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Grande-Moreillo C, Fuentes-Carretero S, Margarit-Mallol J, Pérez-López C, Rodríguez-Molinero A. Alterations in testicular positioning after normal descent: acquired cryptorchidism. Andrology 2024; 12:1119-1124. [PMID: 37985433 DOI: 10.1111/andr.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Acquired cryptorchidism or acquired undescended testis (UDT) is defined as the displacement of a testicle outside the scrotal sac after normal descent has been verified. There are still no clear guidelines on its management. OBJECTIVES To analyze patients who underwent surgery for UDT in our setting to determine the prevalence of acquired cryptorchidism and to analyze the demographic and clinical characteristics of the population of children diagnosed with both acquired and congenital cryptorchidism, the age of presentation of both entities and the percentage of bilateral involvement. MATERIALS AND METHODS This was a retrospective descriptive study using data from the clinical history of patients who underwent surgery for cryptorchidism between 2011 and 2022. The type of cryptorchidism, acquired or congenital, was recorded. Demographic and clinical data were collected. RESULTS A total of 367 patients and 442 testicular units were included in the study (75 patients had bilateral involvement). In 54.75% (95% CI: 50.09%-59.40%) of the cases analyzed, cryptorchidism was acquired, and the mean age at the time of surgery was 7.39 years (SD 2.95). Twenty percent (95% CI: 16.29%-24.58%) of the patients presented with bilateral cryptorchidism and 64% (95% CI: 52.88%-75.11%) out of them were acquired on both sides. The diagnosis was metachronous in 42.6% (95% CI: 31.21%-54.12%) of bilateral cryptorchidism cases. DISCUSSION AND CONCLUSION Acquired cryptorchidism accounts for more than half of cryptorchidism cases requiring surgery in our setting, with a clearly different age of presentation than that for congenital cryptorchidism. Therefore, it is necessary to monitor the presence of the testes in the scrotal sac until adolescence. It is also important to monitor patients with a history of cryptorchidism, not only for the management of the operated testicle but also for the early identification of patients who will develop metachronous contralateral cryptorchidism.
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Affiliation(s)
- Carme Grande-Moreillo
- Pediatric Surgery Unit, Consorci Sanitari Alt Penedès i Garraf, Barcelona, Spain
- Pediatric Surgery Department Hospital, Universitari Mútua Terrassa, Terrassa, Spain
| | | | | | - Carlos Pérez-López
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, Spain
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Chedrawe ER, Keefe DT, Romao RLP. Diagnosis, Classification, and Contemporary Management of Undescended Testicles. Urol Clin North Am 2023; 50:477-490. [PMID: 37385709 DOI: 10.1016/j.ucl.2023.04.011] [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: 07/01/2023]
Abstract
This article provides a comprehensive review regarding undescended testicles and other related conditions. We have included background information summarizing variable clinical presentations, epidemiology, and the implications of undescended testis (UDT) on fertility and malignancy risk. This article has an emphasis on the approach to diagnosis and surgical management for the UDT. The purpose of this review is to provide readers with useful clinical tools for assessing and treating patients with cryptorchidism.
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Affiliation(s)
- Emily R Chedrawe
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada
| | - Daniel T Keefe
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Urology, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; Department of Urology, Dalhousie University, 1276 South Park Street. Room 293, 5 Victoria, Halifax, NS, B3H 2Y9, Canada; Division of Pediatric Surgery and Department of Surgery, IWK Health Centre, Dalhousie University, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8.
