The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles

[Day Surgery in Paediatric Urology in Private Practice for Paediatric Surgery: Treatment of Undescended Testis in Our Private Practice for Paediatric Surgery]

This article describes the reality of paediatric urology treatment in a private practice for paediatric surgery based on the example of undescended testis. It stresses the importance of a paediatric setting as well as treatment according to the guidelines for diagnostic evaluation, treatment and follow-up. German paediatric surgeons in private practise are mostly organised in the BNKD e.V. ("Berufsverband der niedergelassenen Kinderchirurgen Deutschlands", Professional Association of Private-Practice Paediatric Surgeons in Germany) and they have long-standing experience in the treatment of undescended testis. Reactions to guideline developments and changes in therapy have become evident in the statistical data of the BNKD, which shows that the age of children at the time of day surgery for undescended testis has decreased in keeping with the guideline. Further improvement is necessary in this regard. High-quality day-surgical treatment in paediatric urology cases depends on the quality and expertise of the treating teams and treatment continuity in the paediatric setting. Private practices of paediatric surgery in Germany can contribute greatly to the treatment of undescended testis.

Characterization and Survival of Human Infant Testicular Cells After Direct Xenotransplantation

BACKGROUND

Cryopreservation of prepubertal testicular tissue preserves spermatogonial stem cells (SSCs) that may be used to restore fertility in men at risk of infertility due to gonadotoxic treatments for either a malignant or non-malignant disease. Spermatogonial stem cell-based transplantation is a promising fertility restoration technique. Previously, we performed xenotransplantation of propagated SSCs from prepubertal testis and found human SSCs colonies within the recipient testes six weeks post-transplantation. In order to avoid the propagation step of SSCs in vitro that may cause genetic and epigenetic changes, we performed direct injection of single cell suspension in this study, which potentially may be safer and easier to be applied in future clinical applications.

METHODS

Testis biopsies were obtained from 11 infant boys (median age 1.3 years, range 0.5-3.5) with cryptorchidism. Following enzymatic digestion, dissociated single-cell suspensions were prelabeled with green fluorescent dye and directly transplanted into seminiferous tubules of busulfan-treated mice. Six to nine weeks post-transplantation, the presence of gonocytes and SSCs was determined by whole-mount immunofluorescence for a number of germ cell markers (MAGEA, GAGE, UCHL1, SALL4, UTF1, and LIN28), somatic cell markers (SOX9, CYP17A1).

RESULTS

Following xenotransplantation human infant germ cells, consisting of gonocytes and SSCs, were shown to settle on the basal membrane of the recipient seminiferous tubules and form SSC colonies with expression of MAGEA, GAGE, UCHL1, SALL4, UTF1, and LIN28. The colonization efficiency was approximately 6%. No human Sertoli cells were detected in the recipient mouse testes.

CONCLUSION

Xenotransplantation, without in vitro propagation, of testicular cell suspensions from infant boys with cryptorchidism resulted in colonization of mouse seminiferous tubules six to nine weeks post-transplantation. Spermatogonial stem cell-based transplantation could be a therapeutic treatment for infertility of prepubertal boys with cryptorchidism and boys diagnosed with cancer. However, more studies are required to investigate whether the low number of the transplanted SSC is sufficient to secure the presence of sperm in the ejaculate of those patients over time.