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Kose SI. Imaging in Male Infertility. Curr Probl Diagn Radiol 2023; 52:439-447. [PMID: 37270300 DOI: 10.1067/j.cpradiol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Infertility is defined as inability to conceive despite regular unprotected sexual intercourse for greater than 1 year. Conditions involving the male partner accounts for the infertility in approximately 50% of cases. The goals of imaging in male infertility are to detect treatable/ reversible causes, imaging for sperm retrieval from testis or epididymis for assisted reproductive techniques like in vitro fertilization or intracytoplasmic sperm injection and to provide appropriate genetic counselling for prevention of occurrence of disease in future offspring. The purpose of this article is to describe imaging features in various causes of male infertility to acquaint radiologists with various imaging appearances of causes of male infertility to avoid missing these pathologies.
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Affiliation(s)
- Snehal Ishwar Kose
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India.
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Delgouffe E, Braye A, Goossens E. Testicular Tissue Banking for Fertility Preservation in Young Boys: Which Patients Should Be Included? Front Endocrinol (Lausanne) 2022; 13:854186. [PMID: 35360062 PMCID: PMC8960265 DOI: 10.3389/fendo.2022.854186] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/11/2022] [Indexed: 12/11/2022] Open
Abstract
Due to the growing number of young patients at risk of germ cell loss, there is a need to preserve spermatogonial stem cells for patients who are not able to bank spermatozoa. Worldwide, more and more clinics are implementing testicular tissue (TT) banking programs, making it a novel, yet indispensable, discipline in the field of fertility preservation. Previously, TT cryopreservation was predominantly offered to young cancer patients before starting gonadotoxic chemo- or radiotherapy. Nowadays, most centers also bank TT from patients with non-malignant conditions who need gonadotoxic conditioning therapy prior to hematopoietic stem cell (HSCT) or bone marrow transplantation (BMT). Additionally, some centers include patients who suffer from genetic or developmental disorders associated with prepubertal germ cell loss or patients who already had a previous round of chemo- or radiotherapy. It is important to note that the surgical removal of TT is an invasive procedure. Moreover, TT cryopreservation is still considered experimental as restoration methods are not yet clinically available. For this reason, TT banking should preferably only be offered to patients who are at significant risk of becoming infertile. In our view, TT cryopreservation is recommended for young cancer patients in need of high-risk chemo- and/or radiotherapy, regardless of previous low-risk treatment. Likewise, TT banking is advised for patients with non-malignant disorders such as sickle cell disease, beta-thalassemia, and bone marrow failure, who need high-risk conditioning therapy before HSCT/BMT. TT retrieval during orchidopexy is also proposed for patients with bilateral cryptorchidism. Since patients with a medium- to low-risk treatment generally maintain their fertility, TT banking is not advised for this group. Also for Klinefelter patients, TT banking is not recommended as it does not give better outcomes than a testicular sperm extraction later in life.
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Maldescensus testis – Epidemiologische Übersichtsarbeit hinsichtlich Pathophysiologie, Diagnostik und leitliniengerechter Therapiemaßnahmen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Fallara G, Cazzaniga W, Boeri L, Capogrosso P, Candela L, Pozzi E, Belladelli F, Schifano N, Ventimiglia E, Abbate C, Papaleo E, Viganò P, Montorsi F, Salonia A. Male factor infertility trends throughout the last 10 years: Report from a tertiary-referral academic andrology centre. Andrology 2020; 9:610-617. [PMID: 33231922 DOI: 10.1111/andr.12947] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/25/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Trends of male factor causes of couples' infertility over time have been poorly investigated. OBJECTIVE We investigated trends in the causes of pure male factor infertility (MFI) throughout the last 10 years in a tertiary-referral academic andrology center. MATERIAL AND METHODS Baseline characteristics at first presentation from a cohort of 1647 consecutive male factor infertility patients belonging to primary infertile couples between 2008 and 2018 have been comprehensively collected over time. Seven major causes of male factor infertility were identified: varicocoele; history of cryptorchidism; hypogonadism (primary and secondary); obstructive azoospermia; genetic abnormalities; other causes (large group including the remnant conditions of known causes); and idiopathic infertility. Rates of different male factor infertility causes over the study period were analyzed. Multivariable logistic regression models tested the likelihood of male factor infertility causes over time. Estimated trends were explored graphically. RESULTS Of all, varicocoele was found in 615 (37.3%), cryptorchidism in 124 (7.5%), genetic abnormalities in 61 (3.7%), hypogonadism in 165 (10%), obstructive conditions in 55 (3.3%), other causes in 129 (7.8%) patients, and idiopathic infertility in 498 (30.3%) patients, respectively. Over time, a reduction in the proportions of cryptorchidism and varicocoele (all P < 0.001) cases was observed, along with an increase in the proportions of hypogonadism, other causes of MFI and idiopathic cases (all P ≤ 0.01). Rates of genetic and obstructive cases remained stable. The observed trends were confirmed at logistic regression models. DISCUSSION AND CONCLUSIONS A decreasing trend in the proportions of varicocoele and cryptorchidism at first presentation was observed over the last 10 years; conversely, the proportions of idiopathic cases, hypogonadal patients, and infertile men presenting with other male factor infertility causes significantly increased over the same time frame at a single tertiary-referral academic andrology center.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy.,Obstetrics and Gynaecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy.,Obstetrics and Gynaecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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Rodprasert W, Virtanen HE, Mäkelä JA, Toppari J. Hypogonadism and Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:906. [PMID: 32010061 PMCID: PMC6974459 DOI: 10.3389/fendo.2019.00906] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- *Correspondence: Wiwat Rodprasert
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Fénichel P, Chevalier N, Lahlou N, Coquillard P, Wagner-Mahler K, Pugeat M, Panaïa-Ferrari P, Brucker-Davis F. Endocrine Disrupting Chemicals Interfere With Leydig Cell Hormone Pathways During Testicular Descent in Idiopathic Cryptorchidism. Front Endocrinol (Lausanne) 2018; 9:786. [PMID: 30687232 PMCID: PMC6335363 DOI: 10.3389/fendo.2018.00786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/13/2018] [Indexed: 12/15/2022] Open
Abstract
Cryptorchidism, a frequent genital malformation in male newborn, remains in most cases idiopathic. On the basis of experimental, epidemiological, and clinical data, it has been included in the testicular dysgenesis syndrome and believed to be influenced, together with genetic and anatomic factors, by maternal exposure to endocrine disrupting chemicals (EDCs). Here, we analyze how EDCs may interfere with the control of testicular descent, which is regulated by two Leydig cell hormones, testosterone, and insulin like peptide 3 (INSL3).
