1
|
Huen K, Richardson S. Common Pediatric Urologic Conditions: Contemporary Management of Cryptorchidism, the Retractile Testis, and Phimosis. Adv Pediatr 2024; 71:169-179. [PMID: 38944481 DOI: 10.1016/j.yapd.2023.12.001] [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] [Indexed: 07/01/2024]
Abstract
Undescended testis is the most common genital disorder identified at birth. Boys who do not have spontaneous descent of the testis at 6 months of age, adjusted for gestational age, should be referred to pediatric urology for timely orchiopexy. Retractile testes are at risk for secondary ascent of the testes and should be monitored by physical examination annually. If there is concern for ascent of the testis, pediatric urology referral is recommended. Most cases of phimosis can be managed medically with topical corticosteroids and manual retraction of the foreskin.
Collapse
Affiliation(s)
- Kathy Huen
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | | |
Collapse
|
2
|
Baydilli N, Dönmez Mİ, Wilcox DT, Hadziselimovic F, Hayashi Y, Oswald J, Ziylan O, Thorup J, Kapelari K, Soygür T, Favorito LA, Braga LH, 't Hoen LA, O'Kelly F, Sforza S, Lammers R, Bindi E, Paraboschi I, Haid B, Quiroz Madarriaga Y, Banuelos Marco B. Undescended testis: A roundtable discussion based on clinical scenarios - Part 1. J Pediatr Urol 2024; 20:95-101. [PMID: 37845102 DOI: 10.1016/j.jpurol.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
Undescended testis (UDT, cryptorchidism) is the most common congenital anomaly of the genital tract. Despite its high incidence, the management of UDT varies between specialties (urology, pediatric surgery, pediatric urology, pediatric endocrinology). Therefore, as the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we requested experts around the world to express their own personal approaches against various case scenarios of UDT in order to explore their individual reasoning. We intended to broaden the perspectives of our colleagues who deal with the treatment of this frequent genital malformation.
Collapse
Affiliation(s)
- Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - M İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA.
| | - Faruk Hadziselimovic
- Department of Pediatrics, Children's Day Care Center Liestal, Cryptorchidism Research Institute, Liestal, Switzerland.
| | - Yutaro Hayashi
- Department of Pediatric Urology Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Josef Oswald
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
| | - Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
| | - Jorgen Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Klaus Kapelari
- Department for Children and Adolescent Medicine, Innsbruck Medical University, Tyrol, Austria.
| | - Tarkan Soygür
- Division of Pediatric Urology, Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brazil.
| | - Luis H Braga
- Department of Surgery/Urology, McMaster University, Hamilton, Ontario, Canada.
| | - Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - Simone Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy.
| | - Rianne Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Edoardo Bindi
- Ospedale Pediatrico G Salesi, Department of Pediatric Urology, G Salesi Paediatric Hospital, Ancona, Italy.
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Bernhard Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
| | | | | |
Collapse
|
3
|
Soltani M, Rahmati M, Nikravesh MR, Saeedi Nejat S, Jalali M. Inhibition of Autophagy in Heat-Stressed Sperm of Adult Mice: A Possible Role of Catsper1, 2 Channel Proteins. J Trop Med 2023; 2023:6890815. [PMID: 37850157 PMCID: PMC10578978 DOI: 10.1155/2023/6890815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Objective Various phenomena guarantee gamete maturation and formation at all stages of evolution, one of which is autophagy playing a critical role in the final morphology of gametes, particularly sperms. Autophagy is influenced by oxidative stress, disturbances of calcium homeostasis, and hyperthermia conditions. The current study aimed to assess the autophagy-related proteins along with the activity of sperm calcium channel (CatSper) proteins following the induction of heat stress (HS). Methods The study sample includes two groups of adult mice: sham and HS groups. In the HS group, the right testis was transferred to the abdominal cavity for 120 hours and then returned to the scrotum where it remained for 7 days. After 7 days, the testis and epididymis were removed to conduct real-time, immunohistochemical studies, sperm parameter evaluation, and seminiferous tubule assessment. In this study, the expression and distribution of autophagy proteins were measured. Plus, CatSper1 and CatSper2 were evaluated as proteins of calcium channels. Results The results of the present study demonstrated that the expression intensity of autophagy indices in seminiferous tubules decreased significantly after HS induction, which was associated with a decrease in the distribution of CatSper proteins in the sperms. HS led to morphological changes in sperm, reduced motility and viability of sperm, and decreased spermatogenesis indices. Conclusion In this study, following heat stress, the decrease in CatSper protein distribution may lead to the structural disorder of CatSper channels, which could strongly affect autophagic activity. Also, disruption of spermatogenesis and sperm parameters may be the consequence of decreased autophagy activity.
