deleterious effects of estrogen on external genitalia development, especially during the "window of susceptibility" to exogenous estrogens. The male and female developing external genitalia in both the human and mouse express ESR1 and ESR2, along with the androgen receptor (AR). Human clinical data suggests that exogenous estrogens can adversely affect normal penile and urethral development, resulting in hypospadias. Experimental mouse data also strongly supports the idea that exogenous estrogens cause penile and urethral defects. Despite key differences, estrogen-induced hypospadias in the mouse displays certain morphogenetic homologies to human hypospadias, including disruption of urethral fusion and preputial abnormalities. Timing of estrogenic exposure, or the "window of susceptibility," is an important consideration when examining malformations of the external genitalia in both humans and mice. In addition to a review of normal human and mouse external genital development, this article aims to review the present data on the role of estrogens in normal and abnormal development of the mouse and human internal and external genitalia. Based on the current literature for both species, we conclude that estrogen-dependent processes may play a role in abnormal genital development.
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Affiliation(s)
- Laurence Baskin
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA.
| | - Adriane Sinclair
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Amber Derpinghaus
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Mei Cao
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Yi Li
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Maya Overland
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Sena Aksel
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
| | - Gerald R Cunha
- University of California, San Francisco, Division of Pediatric Urology, Department of Urology, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA, 94158, USA
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Sonographic measure techniques of fetal penile length. Obstet Gynecol Sci 2020; 63:555-564. [PMID: 32810976 PMCID: PMC7494763 DOI: 10.5468/ogs.20087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Postnatal penile length is a reliable, standardized, and widely used marker for the diagnosis of genitourinary pathology, as well as genetic and hormonal disorders. In contrast, prenatal diagnosis has not been developed equally and there is a lack of relevant literature. Our objective is to review the studies on fetal penile length, and apply findings to clinical practice. Although the most used technique is the outer penile length, there is no consensus regarding the appropriate technique for prenatal measurement. Several reports have provided reference data with high correlation. However, important issues like poor correlation with post-natal measures or presence of confounding variables are still present. Diagnosis of both a micropenis and macropenis can indicate related pathologies, and this information may benefit parental counseling and facilitate fetal management. Therefore, it is necessary to carry out prospective studies that provide reliable normative data.
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17
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Cunha GR, Liu G, Sinclair A, Cao M, Glickman S, Cooke PS, Baskin L. Androgen-independent events in penile development in humans and animals. Differentiation 2020; 111:98-114. [DOI: 10.1016/j.diff.2019.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/28/2023]
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18
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Baskin L, Derpinghaus A, Cao M, Sinclair A, Li Y, Overland M, Cunha GR. Hot spots in fetal human penile and clitoral development. Differentiation 2019; 112:27-38. [PMID: 31874420 DOI: 10.1016/j.diff.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Abstract
To better understand how the human fetal penis and clitoris grows and remodels, we undertook an investigation to define active areas of cellular proliferation and programmed cell death spatially and temporally during development of human fetal external genitalia from the indifferent stage (8 weeks) to 18 weeks of gestation. Fifty normal human fetal penile and clitoral specimens were examined using macroscopic imaging, scanning electron microscopy and immunohistochemical localization for the cellular proliferation and apoptotic markers, Ki67 and Caspase-3, respectively. A number of hot spots of cellular proliferation characterized by Ki67 localization are present in the penis and clitoris especially early in development, most notably in the corporal body, glans, remodeling glanular urethra, the urethral plate, the roof of the urethral groove and the fully formed penile urethra. The 12-fold increase in penile length over 10 weeks of growth from 8 to 18 weeks of gestation based on Ki67 labelling appears to be driven by cellular proliferation in the corporal body and glans. Throughout all ages in both the developing penis and clitoris Ki67 labeling was consistently elevated in the ventral epidermis and ventral mesenchyme relative to the dorsal counterparts. This finding is consistent with the intense morphogenetic activity/remodeling in the ventral half of the genital tubercle in both sexes involving formation of the urethral/vestibular plates, canalization of the urethral/vestibular plates and fusion of the urethral folds to form the penile urethra. Areas of reduced or absent Ki67 staining include the urethral fold epithelium that fuses to form the penile tubular urethra. In contrast, the urethral fold mesenchyme is positive for Ki67. Apoptosis was rarely noted in the developing penis and clitoris; the only area of minimal Caspase-3 localization was in the epithelium of the ventral epithelial glanular channel remodeling.
