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Langston DM, Fendereski K, Halpern JA, Iko IN, Aston KI, Emery BE, Ferlic EA, Ramsay JM, Horns JJ, Hotaling JM. Hispanic Ethnicity and Fertility Outcomes. Urology 2024; 190:25-31. [PMID: 38663587 DOI: 10.1016/j.urology.2024.03.040] [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: 12/29/2023] [Revised: 03/16/2024] [Accepted: 03/27/2024] [Indexed: 08/25/2024]
Abstract
OBJECTIVE To assess the association between ethnicity and fertility outcomes for men in a statewide cohort. METHODS We linked data from the Utah Population Database and Subfertility Health Assisted Reproduction and Environment database, to comprise a cohort of sub-fertile men who underwent semen analysis between 1998 and 2017 in Utah. A multivariable Cox proportional hazard model was constructed to understand the impact of ethnicity on fertility outcomes in our cohort. RESULTS A total of 11,363 men were included. 1039 (9.1%) were Hispanic. 39.7% of men in the lowest socioeconomic status group were Hispanic (P <.001). When controlling for demographic and clinical factors, the number of live births was reduced for Hispanic men (hazard ratios [HR] = 0.62 [0.57-0.67], P <.001). Though fertility treatment had a positive effect (HR 1.242 [1.085-1.421], P <.001), in competing risks models, Hispanic men were less likely to use fertility treatment (HR = 0.633 [0.526-0.762], P <.001). CONCLUSION Hispanic ethnicity is significantly associated with a lower likelihood of successful fertility outcomes in Utah. Hispanic men had nearly a 40% reduced likelihood of live births when controlling for sociodemographic factors. Our results indicate that, depending on age, Hispanic men have up to approximately 14 fewer live births per 100 men per year, pointing to a significant disparity in fertility outcomes in the state of Utah. Given 15.1% of Utah's population identifies as Hispanic and 18.7% of the United States population identifies as Hispanic on the 2020 Census, a better understanding of the association of ethnicity and fertility outcomes is imperative.
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Affiliation(s)
- Devon M Langston
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | | | - Joshua A Halpern
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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2
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Huang DY, Alsadiq M, Yusuf GT, Deganello A, Sellars ME, Sidhu PS. Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review. Cancers (Basel) 2024; 16:2309. [PMID: 39001372 PMCID: PMC11240835 DOI: 10.3390/cancers16132309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Conventional ultrasonography (US), including greyscale imaging and colour Doppler US (CDUS), is pivotal for diagnosing scrotal pathologies, but it has limited specificity. Historically, solid focal testicular abnormalities often led to radical orchidectomy. This retrospective study evaluated the utilisation of contrast-enhanced ultrasound (CEUS) and strain elastography (SE) in investigating intratesticular focal abnormalities. A total of 124 cases were analysed. This study underscored the superior diagnostic capabilities of CEUS in detecting vascular enhancement in all malignant cases, even those with undetectable vascularity by CDUS. It also highlighted the potential of CEUS in identifying distinctive vascular patterns in benign vascular tumours. Definitive confirmation of benignity could be obtained when the absence of enhancement was demonstrated on CEUS. While SE alone offered no distinctive advantage in differentiating between benign and malignant pathologies, we demonstrated that incorporating a combination of CEUS and SE into the evaluation of focal testicular abnormalities could improve diagnostic performance metrics over conventional CDUS. Our findings underscore the role of advanced ultrasound techniques in enhancing the evaluation of focal testicular abnormalities in clinical practice and could aid a shift towards testis-sparing management strategies.
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Affiliation(s)
- Dean Y Huang
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Majed Alsadiq
- Department of Imaging, The Royal London Hospital, London E1 1FR, UK
| | - Gibran T Yusuf
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Annamaria Deganello
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
| | - Maria E Sellars
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
| | - Paul S Sidhu
- Department of Clinical Radiology, King's College Hospital, London SE5 9RS, UK
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 7EH, UK
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de Angelis C, Galdiero G, Menafra D, Garifalos F, Verde N, Piscopo M, Negri M, Auriemma RS, Simeoli C, Pivonello C, Colao A, Pivonello R. The environment and male reproductive system: the potential role and underlying mechanisms of cadmium in testis cancer. Crit Rev Toxicol 2023; 53:412-435. [PMID: 37737155 DOI: 10.1080/10408444.2023.2250387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Cadmium is a known human carcinogen, and has been shown to profoundly affect male reproductive function, at multiple levels, by exerting both endocrine and non-endocrine actions. Nevertheless, the potential role of cadmium in the etiology of testis cancer has been scantly investigated in humans, and, currently, available epidemiological observational studies are insufficient to draw definitive conclusions in this regard. On the contrary, experimental studies in laboratory animals demonstrated that cadmium is a strong inducer of testis tumors, mostly represented by benign Leydig cell adenoma; moreover, malignant transformation was also reported in few animals, following cadmium treatment. Early experimental studies in animals proposed an endocrine-dependent mechanism of cadmium-induced testis tumorigenesis; however, more recent findings from cell-free assays, in vitro studies, and short-term in vivo studies, highlighted that cadmium might also contribute to testis tumor development by early occurring endocrine-independent mechanisms, which include aberrant gene expression within the testis, and genotoxic effects, and take place well before the timing of testis tumorigenesis. These endocrine-independent mechanisms, however, have not been directly investigated on testis tumor samples retrieved from affected, cadmium-treated animals so far. The present review focuses on the relationship between cadmium exposure and testis cancer, by reporting the few epidemiological observational human studies available, and by providing animal-based experimental evidences of cadmium implication in the pathogenesis and progression of testis tumor. Moreover, the relevance of experimental animal studies to human cadmium exposure and the translational potential of experimental findings will be extensively discussed, by critically addressing strengths and weaknesses of available data.
