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Sato Y, Kirihana Y, Meguro S, Tanji R, Onagi A, Honda-Takinami R, Matsuoka K, Hoshi S, Hata J, Akaihata H, Ogawa S, Uemura M, Kojima Y. Evaluation of testicular stiffness in boys with unilateral cryptorchidism after orchiopexy by ultrasound strain elastography. Fukushima J Med Sci 2024; 70:57-64. [PMID: 38346721 PMCID: PMC11140199 DOI: 10.5387/fms.2023-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/09/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE We assessed the stiffness of unilateral undescended testes after orchiopexy, examining its value in tracking histopathological changes and fertility potential during postoperative follow-up. Additionally, we explored the optimal timing for surgery based on testicular stiffness. PATIENTS AND METHODS Thirty-six boys who had been diagnosed with unilateral undescended testis and treated with orchiopexy were included in the study. Testicular stiffness was evaluated several times over respective follow-up periods by ultrasound strain elastography after orchiopexy. The strain ratios were measured as the ratios of the elasticities of the descended testis to those of the operated testes. The patients were divided into two groups based on the age at which they underwent orchiopexy:under < 2 years (Group A) and ≥ 2 years (Group B). RESULTS The mean strain ratios were 0.90 ± 0.32 and 0.92 ± 0.20 in Groups A and B, respectively. In Group A, the strain ratio was constant regardless of postoperative months (r = 0.01, p = 0.99); however, in Group B, it tended to increase with postoperative months (r = 0.42, p = 0.07). CONCLUSIONS Evaluation of testicular stiffness may be useful for the estimation of histopathological changes and fertility potential in boys with unilateral undescended testes at follow-up appointments after orchiopexy. Our data indicate that performing orchiopexy as early as possible may be recommended to avoid testicular damage.
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Affiliation(s)
- Yuichi Sato
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Yusuke Kirihana
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Satoru Meguro
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Ryo Tanji
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Akifumi Onagi
- Departments of Urology, Fukushima Medical University School of Medicine
| | | | - Kanako Matsuoka
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Seiji Hoshi
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Junya Hata
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Hidenori Akaihata
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Soichiro Ogawa
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Motohide Uemura
- Departments of Urology, Fukushima Medical University School of Medicine
| | - Yoshiyuki Kojima
- Departments of Urology, Fukushima Medical University School of Medicine
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["Uncomplicated" inguinal testis : How practicable are the guidelines?]. Urologe A 2020; 59:300-306. [PMID: 32072199 DOI: 10.1007/s00120-020-01129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It has been known for more than 20 years that early treatment of maldescended testicles can have a positive effect on fertility and a negative effect on the development of tumors. In certain circumstances, hormone therapy is still recommended in German-speaking countries. However, its benefit is still controversially discussed. Therapy is usually initiated by the pediatrician, who is usually the first to detect undescended testicles. Since therapy may involve early hormone therapy as well as surgery, acceptance among pediatricians and also the parents may be reduced. The question also arises as to how far the implementation is practicable. In patients with nonpalpable testis, there are many controversies concerning the value of ultrasound investigations. In the following two case studies, the treatment decisions for undescended testes in infancy are exemplified. Furthermore, the available evidence from the literature and guidelines is presented to provide assistance for daily routine care and to critically discuss potential fields of application and limitations of existing guidelines.