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Nakajima H, Suda K, Arakawa A, Yanai T. A rare case of a toddler with unilateral cryptorchidism-related cranial suspensory ligament remnant. Clin Case Rep 2023; 11:e7310. [PMID: 37215961 PMCID: PMC10196407 DOI: 10.1002/ccr3.7310] [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: 03/06/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Key clinical message Several animal experiment studies have shown that insufficient testicular descent to the scrotum can be caused by persistence of cranial suspensory ligament (CSL). We report a case of right cryptorchidism in a male toddler surgically treated with an orchidopexy possibly associated with CSL persistence based on intraoperative and pathological findings. This case would be a precious source to further investigate the etiopathogenesis of cryptorchidism. Abstract The CSL anchors embryonic gonads to the dorsal abdominal wall during antenatal mammalian development. Although its persistence appears to cause cryptorchidism in animal models, it has never been proven in humans. A 1-year-old boy with right cryptorchidism underwent right orchidopexy. Intraoperatively, a band-like structure running from the right testis into the retroperitoneum and up to the right side of the liver was noticed and resected. The pathological findings of the specimen showed fibrous connective tissues, smooth muscles, and blood vessels but no tissues suggestive of a testis, a spermatic cord, an epididymis, or liver. Immunohistochemical analysis for an androgen receptor antibody did not detect any signal in the specimen. The right cryptorchidism in this case was possibly caused by CSL persistence, which is the first such human case, to our knowledge.
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Affiliation(s)
- Hideaki Nakajima
- Department of Pediatric SurgeryIbaraki Children's HospitalMito City, IbarakiJapan
| | - Kazuto Suda
- Department of Pediatric SurgeryIbaraki Children's HospitalMito City, IbarakiJapan
| | - Atsushi Arakawa
- Department of Human PathologyJuntendo University School of MedicineTokyoJapan
| | - Toshihiro Yanai
- Department of Pediatric SurgeryIbaraki Children's HospitalMito City, IbarakiJapan
- Department of Pediatric UrologyIbaraki Children's HospitalMito City, IbarakiJapan
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Testicular descent revisited: a micro-computed tomography study in fetal rats. Pediatr Surg Int 2023; 39:149. [PMID: 36882585 DOI: 10.1007/s00383-023-05427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE There is a long history of research dealing with the embryology of the testicular descent. However, important aspects like the role of the gubernaculum and the development of the processus vaginalis peritonei are not understood. Micro-computed tomography (µCT) is an established tool for anatomical studies in rodents. Our study applied µCT imaging to visualize the testicular descent in rats and focused on the role of the gubernacular bulb and the development of the processus vaginalis peritonei. METHODS Rats from embryonic day 15 (ED15) to ED21 and newborns (N0) were fixed and dried using the "critical point" technique. We ran a SkyScan® µCT system and scans were analyzed for gender-specific differentiation of the genital ridge and used for 3D visualization of relevant anatomic structures. RESULTS µCT imaging confirmed the intraperitoneal location of the testicles from ED15 to N0. The components of the inner genital moved closer together while the intestinal volume expanded. The gubernacular bulb seemed to be involved in the formation of the processus vaginalis peritonei. CONCLUSION Here, we utilized µCT imaging to visualize the testicular descent in the rat. Imaging provides new morphologic aspects on the development of the processus vaginalis peritonei.
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Reny SE, Mukherjee A, Mol PM. The curious case of testicular descent: factors controlling testicular descent with a note on cryptorchidism. AFRICAN JOURNAL OF UROLOGY 2023. [DOI: 10.1186/s12301-023-00342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Abstract
Background
The testicular descent is a uniquely complex process depending upon multiple factors like growth and reorganisation of the specific gonadal ligaments, hormones, etc., which interplay with each other. Though an unambiguous event, it is still laced with incredulity since the data interpretation were intermingled between different species creating more ambiguity in certain aspects of this process. In order to understand the aetiopathology of cryptorchidism the extensive study of the factors controlling the descent is necessitous.
Main body
Though testes originate in the abdomen, they migrate to an extra abdominal site the scrotum, which makes it vulnerable to pathological conditions associated with the descent. The hormones that play vital role in the first phase of descent are insulin-like hormone 3 (INSL3), Anti-müllerian hormone as well as testosterone, whereas androgens, genitofemoral nerve and its neurotransmitter calcitonin gene-related peptide (CGRP) influence the second phase. Despite the vast research regarding the complex nexus of events involving the descent there are disparities among the cross species studies. However all these discrepancies make testicular descent yet again fascinating and perplexing. Our aim is to provide a comprehensive review including recent advances which provides thorough coverage of anatomical and hormonal factors in the descent as well as cryptorchidism.