Collapse
Affiliation(s)
- Malihe Soltani
- Department of Anatomy, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, IR, Iran
| | - Majid Rahmati
- Department of Medical Biotechnology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, IR, Iran
| | - Mohammad Reza Nikravesh
- Departments of Anatomy and Cell Biology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR, Iran
| | - Shahin Saeedi Nejat
- Schools of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, IR, Iran
| | - Mahdi Jalali
- Departments of Anatomy and Cell Biology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR, Iran
| |
Collapse
|
4
|
Kikkawa K, Ueda Y, Yamashita S, Kohjimoto Y, Hara I. The Importance of Follow-Up and Evaluation of Intraoperative Findings to Determine Surgical Indications for Retractile Testis. Adv Urol 2023; 2023:8764631. [PMID: 37720542 PMCID: PMC10504044 DOI: 10.1155/2023/8764631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/03/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis. Methods We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery. Results A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment. Conclusion Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate.
Collapse
Affiliation(s)
- Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yuko Ueda
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| |
Collapse
|
5
|
Lee J, Kim Y, Jou S, Park C. [Inguinal and Scrotal Diseases in Children and Adolescents]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:792-807. [PMID: 36238923 PMCID: PMC9514593 DOI: 10.3348/jksr.2021.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
In children and adolescents, inguinal and scrotal diseases are relatively common, and imaging is very useful for the diagnosis and differential diagnosis of these diseases. Therefore, it is important to understand the imaging findings of these diseases. In this article, we classify these diseases into small testes, cryptorchidism, patent processus vaginalis, acute scrotum pain, trauma, testicular tumors, and others and describe their characteristic findings.
Collapse
|
6
|
Kim JY, Chung JM. Comprehension and Practice Patterns of Korean Urologists for Retractile and Gliding Testes. J Korean Med Sci 2022; 37:e98. [PMID: 35347906 PMCID: PMC8960942 DOI: 10.3346/jkms.2022.37.e98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is quite difficult to distinguish retractile testis from gliding testis, which requires different treatment planning in the clinic setting. We evaluated practice patterns of urologists in Korea regarding the diagnosis and management of retractile and gliding testes. METHODS We mailed or e-mailed self-completion questionnaires consisting of 20 items to 106 urologists practicing in Korean hospitals concerning the diagnosis and treatment of cryptorchidism. We collected and analyzed the responses statistically. RESULTS Responses were received from 62 urologists. The response rate was 58.5%. Thirty-seven urologists (59.7%) actually felt they had difficulty in distinguishing retractile testis from gliding testis in the clinic setting. This rate was higher for non-pediatric urologists (78.1%) than for pediatric urologists (40.0%) (P = 0.006). In cases of infant retractile testis, only five urologists (8.1%) said that they would perform orchiopexy immediately, with 54 (87.1%) urologists saying they would do follow-up. In cases of preschool-age children with retractile testis, 17 urologists (27.4%) said that they would perform orchiopexy immediately with 41 (66.1%) urologists saying they would do follow-up. In cases of infant gliding testis, 37 urologists (59.7%) said that they would perform orchiopexy immediately with 24 (38.7%) urologists saying they would do a follow-up. CONCLUSION More than half (59.7%) of Korean urologists revealed it challenging to distinguish retractile testis and gliding testis in the clinical setting. The more it was difficult to diagnose retractile testis with certainty, the more frequent surgical correction was chosen for treatment. Therefore, it is essential to prevent unnecessary surgical treatment by establishing a practical guideline.
Collapse
Affiliation(s)
- Jae Yeon Kim
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Min Chung
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
| | | |
Collapse
|
7
|
Shin J, Jeon GW. Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr 2020; 63:415-421. [PMID: 32252147 PMCID: PMC7642136 DOI: 10.3345/cep.2019.01438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/01/2020] [Indexed: 12/17/2022] Open
Abstract
Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treatment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to protect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intra-abdominal undescended testis, or who underwent delayed orchiopexy. Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population. Self-examination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.