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Affiliation(s)
- Cristina de Angelis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
| | - Giacomo Galdiero
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
| | - Davide Menafra
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
| | - Francesco Garifalos
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
- Department of Public Health, Federico II University, Naples, Italy
| | - Nunzia Verde
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
| | - Mariangela Piscopo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
| | - Mariarosaria Negri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Università Federico II di Napoli, Naples, Italy
| | - Renata Simona Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Università Federico II di Napoli, Naples, Italy
| | - Chiara Simeoli
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Università Federico II di Napoli, Naples, Italy
| | | | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Università Federico II di Napoli, Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia ed Andrologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy
- Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
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Maiolino G, Fernández-Pascual E, Ochoa Arvizo MA, Vishwakarma R, Martínez-Salamanca JI. Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1305. [PMID: 37512119 PMCID: PMC10383207 DOI: 10.3390/medicina59071305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.
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Affiliation(s)
- Giuseppe Maiolino
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129 Perugia, Italy
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mario Alberto Ochoa Arvizo
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
| | - Ranjit Vishwakarma
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
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What Is the Malignant Potential of Small (<2 cm), Nonpalpable Testicular Incidentalomas in Adults? A Systematic Review. Eur Urol Focus 2022; 9:361-370. [PMID: 36257887 DOI: 10.1016/j.euf.2022.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/10/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT Unlike palpable lumps, a large number of nonpalpable testicular lesions found incidentally at ultrasound in asymptomatic postpuberal males are either benign tumours or non-neoplastic lesions. The prevalence of malignancy, however, is appraised based on small case series. Dedicated studies report a large number of patients, and systematic review articles are lacking. OBJECTIVE This systematic review is aimed to assess, from the analysis of the pooled data of the available literature, the incidence of benign tumours, malignant tumours, and non-neoplastic lesions, and to identify predictive characteristics for malignancy. EVIDENCE ACQUISITION A systematic review of PubMed, Scopus, Google Scholar, Turning Research Into Practice (TRIP) database, and the Cochrane Library was conducted on January 6, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Studies were retrieved reporting on adult asymptomatic men, with single, incidentally identified small testicular lesions, either fertile or infertile, with negative tumour markers and without specific risk factors for malignancy. Lesions ≤20 mm were considered small. Seventy-four studies were selected for inclusion in this analysis. Twenty-six additional publications have been retrieved by the bibliography quoted in the selected articles. EVIDENCE SYNTHESIS Pooled data of 1348 lesions in 1348 patients were collected. Of these lesions, 408 could be retrieved individually, 44.6% were benign, 27.2% were malignant, and 20.8% were non-neoplastic. Virtually all lesions <3 mm and 86.6% of lesions <5 mm were benign. Lesions >10 mm have a 38.14% probability of being benign. Hyperechoic lesions are likely benign. Fertility status does not affect the risk of malignancy. CONCLUSIONS Very small (<3 mm) and small (<5 mm) incidentally detected testicular lesions in asymptomatic postpuberal men with normal tumour markers could be frequently benign. More prospective studies are needed to better support this finding. Management strategies should be developed for these patients to reduce overtreatment. PATIENT SUMMARY Small testicular lesions are incidentally founded at ultrasound. It is not easy to distinguish a benign lesion from a malignant one. Results of this study are reporting a higher incidence of benign lesions with a diameter of <5 mm. More studies are needed to better understand the biology and the management strategy for small testicular lesions.
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Prevalence and Management of Incidental Testicular Masses-A Systematic Review. J Clin Med 2022; 11:jcm11195770. [PMID: 36233639 PMCID: PMC9573452 DOI: 10.3390/jcm11195770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Management of incidentally diagnosed small testicular masses (STM) is controversial. Although there is the risk of malignancy, it might be realistic to safely seek preservation of testicles bearing benign masses. This study aims to systematically evaluate the evidence regarding prevalence of STMs, their benign or malignant histology and their management. We conducted a systematic literature search for studies reporting small or incidental testicular masses and their management by radical orchiectomy, testis sparing surgery (TSS) or ultrasound (US) surveillance. We initially screened 2126 abstracts and from these, 57 studies met the inclusion criteria. Testicular masses were detected in 1.74% of patients undergoing US examination. Regarding STMs removed by surgery, 41.12% were benign. Intraoperative frozen section examination (FSE) is a reliable tool to discriminate between benign and malignant testicular masses (average 93.05% accuracy), supporting TSS. Benign lesions were associated with smaller diameter (<1 cm 68.78% benign), were often hypoechoic and exhibited regular margins on US. Conclusions: Small testicular masses are often benign. Clinical and US patterns are not accurate enough for including patients in surveillance protocols and TSS paired with FSE is pivotal for precluding the removal of testicles bearing benign lesions. Future research might unveil new imaging tools or biomarkers to support clinical management.