Conclusion
Though our understanding on testicular descent has evolved over the decades there still has obscurity surrounding it and the studies on the factors responsible for descent are becoming more intense with the time. Our knowledge on many factors such as INSL3 and CGRP is more established now; however, on the other hand the role of androgens still remains speculative. As the knowledge and understanding of the biological process of testicular descent increases it will pave ways to new treatment plans to treat cryptorchidism more effectively.
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Dawood W, Youssif M, Badawy H, Ghozlan A, Orabi S, Fahmy A. Laparoscopic staged management of high intrabdominal testis: A prospective randomized study. J Pediatr Surg 2021; 56:2385-2391. [PMID: 33814186 DOI: 10.1016/j.jpedsurg.2021.02.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). MATERIALS AND METHODS Forty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO). Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage. Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. RESULTS Staged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery. At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). CONCLUSIONS Both staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.
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Affiliation(s)
- Waleed Dawood
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Mohamed Youssif
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Haytham Badawy
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Assem Ghozlan
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Samir Orabi
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Ahmed Fahmy
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt.
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The G-Protein-Coupled Membrane Estrogen Receptor Is Present in Horse Cryptorchid Testes and Mediates Downstream Pathways. Int J Mol Sci 2021; 22:ijms22137131. [PMID: 34281183 PMCID: PMC8269005 DOI: 10.3390/ijms22137131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Cryptorchidism in horses is a commonly occurring malformation. The molecular basis of this pathology is not fully known. In addition, the origins of high intratesticular estrogen levels in horses remain obscure. In order to investigate the role of the G-protein-coupled membrane estrogen receptor (GPER) and establish histological and biochemical cryptorchid testis status, healthy and cryptorchid horse testes were subjected to scanning electron microscopy analysis, histochemical staining for total protein (with naphthol blue black; NBB), acid content (with toluidine blue O; TBO), and polysaccharide content (with periodic acid-Schiff; PAS). The expression of GPER was analyzed by immunohistochemistry and Western blot. GPER-mediated intracellular cAMP and calcium (Ca2+) signaling were measured immunoenzymatically or colorimetrically. Our data revealed changes in the distribution of polysaccharide content but not the protein and acid content in the cryptorchid testis. Polysaccharides seemed to be partially translocated from the interstitial compartment to the seminiferous tubule compartment. Moreover, the markedly decreased expression of GPER and GPER downstream molecules, cAMP and Ca2+, suggests their potential role in testis pathology. Increased estrogen levels in cryptorchid conditions may be linked to disturbed GPER signaling. We postulate that GPER is a prominent key player in testis development and function and may be used as a new biomarker of horse testis in health and disease.
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Ganapathy A, Jayaraman Pushpaja J, Kapoor K, Sharma MK, Singh S, Jhajhria SK. Structural and functional significance of scrotal ligament: a comparative histological study. Anat Sci Int 2020; 96:106-111. [PMID: 32894451 DOI: 10.1007/s12565-020-00566-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022]
Abstract
Gubernaculum testes is the most important parameter in testicular migration. At the end of migration, it is described as scrotal ligament, which has implications in testicular torsion. The present study aims to examine the structure of scrotal ligament and compare it with gubernaculum. Sixteen adult cadaveric testicular specimens and fourteen fetal testicular specimens of different age groups were examined after getting ethical clearance from the institute ethics committee and consent from the parents. Meticulous dissection was done. The length, site of proximal, and distal attachment of scrotal ligament and gubernaculum were noted and histologically evaluated. A separate scrotal ligament could not be delineated in any adult specimens. It merged with testicular coverings. Histological examination showed the presence of patchy areas of dense collagen fibres of variable density amidst loose areolar connective tissue. In contrast, fetal specimens showed the presence of a definitive gubernaculum testes and revealed the presence of mesenchymal tissue, collagen, elastic fibres, and myocytes which varied according to gestational age of fetuses. Structure of scrotal ligament and gubernaculum testes is highly variable. Description of scrotal ligament as a firm attachment from lower pole of testes to scrotum is controversial, questioning its role as protective factor in testicular torsion.