Collapse
Affiliation(s)
- Jaeho Shin
- Division of Pediatric Surgery, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|
8
|
Kim SJ. Undescended testis: importance of a timely referral to a surgical specialist. Clin Exp Pediatr 2020; 63:429-430. [PMID: 32252146 PMCID: PMC7642139 DOI: 10.3345/cep.2020.00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Su Jin Kim
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
9
|
Molinaro F, Fusi G, Aglianò M, Volpi N, Franci D, Lorenzoni P, Messina M, Galgano A, Grasso F, Plessi C, Messina M, Angotti R. Clinically Differentiated Abnormalities of the Architecture and Expression of Myosin Isoforms of the Human Cremaster Muscle in Cryptorchidism and Retractile Testis. Urol Int 2020; 104:891-901. [PMID: 32674099 DOI: 10.1159/000508432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). BACKGROUND The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. SUBJECTS AND METHODS Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. RESULTS AND CONCLUSIONS The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.
Collapse
Affiliation(s)
- Francesco Molinaro
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Fusi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
| | - Margherita Aglianò
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniela Franci
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Paola Lorenzoni
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maddalena Messina
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Angela Galgano
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Grasso
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rossella Angotti
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| |
Collapse
|
10
|
Paediatric groin lesions: Imaging findings. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Pajno R, Pacillo L, Recupero S, Cicalese MP, Ferrua F, Barzaghi F, Ricci S, Marzollo A, Pecorelli S, Azzari C, Finocchi A, Cancrini C, Di Matteo G, Russo G, Alfano M, Lesma A, Salonia A, Adams S, Booth C, Aiuti A. Urogenital Abnormalities in Adenosine Deaminase Deficiency. J Clin Immunol 2020; 40:610-618. [PMID: 32307643 PMCID: PMC7253380 DOI: 10.1007/s10875-020-00777-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/30/2020] [Indexed: 01/01/2023]
Abstract
Background Improved survival in ADA-SCID patients is revealing new aspects of the systemic disorder. Although increasing numbers of reports describe the systemic manifestations of adenosine deaminase deficiency, currently there are no studies in the literature evaluating genital development and pubertal progress in these patients. Methods We collected retrospective data on urogenital system and pubertal development of 86 ADA-SCID patients followed in the period 2000–2017 at the Great Ormond Street Hospital (UK) and 5 centers in Italy. In particular, we recorded clinical history and visits, and routine blood tests and ultrasound scans were performed as part of patients’ follow-up. Results and Discussion We found a higher frequency of congenital and acquired undescended testes compared with healthy children (congenital, 22% in our sample, 0.5–4% described in healthy children; acquired, 16% in our sample, 1–3% in healthy children), mostly requiring orchidopexy. No urogenital abnormalities were noted in females. Spontaneous pubertal development occurred in the majority of female and male patients with a few cases of precocious or delayed puberty; no patient presented high FSH values. Neither ADA-SCID nor treatment performed (PEG-ADA, BMT, or GT) affected pubertal development or gonadic function. Conclusion In summary, this report describes a high prevalence of cryptorchidism in a cohort of male ADA-SCID patients which could represent an additional systemic manifestation of ADA-SCID. Considering the impact urogenital and pubertal abnormalities can have on patients’ quality of life, we feel it is essential to include urogenital evaluation in ADA-SCID patients to detect any abnormalities, initiate early treatment, and prevent long-term complications. Electronic supplementary material The online version of this article (10.1007/s10875-020-00777-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Roberta Pajno
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Lucia Pacillo
- Department of Pediatrics, "Pietro Barilla" Children Hospital, University of Parma, via Gramsci, 14, Parma, Italy.,Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria P Cicalese
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ricci
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Antonio Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy
| | - Silvia Pecorelli
- Department of Pediatric Surgery, Ospedale dei Bambini - Spedali Civili, Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Chiara Azzari
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Andrea Finocchi
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Cancrini
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gigliola Di Matteo
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Arianna Lesma
- Unit of Pediatric Surgery, Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Stuart Adams
- SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Claire Booth
- Department of Paediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Alessandro Aiuti
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Università Vita-Salute San Raffaele, Milan, Italy.
| |
Collapse
|
12
|
Arango-Díaz A, Trujillo-Ariza MV, Liñares-Paz MM, Baleato-González S, García-Palacios M. Pediatric groin lesions: imaging findings. RADIOLOGIA 2020; 62:188-197. [PMID: 32165019 DOI: 10.1016/j.rx.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance. CONCLUSIONS Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound.