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Affiliation(s)
- Patrick Fénichel
- Department of Reproductive Endocrinology, University Hospital of Nice, Nice, France
- Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
- *Correspondence: Patrick Fénichel
| | - Nicolas Chevalier
- Department of Reproductive Endocrinology, University Hospital of Nice, Nice, France
- Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
| | - Najiba Lahlou
- Department of Hormonology and Metabolic Disorders, Hôpital Cochin, APHP, Paris-Descartes University, Paris, France
| | | | | | - Michel Pugeat
- Institut National de la Recherche Médicale, U1060 CaRMen, Fédération d'Endocrinologie, Hospices Civils de Lyon-1, Bron, France
| | | | - Françoise Brucker-Davis
- Department of Reproductive Endocrinology, University Hospital of Nice, Nice, France
- Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
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7
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Çildağ MB. Evaluation of Pediatric Undescended Testes with Elastosonography. J Med Ultrasound 2017; 25:157-160. [PMID: 30065481 PMCID: PMC6029294 DOI: 10.1016/j.jmu.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background Undescended testes, which are defined as the failure of testes to descend to scrotum, are the most common developmental defect in male infants. Indirect evaluation of histologic damage can be performed with the help of palpation during operation. Hard texture of testes tissue is likely related with histological damage. Real-time elastography is an emerging technology of ultrasonic imaging of soft tissue strain and elasticity, it aims at providing information regarding the mechanical properties of tissues, such as their hardness or stiffness. This study aim was to investigate the changes in strain and elasticity of testes tissue by using elastography technique. Materials and methods A total of 32 patients, who had undescended testes were included in this study. Only two patients had bilateral undescended testes, other patients had unilateral. The age of the patients were recorded according to the time of ultrasonographic (USG) examination. The undescended testes was displayed in the elastographic box with the neighbouring subcutaneous fat tissues. The strain ratios were measured as the ratios of the elasticities of the subcutaneous fat tissue to the elasticities of the undescended testes. Results A total of 32 patients with 34 testes were included in the study. The mean age of the patients with undescended testes was 32.6 months (range 7-60 months). The mean strain ratios were 0.67 (range 0.12-1.41) for the undescended testes and there were no significant differences in undescended testes strain ratios related to patient age (p = 0.453). Conclusion This preliminary study showed that there were no significant fibrosis which can be demonstrated with elastosonography before the age of 5 years old. Additional studies with his-topathological results are needed to identify sensitivity and specificity of elastosonography in undescended testis and in planning optimal operation time for these patients.
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Affiliation(s)
- Mehmet Burak Çildağ
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, Turkey
- Correspondence to: Mehmet Burak Çildağ, Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aytepe Street, Efeler, Aydın, 09100, Turkey. E-mail address:
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Mittal PK, Little B, Harri PA, Miller FH, Alexander LF, Kalb B, Camacho JC, Master V, Hartman M, Moreno CC. Role of Imaging in the Evaluation of Male Infertility. Radiographics 2017; 37:837-854. [DOI: 10.1148/rg.2017160125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Brent Little
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Lauren F. Alexander
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Bobby Kalb
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Juan C. Camacho
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Viraj Master
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Matthew Hartman
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences (P.K.M., B.L., P.A.H., L.F.A., J.C.C., C.C.M.) and Department of Urology (V.M.), Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (F.H.M.); Department of Medical Imaging, University of Arizona School of Medicine, Tucson, Ariz (B.K.); and Department of Radiology, West Penn Allegheny Health System, Pittsburgh, Pa (M.H.)
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Ucar AK, Alis D, Samanci C, Aslan M, Habibi HA, Dikici AS, Namdar Y, Gultekin MH, Onal B, Adaletli I. A preliminary study of shear wave elastography for the evaluation of unilateral palpable undescended testes. Eur J Radiol 2017; 86:248-251. [DOI: 10.1016/j.ejrad.2016.11.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/19/2016] [Accepted: 11/22/2016] [Indexed: 01/27/2023]
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Jedrzejewski G, Wieczorek AP, Osemlak P, Nachulewicz P. The role of ultrasound in the management of undescended testes before and after orchidopexy - an update. Medicine (Baltimore) 2016; 95:e5731. [PMID: 28002344 PMCID: PMC5181828 DOI: 10.1097/md.0000000000005731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the testicular volume and structure using ultrasound (US) before and up to 3 years after orchidopexy in children with different age.A total of 128 patients underwent orchidopexy for undescended testes. Afterwards, patients were invited for annual follow-up and control scrotal US. The total number of analyzed testes after orchidopexy was 184. Patients were divided according to age at the time of surgery: group I (2-4 years old), group II (5-7), and group III (8-10). In all patients, the testicular volume ratio was calculated as the operated testes volume versus the control testes mean volume.There was an increase in the median ratio in all age groups, from 0.86 to 0.95 in group I, 0.82 to 0.92 in group II and 0.78 to 0.90 in group III. In group of the patients 2 to 4 years old the growth of the ratio 3 years after surgery was statistically significant.Abnormalities in the structure of the testes, which may indicate severe damage to the testis, were seen in approximately 20% of patients on initial exams. On follow-up exams, this type of structure remained in 7% of patients. Testes with an initial ratio <0.25 and inhomogeneous structure did not show any significant growth.Scrotal US can be used for an accurate comparative assessment of the structure and growth of the testes before and after orchidopexy.Abnormalities in the structure of the testes may identify testes requiring more advanced methods of evaluation.
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Affiliation(s)
| | | | - Pawel Osemlak
- Department of Pediatric Surgery, Medical University of Lublin, Lublin, Poland
| | - Pawel Nachulewicz
- Department of Pediatric Surgery, Medical University of Lublin, Lublin, Poland
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Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels: A Study of 7035 Healthy Young Men from Six European Countries. Eur Urol 2016; 70:1019-1029. [DOI: 10.1016/j.eururo.2016.06.044] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/30/2016] [Indexed: 11/23/2022]
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Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D. International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence. Urology 2016; 94:288-310. [DOI: 10.1016/j.urology.2016.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Association of a TDRD1 variant with spermatogenic failure susceptibility in the Han Chinese. J Assist Reprod Genet 2016; 33:1099-104. [PMID: 27233649 PMCID: PMC4974230 DOI: 10.1007/s10815-016-0738-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/13/2016] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Piwi-interacting RNAs (piRNAs) are a broad group of noncoding small RNAs that have important biological functions in germline cells and can maintain genome integrity via silencing of retrotransposons. In this study, we aimed to explore the associations between genetic variants of important genes involved in piRNA biogenesis and male infertility with spermatogenic impairment. METHODS To this end, five single-nucleotide polymorphisms (SNPs) in the ASZ1, PIWIL1, TDRD1, and TDRD9 genes were genotyped by TaqMan allelic discrimination assays in 342 cases of nonobstructive azoospermia (NOA) and 493 controls. RESULTS The SNP rs77559927 in TDRD1 was associated with a reduced risk of spermatogenic impairment. The genotypes TC and TC + CC showed odds ratios and 95 % confidence intervals of 0.73 (0.55-0.98, P = 0.034) and 0.73 (0.56-0.97, P = 0.030), respectively, in patients with NOA compared with those in the controls. CONCLUSION Thus, our results provided the first epidemiological evidence supporting the involvement of TDRD1 genetic polymorphisms in piRNA processing genes in determining the risk of spermatogenic impairment in a Han Chinese population.