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Affiliation(s)
- Arthi Ganapathy
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kanchan Kapoor
- Department of Anatomy, Government Medical College and Hospital, Chandigarh, India
| | - Mahesh Kumar Sharma
- Department of Anatomy, Government Medical College and Hospital, Chandigarh, India
| | - Seema Singh
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Saroj Kaler Jhajhria
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
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Molinaro F, Fusi G, Aglianò M, Volpi N, Franci D, Lorenzoni P, Messina M, Galgano A, Grasso F, Plessi C, Messina M, Angotti R. Clinically Differentiated Abnormalities of the Architecture and Expression of Myosin Isoforms of the Human Cremaster Muscle in Cryptorchidism and Retractile Testis. Urol Int 2020; 104:891-901. [PMID: 32674099 DOI: 10.1159/000508432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/03/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). BACKGROUND The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. SUBJECTS AND METHODS Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. RESULTS AND CONCLUSIONS The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.
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Affiliation(s)
- Francesco Molinaro
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Fusi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,
| | - Margherita Aglianò
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nila Volpi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Daniela Franci
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Paola Lorenzoni
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maddalena Messina
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Angela Galgano
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Grasso
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Rossella Angotti
- Division of Pediatric Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Plataras C, Alexandrou I, Bourikis G, Bourikas D, Christianakis E. An extremely rare case of indirect hernia type co-existing with testicular ectopia. Pan Afr Med J 2020; 35:119. [PMID: 32637017 PMCID: PMC7320778 DOI: 10.11604/pamj.2020.35.119.21129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022] Open
Abstract
We present an extremely rare case of inguinal hernia coexisting with testicular ectopia in a child. Male infant 9.5 month old presented with an empty scrotum and the ipsilateral intravaginal testis lying in a high iliac crest position. When crying a moving right inguinal bulge appeared on clinical examination. This grew bigger in moments of increased abdominal pressure and seemed to move upwards towards the right ileac crest. No abdominal wall defect could be palpated. At operation a large hernia sac fixed in the area of the right iliac crest was identified. Adjacent was the fixation point of the gubernaculum and the testis was found in an ectopic location. We removed the large sac after separating the vas and vessels and the testis and we strengthened the dorsal inguinal wall and fixed the testis in a subdartos scrotal pouch. No postoperative complications happened. An undescended testis may present as an iliac crest ectopy, coexisting with moving inguinal hernia. In our case we propose that the higher position of the aponeurosis of the external oblique in combination with ectopia of gubernacular fixation in the ipsilateral scrotum may have caused the ectopic fixation of the sac in the ipsilateral inguinal crest.
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Affiliation(s)
- Christos Plataras
- Pediatric Surgery Clinic, Penteli's Children Hospital, Attiki, Greece
| | | | - George Bourikis
- General Surgery Department, Tzanio Hospital, Piraeus, Greece
| | - Dimitris Bourikas
- Pediatric Surgery Clinic, Penteli's Children Hospital, Attiki, Greece
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Buur LE, Laurberg VR, Ernst A, Arendt LH, Nybo Andersen AM, Olsen J, Ramlau-Hansen CH. Oral contraceptive use and genital anomalies in sons. A Danish cohort study. Reprod Toxicol 2019; 89:67-73. [PMID: 31299209 DOI: 10.1016/j.reprotox.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Abstract
Exposure to exogenous sex hormones with estrogenic or anti-androgen properties may influence intrauterine development of male genitals. This population-based cohort study based on data from 44,408 live-born singleton sons in the Danish National Birth Cohort (DNBC) aimed to investigate whether maternal use of oral contraceptives prior to or during early pregnancy increase the risk of cryptorchidism or hypospadias. We found no consistent association between use of oral contraceptives and cryptorchidism or hypospadias, neither in those exposed any time four months prior to conception [cryptorchidism: adjusted Odds Ratio (aOR): 1.06 (95% CI: 0.91; 1.23), hypospadias: 0.74 (95% CI: 0.53; 1.03)] nor in those exposed any time during the first trimester of pregnancy [cryptorchidism: aOR: 0.93 (95% CI: 0.53; 1.62), hypospadias: 1.02 (95% CI: 0.32; 3.23)]. Despite relatively strong exposure levels from oral contraceptive use in pregnancy, this study revealed no evidence of an increased risk of either two genital malformations.
