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Hildorf S, Cortes D, Clasen-Linde E, Hildorf A, Thorup J. The Inhibin-B Level at Orchidopexy and Follow-up of 280 Boys With Non-syndromic Unilateral Cryptorchid Testes. J Pediatr Surg 2023; 58:2233-2237. [PMID: 37582667 DOI: 10.1016/j.jpedsurg.2023.07.010] [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: 02/13/2023] [Revised: 06/05/2023] [Accepted: 07/16/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE An impaired germ cell number per tubular cross-section (G/T) at orchidopexy indicates a high risk of infertility. A recent study in boys with bilateral cryptorchidism showed a very high predictive value for a low serum inhibin-B level, indicating bilateral impaired G/T. Several other studies have shown a fairly strong correlation between inhibin-B and G/T. We aimed to evaluate if inhibin-B levels at orchidopexy improved at follow-up in boys with unilateral cryptorchidism. METHODS We included 280 boys with unilateral non-syndromic cryptorchidism at the median age of 1 year (4 months-9 years) who underwent orchidopexy. They were evaluated for serum FSH, LH and inhibin-B levels at surgery and at follow-up (median 16 months later), including multiple of the median (MoM) estimations of inhibin-B due to the age dependency of normal levels. RESULTS The inhibin-B MoM score improved significantly at follow-up. At orchidopexy, 59 (21%) boys had inhibin-B levels below the normal 2.5-percentile indicating impaired G/T bilaterally. At follow-up, 36% of the boys still had low inhibin-B. At orchidopexy, 221 (79%) boys had inhibin-B levels above normal 2.5-percentile and only 5% had low inhibin-B levels at follow-up. The risk of low inhibin-B levels at follow-up was significantly different between the two groups (p < 0.0001). At follow-up, totally, 32 (11%) boys had low inhibin-B levels, hereof only 3 patients with increased FSH. CONCLUSIONS Orchidopexy benefits the fertility potential. About 10% of boys with unilateral non-syndromic cryptorchidism may have a bilateral testicular disease reducing their fertility potential. Insufficient gonadotropin stimulation may possibly be the cause.
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Affiliation(s)
- Simone Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Dina Cortes
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics' and Adolescence Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andrea Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
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3
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Hildorf SE. Clinical aspects of histological and hormonal parameters in boys with cryptorchidism: Thesis for PhD degree. APMIS 2022; 130 Suppl 143:1-58. [PMID: 35822689 PMCID: PMC9542020 DOI: 10.1111/apm.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Engmann Hildorf
- Department of Pediatric Surgery and Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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4
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Guaragna-Filho G, Calixto AR, Astur ABLDV, de Paula GB, de Oliveira LC, Morcillo AM, Gonçalves EM, de Mello MP, Maciel-Guerra AT, Guerra-Junior G. Leydig and Sertoli cell function in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion: a case-control study. SAO PAULO MED J 2022; 140:163-170. [PMID: 35137906 PMCID: PMC9610247 DOI: 10.1590/1516-3180.2021.0042.r1.08062021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Because normal male sexual differentiation is more complex than normal female sexual differentiation, there are more cases of disorders of sex development (DSDs) with 46,XY karyotype that have unclear etiology. However, Leydig and Sertoli cell markers are rarely used in distinguishing such individuals. OBJECTIVES To evaluate the function of Leydig and Sertoli cells in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion. STUDY DESIGN AND SETTING Case-control study with 77 patients, including eight with partial androgen insensitivity syndrome, eight with 5α-reductase deficiency type 2 (5ARD2) and 19 with idiopathic 46,XY DSD, and 42 healthy controls, from the Interdisciplinary Study Group for Sex Determination and Differentiation (GIEDDS), at the State University of Campinas (UNICAMP), Campinas, Brazil. METHODS Baseline levels of gonadotropins, anti-Müllerian hormone (AMH), inhibin B, insulin-like 3 (INSL3), testosterone and dihydrotestosterone in cases, and AMH, inhibin B, and INSL3 levels in controls, were assessed. RESULTS There was no significant difference in age between cases and controls (P = 0.595). AMH and inhibin B levels were significantly lower in cases than in controls (P = 0.031 and P < 0.001, respectively). INSL3 levels were significantly higher in cases than in controls (P = 0.003). Inhibin B levels were lower in 5ARD2 patients (P = 0.045) and idiopathic patients (P = 0.001), in separate comparisons with the controls. CONCLUSION According to our findings, we can speculate that inhibin B levels may be used to differentiate among DSD cases.