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Affiliation(s)
- Laurence Baskin
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA.
| | - Amber Derpinghaus
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Mei Cao
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Adriane Sinclair
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Yi Li
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Maya Overland
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
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19
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Isaacson D, Shen J, Overland M, Li Y, Sinclair A, Cao M, McCreedy D, Calvert M, McDevitt T, Cunha GR, Baskin L. Three-dimensional imaging of the developing human fetal urogenital-genital tract: Indifferent stage to male and female differentiation. Differentiation 2018; 103:14-23. [PMID: 30262218 DOI: 10.1016/j.diff.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
Recent studies in our lab have utilized three imaging techniques to visualize the developing human fetal urogenital tract in three dimensions: optical projection tomography, scanning electron microscopy and lightsheet fluorescence microscopy. We have applied these technologies to examine changes in morphology and differential gene expression in developing human external genital specimens from the ambisexual stage (<9 weeks fetal age) to well-differentiated male and female organs (>13 weeks fetal age). This work outlines the history and function of each of these three imaging modalities, our methods to prepare specimens for each and the novel findings we have produced thus far. We believe the images in this paper of human fetal urogenital organs produced using lightsheet fluorescence microscopy are the first published to date.
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Affiliation(s)
- Dylan Isaacson
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joel Shen
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Maya Overland
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Yi Li
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Adriane Sinclair
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Mei Cao
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Meredith Calvert
- J. David Gladstone Institutes, San Francisco, CA, USA; Histology and Light Microscopy Core, J. David Gladstone Institutes, San Francisco, CA, USA
| | - Todd McDevitt
- J. David Gladstone Institutes, San Francisco, CA, USA
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Laurence Baskin
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, 550 16th St, 5th Floor, Mission Hall Pediatric Urology, San Francisco, CA 94158, USA.
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20
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Cunha GR, Baskin L. Development of human male and female urogenital tracts. Differentiation 2018; 103:1-4. [DOI: 10.1016/j.diff.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 11/28/2022]
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21
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Cunha GR, Vezina CM, Isaacson D, Ricke WA, Timms BG, Cao M, Franco O, Baskin LS. Development of the human prostate. Differentiation 2018; 103:24-45. [PMID: 30224091 PMCID: PMC6234090 DOI: 10.1016/j.diff.2018.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022]
Abstract
This paper provides a detailed compilation of human prostatic development that includes human fetal prostatic gross anatomy, histology, and ontogeny of selected epithelial and mesenchymal differentiation markers and signaling molecules throughout the stages of human prostatic development: (a) pre-bud urogenital sinus (UGS), (b) emergence of solid prostatic epithelial buds from urogenital sinus epithelium (UGE), (c) bud elongation and branching, (d) canalization of the solid epithelial cords, (e) differentiation of luminal and basal epithelial cells, and (f) secretory cytodifferentiation. Additionally, we describe the use of xenografts to assess the actions of androgens and estrogens on human fetal prostatic development. In this regard, we report a new model of de novo DHT-induction of prostatic development from xenografts of human fetal female urethras, which emphasizes the utility of the xenograft approach for investigation of initiation of human prostatic development. These studies raise the possibility of molecular mechanistic studies on human prostatic development through the use of tissue recombinants composed of mutant mouse UGM combined with human fetal prostatic epithelium. Our compilation of human prostatic developmental processes is likely to advance our understanding of the pathogenesis of benign prostatic hyperplasia and prostate cancer as the neoformation of ductal-acinar architecture during normal development is shared during the pathogenesis of benign prostatic hyperplasia and prostate cancer.