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Affiliation(s)
- L E Buur
- Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - V R Laurberg
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A Ernst
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - L H Arendt
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A-M Nybo Andersen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - J Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Whole-Exome Sequencing Identifies Novel Heterozygous Mutation in RAF1 in Family With Neonatal Testicular Torsion. Urology 2019; 129:60-67. [DOI: 10.1016/j.urology.2019.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022]
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Yimpring N, Teankum K, Srisuwatanasagul S, Kunnasut N, Am-In N, Suriyaphol G. Alteration of androgen receptor expression, apoptosis and cell proliferation in cryptorchid suckling, nursery and growing-finishing pigs. Theriogenology 2019; 127:49-55. [PMID: 30665073 DOI: 10.1016/j.theriogenology.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 12/18/2022]
Abstract
Cryptorchidism, a condition of one or two undescended testicles, is a common congenital disease in pigs, causing loss in the pig industry. One of the major factors affecting testicular descent is the androgen receptor (AR), which binds to androgen and then regulates the expression of androgen-responsive genes in the inguinoscrotal phase of testicular descent. AR expression has been reported to regulate apoptosis in testicular stem cells. The present study aimed to immunohistochemically examine AR and Ki-67 protein expression and apoptosis detection in unilateral undescended testicles (UDT) and descended testicles in cryptorchid pigs (DT) of suckling (aged 1-2 weeks), nursery (aged 6 weeks) and growing-finishing pigs (aged 12, 15 and 20 weeks) and in normal testicles (NT) at 1-2 and 12 weeks of age. At 1-2 weeks, decreased expression of AR was observed in UDT and DT compared with NT and was lower than that at 6-20 weeks. The expression of Ki-67, a marker of cell proliferation, in UDT and DT at 12 weeks was lower than that in NT at the same age. In addition, Ki-67 expression in UDT at 6 and 12 weeks was lower than that in UDT at 1-2 and 15-20 weeks. More testicular apoptosis was revealed in UDT at 1-2 weeks than in DT and NT at the same age. At 15-20 weeks, more apoptosis was detected in UDT than in DT. Positive correlation of AR expression in DT at 6 and 12 weeks was also noted, in addition to the association of the expression of AR and Ki-67 in NT at 12 weeks. Taken together, this study unveiled the low expression of AR and high apoptosis detection in UDT, whereas low expression of AR and low apoptosis detection were noted in DT in suckling piglets. Diminished cell proliferation was shown in UDT at 6-12 weeks, whereas high apoptosis was observed in UDT at 15-20 weeks. High expression of AR was shown only in nursery pigs. Distinct expression of AR in DT and NT at 1-2 and 12 weeks indicated that both conditions were not interchangeable.
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Affiliation(s)
- Nathamon Yimpring
- Biochemistry Unit, Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Komkrich Teankum
- Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Sayamon Srisuwatanasagul
- Department of Anatomy, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nanthida Kunnasut
- Biochemistry Unit, Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Nutthee Am-In
- Department of Obstetrics, Gynaecology and Reproduction, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Gunnaporn Suriyaphol
- Biochemistry Unit, Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.
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Rodprasert W, Virtanen HE, Mäkelä JA, Toppari J. Hypogonadism and Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:906. [PMID: 32010061 PMCID: PMC6974459 DOI: 10.3389/fendo.2019.00906] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023] Open
Abstract
Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- *Correspondence: Wiwat Rodprasert
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Juho-Antti Mäkelä
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- The Population Research Centre, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Gandhi J, Zaidi S, Suh Y, Joshi G, Smith NL, Ali Khan S. An index of inguinal and inguinofemoral masses in women: Critical considerations for diagnosis. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Rich AM, Wasserman MD, Deimel C, Breeden SK, Kaestle F, Hunt KD. Is genetic drift to blame for testicular dysgenesis syndrome in Semliki chimpanzees (Pan troglodytes schweinfurthii)? J Med Primatol 2018; 47:257-269. [PMID: 29799118 DOI: 10.1111/jmp.12352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present 3 likely cases of testicular dysgenesis syndrome (TDS) within a community of chimpanzees (Pan troglodytes schweinfurthii). We tested whether genetic drift may be the culprit, as a genetic cause has been suspected to account for TDS among other wildlife. METHODS We successfully sequenced a 367-bp segment spanning the first hypervariable region within the D-loop of the mitochondrial genome for 78 DNA samples. RESULTS We found 24 polymorphic sequence sites consisting of 7 singletons and 17 parsimony informative sites. This sample contained 9 haplotypes with a diversity index of 0.78 (SD = 0.03). All tests against the null hypothesis of neutral polymorphisms were non-significant (P > .10). The mismatch distribution of pairwise differences does not fit a Poisson's curve (raggedness index = 0.166; SSD = 0.12; P = 1). CONCLUSIONS Thus, we found no significant signs of genetic isolation, population expansion, or genetic bottleneck. Alternative causes of TDS and how they might pertain to this population are discussed.