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Affiliation(s)
- Guilherme Guaragna-Filho
- MD, PhD. Adjunct Professor, Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Antônio Ramos Calixto
- PhD. Researcher, Laboratory of Investigation in Metabolism and Diabetes (LIMED), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Anna Beatriz Lima do Valle Astur
- MD. Attending Physician, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Georgette Beatriz de Paula
- MD, MSc. Attending Physician, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Laurione Cândido de Oliveira
- PhD. Researcher, Laboratory of Physiology, Clinical Hospital, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - André Moreno Morcillo
- MD, PhD. Associate Professor, Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Ezequiel Moreira Gonçalves
- PhD. Adjunct Professor, Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Maricilda Palandi de Mello
- PhD. Researcher, Center of Molecular Biology and Genetic Engineering (CBMEG), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Andrea Trevas Maciel-Guerra
- MD, PhD. Full Professor, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Gil Guerra-Junior
- MD, PhD. Full Professor, Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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Batra NV, DeMarco RT, Bayne CE. A narrative review of the history and evidence-base for the timing of orchidopexy for cryptorchidism. J Pediatr Urol 2021; 17:239-245. [PMID: 33551366 DOI: 10.1016/j.jpurol.2021.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Consensus recommendations for surgical management of cryptorchidism recommend orchidopexy between 6 and 18 months of age. The COVID-19 pandemic has impacted elective surgical scheduling. OBJECTIVE In response to the COVID-19 pandemic, we sought to review the available data regarding the natural history, surgical management, and infertility- and cancer-related risks associated with cryptorchid testes. The purpose of this review is to provide parents, referring providers, and surgeons with information to inform their decisions to proceed with or delay orchidopexy. METHODS A retrospective review and analysis of all available articles relevant to the natural history, surgical management, and infertility- and cancer-related risks of cryptorchidism present on PubMed, SCOPUS, and Cochrane Library was conducted. RESULTS The quality of historic literature pertaining to the effect of cryptorchidism on fertility and malignancy differ, with poorer data available on fertility. Cryptorchid testes may show histologic differences as early as birth, and some of these changes may have prognostic value in future fertility. Formerly unilateral cryptorchid men have slightly but not significantly reduced paternity rates compared to the general population. Cryptorchid testes have an increased risk of germ cell carcinogenesis, and robust data suggest the risk for malignancy in cryptorchid testes increases substantially after puberty. CONCLUSION The current body of evidence regarding the risks for future infertility and testicular cancer support the consensus recommendations for surgical correction of cryptorchidism between 6 and 18 months of age. During the uncertain time of the COVID-19 pandemic, decision for orchidopexy is a shared-decision between physician and parent. For an infant or young boy with a unilateral undescended testes, delaying orchidopexy several months until a time of decreased exposure risk is unlikely to result in substantial or sustained fertility or malignant risks.