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Dupeux M, Maxwell F, Rocher L, Izard V, Guettier C, Ferlicot S. Testicular Lesions in Infertile Men. Am J Clin Pathol 2022; 157:936-941. [PMID: 34935941 DOI: 10.1093/ajcp/aqab214] [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: 09/02/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of incidental testicular tumors are diagnosed in patients during infertility workup. The aim of this study was to evaluate the accuracy of frozen section examination (FSE) for the management of these tumors. METHODS We retrospectively studied a series of 46 testicular tumors diagnosed during exploration for infertility from 2000 to 2019 and submitted for FSE. RESULTS A diagnosis of malignancy was made in 23 cases on both gross examination (yellow-white or cream-colored nodules for seminomas) and FSE, then confirmed on final diagnosis in 22 of the cases. One seminoma reported on FSE was revised as being a Leydig cell tumor. The 23 other lesions were diagnosed as benign on FSE, including 11 Leydig cell tumors (yellow-brown nodules), 2 Leydig cell hyperplasias, and 10 whitish fibrous lesions. All Leydig cell lesions were confirmed except 1, which was reclassified as a Sertoli cell tumor. Of the 10 cases of fibrous lesions, 6 were associated with malignancy. CONCLUSIONS The high incidence of Leydig cell tumors and the accuracy of FSE for these lesions demonstrate the interest in FSE. In contrast, FSE is not reliable for fibrous lesions, and surgeons should be aware that a fibrosis result often corresponds with regressed tumors.
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Affiliation(s)
- Margot Dupeux
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Florian Maxwell
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Laurence Rocher
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris Saclay, Ecole Doctorale Biosigne, ED 419 , Le Kremlin-Bicêtre , France
- Institut Langevin , Paris , France
| | - Vincent Izard
- Department of Urology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Catherine Guettier
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Sophie Ferlicot
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
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Narayan Y, Brown D, Ivaz S, Das K, Moussa M, Tsampoukas G, Papatsoris A, Buchholz N. Incidental testicular masses and the role of organ-sparing approach. Arch Ital Urol Androl 2021; 93:296-300. [PMID: 34839628 DOI: 10.4081/aiua.2021.3.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions. MATERIALS AND METHODS A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology. RESULTS Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively. CONCLUSIONS The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.
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Affiliation(s)
- Yash Narayan
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Stella Ivaz
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Krishanu Das
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital, Harlow; U-merge Ltd. (Urology for emerging countries), London.
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London.
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Colpi GM, Caroppo E. Performing Microdissection Testicular Sperm Extraction: Surgical Pearls from a High-Volume Infertility Center. J Clin Med 2021; 10:jcm10194296. [PMID: 34640310 PMCID: PMC8509819 DOI: 10.3390/jcm10194296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/12/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
Microdissection testicular sperm extraction (mTESE) has been demonstrated to be the gold-standard surgical technique for retrieving testicular sperm in patients with non-obstructive azoospermia (NOA) as it enables the exploration of the whole testicular parenchyma at a high magnification, allowing the identification of the rare dilated seminipherous tubules that may contain sperm, usually surrounded by thinner or atrophic tubules. MTESE requires a skilled and experienced surgeon whose learning curve may greatly affect the sperm retrieval rate, as demonstrated in previous reports. The present review is intended to offer a precise and detailed description of the mTESE surgical procedure, accompanied by an extensive iconography, to provide urologists with valuable information to be translated into clinical practice. Advice about the pre-surgical and post-surgical management of patients is also offered.
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Affiliation(s)
- Giovanni M. Colpi
- Andrology Unit, Procrea Institute, 6900 Lugano, Switzerland
- Correspondence:
| | - Ettore Caroppo
- Asl Bari, PTA “F Jaia”, Andrology Outpatients Clinic, 70014 Conversano (Ba), Italy;
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Pozza C, Pofi R, Tenuta M, Tarsitano MG, Sbardella E, Fattorini G, Cantisani V, Lenzi A, Isidori AM, Gianfrilli D. Clinical presentation, management and follow-up of 83 patients with Leydig cell tumors of the testis: a prospective case-cohort study. Hum Reprod 2020; 34:1389-1403. [PMID: 31532522 PMCID: PMC6688875 DOI: 10.1093/humrep/dez083] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/13/2019] [Accepted: 04/17/2019] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION When should ‘not so rare’ Leydig cell tumors (LCTs) of the testis be suspected, diagnosed, and treated? SUMMARY ANSWER LCTs are more frequent than generally believed, are associated with male infertility, cryptorchidism and gynecomastia, and should be treated conservatively (in compliant patients) with active surveillance, which appears to be a safe alternative to surgical enucleation. WHAT IS KNOWN ALREADY Increasing referrals for testicular imaging have led to an increase in findings of LCTs. The features and natural history of these tumors remain largely unknown, as the available studies are small and heterogeneous. LCTs were previously treated aggressively and follow-up data are lacking. STUDY DESIGN, SIZE, DURATION A case-cohort study of consecutive patients diagnosed with LCTs over a 10-year period was prospectively enrolled from 2009 to 2018 and compared to matched cohorts of patients with seminomas or no testicular lesions screened in the same timeframe. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 9949 inpatients and outpatients referred for scrotal ultrasound, a total of 83 men with LCTs were included. Enrolled subjects underwent medical history and clinical examination and were asked to undergo routine blood tests, hormone investigations (FSH, LH, total testosterone, estradiol, inhibin B, sex hormone-binding globulin (SHBG), prolactin), and semen analysis. Patients who consented also underwent contrast-enhanced ultrasound, elastography, gadolinium-enhanced scrotal magnetic resonance imaging, and hCG stimulation test (5000 IU i.m.) with serum total testosterone and estradiol measured at 0, 24, 48, and 72 hours. MAIN RESULTS AND THE ROLE OF CHANCE In total, 83 patients diagnosed with LCTs were compared against 90 patients diagnosed with seminoma and 2683 patients without testicular lesions (NoL). LCTs were diagnosed by enucleation (48.2%), orchiectomy (13.3%), or clinical surveillance (38.5%). Testicular volume, sperm concentration, and morphology were lower (P = 0.001, P = 0.001, and P < 0.001, respectively) in patients with LCTs than in the NoL group. FSH, LH, and SHBG were higher and the testosterone/LH ratio was lower in LCTs than in the NoL group (P < 0.001). The LCT group showed higher SHBG (P = 0.018), lower sperm concentration (P = 0.029), and lower motility (P = 0.049) than the seminoma group. Risk factors for LCTs were cryptorchidism (χ2 = 28.27, P < 0.001), gynecomastia (χ2 = 54.22, P < 0.001), and low testicular volume (χ2 = 11.13, P = 0.001). Five cases were recurrences or bilateral lesions; none developed metastases during follow-up (median, 66 months). LIMITATIONS, REASONS FOR CAUTION This study has some limitations. First, hCG and second-line diagnostic investigations were not available for all tumor patients. Second, ours is a referral center for infertility, thus a selection bias may have altered the baseline features of the LCT population. However, given that the comparison cohorts were also from the same center and had been managed with a similar protocol, we do not expect a significant effect. WIDER IMPLICATIONS OF THE FINDINGS LCTs are strongly associated with male infertility, cryptorchidism, and gynecomastia, supporting the hypothesis that testicular dysgenesis syndrome plays a role in their development. Patients with LCTs are at a greater risk of endocrine and spermatogenesis abnormalities even when the tumor is resected, and thus require long-term follow-up and prompt efforts to preserve fertility after diagnosis. LCTs have a good oncological prognosis when recognized early, as tissue-sparing enucleation is curative and should replace orchiectomy. Conservative surgery and, in compliant patients, active surveillance through clinical and radiological follow-up are safe options, but require monitoring of testicular failure and recurrence. STUDY FUNDING/COMPETING INTEREST(S) The project was funded by the Ministry of University and Research Grant MIUR 2015ZTT5KB. There are no conflicts of interest. TRIAL REGISTRATION NUMBER ALCeP trial (ClinicalTrials.gov Identifier: NCT01206270).
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Fattorini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Vito Cantisani
- UOS Innovazioni Diagnostiche e Ultrasonografiche, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Lagabrielle S, Durand X, Droupy S, Izard V, Marcelli F, Huyghe E, Ferriere JM, Ferretti L. Testicular tumours discovered during infertility workup are predominantly benign and could initially be managed by sparing surgery. J Surg Oncol 2018; 118:630-635. [DOI: 10.1002/jso.25203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Xavier Durand
- Urology Department; Val de Grace Hospital; Paris France
| | - Stéphane Droupy
- Urology Department; Carémeau University Hospital; Nîmes France
| | - Vincent Izard
- Urology Department; Kremelin-Bicêtre Hospital; Le Kremlin-Bicêtre France
| | | | - Eric Huyghe
- Urology Department; Rangueil University Hospital; Toulouse France
| | | | - Ludovic Ferretti
- Urology Department; Robert Picqué Hospital; Villenave d’Ornon France
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12
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Use of Ultrasound in Male Infertility: Appropriate Selection of Men for Scrotal Ultrasound. Curr Urol Rep 2018; 19:58. [DOI: 10.1007/s11934-018-0810-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Keske M, Canda AE, Yalcin S, Kilicarslan A, Kibar Y, Tuygun C, Onder E, Atmaca AF, Yildirim A, Ozkanli SS, Kandemir O, Kargi T, Sar M, Tugcu V, Resorlu B, Aslan Y, Sarikaya S, Boylu U, Cicek AF, Basar H, Tuncel A, Balbay MD. Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study. Can Urol Assoc J 2017; 11:E100-E104. [PMID: 28360955 DOI: 10.5489/cuaj.4016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. METHODS In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0-1 cm; n=35), Group 2 (1.1-2cm; n=99), and Group 3 (2.1-3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. RESULTS Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p<0.05 between groups). TIN was detected in 20%, 42.4%, and 41.5% of Groups 1, 2, and 3, respectively (p<0.05 for Group 1 vs. Groups 2 and 3; p>0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p<0.05 for both Group 1 vs. Group 3 and for Group 2 vs. Group 3; p>0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). CONCLUSIONS Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.