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Affiliation(s)
- Alicia M Rich
- Department of Anthropology, Boston University, Boston, MA, USA
- Department of Anthropology, Indiana University, Bloomington, IN, USA
| | | | - Caroline Deimel
- Department of Anthropology, Indiana University, Bloomington, IN, USA
| | - Scott K Breeden
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Frederika Kaestle
- Department of Anthropology, Indiana University, Bloomington, IN, USA
| | - Kevin D Hunt
- Department of Anthropology, Indiana University, Bloomington, IN, USA
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The Role of the Appendix Testis in Normal Testicular Descent: Is There a Connection? BIOMED RESEARCH INTERNATIONAL 2018; 2018:3078031. [PMID: 29850503 PMCID: PMC5937597 DOI: 10.1155/2018/3078031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/24/2018] [Accepted: 03/18/2018] [Indexed: 11/17/2022]
Abstract
Objective The presence of testicular appendices was prospectively evaluated in 89 boys with 96 undescended testes who underwent orchidopexy over the period of 4 years. Results The patients were divided into two groups. Group A included 42 boys with 49 undescended testes positioned close to the internal inguinal ring, and Group B included 47 boys with 47 undescended testes close to the external inguinal ring. The incidence of appendix testis (AT) in Group A was 57.1% (28 in 49) and 78.7% (37 in 47) in Group B. The results of our study showed significantly decreased incidence of testicular appendices in undescended testes positioned close to the internal inguinal ring compared with undescended testes positioned close to the external inguinal ring (p < 0.05). Conclusion AT may play a role in normal testicular descent and the undescended testis positioned close to the external inguinal ring can be considered as a separate entity of the true congenital undescended testis.
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Anatomy and histology of the scrotal ligament in adults: inconsistency and variability of the gubernaculum testis. Surg Radiol Anat 2017; 40:365-370. [PMID: 28762084 DOI: 10.1007/s00276-017-1904-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The anatomy of gubernaculum testis (GT) is often discussed; however, the postnatal anatomy of the GT or scrotal ligament (SL) is rarely described. Hence, we performed an anatomical and histological study to analyze histologically the structures between testis and scrotum. METHODS We performed anatomical dissections on 25 human fresh cadavers' testes. Each testis was removed with its envelopes and macroscopically analyzed. Then samples were included for histological study. Finally, they were analyzed under microscope, looking for attachments between testis, epididymis and scrotal envelopes. RESULTS The absence of proximal and distal attachment was found in 56.0% of cases. Looking at the proximal attachment of the SL, the main one found is the epididymal attachment (28.0%), whereas no cases of testis attachment was found. Distally, there are more variations with scrotal attachment (12%) and cremaster attachment (12.0%). We found a significant prevalence of multiple adherences in 16.0% of cases too. Finally, in 15 cases (57.7%) an attachment is present between testis and epididymis, as it is commonly described. CONCLUSIONS In the majority of cases there is no attachment of the lower pole of the testis and epididymis and these structures remain free. So it seems that the SL disappears with aging. Moreover, there is not only one kind of ligamentous attachment, but a high variability of attachments at the lower pole of the testiculo-epididymal structure. When it exists, this structure is never a real ligament and it seems more appropriate to use the term "attachments".