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The influence of hormonal treatment with beta-human chorionic gonadotropin for cryptorchidism on future fertility in rats. J Pediatr Urol 2015; 11:92.e1-4. [PMID: 25819376 DOI: 10.1016/j.jpurol.2014.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/18/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There have been two treatment modalities for cryptorchidism such that surgical and hormonal; the latter being highly controversial. While some authors suggest that hormonal treatment increases the number and maturation of germ cells in cryptorchid testes, others believe just the opposite. OBJECTIVE We aimed to find out the sperm counts and testicular index; briefly fertility potential of the normally descended contralateral testes in adulthood period in rats treated with Beta-HCG in early period of their lives. MATERIALS AND METHODS Three groups, each including 10 rats aged 22 days old, in which delactation and normal feeding can be started, were formed to be Group 1: Sham operated, Group 2: Experimental cryptorchidism (EC) and Group 3: Hormone-treated after experimental cryptorchidism was performed (HT-EC). Left testis was placed in the abdomen in group 2 and 3. In group 1, a sham operation was performed. The rats in EC-HT group received subcutaneous injections of 50 IU/kg Beta-HCG daily for 7 days. Right orchidectomy was performed when they reached reproductive period to evaluate fertility potential with sperm counts and testicular index. Testicular index was calculated according to the formula "testicular length × width/weight of rat". Epididymal sperm count was made with hemocytometer. DISCUSSION We evaluated the physical characteristics and fertility potential (sperm counts) of contralateral normal testes during adulthood in rats that underwent experimental unilateral cryptorchidism during infancy. A relationship between testis weight and sperm counts were also investigated. We could not find any direct correlation of sperm count with either testicular weight or testicular index in our study. Although the rats had normal testes at birth, we found decreased sperm counts in contralateral normal testes in EC group. This suggests that unilateral cryptorchidism may cause some systemic effects that reach the other testis. Hormone treatment was not beneficial. This is comparable to Nambirajan et al. who reported histological changes and decreased spermatogenic cell count in contralateral scrotal testes in experimentally induced unilateral cryptorchidism in early period of life in rats. Heiskanen et al. reported that treatment with Beta-HCG leads to decreased total sperm counts in the future due to increased germ cell apoptosis caused by hormonal withdrawal after treatment. Cortes et al. also reported decreased number of germ cells in 1-3 year-old boys who underwent surgery after unsuccessful Beta-HCG treatment. The reasons could be delayed testicular descent or adverse effect of hormone treatment though. Our results concurred with them. Apparently, our model has failed to mimic the pathophysiologic mechanisms of congenital cryptorchidism in humans. Furthermore, we applied hormone treatment in normal rats with normally descended testes. Therefore, the "by-product" information of our study is that, unnecessary use of Beta-HCG during infancy may impair future fertility. CONCLUSION Our study suggests that Beta-HCG treatment may decrease sperm counts and decrease the future fertility potential. We could not find any direct correlation of sperm count with either testicular weight or testicular index.
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Fénichel P, Lahlou N, Coquillard P, Panaïa-Ferrari P, Wagner-Mahler K, Brucker-Davis F. Cord blood insulin-like peptide 3 (INSL3) but not testosterone is reduced in idiopathic cryptorchidism. Clin Endocrinol (Oxf) 2015; 82:242-7. [PMID: 24826892 DOI: 10.1111/cen.12500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/02/2014] [Accepted: 05/09/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cryptorchidism, the most frequent congenital malformation in full-term male newborns, increases the risk of hypofertility and testicular cancer. Most cases remain idiopathic but epidemiological and experimental studies have suggested a role of both genetic and environmental factors. Physiological testicular descent is regulated by two major Leydig hormones: insulin-like peptide 3 (INSL3) and testosterone. OBJECTIVES To study the endocrine context at birth as a reflection of late pregnancy in isolated idiopathic cryptorchidism and to analyse the possible disruptions of INSL3 and/or testosterone. METHODS From a prospective case-control study at Nice University Hospital, we assessed 180 boys born after 34 weeks gestation: 52 cryptorchid (48 unilateral, 4 bilateral; 26 transient, 26 persistent), and 128 controls matched for term, weight and time of birth. INSL3 and testosterone were measured in cord blood and compared in both groups as were other components of the pituitary-gonadic axis: LH, HCG, FSH, AMH and SHBG. RESULTS INSL3 was decreased in cryptorchid boys (P = 0·031), especially transient cryptorchid (P = 0·029), while testosterone was unchanged as were the other hormones measured. INSL3 was significantly decreased (P = 0·018) in the group of 20 with nonpalpable testes compared with the group of 21 with palpable testes (15 suprascrotal, five inguinal, one high scrotal) according to Scorer classification. In the whole population, INSL3 correlated positively with LH and negatively with AMH, but with no other measured hormones. CONCLUSIONS INSL3 but not testosterone is decreased at birth in idiopathic cryptorchidism, especially in transient forms. This hormonal decrease may contribute to the impaired testicular descent along with genetic and anatomical factors. Whether foetal environment (nutritional and/or toxicological) interferes with INSL3 secretion in humans remains to be confirmed.
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Affiliation(s)
- Patrick Fénichel
- Department of Endocrinology, Diabetology and Reproductive Medicine, CHU Nice, Nice, France; Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
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Stukenborg JB, Kjartansdóttir KR, Reda A, Colon E, Albersmeier JP, Söder O. Male germ cell development in humans. Horm Res Paediatr 2015; 81:2-12. [PMID: 24356336 DOI: 10.1159/000355599] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Germ cells are unique cells that possess the ability to transmit genetic information between generations. Detailed knowledge about the molecular and cellular mechanisms determining the fate of human male germ cells still remains sparse. This is partially due to ethical issues limiting the access to research material. Therefore, the mechanisms of proliferation, differentiation and apoptosis of human male germ cells still remain challenging study objectives. METHODS This review focuses on using English articles accessible in PubMed as well as personal files on the current knowledge of the molecular and cellular mechanisms connected with human testicular germ cell development, maturation failure and the possibility of fertility preservation in patients in whom there is a risk of gonadal failure. However, since rodents, particularly mice, offer the possibility of studying germ cell development by use of genetic modification techniques, some studies using animal models are also discussed. CONCLUSION This mini review focuses on the current knowledge about male germ cells. However, the reader is referred to two previous mini reviews focusing on testicular somatic cells, i.e. on Sertoli cells and Leydig cells.
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Affiliation(s)
- Jan-Bernd Stukenborg
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Chevalier N, Brucker-Davis F, Lahlou N, Coquillard P, Pugeat M, Pacini P, Panaïa-Ferrari P, Wagner-Mahler K, Fénichel P. A negative correlation between insulin-like peptide 3 and bisphenol A in human cord blood suggests an effect of endocrine disruptors on testicular descent during fetal development. Hum Reprod 2014; 30:447-53. [PMID: 25527819 DOI: 10.1093/humrep/deu340] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY QUESTION Does a relationship exist between insulin-like peptide 3 (INSL3) and selected environmental endocrine disruptors (EEDs) in human cord blood (cb)? SUMMARY ANSWER In the whole population (cryptorchid and control boys) cbINSL3 correlated negatively with cb free bisphenol A (BPA) providing indirect evidence for an impact of EEDs on fetal Leydig cell INSL3 production. WHAT IS KNOWN ALREADY INSL3 is a major regulator of testicular descent. This hormone has been shown to be decreased in cord blood from boys with idiopathic cryptorchidism, the most frequent male malformation. Fetal exposure to several EEDs has been suspected to be involved in the occurrence of idiopathic cryptorchidism. STUDY DESIGN, SIZE, DURATION Correlations between cb INSL3 or testosterone and cb free bioactive BPA and maternal milk polychlorinated biphenyls (PCB153), dichlorodiphenyldichloroethylene (DDE), and monobutyl phthalate (mBP) were assessed in newborn boys in a prospective case-control study. All boys (n = 6246) born after 34 weeks of gestation were systematically screened at birth for cryptorchidism over a 3-year period (2002-2005), and a diagnosis of cryptorchidism confirmed by a senior paediatrician. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied 52 cryptorchid (26 transient, 26 persistent) and 128 control boys born at two hospitals in southern France. INSL3 was assayed in CB by a modified validated enzyme-linked immunosorbent assay. Testosterone was measured in CB after diethyl-ether extraction by means of ultra-pressure liquid chromatography-tandem mass spectrometry. Free cbBPA was measured after an extraction step with a radioimmunoassay validated after comparison of values obtained by high-pressure liquid chromatography-mass spectrometry. The xenobiotic analysis in mothers' milk was performed after fat extraction by gas chromatography-mass spectrometry. MAIN RESULTS AND THE ROLE OF CHANCE EED concentrations were not increased in the cryptorchid versus control group although a trend for increased mBP (P = 0.09) was observed. In the whole study population, cb levels of BPA correlated negatively with INSL3 (P = 0.01; R² = 0.05) but not with testosterone. No other EED correlated with INSL3 or with testosterone. LIMITATIONS, REASONS FOR CAUTION The levels of BPA and INSL3 in cb may not reflect chronic fetal exposure to EEDs. The deleterious impact of EEDs on fetal testicular descent during specific windows of development has yet to be demonstrated. WIDER IMPLICATIONS OF THE FINDINGS The negative correlation between cb free BPA and INSL3 provides indirect evidence for an impact of EEDs on human fetal Leydig cell INSL3 production and points to cbINSL3 as a possible target of EED action during fetal testis development.