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Affiliation(s)
- Nikhil V Batra
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA.
| | - Romano T DeMarco
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA
| | - Christopher E Bayne
- Department of Urology, University of Florida College of Medicine, 1600 SW Archer Road, Room N216, Gainesville, FL 32610, USA
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Spinelli C, Morelli G, Cito G, Bertocchini A, Ghionzoli M, Pucci A, Cocci A, Morganti R, Strambi S. Correlation between testicular volume and histological findings in children with unilateral cryptorchidism: Potential impact on future fertility. Urologia 2021; 89:292-297. [PMID: 33781144 DOI: 10.1177/03915603211004732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our aim is to assess the correlation between testicular volume and histological findings in children with unilateral cryptorchidism. METHODS From September 2016 to August 2018, from 60 patients surgically treated for cryptorchidism, 45 children were enrolled in this single-center prospective study. Depending on the degree of testicular volume reduction, patients were divided into Group 1 with <20% reduction and Group 2 with reduction ⩾20%. Patients underwent unilateral orchidopexy and simultaneous biopsy of the undescended testis. Tanner stage was assigned. Tubular Fertility Index was measured. RESULTS Group 1 included 20 patients (44.4%) and Group 2 included 25 patients (55.5%). Mean age was 2.10 years (range 12 months-3.8 years) in Group 1 and 2.8 years (range 18 months-4.41 years) in Group 2. Although there is a positive correlation between testicular volume and Tubular Fertility Index, no significant association was found between groups (p-value = 0.29). Furthermore, histological patterns did not differ significantly among groups. CONCLUSIONS The degree of volume reduction in undescended testis does not seem to correlate significantly with the severity of histological changes that accompany cryptorchidism. Tubular Fertility Index could serve as objective tool for the assessment of future fertility.
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Affiliation(s)
- Claudio Spinelli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa, Pisa, Italy
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessia Bertocchini
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Angela Pucci
- Division of Pathology, University of Pisa, Pisa, Italy
| | - Andrea Cocci
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
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7
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Fertility after the Operation of Cryptorchism in Childhood. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cryptorchism is a congenital anomaly of male genitalia, and is defined as a disorder of lowering testicles into the scrotum. In our study, the quality of sperm and fertility of men who were operated from unilateral or bilateral cryptorchism in childhood were analyzed. According to the age in which they were operated, patients were classified into different time groups, subjected to clinical examination and sperm analysis. A normal sperm count was found: 36.9% of the total number of patients operated from unilateral to bilateral cryptorchism. The highest percentage of normal sperm counts was 73.97%: the data which was found in the group that was operated from one-sided cryptorchism to the end of the second year of life. Regardless of the age of the cryptorchism operation, it is possible to expect a disorder of spermatogenesis.
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8
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Wilson V, Thorup J, Clasen-Linde E, Cortes D, Hutson JM, Li R. Gonocyte transformation in congenital undescended testes: what is the role of inhibin-B in cell death? Pediatr Surg Int 2019; 35:1309-1316. [PMID: 31435735 DOI: 10.1007/s00383-019-04545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Undescended testes (UDT) are subjected to heat stress, which can disturb gonocyte transformation as well as apoptosis. This study aims to describe the apoptosis pathway occurring during minipuberty of children with unilateral (UDT), and to investigate the role of inhibin-B. METHODS Testicular biopsies at unilateral orchidopexy of 10 boys (6-9 months old) with normal inhibin-B (n = 5) or low inhibin-B (n = 5) were selected for immunohistochemistry and TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labelling) assay. Testicular tubules were labelled with antibodies against Anti-Müllerian hormone (AMH, Sertoli cell marker), mouse Vasa Homolog (MVH) and placental alkaline phosphatase (PLAP) (both germ cell markers), cleaved caspase3 (apoptotic marker), and followed by confocal imaging and cell counting with Fiji/ImageJ. Data were analyzed with GraphPad Prism. RESULTS In males with low and normal inhibin-B, there was no statistical difference (p > 0.05) in the percentage of testicular tubules containing TUNEL + cells, number of cleaved caspase3 ± germ cells/tubule, total number of germ cells/tubule, and the percentage of fibrotic tubules or number of Sertoli cells/tubule. CONCLUSIONS These results suggest that inhibin-B does not regulate cell death of gonocytes and further studies are required to uncover any role of inhibin-B in gonocyte transformation.