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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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Hrivatakis G, Astfalk W, Schmidt A, Hartwig A, Kugler T, Heim T, Clausner A, Frunder A, Weber H, Loff S, Fuchs J, Ellerkamp V. The timing of surgery for undescended testis - a retrospective multicenter analysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:649-57. [PMID: 25323022 PMCID: PMC4200414 DOI: 10.3238/arztebl.2014.0649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND n Germany, it is recommended that the surgical treatment of an undescended testis should be carried out between the ages of 6 months and 1 year to lower the risks of subfertility and testicular carcinoma. Although this recommendation has appeared in the German guidelines from 2007 onward, orchidopexy is still frequently performed at later ages. METHOD We retrospectively analyzed data from seven pediatric surgical services in the German state of Baden-Württemberg on all boys who underwent orchidopexy from 2009 to 2012. We classified the timing of surgery as Age Group I (before the first birthday), Age Group II (between the first and second birthdays), and Age Group III (after the second birthday). We determined whether preoperative hormonal treatment was given and distinguished primary from secondary undescended testis. RESULTS Among 2213 boys who underwent orchidopexy, 1850 had primary and 363 had secondary undescended testis. Of those with primary undescended testis, the percentages of boys who underwent surgery in Age Groups I, II, and III were (respectively, with 95% confidence intervals): 18.7% (17-20.6%), 24.4% (22.5-26.5%), and 57% (54.6-59.2%). A small percentage of boys in each group also received preoperative hormonal treatment. From 2009 to 2012, there was a secular trend favoring earlier orchidopexy. In 2012, 28 boys (14.2% [9.7-20.0%]) had orchidopexy in outpatient pediatric surgery practices before their first birthday, while 68 did on hospital inpatient services (40.7% [33.2-48.6%]). CONCLUSION Most of the patients studied had surgery at a later age than recommended. Adherence to the guidelines in this respect is nonetheless relatively good in Germany compared to other countries, as studies from abroad have yielded findings that are just as bad or worse.
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Affiliation(s)
- Georg Hrivatakis
- Outpatient clinic for Pediatric and Adolescent Surgery, Stuttgart
| | | | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University of Tübingen
| | - Andreas Hartwig
- Outpatient clinic for Pediatric and Adolescent Surgery,, Stuttgart
| | - Thomas Kugler
- Outpatient clinic for Pediatric and Adolescent Surgery, Ulm
| | - Thomas Heim
- Outpatient clinic for Pediatric and Adolescent Surgery, Stuttgart
| | | | | | - Harduin Weber
- Department of Pediatric and Adolescent Surgery, Olga Hospital, Stuttgart
| | - Steffan Loff
- Department of Pediatric and Adolescent Surgery, Olga Hospital, Stuttgart
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University of Tübingen
| | - Verena Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University of Tübingen
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van Brakel J, Kranse R, de Muinck Keizer-Schrama SMPF, Hendriks AEJ, de Jong FH, Bangma CH, Hazebroek FWJ, Dohle GR. Fertility potential in men with a history of congenital undescended testes: a long-term follow-up study. Andrology 2012; 1:100-8. [PMID: 23258637 DOI: 10.1111/j.2047-2927.2012.00024.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/29/2022]
Abstract
Men with a history of congenital undescended testes (UDT) have an increased risk of fertility problems. Despite no definitive proof, current guidelines recommend early surgical intervention because this may have a positive effect on future fertility potential by preventing degenerative changes of the testes in early life. Also surgical intervention facilitates observability of the testes in view of possible malignancy. We evaluated testicular function in adult men with previous UDT treated at different ages before puberty. A long-term follow-up study of men with previous UDT was performed. Andrological evaluation included medical history taking, physical examination, scrotal ultrasound, determination of reproductive hormones, and semen analysis. Findings were compared with those of a control group of men with normal testicular descent. The influence of age at orchiopexy on future fertility parameters was evaluated in a multivariate regression analysis. 62 men were included of whom seven had had bilateral UDT. Twenty-four patients had had their orchiopexy before the age of 24 months of whom eight men had it before 12 months of age. Forty-eight men had had unsuccessful luteinizing-hormone-releasing-hormone (LHRH) nasal spray treatment during childhood, whereas 14 of 24 men operated before 24 months of age had not received LHRH treatment before orchiopexy. Fertility potential in men with a history of UDT is compromised in comparison with controls. We could not detect any influence of age at orchiopexy on fertility parameters. However, the number of patients operated before the age of 12 months is limited. This study does not support the assumption that early orchiopexy results in better fertility potential.