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Affiliation(s)
- Nicolas Chevalier
- Department of Endocrinology, Diabetology and Reproductive Medicine, CHU Nice, Nice, France Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
| | - Françoise Brucker-Davis
- Department of Endocrinology, Diabetology and Reproductive Medicine, CHU Nice, Nice, France Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
| | - Najiba Lahlou
- Department of Hormonology and Metabolic Disorders, Hôpital Cochin, APHP, Paris-Descartes University, Paris, France
| | - Patrick Coquillard
- Institut Sophia-Agrobiotech [INRA-CNRS, Nice University], 06903 Sophia-Antipolis, France
| | - Michel Pugeat
- Institut National de la Recherche Médicale U1060 CaRMen, Fédération d'Endocrinologie, Hospices civils de Lyon, Université Lyon-1, Bron, France
| | - Patricia Pacini
- Laboratoire de l'Environnement de la Ville de Nice, Nice, France
| | | | | | - Patrick Fénichel
- Department of Endocrinology, Diabetology and Reproductive Medicine, CHU Nice, Nice, France Institut National de la Recherche Médicale, UMR U1065, Université Nice-Sophia Antipolis, Nice, France
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A diagnostic model for histologic damage in undescended testes based on testis rigidity measurement: an experimental study with a novel device. J Surg Res 2014; 192:521-30. [PMID: 25214261 DOI: 10.1016/j.jss.2014.07.032] [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: 12/01/2013] [Revised: 05/14/2014] [Accepted: 07/16/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND We aimed to test whether testis rigidity (hardness) measured using a newly-designed device we previously introduced would offer more reliable assessment of histologic damage in undescended testes than conventional methods (consistency feel at palpation, volume measurement). MATERIALS AND METHODS Forty-five 18-d-old Lewis rats underwent surgical inhibition of descent of left testes and were followed to 40 (n = 16), 63 (n = 14), or 90 days (n = 15). Another 45 18-d-old Lewis rats were sham operated (left side) and followed likewise (n = 14, n = 15, and n = 16). At the designated time points, testes were exposed bilaterally, rigidity was measured, and consistency at palpation was scored; testes were removed and subjected to length, width, weight measurements, volume calculation, and histomorphometry (mean Johnsen score [MJS], mean tubular diameter [MTD], and mean capsule width [MCW]). Testes of experimental group were compared with ipsilateral testes of sham-operated rats. RESULTS At all time points, undescended testes had decreased rigidity, MJS, and MTD, increased MCW, decreased volume and weight; contralateral testes remained unaffected. Rigidity was associated only with MJS and MTD, and most strongly with MJS (multiple stepwise linear regression, F = 694.44, P < 0.0005). MJS could be precisely predicted from rigidity: MJS = 0.699 × testis rigidity (F = 1358.82, P < 0.0005). This model showed good fit between predicted and actual MJS values (R(2) = 0.94), low error, nonsignificant bias, sensitivity 75% and specificity 90%. Model validation showed low prediction error and nonsignificant bias, indicating generalizability. Testis volume and palpation proved imprecise MJS predictors. CONCLUSIONS Testis rigidity is an effective predictor of histologic damage in rat undescended testes, with diagnostic value superior to testis palpation scoring and volume measurement.
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Håkonsen LB, Ernst A, Ramlau-Hansen CH. Maternal cigarette smoking during pregnancy and reproductive health in children: a review of epidemiological studies. Asian J Androl 2014; 16:39-49. [PMID: 24369132 PMCID: PMC3901880 DOI: 10.4103/1008-682x.122351] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Maternal cigarette smoking may affect the intrauterine hormonal environment during pregnancy and this early fetal exposure may have detrimental effects on the future trajectory of reproductive health. In this review, we discuss the epidemiological literature on the association between prenatal exposure to maternal cigarette smoking and several aspects of reproductive health. The literature points towards an increased risk of the urogenital malformation cryptorchidism, but a potential protective effect on the risk of hypospadias in sons following prenatal cigarette smoking exposure. Studies on sexual maturation find a tendency towards accelerated pubertal development in exposed boys and girls. In adult life, prenatally exposed men have impaired semen quality compared with unexposed individuals, but an influence on fecundability, that is, the biological ability to reproduce, is less evident. We found no evidence to support an association between prenatal cigarette smoking exposure and testicular cancer. Among adult daughters, research is sparse and inconsistent, but exposure to cigarette smoking in utero may decrease fecundability. In conclusion, prenatal exposure to cigarette smoking may cause some long-term adverse effects on the reproductive health.
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Affiliation(s)
- Linn Berger Håkonsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Springer A, Subramaniam R, Krall C, Fülöp G. Orchidopexy patterns in Austria from 1993 to 2009. J Pediatr Urol 2013; 9:535-41. [PMID: 22968042 DOI: 10.1016/j.jpurol.2012.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate orchidopexy patterns in Austria. MATERIAL AND METHODS All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type. RESULTS Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p < 0.001) and 3-7 years (p < 0.001) increased, while the rate in boys older than 7 years decreased (p < 0.001). Year of birth (p < 0.0001) and place of residence (p < 0.0001 and p < 0.024) are significant predictors for having early orchidopexy. CONCLUSION In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.
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Abstract
This article summarizes the current literature regarding azoospermia caused by spermatogenic failure. The causes and genetic contributions to spermatogenic failure are reviewed. Medical therapies including use of hormonal manipulation, whether guided by a specific abnormality or empiric, to induce spermatogenesis are discussed. The role of surgical therapy, including a discussion of varicocelectomy in men with spermatogenic failure, as well as an in-depth review of surgical sperm retrieval with testicular sperm extraction and microdissection testicular sperm extraction, is provided. Finally, future directions of treatment for men with spermatogenic failure are discussed, namely, stem cell and gene therapy.
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Affiliation(s)
- Boback M Berookhim
- Department of Urology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA; Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Springer A, Kidger E, Krois W, Fengler D, Reck CA, Horcher E. Decision making among different treatment options for neurologically impaired boys with undescended testis: a multinational pediatric survey. J Pediatr Urol 2013; 9:42-5. [PMID: 22197221 DOI: 10.1016/j.jpurol.2011.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/16/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the attitude of referring pediatricians towards the decision of treatment modalities for undescended testis (UDT) in neurologic impaired boys (NIB). METHODS AND MATERIALS An online questionnaire was offered to registered pediatricians in Austria and Germany for online completion. RESULTS 221 male (61.6%) and 138 female (38.4%) pediatricians completed the survey; 326 (90.8%) believe that UDT should be treated according to national guidelines; 31 (8.6%) believe that UDT should be treated according to the parental wish, whereas only 2 (0.6%) tend to no treatment at all. Tumor prophylaxis, further sexual life, legal concerns, risks of anesthesia, and the choice of the parents have major impact on the perception of UDT. Moreover, fertility and limited life expectancy seem to be of minor importance only. In general, Pearson χ2 test could not identify age and sex of pediatricians as significant predictor of how the importance of the treatment of UDT is appraised. CONCLUSION From the pediatric point of view UDT in NIB is an important issue and should be treated according to guidelines. Nevertheless, this study indicates the problems in decision-making and choosing the best management for UDT in NIB. Undoubtedly, further ethical discussion is needed to optimize treatment of UDT in NIB.