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Affiliation(s)
- Vanessa Wilson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jorgen Thorup
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erick Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - John M Hutson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Urology, The Royal Children's Hospital, Melbourne, Australia
| | - Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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9
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Impaired serum inhibin-B and number of germ cells in boys with cryptorchidism following heavily gestational maternal smoking. J Pediatr Surg 2019; 54:809-814. [PMID: 29706444 DOI: 10.1016/j.jpedsurg.2018.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE A meta-analysis including 11,900 cases showed that maternal gestational smoking was associated with increased risk of cryptorchidism. The aim of study was to investigate whether a hormone profile of cryptorchid boys and a supplementing histopathological evaluation of testicular biopsies could add detailed knowledge to the impact of maternal gestational smoking on pathogenesis of cryptorchidism. METHODS 601 cryptorchid boys aged 4 months to 14 years old were included. Because normal hormones have a pronounced age dependency, we compared results from boys whose mothers had smoked heavily (>10 cigarettes/day) during pregnancy with age matched cryptorchid controls of nonsmoking mothers (1:6). We studied: birthweight, germ-cell number/tubular cross section, frequency of germ cells positive for placental-like alkaline phosphatase (PLAP), gonadotropins and inhibin-B. RESULTS 501 boys were sons of nonsmokers, 72 boys of intermittent smokers and 28 boys of heavy smokers. 39%, 44% and 61% respectively had bilateral cryptorchidism. Compared to age-matched cryptorchid controls of nonsmoking mothers, sons of heavy smokers had lower birthweight (p = 0.006), germ-cell number/tubular cross section (p = 0.009), frequency of germ cells positive for PLAP (p = 0.037) and inhibin-B (p = 0.042). CONCLUSIONS All findings could be associated with placental dysfunction with altered human chorionic gonadotropin production well described in women smoking during pregnancy. TYPE OF STUDY Prognosis study (prospective cohort study with >80% follow-up). LEVEL OF EVIDENCE Level 1.
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10
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Hildorf S, Dong L, Thorup J, Clasen-Linde E, Yding Andersen C, Cortes D. Sertoli Cell Number Correlates with Serum Inhibin B in Infant Cryptorchid Boys. Sex Dev 2019; 13:74-82. [DOI: 10.1159/000497374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/26/2022] Open
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11
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Thorup J, Cortes D. Surgical Management of Undescended Testis - Timetable and Outcome: A Debate. Sex Dev 2019; 13:11-19. [PMID: 30685766 DOI: 10.1159/000496417] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
Around 1.4-3.8% of boys in the Western world are operated because of cryptorchidism. This means that orchidopexy remains one of the most common surgical procedures performed in boys. As a consequence, several consensus reports, guidelines, and reviews dealing with the management of cryptorchidism have been published recently. Based on our research and 30 years' experience with the management of cryptorchidism, the intention of the present publication is to advise on the surgical management and comment on the expected outcome, especially with focus on the controversies related to guidelines and reviews. Except for late referral and waiting lists, which may be practical problems, there is no reason to postpone orchidopexy for nonsyndromic congenital cryptorchid testes beyond 6 months. There is good evidence that such strategy improves the fertility potential and decreases the risk of testicular cancer. In cases with genuine gonadotropin insufficiency, early surgical correction is not enough and adjuvant LH-RH treatment should be implemented to improve the fertility potential. Cryopreservation may be an option in case of treatment failure of adjuvant LH-RH. A prerequisite for such management includes serum hormone assessment and evaluation of testicular biopsies at orchidopexy. Ascended testes contribute to 20-60% of operative cases and should be treated when diagnosed.