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Affiliation(s)
- J van Brakel
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
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Anomalies postnatales du développement de la spermatogenèse associées aux troubles de la migration testiculaire. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0096-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Résumé
La cryptorchidie, testicule non descendu dans sa position normale intrascrotale, est l’une des anomalies congénitales les plus fréquentes du système génital masculin. Le mécanisme de cette migration est un processus complexe encore mal connu. Plusieurs hypothèses étiologiques ont été avancées pour tenter d’expliquer la survenue de la cryptorchidie. L’existence d’une anomalie de la descente testiculaire, même traitée dans l’enfance, est un facteur de risque de cancer du testicule. Mais elle peut aussi se traduire à l’âge adulte par des anomalies des paramètres spermatiques et une atteinte de la fertilité. Dans la présente revue sont rassemblées les données concernant les anomalies du développement postnatal de la spermatogenèse observées en cas de troubles isolés de la migration du testicule et leurs conséquences à l’âge adulte sur les paramètres de la fertilité.
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Aspects cliniques, biologiques et thérapeutiques de la cryptorchidie diagnostiquée à l’âge adulte: analyse d’une série de 69 cas. Basic Clin Androl 2009. [DOI: 10.1007/s12610-009-0029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Résumé
But
Rapporter les aspects cliniques, biologiques et thérapeutiques de la cryptorchidie chez l’adulte et discuter de l’intérêt de l’abaissement du testicule non descendu (TND) chez l’adulte.
Patients et méthodes
Il s’agit d’une étude rétrospective colligeant 69 patients âgés de plus de 18 ans pris en charge au service d’urologie-andrologie du CHU Aristide-Le-Dantec pour cryptorchidie entre janvier 1999 et décembre 2007.
Résultats
L’âge moyen de nos patients était de 31,04 ± 8,4 ans (extrêmes 18 et 55 ans). Les principales circonstances de découverte ont été l’infertilité masculine (38 cas), la vacuité des bourses (21 cas) et la dégénérescence maligne du TND (six cas). La cryptorchidie était unilatérale dans 69,5 % et bilatérale dans 30,4 % des cas. Le spermogramme effectué chez 60 de nos patients a montré une azoospermie dans 46,6 % des cas, une oligozoospermie dans 38,3 % et une numération de spermatozoïdes normale dans 15 % des cas. Tous les patients ayant une cryptorchidie bilatérale avaient une azoospermie. À l’exploration chirurgicale, le TND a été retrouvé dans 95,6 % des cas (66 patients). Le principal type de traitement réalisé a été l’abaissement testiculaire. L’histologie des pièces d’orchidectomie sur testicule non tumoral (n = 7) a trouvé dans tous les cas une atrophie testiculaire sévère avec absence complète de cellules germinales. Les types histologiques des cancers étaient le séminome (n = 3) et le carcinome embryonnaire (n = 3). Parmi les patients ayant une azoospermie (n = 28), aucun cas d’induction de la spermatogenèse après abaissement testiculaire n’a été observé. Parmi les patients ayant consulté pour infertilité masculine, trois d’entre eux ont eu des enfants après abaissement testiculaire, soit un taux de paternité de 7,8 %.
Conclusion
Dans la cryptorchidie de l’adulte, l’abaissement du testicule a peu d’impact sur la fertilité masculine. Mais, vu les progrès actuels de l’assistance médicale à la procréation (AMP), le dogme d’orchidectomie systématique devant un TND diagnostiqué à l’âge adulte doit être reconsidéré.