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Affiliation(s)
- Murat Keske
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | | | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Ankara, Turkey
| | - Can Tuygun
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Evrim Onder
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Asif Yildirim
- Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Olcay Kandemir
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Taner Kargi
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Sar
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berkan Resorlu
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Numune Training and Research Hospital, Ankara, Turkey
| | | | - Ugur Boylu
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Halil Basar
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Numune Training and Research Hospital, Ankara, Turkey
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Maqdasy S, Bogenmann L, Batisse-Lignier M, Roche B, Franck F, Desbiez F, Tauveron I. Leydig cell tumor in a patient with 49,XXXXY karyotype: a review of literature. Reprod Biol Endocrinol 2015; 13:72. [PMID: 26160035 PMCID: PMC4496935 DOI: 10.1186/s12958-015-0071-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022] Open
Abstract
49,XXXXY pentasomy or Fraccaro's syndrome is the most severe variant of Klinefelter's syndrome (KS) affecting about 1/85000 male births. The classical presentation is the triad: mental retardation, hypergonadotropic hypogonadism and radio ulnar synostosis. Indeed, the reproductive function of Fraccaro's syndrome is distinguished from KS. Besides, Leydig cell tumors are described in cases of KS, but never documented in the Klinefelter variants.We describe a young adult of 22 years old who presented with hyper gonadotropic hypogonadism, delayed puberty and bilateral micro-cryptorchidism. Chromosomal pentasomy was confirmed since infancy. Bilateral orchidectomy revealed a unilateral well-circumscribed Leydig cell tumor associated with bilateral Leydig cell hyperplasia.Inspired from reporting the first case of Leydig cell tumor in a 49,XXXXY patient, we summarize the particularities of testicular function in 49,XXXXY from one side, and the risk and mechanisms of Leydig cell tumorigenesis in Klinefelter variants on the other side. The histological destructions in 49,XXXXY testes and hypogonadism are more profound than in Klinefelter patients, with early Sertoli, Leydig and germ cell destruction. Furthermore, the risk of Leydigioma development in KS and its variants remains a dilemma. We believe that the risk of Leydigioma is much higher in KS than the general population. By contrast, the risk could be lower in the Klinefelter variants with more than 3 supplementary X chromosomes, owing to an earlier and more profound destruction of Leydig cells rendering them irresponsive to chronic Luteinizing hormone (LH) stimulation.
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Affiliation(s)
- Salwan Maqdasy
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
- Service de Médecine Nucléaire, Centre Jean Perrin, 58 rue Montalembert, F-63011, Clermont-Ferrand, France.
| | - Laura Bogenmann
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | - Marie Batisse-Lignier
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
| | - Béatrice Roche
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | | | - Françoise Desbiez
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | - Igor Tauveron
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
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Ferretti L, Sargos P, Gross-Goupil M, Izard V, Wallerand H, Huyghe E, Rigot JM, Durand X, Benoit G, Ferriere JM, Droupy S. Testicular-sparing surgery for bilateral or monorchide testicular tumours: a multicenter study of long-term oncological and functional results. BJU Int 2014; 114:860-4. [DOI: 10.1111/bju.12549] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ludovic Ferretti
- Department of Urology; University Hospital Pellegrin; Bordeaux France
- Department of Surgery; HIA Robert Picque; Villenave d'Ornon France
| | - Paul Sargos
- Department of Radiotherapy; Bergonie Institut; Bordeaux France
| | | | - Vincent Izard
- Department of Urology; Paris XI University Hospital; Le Kremlin-Bicêtre
| | - Hervé Wallerand
- Department of Urology; University Hospital Pellegrin; Bordeaux France
| | - Eric Huyghe
- Department of Urology; University Hospital Rangueil; Toulouse France
| | - Jean-Marc Rigot
- Andrology and Fertility Department; University Hospital of Lille; Lille France
| | - Xavier Durand
- Department of Urology; HIA of the Val-De-Grâce; Paris France
| | - Gerard Benoit
- Department of Urology; Paris XI University Hospital; Le Kremlin-Bicêtre
| | | | - Stéphane Droupy
- Department of Urology-Andrology; University Hospital of Nîmes; Nîmes-Montpellier University; Nîmes France
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Shedding light on the controversy surrounding the temporal decline in human sperm counts: a systematic review. ScientificWorldJournal 2014; 2014:365691. [PMID: 24672311 PMCID: PMC3929517 DOI: 10.1155/2014/365691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022] Open
Abstract
We systematically examined the evidence of declining sperm counts and the hypothesis that an increased exposure to environmental pollutants is responsible for such decline. Search engines, including PUBMED, MEDLINE, EMBASE, BIOSIS, and Cochrane library, were used to identify epidemiologic studies published from 1985 to 2013. We concluded that there is no enough evidence to confirm a worldwide decline in sperm counts. Also, there seems to be no scientific truth of a causative role for endocrine disruptors in the temporal decline of sperm production. Such assumptions are based on few meta-analyses and retrospective studies, while other well-conducted researches could not confirm these findings. We acknowledge that difficult-to-control confounding factors in the highly variable nature of semen, selection criteria, and comparability of populations from different time periods in secular-trend studies, the quality of laboratory methods for counting sperm, and apparently geographic variations in semen quality are the main issues that complicate the interpretation of the available evidence. Owing to the importance of this subject and the uncertainties still prevailing, there is a need not only for continuing monitoring of semen quality, reproductive hormones, and xenobiotics, but also for a better definition of fecundity.