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12
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Rodprasert W, Virtanen HE, Mäkelä JA, Toppari J. Hypogonadism and Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:906. [PMID: 32010061 PMCID: PMC6974459 DOI: 10.3389/fendo.2019.00906] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- *Correspondence: Wiwat Rodprasert
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Guaragna-Filho G, Calixto AR, De Paula GB, De Oliveira LC, Morcillo AM, De Mello MP, Maciel-Guerra AT, Guerra-Junior G. Comparison between two inhibin B ELISA assays in 46,XY testicular disorders of sex development (DSD) with normal testosterone secretion. J Pediatr Endocrinol Metab 2018; 31:191-194. [PMID: 29306929 DOI: 10.1515/jpem-2017-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/01/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inhibin B is a hormone produced by the Sertoli cells that can provide important information for the investigation of disorders of sex development (DSD) with 46,XY karyotype. The aim of this study is to compare two enzyme-linked immunosorbent assay (ELISA) assays for dosage of serum inhibin B in patients with 46,XY DSD with normal testosterone secretion. METHODS Twenty-nine patients with 46,XY DSD and normal testosterone secretion (partial androgen insensitivity syndrome [PAIS] [n=8]; 5α-reductase deficiency [n=7] and idiopathic 46,XY DSD [n=14]) were included. Molecular analysis of the AR and SRD5A2 genes were performed in all patients and the NR5A1 gene analysis in the idiopathic group. Measurements of inhibin B were performed by two second-generation ELISA assays (Beckman-Coulter and AnshLabs). Assays were compared using the interclass correlation coefficient (ICC) and the Bland-Altman method. RESULTS ICC was 0.915 [95% confidence interval (CI): 0.828-0.959], however, a discrepancy was observed between trials, which is more evident among higher values when analyzed by the Bland-Altman method. CONCLUSIONS It is recommended to perform the inhibin B measurement always using the same ELISA kit when several evaluations are required for a specific patient.
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Affiliation(s)
- Guilherme Guaragna-Filho
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), Growth and Development Laboratory, Center for Investigation in Pediatrics (CIPED), School of Medicine, State University of Campinas (UNICAMP),R. Tessalia Vieira de Camargo, 126, Campinas, São Paulo 13083-887, Brazil
| | - Antônio Ramos Calixto
- Laboratory of Investigation in Metabolism and Diabetes (LIMED), UNICAMP, Campinas, São Paulo, Brazil
| | - Georgette Beatriz De Paula
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | - Andrea Trevas Maciel-Guerra
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group for Study of Sex Determination and Differentiation (GIEDDS), School of Medicine, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Verkauskas G, Malcius D, Eidukaite A, Vilimas J, Dasevicius D, Bilius V, Hadziselimovic F. Prospective study of histological and endocrine parameters of gonadal function in boys with cryptorchidism. J Pediatr Urol 2016; 12:238.e1-6. [PMID: 27321556 DOI: 10.1016/j.jpurol.2016.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/03/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A transient increase in gonadotropins and testosterone during mini-puberty causes gonocytes to differentiate into Ad spermatogonia, which establish male germ cell memory and male-specific DNA methylation pathways. Over half of patients with unilateral cryptorchidism and the majority of patients with bilateral cryptorchidism display an abnormal spermiogram, which indicates that unilateral cryptorchidism is a bilateral disease; therefore, it represents a serious andrological problem. The aim of this study was to evaluate relationships between hormonal parameters and testicular biopsy findings in boys with cryptorchidism. METHOD Seventy-one boys (median age 15 months; range 7-65 months) who underwent orchidopexy (24% had bilateral cryptorchidism) were tested for serum LH, FSH, and inhibin B. With ipsilateral testis biopsy histology, we determined the tubular fertility index (TFI), Ad spermatogonia counts, and Ad/tubular index (Ad/T). We compared age groups (<18 vs. >18 months old); groups with and without Ad spermatogonia; groups with unilateral and bilateral cryptorchidism; and extreme groups with high infertility risk (HIR; n = 12; TFI <0.2; Ad/T = 0) and low infertility risk (LIR; n = 9; TFI >0.9; Ad/T>0.02). RESULTS Of the specimens, 38% had no Ad spermatogonia. Age was significantly negatively correlated with TFI and Ad/T, but positively correlated with FSH. Median LH values were significantly higher in LIR than in HIR groups. Unilateral and bilateral cryptorchidism showed similar TFI, Ad/T, and hormone concentrations. The areas under ROC curves for FSH, LH, and inhibin B (0.66, 0.601, and 0.599, respectively) showed low diagnostic value for predicting HIR (no Ad spermatogonia). CONCLUSION Our observation of lower plasma LH levels in the group with the most pronounced testicular pathology was the opposite of what we would have expected if testicular pathological changes were caused by a primary gonadal defect. Therefore, low plasma LH levels in the HIR group confirmed the notion that this group of patients with cryptorchidism had hypogonadotropic hypogonadism. The estimated incidence of defective mini-puberty in boys with cryptorchidism could be as high as 50%. Testicular biopsies from boys with cryptorchidism lacked Ad spermatogonia. Fertility parameters worsened with age. Significantly lower basal LH in the HIR group indicated hypogonadotropic hypogonadism. Serum hormone levels could not predict histological biopsy findings.