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8
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Fertility potential after unilateral and bilateral orchidopexy for cryptorchidism. World J Urol 2009; 27:513-9. [DOI: 10.1007/s00345-009-0406-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 03/23/2009] [Indexed: 11/26/2022] Open
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Early orchiopexy improves subsequent testicular development and spermatogenesis in the experimental cryptorchid rat model. J Urol 2008; 179:1195-9. [PMID: 18206164 DOI: 10.1016/j.juro.2007.10.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE The most appropriate period for orchiopexy is controversial. We performed histological analyses of undescended testes to evaluate the influence of orchiopexy timing in an experimental cryptorchid rat model. Furthermore, we extrapolated the timing of orchiopexy in humans from our results. MATERIALS AND METHODS Experimental cryptorchid rats were induced with androgen blocker by injecting flutamide into the abdomen of pregnant Sprague-Dawley rats (Chubu Kagaku Shizai, Nagoya, Japan) for 7 days from days 14 to 20 of gestation. Approximately 90% of male newborns had undescended testes and we performed orchiopexy on them 4, 5 and 7 weeks after birth. The testes were removed 10 weeks after birth in all groups, and weight and histological findings were assessed. A modified Johnsen score was used to determine spermatogenesis maturity and germ cell apoptosis was also evaluated. RESULTS Nonoperated undescended testes showed atrophic and hypospermatogenesis with germ cell apoptosis, whereas treated undescended testes showed the development of early elongated spermatids. In addition, performing orchiopexy 4 weeks after birth decreased the degeneration of undescended testes compared with that in other groups. CONCLUSIONS From the point of view of only testicular development 4-week-old rats reportedly correspond to 1-year-old humans. While we should be cautious when extrapolating our findings to the clinical setting, our current study provides evidence in support of early orchiopexy during the first year of life.
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Lim HS, Kim HT, Moon KH. Five Year Follow-up Testicular Growth Results after Orchiopexy in Palpable Cryptorchid Testis. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.3.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hwa Su Lim
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Ki Hak Moon
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
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Kojima Y, Hayashi Y, Mizuno K, Kurokawa S, Sasaki S, Kohri K. Assessment of Serum Follicle-Stimulating Hormone Level and Testicular Volume for Prediction of Paternity Potential in Pubertal Boys Who Underwent Bilateral Orchiopexy in Childhood. J Urol 2006; 175:2290-4. [PMID: 16697861 DOI: 10.1016/s0022-5347(06)00341-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE We examined infertile adults for the presence of spermatozoa in the testes, serum FSH level and testicular volume to predict paternity potential in pubertal boys who had undergone bilateral orchiopexy in childhood. MATERIALS AND METHODS The study included 58 idiopathic infertile men (group 1), 14 infertile men who had undergone bilateral orchiopexy in childhood (group 2) and 21 pubertal boys who had undergone bilateral orchiopexy in childhood (group 3). We evaluated the correlation between FSH level and testicular volume in all groups. In groups 1 and 2 the testes were examined for the presence of spermatozoa using bilateral testicular biopsy samples. RESULTS Judging from the presence of spermatozoa in the testes and correlation between FSH level and testicular volume, 14 patients in group 1 (24%) were categorized as being at high risk, 32 (55%) at intermediate risk and 12 (21%) at low risk for loss of paternity potential, with spermatozoa positive rates of 0%, 49% and 100%, respectively. In comparison, 4 patients in group 2 (29%) were categorized as being at high risk, 7 (50%) at intermediate risk and 3 (21%) at low risk, with spermatozoa positive rates of 0%, 43% and 100%, respectively. According to this categorization, 19% of pubertal boys in group 3 were at high risk and may already have lost their paternity potential. CONCLUSIONS Despite bilateral orchiopexy in childhood, some male adolescents may not have the potential for paternity.