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Affiliation(s)
- Alexander Springer
- Department of Pediatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Zhou J, Wang X, Zhang S, Gu Y, Yu L, Wu J, Gao T, Chen F. Generation and characterization of human cryptorchid-specific induced pluripotent stem cells from urine. Stem Cells Dev 2013; 22:717-25. [PMID: 23025704 DOI: 10.1089/scd.2012.0260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cryptorchidism is a common congenital birth defect in human beings with the possible complication of infertility. An in vitro model of cryptorchidism might be valuable due to the inaccessibility of human embryos for research purposes. In this study, we reprogrammed urine cells containing genetic variations in insulin-like factor 3, zinc finger (ZNF) 214, and ZNF215 from a cryptorchid patient by introducing human OCT4, SOX2, C-MYC, and KLF4 with lentivirus. The cells were then replated on irradiated mouse embryonic fibroblasts and cultured with the human embryonic stem (ES) cell medium. The compact colonies with well-defined borders were manually picked, and 2 induced pluripotent cell lines were fully characterized. Our results demonstrated that these 2 cell lines were similar to human ES cells in morphological appearance, marker expression, and epigenetic status of the pluripotent cell-specific gene, OCT4. These cells could be differentiated into cells of all 3 germ layers in teratomas and in vitro, including into the VASA-positive germ cell lineage. Both parental urine cells and the reprogrammed cells possessed the normal karyotype and the same short tandem repeat loci, indicating that these 2 cell population share the same genetic identity. This establishment and characterization of human urine-derived cryptorchid-specific induced pluripotent stem cells could present a good human genetic system for future studies investigating the molecular mechanism of cryptorchidism.
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Affiliation(s)
- Junmei Zhou
- Central Laboratory, Children's Hospital of Shanghai, Shanghai Jiaotong University, Shanghai, China
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Jahnukainen K, Stukenborg JB. Clinical review: Present and future prospects of male fertility preservation for children and adolescents. J Clin Endocrinol Metab 2012; 97:4341-51. [PMID: 23038680 DOI: 10.1210/jc.2012-3065] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Rapid progress in fertility preservation strategies has led to the investigation of ways in which fertile gametes could be generated from cryopreserved immature testicular tissue. Childhood cancer patients remain the major group that can benefit from these techniques. Other potential candidates include patients undergoing gonadectomy and patients with Klinefelter's syndrome and cryptorchid testes. This review aims to present an overview of the current state of knowledge in experimental germ cell transplantation, testicular tissue transplantation, and germ cell culture as fertility preservation methods for males. METHODOLOGY We included English articles published in PubMed as well as personal files with the focus on studies including human or nonhuman material. MAIN FINDINGS Germ cell and testicular tissue transplantation demonstrate clinical options to mature germ cells from immature primate testicular tissue. The most promising approach involves autologous grafting of immature testicular tissue, whereas germ cell maturation in vitro provides the best strategies to overcome problems of cancer contamination in cryopreserved testicular tissue. Three-dimensional and organ culture systems offer the possibility to differentiate immature male germ cells up to the stage of elongated spermatids. Further characterization of early germ cell development in humans is needed to modify these systems for clinical use.
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Affiliation(s)
- Kirsi Jahnukainen
- Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska University Hospital and Karolinska Institutet, SE-17176 Stockholm, Sweden.
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Chen J, Fok KL, Chen H, Zhang XH, Xu WM, Chan HC. Cryptorchidism-induced CFTR down-regulation results in disruption of testicular tight junctions through up-regulation of NF-κB/COX-2/PGE2. Hum Reprod 2012; 27:2585-97. [PMID: 22777528 DOI: 10.1093/humrep/des254] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
STUDY QUESTION Does elevated temperature-induced cystic fibrosis transmembrane conductance regulator (CFTR) down-regulation in Sertoli cells in cryptorchid testis disrupt testicular tight junctions (TJs) through the nuclear factor kappa B (NF-κB)/cyclooxygenase-2 (COX-2)/prostaglandin E(2) (PGE(2)) pathway? SUMMARY ANSWER Our results suggest that CFTR may be involved in regulating testicular TJs and the blood-testis barrier (BTB) through its negative regulation of the NF-κB/COX-2/PGE(2) pathway in Sertoli cells, a defect of which may result in the spermatogenesis defect in cryptorchidism. WHAT IS KNOWN ALREADY Cryptorchidism, or undescended testes, is known to result in defective spermatogenesis. Although an elevated testicular temperature is regarded as an important factor affecting spermatogenesis in cryptorchidism, the exact mechanism remains elusive. It is known that the expression of functional CFTR is temperature sensitive. Our previous study has demonstrated that CFTR negatively regulates NF-κB/COX-2/PGE(2) in bronchial epithelial cells. Disruption of TJs by COX-2/PGE(2) has been found in tumour cells. STUDY DESIGN AND METHODS Expression of CFTR, NF-κB, COX-2 and TJ proteins was examined in the testes of a surgical-induced cryptorchidism mouse model and a testicular hyperthermia mouse model, as well as in control or CFTR-inhibited/knocked down primary rat Sertoli cells. PGE(2) production was measured by ELISA. Sertoli cell barrier function was determined by transepethelial resistance (TER) measurements in rat Sertoli cell primary cultures. BTB integrity in the cryptorchidism model was monitored by examining tracker dye injected into seminiferous tubules. MAIN RESULTS Down-regulation of CFTR accompanied by activation of NF-κB, up-regulation of COX-2 and down-regulation of TJ proteins, including ZO-1 and occludin, was observed in a cryptorchidism mouse model. BTB leakage revealed impaired BTB integrity in cryptorchid testes, confirming the destruction of TJs. The inverse correlation of CFTR and COX-2 was further confirmed in a mouse testis hyperthermia model and CFTR knockout mouse model. Culturing primary Sertoli cells at 37°C, which mimics the pathological condition of cryptorchidism, led to a significant decrease in CFTR and increase in COX-2 expression and PGE(2) production compared with the culture at the physiological 32°C. Inhibition or knockdown of CFTR led to increased COX-2 but decreased ZO-1 and occludin expression in Sertoli cells, which could be mimicked by PGE(2), but reversed by NF-κB or COX-2 inhibitor, suggesting that the regulation of TJs by CFTR is mediated by a NF-κB/COX-2/PGE(2) pathway. Inhibition of CFTR or administration of PGE(2) significantly decreased Sertoli cell TER. LIMITATIONS This study has tested only the CFTR/NF-κB/COX-2/PGE(2) pathway in mouse testes in vivo and in rat Sertoli cells in vitro, and thus, it has some limitations. Further investigations in other species, especially humans, are needed. WIDER IMPLICATIONS OF THE FINDINGS Our study may shed more light on one of the aspects of the complicated underlying mechanisms of defective spermatogenesis induced by cryptorchidism.
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Affiliation(s)
- Jing Chen
- Epithelial Cell Biology Research Center, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, Krausz C. European Association of Urology guidelines on Male Infertility: the 2012 update. Eur Urol 2012; 62:324-32. [PMID: 22591628 DOI: 10.1016/j.eururo.2012.04.048] [Citation(s) in RCA: 550] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/24/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT New data regarding the diagnosis and treatment of male infertility have emerged and led to an update of the European Association of Urology (EAU) guidelines for Male Infertility. OBJECTIVE To review the new EAU guidelines for Male Infertility. EVIDENCE ACQUISITION A comprehensive work-up of the literature obtained from Medline, the Cochrane Central Register of Systematic Reviews, and reference lists in publications and review articles was developed and screened by a group of urologists and andrologists appointed by the EAU Guidelines Committee. Previous recommendations based on the older literature on this subject were taken into account. Levels of evidence and grade of guideline recommendations were added, modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence. EVIDENCE SUMMARY These EAU guidelines are a short comprehensive overview of the updated guidelines of male infertility as recently published by the EAU (http://www.uroweb.org/guidelines/online-guidelines/), and they are also available in the National Guideline Clearinghouse (http://www.guideline.gov/).