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Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States.
| | - Chad M Vezina
- School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, United States
| | - Dylan Isaacson
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States
| | - William A Ricke
- Department of Urology, University of Wisconsin, Madison, WI 53705, United States
| | - Barry G Timms
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57069, United States
| | - Mei Cao
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Omar Franco
- Department of Surgery, North Shore University Health System, 1001 University Place, Evanston, IL 60201, United States
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA 94143, United States
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22
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Shen J, Isaacson D, Cao M, Sinclair A, Cunha GR, Baskin L. Immunohistochemical expression analysis of the human fetal lower urogenital tract. Differentiation 2018; 103:100-119. [PMID: 30287094 PMCID: PMC6589035 DOI: 10.1016/j.diff.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Abstract
We have studied the ontogeny of the developing human male and female urogenital tracts from 9 weeks (indifferent stage) to 16 weeks (advanced sex differentiation) of gestation by immunohistochemistry on mid-sagittal sections. Sixteen human fetal pelvises were serial sectioned in the sagittal plane and stained with antibodies to epithelial, muscle, nerve, proliferation and hormone receptor markers. Key findings are: (1) The corpus cavernosum in males and females extends into the glans penis and clitoris, respectively, during the ambisexual stage (9 weeks) and thus appears to be an androgen-independent event. (2) The entire human male (and female) urethra is endodermal in origin based on the presence of FOXA1, KRT 7, uroplakin, and the absence of KRT10 staining. The endoderm of the urethra interfaces with ectodermal epidermis at the site of the urethral meatus. (3) The surface epithelium of the verumontanum is endodermal in origin (FOXA1-positive) with a possible contribution of Pax2-positive epithelial cells implying additional input from the Wolffian duct epithelium. (4) Prostatic ducts arise from the endodermal (FOXA1-positive) urogenital sinus epithelium near the verumontanum. (5) Immunohistochemical staining of mid-sagittal and para-sagittal sections revealed the external anal sphincter, levator ani, bulbospongiosus muscle and the anatomic relationships between these developing skeletal muscles and organs of the male and female reproductive tracts. Future studies of normal human developmental anatomy will lay the foundation for understanding congenital anomalies of the lower urogenital tract.
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Affiliation(s)
- Joel Shen
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Dylan Isaacson
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Mei Cao
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Adriane Sinclair
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States
| | - Laurence Baskin
- Department of Urology, University of California, San Francisco, San Francisco, CA, United States; Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, United States.
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Liu X, Liu G, Shen J, Yue A, Isaacson D, Sinclair A, Cao M, Liaw A, Cunha GR, Baskin L. Human glans and preputial development. Differentiation 2018; 103:86-99. [PMID: 30245194 PMCID: PMC6234068 DOI: 10.1016/j.diff.2018.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023]
Abstract
The urethra within the human penile shaft develops via (1) an "Opening Zipper" that facilitates distal canalization of the solid urethral plate to form a wide urethral groove and (2) a "Closing Zipper" that facilitates fusion of the epithelial surfaces of the urethral folds. Herein, we extend our knowledge by describing formation of the human urethra within the glans penis as well as development of the prepuce. Forty-eight normal human fetal penile specimens were examined using scanning electron microscopy and optical projection tomography. Serial histologic sections were evaluated for morphology and immunohistochemical localization for epithelial differentiation markers: Cytokeratins 6, 7, 10, FoxA1, uroplakin and the androgen receptor. As the closing zipper completes fusion of the urethral folds within the penile shaft to form a tubular urethra (~ 13 weeks), canalization of the urethral plate continues in proximal to distal fashion into the glans penis to directly form the urethra within the glans without forming an open urethral groove. Initially, the urethral plate is attached ventrally to the epidermis via an epithelial seam, which is remodeled and eliminated, thus establishing mesenchymal confluence ventral to the glanular urethra. The morphogenetic remodeling involves the strategic expression of cytokeratin 7, FoxA1 and uroplakin in endodermal epithelial cells as the tubular glanular urethra forms. The most ventral epithelial cells of the urethral plate are pinched off from the glanular urethra and are reabsorbed into the epidermis ultimately losing expression of their markers, a process undoubtedly regulated by androgens. The prepuce initially forms on the dorsal aspect of the glans at approximately 12 weeks of gestation. After sequential proximal to distal remodeling of the ventral urethral plate along the ventral aspect of glans, the prepuce of epidermal origin fuses in the ventral midline.