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Affiliation(s)
- Yoshiyuki Kojima
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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12
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Woodhouse CRJ. Which pediatric urological conditions can be handled by adult urologists? NATURE CLINICAL PRACTICE. UROLOGY 2006; 2:152-3. [PMID: 16474739 DOI: 10.1038/ncpuro0146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 03/21/2005] [Indexed: 11/10/2022]
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Lee PA. Fertility after cryptorchidism: epidemiology and other outcome studies. Urology 2005; 66:427-31. [PMID: 16098371 DOI: 10.1016/j.urology.2005.01.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Revised: 12/17/2004] [Accepted: 01/11/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Peter A Lee
- Department of Pediatrics, Pennsylvania State College of Medicine, The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
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Roh J, Virtanen H, Kumagai J, Sudo S, Kaleva M, Toppari J, Hsueh AJW. Lack of LGR8 gene mutation in Finnish patients with a family history of cryptorchidism. Reprod Biomed Online 2004; 7:400-6. [PMID: 14656401 DOI: 10.1016/s1472-6483(10)61883-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cryptorchidism is the most frequent congenital anomaly of the urogenital tract in the male. Although in Western countries 1-2% of males at the age of 3 months are diagnosed with this condition, its aetiology is still unknown. Animal models suggest a possible genetic basis for this disorder. Recently, the INSL3 (Leydig insulin-like peptide) gene and its cognate receptor, LGR8, were found to be important in testicular descent by regulating gubernacular development. Male mice null for either INSL3 or LGR8 genes exhibited bilateral cryptorchidism. Because earlier studies indicated that mutation of the INSL3 gene is not associated with the development of human cryptorchidism, this study analysed whether mutations in the LGR8 gene could be associated with this disorder. Sequencing of 18 exons of the LGR8 gene in 23 cryptorchid Finnish patients and a group of 33 control subjects allowed the identification of three nucleotide changes in exons 12 and 17, showing single base substitutions from A to G at positions 957, 993, and 1810 of LGR8. Among the three changes, only the 1810 A to G substitution is associated with an amino acid change from isoleucine to valine (Ile604Val) located in the fifth transmembrane domain of this seven-transmembrane receptor. This change was more frequent in a control group of normal fertile adult males and infant boys than in the group of cryptorchid males. The change is not associated with altered receptor signalling, thus suggesting the presence of a polymorphism unrelated to the cryptorchid phenotype. These data indicate that mutations involving the human LGR8 gene do not represent a frequent cause of cryptorchidism in the Finnish population.
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Affiliation(s)
- Jaesook Roh
- Division of Reproductive Biology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305-5317, USA
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Brucker-Davis F, Pointis G, Chevallier D, Fenichel P. Update on cryptorchidism: endocrine, environmental and therapeutic aspects. J Endocrinol Invest 2003; 26:575-87. [PMID: 12952375 DOI: 10.1007/bf03345224] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cryptorchidism is the most frequent developmental abnormality in boys, present in more than 1% of infants above three months of age. It is associated with an increased risk of infertility and testicular cancer. The etiological quest is often disappointing, except in bilateral cases or associated malformations. Recent focus is on genetic and environmental aspects. Animal models have revealed the role of genes encoding for proteins implicated in testicular migration (InsI3, Hoxa 10), but in humans results are less convincing. While some degree of endogenous hormonal abnormality is suspeeted in some patients, the endocrine disruptor hypothesis is also tested. It is unclear whether the incidence of cryptorchidism has really increased, or whether there is only a better screening for this condition. However, other male reproductive problems, such as subfertility, hypospadias and testicular cancer seem on the rise. This secular trend suggests the possible in utero impact of hormonally active environmental factors, such as pesticides with estrogenic or antiandrogenic effect, and is consistent with the increased risk of cryptorchidism observed in the sons of mothers exposed to diethylstilbestrol during pregnancy. From a therapeutic point of view, there is an agreement that the correction of cryptorchidism is needed, but there is controversy on the best medical and/or surgical approach and on the optimal timing. There is a recent trend in proposing early therapeutic intervention, before 1 yr of age, in the hope of improving fertility; however, there is no proof that such a strategy can reduce the risk of testicular cancer.
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Affiliation(s)
- F Brucker-Davis
- Centre Hospitalier Universitaire de Nice, Service d'Endocrinologie, Diabétologie et Médecine de la Reproduction, Hôpital l'Archet 1, Nice, France.
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16
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Melchior D, Kaefer M, Eugster E, Havlik R. A novel microvascular approach to treatment of the high undescended testicle. J Pediatr Surg 2002; 37:1501-3. [PMID: 12378468 DOI: 10.1053/jpsu.2002.35432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 9-year-old boy presented for evaluation of bilateral nonpalpable testes. Despite a negative human Chorionic gonadotropin (hCG) simulation test, laparoscopy found high undescended testicles on both sides. The authors report the unusual microvascular approach utilized to accomplish testicular transfer into the scrotum and discuss the diagnostic difficulties experienced in this case.
