Absence of antisperm surface antibodies in prepubertal boys with cryptorchidism and other anomalies of the inguinoscrotal region before and after surgery

ANTISPERM ANTIBODIES IN PREPUBERTAL BOYS WITH CRYPTORCHIDISM

The presence of antisperm antibodies in male individuals before puberty is controversial due to the lack of finally differentiated male germ cells. It was questioned whether the pathologic conditions of the male gonad may influence antisperm antibody formation in individuals before puberty. Sera samples of 76 individuals and 10 healthy boys with testicular failure (mainly uni- or bilateral cryptorchidism) were examined by means of indirect immunobead-binding test (IDIBT). The presence of antisperm antibodies was found in 3.95% of the studied subjects. Antibodies recognizing antigenic determinants present on the surface of mature sperm cells may be produced before puberty in individuals suffering from cryptorchidism or the other gonadal disorders. Antisperm antibodies that did develop in a minority of the studied male population may be proof for individual predispositions to autoimmune reactions.

TESTICULAR MICROLITHIASIS AND ANTISPERM ANTIBODIES FOLLOWING TESTICULAR BIOPSY IN BOYS WITH CRYPTORCHIDISM

PURPOSE

Testicular biopsy (TBx) performed during orchiopexy in boys with cryptorchidism can help to predict future semen analyses and possibly identify patients at risk for testicular cancer. It has been theorized that TBx can be detrimental to the long-term health of the testis. We examined testicular microlithiasis (TM) and antisperm antibody (ASA) production in cryptorchid TBx.

MATERIALS AND METHODS

A total of 112 males underwent fertility evaluation. These patients had previously undergone orchiopexy and bilateral TBx (mean age 8.6 years) for unilateral or bilateral undescended testis. At a mean age of 19.6 years all patients underwent physical examination and scrotal ultrasound for evaluation of testis size, echotexture and abnormalities. Of 112 patients 57 also underwent direct Immunobead(R) assay with positive controls. Moving sperm free and/or bound to IgG bead complex were counted in the preparation.

RESULTS

A total of 29 patients had bilateral and 83 had unilateral undescended testis. Of the 112 patients 26 were black and 86 were white. Four black patients (15.4%) and 4 white patients (4.7%) had testicular microlithiasis. Three patients had bilateral and 5 had unilateral diffuse TM. No tunica albuginea scars or testis masses were noted. In the 57 patients who underwent direct Immunobead assay no semen sample demonstrated evidence of forming bead-sperm complex, ie none had direct ASA.

CONCLUSIONS

No patient exhibited evidence of direct ASA. Prepubertal open TBx does not increase the rate of TM. We found no evidence of additive testicular damage associated with TBx at the time of orchiopexy.

Puberty Does Not Induce Serum Antisperm Surface Antibodies in Patients With Previously Operated Cryptorchidism

PURPOSE

We investigated serum antisperm surface antibody (ASA) prevalence at puberty, which is reported to be as high as 38% in the sera of males with cryptorchidism operated on before puberty. Operative technique impact, dartos pouch orchiopexy or testis fixation, was also examined.

MATERIALS AND METHODS

We examined a total of 61 pubertal males (Tanner stage 2 or greater) divided into 3 groups. Group 1 consisted of 24 males with cryptorchidism 10 to 17.9 years old who underwent unilateral dartos pouch orchiopexy before puberty (median age 5.85). All of these cases were known to be negative for ASA preoperatively, and 20 before puberty. Group 2 consisted of 22 males with cryptorchidism 12.1 to 17.7 years old operated on previously (median age 10.35) by testicular fixation among other techniques. Group 3 consisted of 15 healthy males 12.2 to 17.3 years old. Prepubertal ASA status was unknown for groups 2 and 3. Operated testis was compared with counterpart before serum collection in group 1 and during operation in group 2. IgG IgM and IgA ASA were studied by the indirect Immunobead (BioRad, Clinisciences S.A., Montrouge, France) test.

RESULTS

All sera tested were found negative in the 3 groups. Dartos pouch operation, testis fixation or even consecutive operations did not induce ASA production. Alterations in size or consistency were observed in operated testes in 10 patients in group 1, and in 8 patients in group 2.

CONCLUSIONS

Our results suggest that dartos pouch orchiopexy, testicular fixation and/or intrinsic developmental alterations of the cryptorchid testis does not elicit an autoimmune response against sperm surface antigens at puberty.