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17
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[Non palpable testicular tumors. Retrospective series]. Prog Urol 2013; 24:46-50. [PMID: 24365628 DOI: 10.1016/j.purol.2013.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/20/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To report our experience in 13 cases with nonpalpable testicular tumors and review the literature. MATERIAL AND METHODS From 1998 to 2012, 13 patients were diagnosed with nonpalpable testicular tumors. The data base was performed prospectively, and analyzed retrospectively. We evaluated demographic data, clinical presentation, ultrasound tumor features, tumor markers, frozen and final histopathological findings. All patients were also evaluated with serum tumor markers and the surgical approach was inguinal. RESULTS The mean age was 46.4 years and the most frequent clinical presentation were orchialgia in six patients (46.1%) and infertility in three (23%). All masses were hypoechoic with an average tumor size of 8.9 mm. The serum tumor markers were negative in all patients and the final histopathological findings were six seminomas, two embryonal carcinomas, one seminiferous tubules atrophy, a segmental testicular infarction, a Sertoli cell tumor and a Leydig cell tumor. CONCLUSIONS Nonpalpable testicular masses were benign in almost half of the cases; therefore, we recommend using the frozen section pathology as a tool to perform conservative surgery in selective cases.
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18
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Winnall WR, Hedger MP. Phenotypic and functional heterogeneity of the testicular macrophage population: a new regulatory model. J Reprod Immunol 2013; 97:147-58. [DOI: 10.1016/j.jri.2013.01.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/12/2013] [Accepted: 01/24/2013] [Indexed: 11/17/2022]
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19
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Eiss D, Cornud F, Thiounn N, Wolf JP, Amar E, Ghouadni M, Hélénon O. Imagerie de l’hypofertilité masculine : technique et résultats. ACTA ACUST UNITED AC 2012; 40:481-9. [DOI: 10.1016/j.gyobfe.2012.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
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20
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Abstract
Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications for a diagnostic testicular biopsy to the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones. Nowadays, testicular biopsies are mainly performed for sperm harvesting in men with non-obstructive azoospermia, to be used for intracytoplasmic sperm injection. Testicular biopsy is also performed in men with risk factors for testicular malignancy. In a subgroup of infertile men, there is an increased risk for carcinoma in situ of the testis, especially in men with a history of cryptorchidism and testicular malignancy and in men with testicular atrophy. Ultrasonographic abnormalities, such as testicular microlithiasis, inhomogeneous parenchyma and lesions of the testes, further increase the risk of carcinoma in situ (CIS) in these men. For an accurate histological classification, proper tissue handling, fixation, preparation of the specimen and evaluation are needed. A standardized approach to testicular biopsy is recommended. In addition, approaches to the detection of CIS of the testis testicular immunohistochemistry are mandatory. In this mini-review, we describe the current indications for testicular biopsies in the diagnosis and management of male infertility.
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Giannarini G, Mogorovich A, Bardelli I, Manassero F, Selli C. Testis-sparing surgery for benign and malignant tumors: A critical analysis of the literature. Indian J Urol 2011; 24:467-74. [PMID: 19468498 PMCID: PMC2684381 DOI: 10.4103/0970-1591.44249] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In order to explore the latest advances in organ-sparing treatment of testicular tumors, a literature search of the Medline/PubMed database was carried out for published data in the English language up to 2007. In the recent past the management of testicular tumors has evolved in favor of a testis-sparing approach in selected cases, both in the adult and pediatric population. The widespread use of high-frequency testicular ultrasound has led to detecting an increasing number of asymptomatic, non-palpable, small-volume masses. A higher proportion of testicular lesions of benign nature than previously reported has now been documented. The high accuracy of frozen section examination and the increasing interest in the potential functional, psychological and cosmetic advantages related to preserved testicular parenchyma are other arguments currently favoring the adoption of an organ-sparing policy for most testicular masses. Greater experience has been gained in also managing conservatively malignant tumors. Patients with germ-cell cancer in solitary testis or bilateral tumors can be submitted to testis-sparing surgery, provided that the maximum size of the lesion is <2 cm, preoperative testosterone is normal and adjuvant radiotherapy of the residual parenchyma is delivered. Cancer-specific survival is excellent, local recurrence rate very low and androgen supplementation unlikely.