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Ghirri P, Ciulli C, Vuerich M, Cuttano A, Faraoni M, Guerrini L, Spinelli C, Tognetti S, Boldrini A. Incidence at birth and natural history of cryptorchidism: a study of 10,730 consecutive male infants. J Endocrinol Invest 2002; 25:709-15. [PMID: 12240903 DOI: 10.1007/bf03345105] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Of the 10,730 neonates born in the period 1978-1997 and examined for cryptorchidism (C) at birth, 1387 were pre-term (gestational age <37 wk), and 9343 were full-term. At birth, a total of 737 neonates (6.9%) were cryptorchid, 487 had bilateral C and 250 unilateral C. The C rate of pre-terms was 10 times higher than that of the full-terms (30.1 and 3.4%, respectively). Comparing the two studied decades, a significant decrease of C rate was found in the second decade in full-term neonates. The rates of C at birth were significantly elevated for low birth weight, babies born from mothers with an age <20 or >35 yr, newborns from mothers with A Rh positive and B Rh positive blood group. Of the 737 cryptorchid newborns at birth, 613 (83%) were re-examined after 12 months from the expected date of delivery, and those born in the period 1988-1997 were also re-evaluated at 6 months of life. Late spontaneous descent occurred in 464 cases (75.7%), while 149 (24.3%) were still cryptorchid. The incidence of C at 12 months from the expected date of delivery, after survival curve calculation, in term and pre-term infants, was 1.53 and 7.31%, respectively, in the period 1978-1987, and 1.22 and 3.13% respectively, in the 2nd decade (1988-1997). In the groups also examined at 6 months of life, spontaneous descent occurred almost completely within the first 6 months of life in term infants, but not in pre-terms. No evidence of seasonal cyclicity was found. Medical and/or surgical treatment was generally started within 2-4 yr of age earlier in the second decade of the study. In conclusion, the main risk factor for C at birth and at 12 months of life seems to be pre-term birth and low birth weight. If this is associated itself to a higher risk of infertility too, it remains to be defined.
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Affiliation(s)
- P Ghirri
- Division of Neonatology, University of Pisa, S. Chiara Hospital, Italy.
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18
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Abstract
PURPOSE The effect of congenital genitourinary anomalies on fertility and the impact of current therapies are reviewed. MATERIALS AND METHODS The literature of each of the 2 components was used to define the present status and to make proposals for future management. RESULTS Infertility may be caused by gonadal failure (intersex states), failure of sperm transport (exstrophy) or both (bilateral undescended testes). In some conditions it is uncertain whether there are any fertility problems despite an identifiable genital problem. In cases of unilateral undescended testis the fertility rate may be unaffected by surgery and be no different from that in the normal population. Techniques of in vitro fertilization, particularly intracytoplasmic sperm injection, have allowed previously untreatable patients to become parents. Successful pregnancies in patients who had the prune belly syndrome and Klinefelter's syndrome have been reported in the last year. CONCLUSIONS Prospects for fertility with current techniques and those that might be discovered in the next 20 years should strongly influence decisions about the treatment of infants and children.
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Affiliation(s)
- C R Woodhouse
- Institute of Urology and Nephrology, University College London, London, England
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19
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Abstract
PURPOSE The effect of congenital genitourinary anomalies on fertility and the impact of current therapies are reviewed. MATERIALS AND METHODS The literature of each of the 2 components was used to define the present status and to make proposals for future management. RESULTS Infertility may be caused by gonadal failure (intersex states), failure of sperm transport (exstrophy) or both (bilateral undescended testes). In some conditions it is uncertain whether there are any fertility problems despite an identifiable genital problem. In cases of unilateral undescended testis the fertility rate may be unaffected by surgery and be no different from that in the normal population. Techniques of in vitro fertilization, particularly intracytoplasmic sperm injection, have allowed previously untreatable patients to become parents. Successful pregnancies in patients who had the prune belly syndrome and Klinefelter's syndrome have been reported in the last year. CONCLUSIONS Prospects for fertility with current techniques and those that might be discovered in the next 20 years should strongly influence decisions about the treatment of infants and children.