Collapse
Affiliation(s)
- A Arango-Díaz
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España.
| | - M V Trujillo-Ariza
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - M M Liñares-Paz
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - S Baleato-González
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| | - M García-Palacios
- Complexo Hospitalario Universitario de Santiago de Compostela (CHUS). Santiago de Compostela, A Coruña, España
| |
Collapse
|
13
|
Bryant RJ, Hobbs C, Richardson C, Fox S, Joseph J, Verrill C, Woodcock VK, Sullivan ME, Protheroe AS. Testicular cancer in men with undescended testis: Insights from the Thames Valley Testicular Cancer database. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818821215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Undescended testis (UDT) increases the risk of testicular cancer (TCa) development. Historical evidence suggests that malignant transformation of uncorrected UDT primarily results in seminomas, whereas mixed germ cell tumours predominate in corrected UDT; however, the risk of malignancy in the ‘normal’ contralateral testis is unclear. We investigated the contemporary Oxford TCa cohort to report the frequency of prior UDT and types of tumours developing in the prior UDT and normal contralateral testis. Patients and Methods: A 607 patient contemporary TCa cohort within the Thames Valley Testicular Cancer database. Results: Of men with new TCa, 8% had a history of UDT. Of men with TCa and prior UDT, 61% developed seminomas, whereas 56% of men with TCa without previous UDT developed this subtype. Among men with prior UDT, 77% developed tumours in the UDT, whilst 23% developed TCa in the contralateral normal testis. Conclusion: Seminoma was the most frequent malignancy following UDT, with a greater frequency than without prior UDT. Around one in four TCa patients with UDT developed contralateral tumours, emphasising the need for self-examination of both testes. Advice should be given to any patient with a history of UDT stressing the importance of ongoing self-examination of both testes. Level of evidence: Level 4.
Collapse
Affiliation(s)
- Richard J Bryant
- Department of Urology, Churchill Hospital, UK
- Nuffield Department of Surgical Sciences, University of Oxford, UK
| | | | | | | | | | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, UK
- Department of Cellular Pathology, John Radcliffe Hospital, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, UK
| | | | | | | |
Collapse
|
14
|
Affiliation(s)
- Alexander Cho
- Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Abraham Cherian
- Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
15
|
Kuiri-Hänninen T, Koskenniemi J, Dunkel L, Toppari J, Sankilampi U. Postnatal Testicular Activity in Healthy Boys and Boys With Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:489. [PMID: 31396156 PMCID: PMC6663997 DOI: 10.3389/fendo.2019.00489] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 01/25/2023] Open
Abstract
Cryptorchidism, or undescended testis, is a well-known risk factor for testicular cancer and impaired semen quality in adulthood, conditions which have their origins in early fetal and postnatal life. In human pregnancy, the interplay of testicular and placental hormones as well as local regulatory factors and control by the hypothalamic-pituitary (HP) axis, lead to testicular descent by term. The normal masculine development may be disrupted by environmental factors or genetic defects and result in undescended testes. Minipuberty refers to the postnatal re-activation of the HP-testicular (T) axis after birth. During the first weeks of life, gonadotropin levels increase, followed by activation and proliferation of testicular Leydig, Sertoli and germ cells. Consequent rise in testosterone levels results in penile growth during the first months of life. Testicular size increases and testicular descent continues until three to five months of age. Insufficient HPT axis activation (e.g., hypogonadotropic hypogonadism) is often associated with undescended testis and therefore minipuberty is considered an important phase in the normal male reproductive development. Minipuberty provides a unique window of opportunity for the early evaluation of HPT axis function during early infancy. For cryptorchid boys, hormonal evaluation during minipuberty may give a hint of the underlying etiology and aid in the evaluation of the later risk of HPT axis dysfunction and impaired fertility. The aim of this review is to summarize the current knowledge of the role of minipuberty in testicular development and descent.