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Liaw A, Cunha GR, Shen J, Cao M, Liu G, Sinclair A, Baskin L. Development of the human bladder and ureterovesical junction. Differentiation 2018; 103:66-73. [PMID: 30236462 DOI: 10.1016/j.diff.2018.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022]
Abstract
The urinary bladder collects urine from the kidneys and stores it until the appropriate moment for voiding. The trigone and ureterovesical junctions are key to bladder function, by allowing one-way passage of urine into the bladder without obstruction. Embryological development of these structures has been studied in multiple animal models as well as humans. In this report we review the existing literature on bladder development and cellular signalling with particular focus on bladder development in humans. The bladder and ureterovesical junction form primarily during the fourth to eighth weeks of gestation, and arise from the primitive urogenital sinus following subdivision of the cloaca. The bladder develops through mesenchymal-epithelial interactions between the endoderm of the urogenital sinus and mesodermal mesenchyme. Key signalling factors in bladder development include shh, TGF-β, Bmp4, and Fgfr2. A concentration gradient of shh is particularly important in development of bladder musculature, which is vital to bladder function. The ureterovesical junction forms from the interaction between the Wolffian duct and the bladder. The ureteric bud arises from the Wolffian duct and is incorporated into the developing bladder at the trigone. It was previously thought that the trigonal musculature developed primarily from the Wolffian duct, but it has been shown to develop primarily from bladder mesenchyme. Following emergence of the ureters from the Wolffian ducts, extensive epithelial remodelling brings the ureters to their final trigonal positions via vitamin A-induced apoptosis. Perturbation of this process is implicated in clinical obstruction or urine reflux. Congenital malformations include ureteric duplication and bladder exstrophy.
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Affiliation(s)
- Aron Liaw
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Gerald R Cunha
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Joel Shen
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Mei Cao
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Ge Liu
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Adriane Sinclair
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States
| | - Laurence Baskin
- Department of Urology, University of California, San Francisco, San Francisco, CA Division of Pediatric Urology, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94143, United States.
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25
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Baskin L, Shen J, Sinclair A, Cao M, Liu X, Liu G, Isaacson D, Overland M, Li Y, Cunha GR. Development of the human penis and clitoris. Differentiation 2018; 103:74-85. [PMID: 30249413 DOI: 10.1016/j.diff.2018.08.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Abstract
The human penis and clitoris develop from the ambisexual genital tubercle. To compare and contrast the development of human penis and clitoris, we used macroscopic photography, optical projection tomography, light sheet microscopy, scanning electron microscopy, histology and immunohistochemistry. The human genital tubercle differentiates into a penis under the influence of androgens forming a tubular urethra that develops by canalization of the urethral plate to form a wide diamond-shaped urethral groove (opening zipper) whose edges (urethral folds) fuse in the midline (closing zipper). In contrast, in females, without the influence of androgens, the vestibular plate (homologue of the urethral plate) undergoes canalization to form a wide vestibular groove whose edges (vestibular folds) remain unfused, ultimately forming the labia minora defining the vaginal vestibule. The neurovascular anatomy is similar in both the developing human penis and clitoris and is the key to successful surgical reconstructions.
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