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Koskimies P, Virtanen H, Lindström M, Kaleva M, Poutanen M, Huhtaniemi I, Toppari J. A common polymorphism in the human relaxin-like factor (RLF) gene: no relationship with cryptorchidism. Pediatr Res 2000; 47:538-41. [PMID: 10759163 DOI: 10.1203/00006450-200004000-00020] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The incidence of impaired testicular descent (cryptorchidism) is high; 1-2% of boys at the age of 3 mo are diagnosed for this condition in western countries. Recent data on mice with targeted disruption of the Insl3/relaxin-like factor (RLF) gene proposed that this factor plays a role in testicular descent in fetal life. Male RLF-/- mice exhibit bilateral cryptorchidism due to developmental abnormalities of the gubernaculum, associated with abnormal spermatogenesis and infertility. In the present study, we have sequenced the promoter region and both exons of the RLF gene in a cohort of 30 boys, seven of whom presented with a possible familial form of cryptorchidism and 23 with sporadic cryptorchidism. One of the nucleotide substitutions detected, G to A at position 178, predicted amino acid change. The mutation was localized to the C-peptide region, resulting in an alanine to threonine change and therefore classified as a conservative mutation. Four of the 30 cases analyzed were homozygous (13%), and 15 were heterozygous for the mutation (50%). However, the same mutation was also found in a control group of 89 men; 10% of them were homozygous, and 39% were heterozygous. Our results indicate that mutations in the RLF gene are not a common reason for cryptorchidism and that the common G178A polymorphism has no apparent relationship with this condition.
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Affiliation(s)
- P Koskimies
- Department of Physiology, Turku Graduate School of Biomedical Sciences, University of Turku, Finland
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21
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Leissner J, Filipas D, Wolf HK, Fisch M. The undescended testis: considerations and impact on fertility. BJU Int 1999; 83:885-91; quiz 891-2. [PMID: 10368225 DOI: 10.1046/j.1464-410x.1999.00093.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Leissner
- Department of Urology, Johannes Gutenberg University, Medical School, Mainz, Germany
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22
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Zakaria O, Shono T, Imajima T, Suita S. Fertility and histological studies in a unilateral cryptorchid rat model during early and late adulthood. BRITISH JOURNAL OF UROLOGY 1998; 82:404-7. [PMID: 9772879 DOI: 10.1046/j.1464-410x.1998.00734.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of age on fertility and testicular development in rats with untreated unilateral undescended testes. MATERIALS AND METHODS Newborn male Wistar King-A rats were divided into two groups. In group 1, a mechanical model of unilateral undescended testis was created by performing extra-abdominal fixation of the gubernaculum in the neonatal period, and in group 2, sham-operated rats were used as controls. At 90 days old (early adulthood), the fertility of both groups was assessed by mating the rats with mature virgin females for 2 weeks. Thereafter, some of the rats were killed and their testes examined histologically, while the remaining rats were allowed to develop further. At the age of 180 days (late adulthood), fertility was re-assessed in the same way. All the rats were then killed and their testes removed for histological examination. RESULTS There was no significant difference in pregnancy rate of females mated with males from either group in early adulthood. However, in late adulthood there was a significant reduction in pregnancy rate in females coupled with cryptorchid rats compared with that of females coupled with control rats. There was a significant degeneration of the unilateral cryptorchid testes compared with control testes in both early and late adulthood. In contrast, there were no significant changes in histological development between the contralateral scrotal testes and the controls in early adulthood, although they were significantly different from the controls in late adulthood. CONCLUSION These results suggest that fertility is affected by ageing in untreated unilateral cryptorchidism; this may be induced by extensive damage not only in the undescended testes, but also in the contralateral scrotal testis, in this mechanically induced model of unilateral cryptorchidism.