Collapse
Affiliation(s)
- Tanja Kuiri-Hänninen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- *Correspondence: Tanja Kuiri-Hänninen
| | - Jaakko Koskenniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Leo Dunkel
- Barts and the London, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
16
|
Moriya K, Nakamura M, Nishimura Y, Nishida M, Kudo Y, Kanno Y, Kitta T, Kon M, Shinohara N. Impact of Preoperative Ultrasonographic Evaluation for Detection of a Viable Testis in Patients With a Unilateral Nonpalpable Testis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1665-1670. [PMID: 29214663 DOI: 10.1002/jum.14509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the impact of preoperative ultrasonography (US) for detecting a viable testis in patients with a unilateral nonpalpable testis. METHODS Patients with a unilateral nonpalpable testis or unilateral palpable undescended testis who underwent preoperative US were enrolled. Patients were divided into 3 groups as follows: nonpalpable testis/no testis (n = 27), which included patients who had a unilateral nonpalpable testis with no viable testis detected at surgery; nonpalpable testis/viable testis (n = 10), which included patients who had a unilateral nonpalpable testis with a viable testis identified at surgery; and palpable undescended testis (n = 63), which included patients who had a unilateral palpable undescended testis. Preoperative US findings were compared among each group. RESULTS The testicular volume on the contralateral descended side in the nonpalpable testis/no testis group was significantly greater than that in the nonpalpable testis/viable testis and palpable undescended testis groups. When a testicular volume of 0.54 mL was used as the cutoff value, the sensitivity, specificity, positive predictive value, and negative predictive value for the presence of the affected testis were 75.3%, 100%, 100%, and 60.0%, respectively. The testis on the affected side was detected in none of the nonpalpable testis/no testis group, 7 of the nonpalpable testis/viable testis group, and all of the palpable undescended testis group. When a visible testis on the affected side and a testicular volume of 0.54 mL or less were defined as positive, all patients in the nonpalpable testis/viable testis and palpable undescended testis groups had positive findings versus none in the nonpalpable testis/no testis group. CONCLUSIONS Preoperative US provides valuable information for predicting the presence of a viable testis in patients with a unilateral nonpalpable testis by estimating both the unaffected testis and the affected side.
Collapse
Affiliation(s)
- Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography and Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Kudo
- Diagnostic Center for Sonography and Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
17
|
Favorito LA, Anderson KM, Costa SF, Costa WS, Sampaio FJ. Structural study of the cremaster muscle in patients with retractile testis. J Pediatr Surg 2018; 53:780-783. [PMID: 28495418 DOI: 10.1016/j.jpedsurg.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/16/2017] [Accepted: 04/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the structure of the cremaster in patients with retractile testis (RT), comparing the distribution of nerves, elastic system and muscles with patients having cryptorchidism and inguinal hernia (IH). PATIENTS AND METHODS We studied 31 patients, 17 with RT (mean age=5.17years); 9 with IH (mean age=2.6) and 5 with cryptorchidism (mean age=3). A cremaster biopsy was performed and submitted to routine histological processing and studied using histochemistry and immunohistochemistry. The samples were photographed under an Olympus BX51 microscope. The images were processed with the Image J software and the cremaster muscle structures were quantified. Means were compared statistically using ANOVA and the unpaired t-test (p<0.05). RESULTS There were no differences (p=0.08) in diameter of muscle fiber between the groups. The muscle fiber density differed between patients with RT and IH (p=0.02): RT (mean=17.71%, SD=16.67), IH (mean=38.06%, SD=14) and cryptorchidism (mean=21.47%, SD=16.18). There was no difference (p=0.07) in the density of elastic fibers in the three groups. We observed a lower concentration of cremaster nerves of patients with RT compared with IH (p=0.0362): RT (mean=1.72%, SD=0.58), IH (mean=3.28% SD=0.94) and cryptorchidism (mean=2.52%, SD=0.53). CONCLUSIONS Retractile testis is not a normal variant, and presented a similar cremaster muscle structure as in patients with cryptorchidism. LEVEL OF EVIDENCE II; prospective comparative study.
Collapse
Affiliation(s)
| | - Kleber M Anderson
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | - Suelen F Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | - Waldemar S Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | | |
Collapse
|
18
|
Nishimura Y, Moriya K, Nakamura M, Nishida M, Sato M, Kudo Y, Omotehara S, Iwai T, Wakabayashi Y, Kanno Y, Kitta T, Kon M, Shinohara N. Prevalence and Chronological Changes of Testicular Microlithiasis in Isolated Congenital Undescended Testes Operated On at Less Than 3 Years of Age. Urology 2017; 109:159-164. [DOI: 10.1016/j.urology.2017.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
|
19
|
Revzin MV, Ersahin D, Israel GM, Kirsch JD, Mathur M, Bokhari J, Scoutt LM. US of the Inguinal Canal: Comprehensive Review of Pathologic Processes with CT and MR Imaging Correlation. Radiographics 2016; 36:2028-2048. [PMID: 27715712 DOI: 10.1148/rg.2016150181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) has a fundamental role in the initial examination of patients who present with symptoms indicating abnormalities of the inguinal canal (IC), an area known for its complex anatomy. A thorough understanding of the embryologic and imaging characteristics of the contents of the IC is essential for any general radiologist. Moreover, an awareness of the various pathologic conditions that can affect IC structures is crucial to preventing misdiagnoses and ensuring optimal patient care. Early detection of IC abnormalities can reduce the risk of morbidity and mortality and facilitate proper treatment. Abnormalities may be related to increased intra-abdominal pressure, which can result in development of direct inguinal hernias and varicoceles, or to congenital anomalies of the processus vaginalis, which can result in development of indirect hernias and hydroceles. US is also helpful in assessing postoperative complications of hernia repair, such as hematoma, seroma, abscess, and hernia recurrence. In addition, it is often the modality initially used to detect neoplasms arising from or invading the IC. US is an important tool in the examination of patients suspected of having undescended testes or posttraumatic testicular retraction and is essential for the examination of patients suspected of having torsion or infectious inflammatory conditions of the spermatic cord. Online supplemental material is available for this article. ©RSNA, 2016.