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Freour T, Delvigne A, Barrière P. L’exploration de l’homme du couple infécond. ACTA ACUST UNITED AC 2010; 39:S45-52. [DOI: 10.1016/s0368-2315(10)70030-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Organ-Sparing Surgery for Adult Testicular Tumours: A Systematic Review of the Literature. Eur Urol 2010; 57:780-90. [DOI: 10.1016/j.eururo.2010.01.014] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 01/08/2010] [Indexed: 11/18/2022]
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24
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Toren PJ, Roberts M, Lecker I, Grober ED, Jarvi K, Lo KC. Small Incidentally Discovered Testicular Masses in Infertile Men—Is Active Surveillance the New Standard of Care? J Urol 2010; 183:1373-7. [DOI: 10.1016/j.juro.2009.12.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Paul J. Toren
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Irene Lecker
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ethan D. Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C. Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Gianfrilli D, Isidori AM, Lenzi A. Segmental testicular ischaemia: presentation, management and follow-up. ACTA ACUST UNITED AC 2009; 32:524-31. [DOI: 10.1111/j.1365-2605.2008.00891.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Hallak J, Cocuzza M, Sarkis AS, Athayde KS, Cerri GG, Srougi M. Organ-Sparing Microsurgical Resection of Incidental Testicular Tumors Plus Microdissection for Sperm Extraction and Cryopreservation in Azoospermic Patients: Surgical Aspects and Technical Refinements. Urology 2009; 73:887-91; discussion 891-2. [DOI: 10.1016/j.urology.2008.08.510] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Revised: 08/11/2008] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
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27
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Negri L, Benaglia R, Fiamengo B, Pizzocaro A, Albani E, Levi Setti PE. Cancer risk in male factor-infertility. Placenta 2008; 29 Suppl B:178-83. [PMID: 18755508 DOI: 10.1016/j.placenta.2008.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/23/2008] [Accepted: 07/31/2008] [Indexed: 11/26/2022]
Abstract
Severe forms of male-factor infertility are associated with an increased risk of testicular cancer and scrotal ultrasonography is widely used for diagnosis. In this study, 2172 male members of infertile couples referred to our Reproductive Medicine Unit were submitted to scrotal ultrasonography and 835 selected patients had been followed during a 2-year period. Eight out of nine neoplastic nodules found at the initial examination were unpalpable and discovered by ultrasonography. Ten tumoral lesions were found in 370 testicular biopsies performed for diagnostic purposes or to extract spermatozoa; and eight additional neoplastic lesions were discovered during the 2-year follow-up of 835 patients. The cumulative rate of neoplastic disease was 3.2%. Thirteen cases (1.5%) were malignant (12 germ cell tumours and one non-Hodgkin lymphoma of testicular origin); the remaining 14 were benign forms (Leydig cell tumours and hyperplasias, Sertoli cell nodules, adenomatoid tumours). Testicular volume (cut-off: 12ml) resulted weakly correlated with germ cell cancer (p=n.s., odds ratio 2.01) while low total sperm count (<40x10(6)) (p=0.002, odds ratio 8.4), previous cryptorchidism (p=0.04, odds ratio 7.5) and hypergonadotrophic hypogonadism (p=0.04, odds ratio 7.9) were associated with an increased risk. But a stronger correlation with germ cell cancer was found in the patients with some utrasonographic anomalies, i.e. testicular microlithiasis (p=0.0015, odds ratio 37.1) or larger calcifications not fitting the description of testicular microlithiasis (p<0.0001, odds ratio 69.5). Our findings indicate that scrotum ultrasonography should always be advised in subfertile men with <40x10(6) spermatozoa/ejaculate or hypergonadotrophic hypogonadism or previous cryptorchidism, and that particular care should be taken in the presence of testicular microlithiasis or testicular calcifications. These men should be aware of the existence of higher risk of testicular cancer and trained in testicular self-examination.
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Affiliation(s)
- L Negri
- U.O. di Medicina della Riproduzione, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy.
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Eifler JB, King P, Schlegel PN. Incidental Testicular Lesions Found During Infertility Evaluation are Usually Benign and May be Managed Conservatively. J Urol 2008; 180:261-4; discussion 265. [DOI: 10.1016/j.juro.2008.03.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Indexed: 11/28/2022]
Affiliation(s)
- John B. Eifler
- Brady Urology Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Peggy King
- Brady Urology Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Peter N. Schlegel
- Brady Urology Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Papachristou F, Simopoulou M, Touloupidis S, Tsalikidis C, Sofikitis N, Lialiaris T. DNA damage and chromosomal aberrations in various types of male factor infertility. Fertil Steril 2007; 90:1774-81. [PMID: 18082736 DOI: 10.1016/j.fertnstert.2007.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 09/05/2007] [Accepted: 09/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To understand and delineate the nature and level of DNA damage in association to semen parameters in infertile men. DESIGN A prospective experimental study. SETTING Alexandroupolis University General Hospital. PATIENT(S) Eleven fertile and 27 infertile men with various types of infertility. INTERVENTION(S) DNA damage was induced by addition of mitomycin C and caffeine to lymphocyte cultures. MAIN OUTCOME MEASURE(S) Sister chromatid exchange (SCE) levels were assessed in cultures providing a quantitative index of genotoxicity and chromosomal analysis was performed using G-banding and C-banding techniques. RESULT(S) Karyotyping analysis indicated chromosomal fragility, trisomic lines, and marker chromosomes in some infertile men. Double minute chromosomes were noticed in 11 infertile men and were positively correlated with elevated SCE levels. Necrospermia and varicocele, irrespectively of the degree of severity, were positively correlated with elevated SCE levels. CONCLUSION(S) Infertile men are prone to have DNA damage; the nature and level of DNA damage varies and is associated with semen parameters. The presence of double minute chromosomes alone is associated with increased double-stranded breaks and abnormal sperm concentration. This study could provide the basis to establish whether and through which process double minute chromosomes could be related to poor semen parameters and regulation of DNA repair.