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Affiliation(s)
| | - Dalius Malcius
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audrone Eidukaite
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Juozas Vilimas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Faruk Hadziselimovic
- Institute for Cryptorchidism Research, Kindermedizinisches Zentrum, Liestal, Switzerland
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Cortes D, Clasen-Linde E, Hutson JM, Li R, Thorup J. The Sertoli cell hormones inhibin-B and anti Müllerian hormone have different patterns of secretion in prepubertal cryptorchid boys. J Pediatr Surg 2016; 51:475-80. [PMID: 26452703 DOI: 10.1016/j.jpedsurg.2015.08.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/09/2015] [Accepted: 08/15/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES AND HYPOTHESES The Sertoli-cells produce inhibin-B and Anti-Müllerian-Hormone (AMH). Much is still unknown about these hormones in prepubertal cryptorchids. The Sertoli-cells are mandatory for germ cell development. The aim of the study was to investigate if there are differences in secretion pattern of Sertoli-cell hormones and their gonadotropin feed-back mechanisms. METHODS Included were 94 prepubertal cryptorchid boys 0.5-13.1years with measurements of serum-inhibin-B, Anti-Müllerian-Hormone (AMH), Luteinizing Hormone (LH) and Follicle Stimulation Hormone (FSH). The serum values were measured using commercially available kits. The hormonal values were related to age-matched normal values. Testicular biopsy was taken at orchiopexy. RESULTS Inhibin-B positively correlated to AMH for 1-13year-old patients (p<0.0001), but not for 0.5-1year-old patients (p=0.439). For 0.5-1year-old patients inhibin-B-values tended to decrease (p=0.055), in contrast to AMH-values (p=0.852). LH was elevated more often than FSH (p=0.014). FSH and LH were positively associated in patients both 0.5-1year (p=0.042) and 1-13years of age (p<0.0001). LH correlated positively to inhibin- B (p=0.001). In contrast, FSH did not correlate to inhibin-B or AMH (p=0.755 and p=0.528). The number of A-dark spermatogonia per tubular transverse section was positively correlated to inhibin-B serum level. CONCLUSION Our new finding of an association between LH and inhibin-B in infancy of cryptorchid boys may be essential for the transformation of gonocytes to A-dark spermatogonia. Previously, LH associated to inhibin-B was described in early puberty only. During the first year of life inhibin-B values decreased faster than AMH. The AMH-levels may just reflect the increased Sertoli cell number that occurs during the first 3months of life.
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Affiliation(s)
- Dina Cortes
- The Department of Pediatric Surgery, Rigshospitalet, DK-2100 Copenhagen; Section of Endocrinology, Department of Pediatrics, Hvidovre University Hospital, Copenhagen; Faculty of Health Science, University of Copenhagen
| | | | - John M Hutson
- Douglas Stephens Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne
| | - Ruili Li
- Douglas Stephens Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Jorgen Thorup
- The Department of Pediatric Surgery, Rigshospitalet, DK-2100 Copenhagen; Faculty of Health Science, University of Copenhagen.
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