Collapse
Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Devrim Ersahin
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Gary M Israel
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jonathan D Kirsch
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Jamal Bokhari
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Leslie M Scoutt
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| |
Collapse
|
20
|
Merens TA. The Prepubertal Boy: Common Genital Anomalies. Pediatr Ann 2016; 45:e311-3. [PMID: 27622912 DOI: 10.3928/19382359-20160816-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The examination of the newborn is one of the most common yet crucial tasks performed by the pediatrician. The initial hospital visit (immediately after the birth), with the confirmation that an infant is healthy, often sets the tone for the future relationship between the physician and the family. Many routine visits during the first few years also find the parents looking for the same reassurance from their doctor. However, when there is concern for the health of the newborn, toddler, or young child, the physician must balance appropriate medical intervention with words of comfort and consolation. This article delineates the need for when more immediate attention is warranted from those situations where watchful waiting can be advised, with specific attention to the male genitalia of the prepubertal boy. [Pediatr Ann. 2016;45(9):e311-e313.].
Collapse
|
21
|
Anderson KM, Costa SF, Sampaio FJB, Favorito LA. Do retractile testes have anatomical anomalies? Int Braz J Urol 2016; 42:803-9. [PMID: 27564294 PMCID: PMC5006779 DOI: 10.1590/s1677-5538.ibju.2015.0538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/03/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To assess the incidence of anatomical anomalies in patients with retractile testis. MATERIALS AND METHODS We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p<0.05). RESULTS The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). CONCLUSIONS Retractile testis is not a normal variant with a significant risk of patent processos vaginalis and epididymal anomalies.
Collapse
Affiliation(s)
- Kleber M Anderson
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro, RJ, Brasil
| | - Suelen F Costa
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro, RJ, Brasil
| | | | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro, RJ, Brasil
| |
Collapse
|
22
|
Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 14. Natural History of Undescended Testes. Pediatr Dev Pathol 2016; 19:183-201. [PMID: 25105691 DOI: 10.2350/14-05-1483-pb.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cryptorchidism is one of the most frequent problems encountered in pediatric urology. Its causes, associated lesions, and prognosis in terms of fertility have been a source of interest and discrepancies for pediatric pathologists and urological surgeons.
Collapse
Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW Normal testicular descent is now recognized to occur in two steps with the first, transabdominal stage controlled by insulin-like hormone 3. The second, inguinoscrotal stage is controlled by androgens, mostly indirectly via the genitofemoral nerve, which appears to direct the migration of the gubernaculum to the scrotum. Undescended testis (UDT) is multifactorial, with only some of the genes identified. This review highlights recent developments that are leading to changes in practice. RECENT FINDINGS There is an emerging consensus among pediatric surgeons and urologists about the management of UDT with recommendations that the diagnosis of congenital UDT should be confirmed at 3-6 months of age and orchidopexy done at 6-12 months of age. With the recommendations for early surgery, recent studies focus on the complications of orchidopexy, to determine whether this is higher in infants than older children. In addition, there is general acceptance of the existence of 'acquired' UDT, which develops after about 2 years of age, but treatment for this group remains controversial. SUMMARY Evaluation of children with UDT now needs to be separated into the assessment of possible congenital UDT in infants at 0-6 months, for orchidopexy before 12 months, and preschool boys, who may be developing acquired UDT.