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Jedrzejewski G, Wozniak MM, Madej T, Kryza R, Zielonka-Lamparska E, Wieczorek AP. The differences in testicular volumes in boys 8-36 months old with undescended, retractile and hydrocele testis--usefulness of scrotal screening ultrasound. Early Hum Dev 2012; 88:185-9. [PMID: 21889272 DOI: 10.1016/j.earlhumdev.2011.07.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/30/2011] [Accepted: 07/30/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the study was quantitative and qualitative assessments of scrotal abnormalities diagnosed in boys 8 to 36 months old during ultrasound screening and estimation if these abnormalities influence testes volume. MATERIALS AND METHODS High frequency scrotal ultrasound was performed in 1448 patients aged 8-36 months as additional exam during screening ultrasound program for children including cervical and abdominal ultrasound. The mean age of examined boys was 17 months. For further analysis the children were divided in 5 age groups. RESULTS The abnormalities in scrotal ultrasound were found in 20.1% of boys. Undescended, cryptorchid testes were found in 4.8% of patients, mobile testicle in 7.6% and hydrocele in 2.8%. The volume of undescended testes was statistically lower than volume of the descended testes in 3 youngest groups of boys (p=0.003-0.011). The volume of mobile testicles did not increase with age, while in patients with hydrocele the testicular volume decreased with age. CONCLUSION Scrotal screening ultrasound performed in boys up to 3 years old may deliver information about the number and type of existing pathologies as well as their influence on the testicular volume. The volume of the pathological testes was lower than the volume of the normal ones. Improper growth of testes may potentially have important clinical implication for the function of testes in the future.
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Affiliation(s)
- G Jedrzejewski
- Department of Pediatric Radiology, Medical University of Lublin, Poland.
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Wagner-Mahler K, Kurzenne JY, Delattre I, Bérard E, Mas JC, Bornebush L, Tommasi C, Boda-Buccino M, Ducot B, Boullé C, Ferrari P, Azuar P, Bongain A, Fénichel P, Brucker-Davis F. Prospective study on the prevalence and associated risk factors of cryptorchidism in 6246 newborn boys from Nice area, France. ACTA ACUST UNITED AC 2011; 34:e499-510. [PMID: 21831232 DOI: 10.1111/j.1365-2605.2011.01211.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To assess the incidence and risk factors of cryptorchidism in Nice area. A 3-year prospective study was conducted at two maternity wards involving neonatal screening of boys born ≥34weeks of amenorrhoea. Methodology was strict with examination at birth, 3 and 12months by the same paediatrician. Two strictly matched controls were included for each case. Information on child and parents (medical history, pregnancy, lifestyle) was recorded using medical chart and self-administered questionnaires. A total of 102 of 6246 boys were born with cryptorchidism (prevalence 1.6%, 95 included). Half of them were still cryptorchid at three and 12months with, however, 10% of secondary re-ascent (recurrent cryptorchidism) at 12months, justifying long-term follow-up. Cryptorchidism at birth was associated with instrumental delivery, inguinal hernia and urogenital malformations, particularly micropenis and paternal history of cryptorchidism. Our results suggest that maternal exposure to anti-rust or phthalates could be a risk factor, whereas eating fruits daily seemed somewhat protective. Prevalence of cryptorchidism in our area is on the lower bracket compared with other countries, and is associated with both familial and environmental risk factors.
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Affiliation(s)
- K Wagner-Mahler
- Pediatrics Department, CHU Nice, Nice, France Conseil Général Des Alpes Maritimes, Nice, France.
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Chung E, Brock GB. Cryptorchidism and its impact on male fertility: a state of art review of current literature. Can Urol Assoc J 2011; 5:210-4. [PMID: 21672488 DOI: 10.5489/cuaj.10106] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cryptorchidism is associated with impairment of germ cell maturation and subsequent infertility in adulthood. The present report details common scenarios of referral of men with prior history of cryptorchidism and orchidopexy seeking advice for infertility, and examines the association between cyrptorchidism and male infertility. The increase in the understanding of the hormonal profiles and patho-physiological changes in germ cell maturation in cryptorchid boys may potentially change our approach and management strategies. Improvement in sperm retrieval techniques and micromanipulation techniques, such as intracytoplasmic sperm injection, has led to excellent fertilization and pregnancy outcomes of treatment cycles.
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Affiliation(s)
- Eric Chung
- Division of Urology, University of Western Ontario, London, ON
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Mathers MJ, Degener S, Roth S. [Cryptorchidism and infertility from the perspective of interdisciplinary guidelines]. Urologe A 2011; 50:20-5. [PMID: 21207009 DOI: 10.1007/s00120-010-2438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cryptorchidism is the most common genital disorder in boys. Early-born boys are affected in up to one third of the cases, while about 2-5% of full-term newborns suffer from at least one undescended testicle. As a result of short-term endogenous testosterone secretion after birth the prevalence decreases to 1-2% after 3 months. According to most studies, watchful waiting after 6 months is not justified because after this time spontaneous testicular descent only very rarely occurs. Even though the effects of testicular development and fertility in undescended testis have been extensively examined, the only fact that remains certain is that approximately 90% of untreated men with bilateral cryptorchidism develop azoospermia. The remaining scenarios of cryptorchidism (unilateral, ectopic, inguinal, treated or not treated) exhibit unpredictable fertility and likelihood of fatherhood.
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Affiliation(s)
- M J Mathers
- Urologische Gemeinschaftspraxis Remscheid, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Helios Klinikum Wuppertal, Universität Witten/Herdecke, Fastenrathstraße 1, 42853 Remscheid, Deutschland.
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AbouZeid AA, Mousa MH, Soliman HA, Hamza AF, Hay SA. Intra-abdominal testis: histological alterations and significance of biopsy. J Urol 2011; 185:269-74. [PMID: 21075394 DOI: 10.1016/j.juro.2010.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Intra-abdominal testes represent only 5% of undescended testes. Review of the literature reveals that few data exist on the histological analysis of intra-abdominal testes. We studied histological alterations in intra-abdominal testes in relation to patient age at orchiopexy. MATERIALS AND METHODS A total of 57 boys underwent laparoscopy for impalpable undescended testes between October 2002 and June 2005. Testicular biopsies were taken from intra-abdominal testes, fixed in 3% glutaraldehyde, embedded in Epon, sectioned at 1 micron thickness and stained with toluidine blue. Histomorphometric analysis was performed by light microscopy. Effect of age at operation on histological evaluation of abdominal testes was also studied. RESULTS Testicular biopsies from 29 patients with intra-abdominal testes showed the histological alterations of decreased mean diameter of seminiferous tubules, germinal cell depletion (55%) and presence of microliths (6.9%). CONCLUSIONS As age at orchiopexy increases, deviation from the norm is more evident and absence of germ cells on biopsy becomes more pronounced, reaching a rate of 93% after age 3 years. Further studies on orchiopexy with or without biopsy in the first few months of life would likely improve our understanding and treatment of cryptorchidism.
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Cryptorchidie: influence sur la fertilité de l’âge au moment de l’orchidopexie, du siège et de la taille du testicule et de l’existence d’anomalies épididymaires. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Résumé
Malgré le traitement chirurgical, la cryptorchidie reste la cause la plus fréquente de stérilité. À travers une revue de la littérature, les auteurs relatent les données actuelles concernant l’influence de l’âge au moment de l’orchidopexie, de la taille du testicule, du siège du testicule et de l’existence d’une indépendance épididymotesticulaire sur la fertilité ultérieure.