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Affiliation(s)
- Fotini Papachristou
- Department of Genetics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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30
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Kanto S, Takahashi K, Maehara I, Fukuzaki A, Kyono K, Arai Y. Incidental testicular cancers that subsequently developed in oligozoospermic and azoospermic patients: report of three cases. Fertil Steril 2007; 88:1374-6. [PMID: 17408623 DOI: 10.1016/j.fertnstert.2007.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 01/05/2007] [Accepted: 01/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether infertile men with poor semen count subsequently developed testicular cancers and to describe their clinical presentation. DESIGN We reviewed 460 male patients with abnormal semen counts between 1989 and 2004. SETTING University hospital. PATIENT(S) Infertile men who developed testicular cancers after assisted reproductive technologies (ART). INTERVENTION(S) Description of patient characteristics: age at infertility, presentation, semen quality, and ART. MAIN OUTCOME MEASURE(S) The number of patients who subsequently developed testicular cancers and the period from ART to the development of clinical testicular cancers. RESULT(S) Of the 460 patients, 169 patients presented with mild oligozoospermia, 117 patients with severe oligozoospermia, and 174 patients with azoospermia. The follow-up periods were as follows: 1-192 months (median, 96.5 mo) for mild oligozoospermia, 1-156 months (median, 78.5 mo) for severe oligozoospermia, and 1-197 months (median, 99 mo) for azoospermia. We subsequently found three testicular cancers that had developed among severely oligozoospermic and azoospermic patients. The period from the claim of sterility to developing testicular cancers varied from 4 to 14 years (median, 9 y). CONCLUSION(S) These results indicate that severe semen abnormality may be a risk factor in developing testicular cancers. Self-examination of the testes could be used as an alternative or supplement to physical examination and testicular ultrasound as part of the infertility workup, even after ART.
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Affiliation(s)
- Satoru Kanto
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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31
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Lakmichi MA, Niang L, Tligui M, Traxer O, Cussenot O, Gattegno B, Thibault P, Sebe P. [Infertility and testicular seminoma]. Presse Med 2007; 36:1753-5. [PMID: 17560758 DOI: 10.1016/j.lpm.2007.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 04/05/2007] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Infertility in men may be associated with an elevated risk of testicular cancer. The authors report a case of testicular seminoma discovered fortuitously during a workup for infertility. CASE A 30 year-old male was seen for infertility. Physical examination and testicular ultrasonography were normal. The sperm count found oligoasthenospermia related to the excretory ducts. The patient underwent testicular biopsies for infertility, which showed an intratubular germ cell tumor. Tumor markers (beta HCG, alpha FP, LDH) were normal. Computed tomography was normal for the thorax, abdomen, and pelvis. We performed an inguinal orchiectomy. The pathology examination found seminoma, at a pT1 stage. One course of chemotherapy followed. DISCUSSION The incidence of testicular cancer is increasing throughout the world. Recent studies show a strong relation between infertility and an increased risk of testicular cancer, and some authors even suggest a causal relation.
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Mancini M, Carmignani L, Gazzano G, Sagone P, Gadda F, Bosari S, Rocco F, Colpi GM. High prevalence of testicular cancer in azoospermic men without spermatogenesis. Hum Reprod 2007; 22:1042-6. [PMID: 17220165 DOI: 10.1093/humrep/del500] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An increased risk of testicular cancer in men with infertility and poor semen quality has been reported. Our aim was to investigate the prevalence of testicular nodules and cancer in azoospermic subjects with different spermatogenetic patterns. METHODS A total of 1443 consecutive infertile men were investigated, out of which 145 (10.0%) were found to be azoospermic. By using clinical examination and testicular ultrasound, 11 out of the 145 patients showed testicular nodules (2.8-26 mm). To obtain spermatozoa for assisted reproduction, 97 subjects required testicular sperm extraction (TESE) and biopsy, including the 11 patients with nodules. They were divided into two groups according to biopsy results: Group A (n = 38) with complete Sertoli cell-only syndrome (SCOS) and Group B (n = 59) with varying spermatogenetic patterns. Ten nodules were found in Group A and one in Group B. RESULTS In azoospermic men, the overall prevalence of nodules was 7.5%. In complete SCOS, the prevalence of nodules and cancer was 10/38 (26.3%) and 4/38 (10.5%), respectively. Amongst the cancers, one embryonal carcinoma, one seminoma and two in-situ carcinomas were found. CONCLUSION The prevalence of testicular nodules and cancer in azoospermic men with complete SCOS is very high. In these subjects, the role of clinical evaluation, ultrasound and biopsy should be emphasized.
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Affiliation(s)
- M Mancini
- Andrology Unit, San Paolo Hospital, University of Milan, Milan, Italy.
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Sakamoto H, Saito K, Shichizyo T, Ishikawa K, Igarashi A, Yoshida H. Color Doppler ultrasonography as a routine clinical examination in male infertility. Int J Urol 2006; 13:1073-8. [PMID: 16903932 DOI: 10.1111/j.1442-2042.2006.01499.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. METHODS Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. RESULTS Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. CONCLUSIONS The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.
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Affiliation(s)
- Hideo Sakamoto
- Department of Urology, Showa University Fujigaoka Hospital, Showa University School of Medicine, Kanagawa, Japan.
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