Collapse
|
24
|
Nah SA, Yeo CSW, How GY, Allen JC, Lakshmi NK, Yap TL, Jacobsen AS, Low Y, Ong CCP. Undescended testis: 513 patients' characteristics, age at orchidopexy and patterns of referral. Arch Dis Child 2014; 99:401-6. [PMID: 24225274 DOI: 10.1136/archdischild-2013-305225] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Undescended testis (UDT) affects 1-6% of males. Current recommendations are to correct maldescent by 1 year of age. We identify the population characteristics of children referred and managed for UDT, age at referral and orchidopexy, and patterns of referral. DESIGN, SETTING AND PATIENTS Retrospective 5-year review of all patients operated for UDT from 2007 to 2011 in our institution. Patient demographics, neonatal diagnosis of UDT, age at referral, referral source and age at first orchidopexy were recorded. Data are reported as median (range). RESULTS There were 513 boys with 576 undescended gonads; 450 (88%) had unilateral UDT. Congenital (present at birth) UDT was diagnosed in 287 (56%) children. Seventy-nine (15%) were premature births, 41 (8%) had associated major genitourinary abnormalities. Median age at referral was 1.1 (0-16.2) years; median age at first orchidopexy was 1.6 (0-17.2) years. When corrected for age, those with a history of prematurity and associated major genitourinary malformations were referred and operated on earlier. There was no difference in age at referral and orchidopexy when comparing unilateral versus bilateral maldescent, and palpability of UDT. Of those with congenital UDT, 70% were operated at beyond 1 year of age. Those referred from public tertiary hospitals were younger than those referred from community clinics (p<0.0001) and private healthcare institutions (p=0.003). CONCLUSIONS Despite early diagnosis in many patients with UDT, most are referred and operated after 1 year of age, even in congenital UDT. Premature babies, those with major genitourinary anomalies, and those seen in public tertiary hospitals are referred earlier. Community health initiatives must emphasise prompt referral to allay the impact of delayed surgery.
Collapse
Affiliation(s)
- Shireen A Nah
- Department of Paediatric Surgery, KK Women's & Children's Hospital, , Singapore, Singapore
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
The term cryptorchidism is related to the failure of the migration of the testis to the scrotum. In most cases, testis are retained along the physiological route through the inguinal canal. In 1% of cases the gubernaculum testis is abnormally fixed (testicular ectopy). In 20% of cases, one testis is not clinically palpable. The US has a sensitivity of 45% and a specificity of 78% in detecting intra-abdominal testis. Consequently, laparoscopy should be considered the gold-standard in these cases. Hormonal therapy has been considered in order to aid testicular descent, without or before surgery. Recent data suggest that these strategies seem to have a success rate 10% higher than placebo, while surgery alone is effective in 33-100% of cases. Several histological studies showed microscopic damages due to cryptorchidism since age of 6-9 months. Some Authors suggest that up to 40% retained testis completely lose their own germinal cells pool at the age of two years. Consequently guide-lines suggest that surgery should be proposed at the age of 6-18 months. Cancer relative risk associated to cryptorchidism is calculated to be 1.5-7.5% higher than in general population and lower than what is traditionally estimated (15-33%). Moreover, this risk increases 2.9-32.0 times when surgery is performed after the age of 10-11 years.
Collapse
|
26
|
Sapin E. [Cryptorchidism: guidelines for surgical management]. Arch Pediatr 2013; 21:113-7. [PMID: 24139390 DOI: 10.1016/j.arcped.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
Cryptorchidism is one of the commonest congenital anomalies in the male genitalia, affecting 3 to 5% of male full-term neonates. It is a known cause of infertility associated with a greater risk of development of germ cell tumor. The benefits of early orchidopexy include psychological affects, prevention of testicular degeneration and decrease in the risk of testicular cancer. Laparoscopy is the best way to diagnose and manage intra-abdominal testes.
Collapse
Affiliation(s)
- E Sapin
- Service de chirurgie infantile, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon, France.