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Jhaveri KS, Mazrani W, Chawla TP, Filobbos R, Toi A, Jarvi K. The Role of Cross-sectional Imaging in Male Infertility: A Pictorial Review. Can Assoc Radiol J 2010; 61:144-55. [DOI: 10.1016/j.carj.2010.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 01/04/2010] [Accepted: 01/05/2010] [Indexed: 11/17/2022] Open
Abstract
Infertility is a common problem. The role of imaging in assisting clinical evaluation is discussed. Ultrasound and magnetic resonance imaging are first-line, noninvasive imaging techniques that provide accurate definition of anatomical causes of infertility. This affords an opportunity to deliver timely and appropriate treatment. This pictorial review illustrates normal imaging anatomy and various causes of male infertility, and focuses on congenital and acquired testicular abnormalities and post-testicular obstruction, such as congenital absence of the vasa deferentia, seminal vesicle cysts, prostatic utricle cysts, Mullerian cysts, ejaculatory duct cysts (Wolffian cysts), and epididymal obstruction.
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Affiliation(s)
- Kartik S. Jhaveri
- Abdominal Imaging, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Waseem Mazrani
- Abdominal Imaging, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tanya P. Chawla
- Abdominal Imaging, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rafiq Filobbos
- Abdominal Imaging, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ants Toi
- Abdominal Imaging, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Keith Jarvi
- Department of Urology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Testis Rigidity Tester: a prototype device for intraoperative detection of changes in testicular pressure and/or elasticity. First experimental experiences. J Pediatr Urol 2010; 6:277-81. [PMID: 19879808 DOI: 10.1016/j.jpurol.2009.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 08/23/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In order to quantitatively evaluate testicular consistency, we designed a device for measurement of testis rigidity, which reflects the resistance caused by testicular pressure and elasticity. The device was tested in experimental models of cryptorchidism and torsion. MATERIALS AND METHODS The Testis Rigidity Tester (TRT) prototype consists of a system of weights and levers. It measures the force needed for a known deformation of the testis, defined as rigidity. We inhibited testis descent in 10 18-day-old Lewis rats; another 10 age-matched rats underwent sham operation. At the age of 40 days we measured testicular rigidity using the TRT. Additionally, left testes of eight adult Lewis rats underwent 720 degrees torsion; rigidity was measured by the TRT before and 1h after torsion. To investigate repeatability of TRT measurements, the rigidity of five twisted testes was measured 10 times by three researchers. RESULTS The TRT revealed a significant decrease of rigidity in undescended testes and an increase in twisted testes. Measurements were repeatable, independent of the observer. CONCLUSION The TRT is a safe, reliable and objective device that successfully measured the altered rigidity in experimental models of testicular disease.
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Testicular histology after intestinal pedicle flap (cecum) apposition in rats. Acta Cir Bras 2010; 25:241-8. [PMID: 20498936 DOI: 10.1590/s0102-86502010000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/19/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Histological study of vascularization between a cecal pedicle flap and the testicle of Wistar rats. METHODS Fifty-three rats were studied. G1: submitted to celiotomy (a), mobilization of the right testicle (RT) to the abdomen (b), cecal flap suture to the RT (d) and cavity closure. G1: procedures a, b and d and fixation of RT into abdomen. G3: procedures a, b and d, exposition of RT to air and reposition into scrotum. G4: not operated. Euthanasia and histology was done after 20 days. Histometry and lesions score classification was done. Testicular vascularization was studied with comparison between G1 and G3. A p < .05 was considered significant. RESULTS The G1 RT diameters were not different to G2 RT and all have decreased size in comparison with RT of G3 and G4. The lesions score in the RT was 5.83 in G1 and 3.3 in G2 without statistical difference. The vascularization's average in G1 was 16.9 vessels in 400X field in the RT. In the G3 this average was 0.96 to the RT and 0.92 to left testicles. The weight's average in G1 was similar with G2 but different of G3 and G4. CONCLUSION A significant increase of vascularization was observed between the intestinal flap and the rat testicle.
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Hou W, Hu J, Li Y, Zhao J, Li Z, Liu X, Yao L, Zhang Y. Altered Expression of NDRG2 in the Testes of Experimental Rat Model of Cryptorchidism. Urology 2010; 75:985-91. [DOI: 10.1016/j.urology.2009.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/05/2009] [Accepted: 05/16/2009] [Indexed: 11/28/2022]
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Mathers MJ, Sperling H, Rübben H, Roth S. The undescended testis: diagnosis, treatment and long-term consequences. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:527-32. [PMID: 19738919 PMCID: PMC2737432 DOI: 10.3238/arztebl.2009.0527] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 01/15/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The late descent of a testicle into the scrotum may impair its development. Reduced fertility is the main risk of primary cryptorchidism even after timely treatment, as histopathological changes (Leydig cell hypoplasia) already become apparent in the first few months of life. There is evidence, however, that treatment is often delayed. Hormonal and surgical treatments complement each other and should be provided before the child's first birthday. METHODS Selective literature search in PubMed (January 2008) based on the following keywords: "cryptorchidism", "maldescensus testis", "etiology", "therapy", "semen quality", "testicular cancer". Particular attention was paid to the current S2 guidelines on cryptorchidism. RESULTS/DISCUSSION Hormone therapy is the best initial treatment in most cases, with a few exceptions. If this is unsuccessful, surgery should be performed without delay. The success of treatment depends on the initial position of the testicle. Treatment does not lessen the risk of malignancy. Parents must be informed about this risk. The undescended testicle is the most common genital malformation in boys. When diagnosed, it should be treated hormonally and/or surgically before the child's first birthday to minimize the risk of impaired fertility. Successful treatment before age 13 appears not to lessen the risk of testicular cancer, but it does facilitate early detection by enabling physical examination of the testicle.
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Affiliation(s)
- Michael J Mathers
- Urologische Gemeinschaftspraxis Remscheid, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke.
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Jallouli M, Rebai T, Abid N, Bendhaou M, Kassis M, Mhiri R. Neoadjuvant Gonadotropin-releasing Hormone Therapy Before Surgery and Effect on Fertility Index in Unilateral Undescended Testes: A Prospective Randomized Trial. Urology 2009; 73:1251-4. [DOI: 10.1016/j.urology.2008.10.078] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 10/14/2008] [Accepted: 10/20/2008] [Indexed: 11/26/2022]
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Abstract
The possession of a scrotum to contain the male gonads is a characteristic feature of almost all mammals, and appears to have evolved to allow the testes and epididymis to be exposed to a temperature a few degrees below that of core body temperature. Analysis of cryptorchid patients, and those with varicocele suggest that mild scrotal warming can be detrimental to sperm production, partly by effects on the stem cell population, and partly by effects on later stages of spermatogenesis and sperm maturation. Recent studies on the effects of clothing and lifestyle emphasize that these can also lead to chronically elevated scrotal temperatures. In particular, the wearing of nappies by infants is a cause for concern in this regard. Together all of the evidence indirectly supports the view that lifestyle factors in addition to other genetic and environmental influences could be contributing to the secular trend in declining male reproductive parameters. The challenge will be to provide relevant and targeted experimental results to support or refute the currently circumstantial evidence.
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Affiliation(s)
- Richard Ivell
- Research Centre for Reproductive Health, and School of Molecular and Biomedical Science, University of Adelaide, SA, Australia.