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Affiliation(s)
- O Zakaria
- Department of Paediatric Surgery, Faculty of Medicine, Kyushu University, Japan
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23
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Abstract
Cryptorchidism is the most common genitourinary disorder of childhood. Even though its incidence has changed only slightly over the years, the number of operations for cryptorchid testes has tripled. Better understanding of the natural history of cryptorchidism, as well as changes that occur in testicular histology both in the cryptorchid and the contralateral descended testis very early in life, are the cause. This experience has led us to advocate early orchiopexy as the optimum means of treatment.
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Affiliation(s)
- B Gill
- Department of Urology, Albert Einstein College of Medicine, Bronx, New York, USA
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24
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Lenzi A, Gandini L, Lombardo F, Dondero F, Culasso F, Ferro F, Cambiaso P, Caione P, Cappa M. Unilateral cryptorchidism corrected in prepubertal age: evaluation of sperm parameters, hormones, and antisperm antibodies in adult age. Fertil Steril 1997; 67:943-8. [PMID: 9130905 DOI: 10.1016/s0015-0282(97)81412-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate whether prepubertal orchidopexy for unilateral cryptorchidism can reduce adult dysspermia. DESIGN Patient follow-up comparison with control groups. SETTING Surgical and endocrinologic sections of a children's hospital and a university infertility-care center. PATIENT(S) Seventy-one patients with unilateral cryptorchidism who underwent orchidopexy in prepubertal age (6.4 +/- 2.8 years) were followed up as adults (20.0 +/- 2.8 years). MAIN OUTCOME MEASURE(S) Patients underwent testicular examination and hormonal evaluation, 49 of these had semen analysis and antisperm antibody tests. Semen results were compared with those of two age-matched control groups: a group of 20 healthy, randomly selected subjects and a group of 20 patients operated on in postpubertal age for cryptorchidism. RESULT(S) Unilateral reduced testis size was found in 30.1% of patients, eight patients had a low LH level, eight had a low T level, and none had abnormal FSH values. Antisperm antibodies were found in 1 of 49 cases. Cluster analysis of sperm parameters showed that the mean values of patients were worse than those of the healthy controls but better than those of the subjects operated on in postpubertal age. CONCLUSION(S) This study indicates that prepubertal orchidopexy can given better results than postpubertal correction.
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Affiliation(s)
- A Lenzi
- University of Rome La Sapienza, Italy
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25
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Fertility Potential after Unilateral Orchiopexy. J Urol 1996. [DOI: 10.1097/00005392-199607000-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Cortes D, Thorup JM, Lindenberg S. Fertility potential after unilateral orchiopexy: an age independent risk of subsequent infertility when biopsies at surgery lack germ cells. J Urol 1996; 156:217-20. [PMID: 8648809 DOI: 10.1016/s0022-5347(01)66004-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We evaluated whether adult fertility potential was better when unilateral orchiopexy was done at ages 2 to 6 years or later, and we identified those at risk for infertility. MATERIALS AND METHODS Unilateral orchiopexy was performed simultaneously with testicular biopsy in 11 patients 2.8 to 6.8 years old and in 54, 10.0 to 11.9 years old. In adulthood measurement of testicular volume, serum follicle-stimulating hormone, luteinizing hormone and testosterone was done, as well as analysis of semen specimens. RESULTS At orchiopexy the 2 groups were statistically similar, and statistically similar fertility potentials were found in adulthood. Five of the 65 patients (7.7%, 95% confidence limits 2.5 to 17%) may experience infertility, representing 33% of both groups with less than 1% of the age matched number of spermatogonia per tubular transverse section (approximately no germ cells) in the biopsy specimen at orchiopexy. CONCLUSIONS Between ages 2 and 12 years the timing of unilateral orchiopexy may vary without an effect on subsequent fertility potential. When biopsy at surgery lacks germ cells, there is an approximately 33% age independent risk of subsequent infertility. Otherwise patients may be fertile after unilateral orchiopexy between ages 2 and 12 years.
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Affiliation(s)
- D Cortes
- Department of Pediatric Surgery and Pathology, Righospitalet, University Hospital, Copenhagen, Denmark
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