| |
Collapse
|
27
|
Hutson JM, Southwell BR, Li R, Lie G, Ismail K, Harisis G, Chen N. The regulation of testicular descent and the effects of cryptorchidism. Endocr Rev 2013; 34:725-52. [PMID: 23666148 DOI: 10.1210/er.2012-1089] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The first half of this review examines the boundary between endocrinology and embryonic development, with the aim of highlighting the way hormones and signaling systems regulate the complex morphological changes to enable the intra-abdominal fetal testes to reach the scrotum. The genitoinguinal ligament, or gubernaculum, first enlarges to hold the testis near the groin, and then it develops limb-bud-like properties and migrates across the pubic region to reach the scrotum. Recent advances show key roles for insulin-like hormone 3 in the first step, with androgen and the genitofemoral nerve involved in the second step. The mammary line may also be involved in initiating the migration. The key events in early postnatal germ cell development are then reviewed because there is mounting evidence for this to be crucial in preventing infertility and malignancy later in life. We review the recent advances in what is known about the etiology of cryptorchidism and summarize the syndromes where a specific molecular cause has been found. Finally, we cover the recent literature on timing of surgery, the issues around acquired cryptorchidism, and the limited role of hormone therapy. We conclude with some observations about the differences between animal models and baby boys with cryptorchidism.
Collapse
Affiliation(s)
- John M Hutson
- Urology Department, Royal Children's Hospital, Parkville 3052, Victoria, Australia.
| | | | | | | | | | | | | |
Collapse
|
28
|
Bae JJ, Kim BS, Chung SK. Long-term outcomes of retractile testis. Korean J Urol 2012; 53:649-53. [PMID: 23061004 PMCID: PMC3460009 DOI: 10.4111/kju.2012.53.9.649] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose Retractile testis is considered to be a variant of normal testis in prepubertal boys. There is no agreed-upon management of retractile testis. The aim of this study was to provide data on the long-term outcomes of patients with retractile testis. Materials and Methods This study retrospectively reviewed the medical record of 43 boys who were referred for suspected undescended or retractile testis and were finally diagnosed with retractile testis between January 2001 and December 2008. All boys were biannually examined by a pediatric urologist to evaluate the presence of retractile, descended, or undescended testis and testicular volume. Results Of 43 boys, there were 22 boys with unilateral retractile testis (51.1%) and 21 boys with bilateral retractile testis (48.9%). Their mean age was 3.0±2.7 years and the follow-up duration was 4.4±1.7 years. Of 64 retractile testes, 29 (45.3%) succeeded in descending, 26 (40.6%) remained retractile, and 9 (14.1%) became undescended testis or of a decreased size requiring orchiopexy. The mean initial diagnostic age of the patients who underwent orchiopexy was 1.3±0.9 years; meanwhile, the mean initial diagnostic age of those who went on to have normal testis was 4.3±3.3 years (p=0.009). The mean follow-up duration was 3.6±1.5 years in the orchiopexy group, 4.0±1.4 years in the descended testis group, and 5.1±1.8 years in group with remaining retractile testis. Conclusions Retractile testis has a risk of requiring orchiopexy. The risk is higher in the population diagnosed at a younger age. Boys with retractile testis should be observed periodically until the testis is descended in the normal position.
Collapse
Affiliation(s)
- Jae Jun Bae
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | | | | |
Collapse
|
29
|
Goede J, van der Voort-Doedens LM, Sijstermans K, Hack WWM. The volume of retractile testes. J Urol 2011; 186:2050-4. [PMID: 21944090 DOI: 10.1016/j.juro.2011.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE We used ultrasound to determine the volume of retractile testes in boys and compared these volumes with normative testicular volume values. MATERIALS AND METHODS A total of 171 boys were enrolled in the study, of whom 14 were excluded from analysis. The 157 boys included (age 0.8 to 11.5 years) were recruited from 2 different populations. The first subgroup comprised 92 boys previously excluded from a study aimed at obtaining normative values of ultrasonographically scanned testes. The second group included 65 boys who had been referred to our outpatient clinic for nonscrotal testis and who were diagnosed with retractile testis. Testicular volume was measured by ultrasound in a scrotal position or in an inguinal position. Three separate transverse and longitudinal images of each testis were recorded. Length, width and height were measured, and the volume was calculated with the formula for an ellipsoid, π/6 × length × width × height. The highest value of the 3 testicular volumes was determined and taken as the volume measurement. RESULTS The volumes measured by ultrasound for the 157 boys with 276 retractile testes ranged from 0.18 to 1.49 ml (mean 0.50). The volumes of the retractile testes were significantly smaller than normative values (p <0.001). Furthermore, the testicular volumes of retractile testes measured in an inguinal position were significantly smaller than those measured in a scrotal position (p <0.001). CONCLUSIONS The volumes of retractile testes are significantly smaller than recently determined normative values.
Collapse
Affiliation(s)
- J Goede
- Department of Paediatrics, Medical Centre Alkmaar, Alkmaar, The Netherlands.
| | | | | | | |
Collapse
|