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Karabulut R, Türkyilmaz Z, Sönmez K, Demiroğullari B, Ozen IO, Poyraz A, Başaklar AC, Kale N. Effects of Propylthiouracil on Testicular Tissue in Undescended Testes of Newborn Rats. Urol Int 2006; 77:264-8. [PMID: 17033216 DOI: 10.1159/000094820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 03/09/2006] [Indexed: 11/19/2022]
Abstract
AIM The most important goal in the treatment of cryptorchidism is to preserve the potential for fertility. This experimental study was performed to investigate the effect of propylthiouracil (PTU) on the undescended testes (UTs) of newborn rats. MATERIALS AND METHODS The experimental cryptorchidism model in newborn male rats consisted of 4 groups. The groups A (control) and B (PTU) underwent no surgical intervention, whereas in groups C (UT only) and D (treatment) UTs were produced by dissecting and suturing the future right scrotal area. In groups D and B, 0.1% (w/v) PTU was added to the drinking water of mother rats between 2 and 24 days. At the end of the 90th day rat body weights, testicular weights, Johnsen tubular biopsy scores (JTBSs), seminiferous tubule diameters (STDs), testosterone, and thyroid hormone levels were measured. Mann-Whitney U test was used for statistical analysis. RESULTS Mean testicular weight was similar between groups A, B and D, and statistically lowest in group C. Mean body weight was statistically higher in groups A and C compared with groups B and D. Mean testosterone levels showed no statistical difference between the groups. Mean JTBSs were statistically higher in groups A and B compared with groups C and D. The value in treatment group D was statistically higher compared to group C (p<0.05). Mean STDs were statistically lowest in group C compared to other groups (p<0.05). No difference was found between groups A, B, and D (p>0.05). Both the mean free triiodothyronine and free thyroxine values between groups A and C and between groups B and D were similar. The values in groups A and C were statistically higher than those of groups B and D (p<0.05). CONCLUSION PTU-induced transient hypothyroidism in the newborn rat UT model shows protective effects on testicular growth parameters.
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Affiliation(s)
- Ramazan Karabulut
- Department of Pediatric Surgery, Gazi University Medical Faculty, Ankara, Turkey.
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Zivkovic D, Bica DG, Hadziselimovic F. Effects of hormonal treatment on the contralateral descended testis in unilateral cryptorchidism. J Pediatr Urol 2006; 2:468-72. [PMID: 18947658 DOI: 10.1016/j.jpurol.2005.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 11/15/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE One of the therapeutic options in the treatment of cryptorchidism is hormonal therapy with luteinizing hormone releasing hormone (LHRH) and/or human chorionic gonadotropin (HCG); concerns have, however, been raised regarding its safety. The purpose of this study was to demonstrate that hormonal therapy improves the abnormal histology of the contralateral descended testis without harming the germ cells. METHOD Patients with unilateral cryptorchidism were randomized into two groups: those treated with orchiopexy alone and those treated with LHRH long acting analog and HCG. Biopsies taken from contralateral descended testes were analyzed and compared with controls. RESULTS The number of germ cells per tubule in contralateral testes of patients treated with orchiopexy alone is significantly lower than the number of germ cells in testes of patients with spontaneously descended testes (P<0.0001). Hormonal therapy did not have any adverse effect upon the histology of the contralateral testis, but in fact improved it. Seven weeks of hormonal therapy induced a rise in the number of germ cells per tubule (P<0.05). It was also beneficial for the number of adult dark spermatogonia per tubule and the number of primary spermatocytes, although these differences did not reach statistical significance. CONCLUSION The contralateral testis in patients with unilateral cryptorchidism is abnormal. Hormonal therapy improves the histopathology of the contralateral testis without harming the germ cells.
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Affiliation(s)
- D Zivkovic
- Kindertagesklinik, Oristalstrasse 87a, CH-4410 Liestal, Switzerland.
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Karaman IM, Kaya C, Ozturk M, Pirincci N, Yimazgumrukcu G, Tuken M. The effects of human chorionic gonadotrophin on normal testicular tissue of rats: dose-dependence and reversibility. BJU Int 2006; 97:1116-8. [PMID: 16643501 DOI: 10.1111/j.1464-410x.2006.06139.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of human chorionic gonadotrophin (hCG) on rat testicular tissue, and its reversibility and dose dependence. MATERIALS AND METHODS Male Wistar rats were assigned to groups (10 rats/group) receiving 10, 30 or 50 IU/kg hCG subcutaneously once daily for 15 days; 10 controls received subcutaneous isotonic saline. At 1 and 3 months later, five rats in each group were killed and their testes removed. The testes were examined histologically to measure seminiferous tubular diameter and germinal membrane thickness. RESULTS At 1 month after hCG administration, the mean germinal membrane thickness in the testicular tissues of the hCG-treated rats was significantly less than in control rats, and was also significantly different between all of the hCG-treated groups (P < 0.05). However, at 3 months after hCG administration, all histological variables were similar to those in control rats (P > 0.05), and the mean germinal membrane thickness at 3 months after hCG administration was larger than that at 1 month (P < 0.05). There were no significant differences in the mean seminiferous tubular diameter between hCG-treated rats and control rats. CONCLUSION hCG impairs seminiferous tubule histology in the 'normal' descended testes of rats. This effect was dose-dependent, and the changes were reversed at 3 months after treatment. Thus, although hCG therapy might affect the seminiferous tubules of contralateral descended testes in cryptorchid boys, these effects might be reversible.
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Affiliation(s)
- Ihsan M Karaman
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Schwentner C, Oswald J, Kreczy A, Lunacek A, Bartsch G, Deibl M, Radmayr C. NEOADJUVANT GONADOTROPIN-RELEASING HORMONE THERAPY BEFORE SURGERY MAY IMPROVE THE FERTILITY INDEX IN UNDESCENDED TESTES: A PROSPECTIVE RANDOMIZED TRIAL. J Urol 2005; 173:974-7. [PMID: 15711353 DOI: 10.1097/01.ju.0000153562.07287.77] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Subfertility is considered the principal consequence of cryptorchidism even after timely orchiopexy. Gonadotropin-releasing hormone (GNRH) treatment appears to improve fertility later in life by inducing germ cell maturation. In a prospectively randomized trial we investigated whether preoperative GNRH therapy improves the fertility index in primary cryptorchidism. MATERIALS AND METHODS A total of 42 boys 11 to 100 months old (median 33.5) with 63 undescended testes were prospectively assigned to 2 groups during a 6-month period. Patients were randomized to receive either orchiopexy alone (21 patients) or with neoadjuvant GNRH therapy (21) as a nasal spray for 4 weeks at 1.2 mg per day. In both groups testicular biopsies were performed at the time of orchiopexy and histopathological fertility index was determined. RESULTS Mean fertility index in the group treated with GNRH before surgery was significantly higher (1.05, SD +/- 0.71) compared to the group without hormonal stimulation (0.52, SD +/- 0.39, p <0.05). The subgroup of neoadjuvant stimulated boys younger than 24 months achieved the best results compared to the age matched boys without hormonal treatment. CONCLUSIONS Neoadjuvant GNRH treatment improves fertility index in prepubertal cryptorchidism. Consequently, preoperative hormone therapy should improve fertility in adulthood. Additionally, the nasal application is well tolerated, safe and already recommended in an adjuvant setting after orchiopexy. Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life.
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Affiliation(s)
- Christian Schwentner
- Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria
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Abstract
Cryptorchidism is the most common genitourinary disorder of childhood, resulting in 27,000 surgical cases each year in the United States. Of the 3% of full-term infants affected, most will have testes that will descend normally within a few months. The remaining 1%, who have a cryptorchid condition that persists, should consider medical or surgical intervention. In addition, although the effect of cryptorchidism on testicular development and fertility has been studied extensively, the only fact of certainty is that untreated men with bilateral abdominal testes will be infertile. The remaining scenarios (unilateral, inguinal, gliding, and medically or surgically treated conditions) offer unpredictable levels of fertility. Fortunately, based on recent research, the correlation between testis maldescent and infertility may not be as prevalent as previously reported.
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Affiliation(s)
- J C Trussell
- Penn State College of Medicine, The Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033-0850, USA
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