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Wright NJ, Davidson JR, Major C, Durkin N, Tan YW, Jobson M, Ade-Ajayi N, Hall NJ, Bouhadiba N. The management of boys under 3 months of age with an inguinal hernia and ipsilateral palpable undescended testis. J Pediatr Surg 2017; 52:1108-1112. [PMID: 28292594 DOI: 10.1016/j.jpedsurg.2017.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 12/29/2022]
Abstract
AIMS The optimal management for boys under 3 months of age with an indirect inguinal hernia (IIH) and ipsilateral palpable undescended testis (IPUDT) is unknown. We aimed to: 1) determine the current practice for managing these boys across the UK, and 2) compare outcomes of different treatment strategies. METHODOLOGY We undertook two studies. Firstly, we completed a National Survey of all surgeons on the British Association of Paediatric Surgeons email list in 2014. Subsequently, we undertook a multi-centre, retrospective, 10-year (2005-2015) review across 4 pediatric surgery centers of boys under 3months of age with concomitant IIH and IPUDT. Primary outcome was testicular atrophy. Secondary outcomes included need for subsequent orchidopexy, testicular ascent and hernia recurrence. Data are presented as median (range). Chi-squared test and multivariate binomial logistic regression analysis were used for analysis; p<0.05 was considered significant. RESULTS Survey: Consultant practice varies widely across the UK, with a tendency towards performing concurrent orchidopexy at the time of herniotomy under 3 months of age. Concurrent orchidopexy is favored less in cases where the hernia is symptomatic. Case Series Review: Forty-one boys with 43 concomitant IIH and IPUDT were identified, and all included. 32 (74%) hernias were reducible, 11 (26%) were symptomatic requiring urgent or emergency repair. Post-conceptual age at surgery was 45weeks (36-65). Primary operations included: 29 (67%) open hernia repair and standard orchidopexy, 8 (19%) open hernia repair with future orchidopexy if required, 4 (9%) laparoscopic hernia repair with future orchidopexy if required, 2 (5%) open hernia repair and suturing of the testis to the inverted scrotum without scrotal incision. Variation in atrophy rate between different surgical approaches did not reach statistical significance (p=0.42). Overall atrophy rate was 18%. If hernia repair alone was undertaken (8 open and 4 laparoscopic), the testis did not descend in 8 patients, requiring subsequent orchidopexy (67%); if orchidopexy was undertaken at the time of hernia repair, 1 in 29 required a repeat orchidopexy (3%) (p=0.0001). No hernia recurred. CONCLUSION This study suggests that orchidopexy at the time of inguinal herniotomy does not increase the risk of testicular atrophy in boys under 3months of age.
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Affiliation(s)
- Naomi J Wright
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK.
| | - Joseph R Davidson
- Department of Paediatric Surgery, University Hospital Lewisham, London, UK
| | - Christina Major
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK
| | - Natalie Durkin
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Yew-Wei Tan
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Matthew Jobson
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Nigel J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nordeen Bouhadiba
- Department of Paediatric Surgery, Evelina Children's Hospital, Guy's and St.Thomas' NHS Trust, London, UK; Department of Paediatric Surgery, University Hospital Lewisham, London, UK
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An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report. Int J Surg Case Rep 2017; 31:193-196. [PMID: 28171846 PMCID: PMC5295633 DOI: 10.1016/j.ijscr.2017.01.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights. PRESENTATION OF CASE An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, computed tomography scan revealed a round lesion in the hernia sac, which was suspected to be the ectopic testis. Laparoscopic exploration was performed in combination with an open anterior approach. The hernia orifice was the right internal inguinal ring, and the inguinal canal was obliterated by adhesions because the spermatic cord did not pass through it. The ectopic testis was resected with the hernia sac, and the hernia repaired with a KUGEL™ patch (Bard, USA). DISCUSSION Laparoscopic exploration was useful to delineate the anatomy of this unusual inguinal hernia. The open anterior approach was necessary to dissect the ectopic testis and the hernia sac. Pathological findings revealed tumor cells with clear cytoplasm in the resected testis, diagnosed as a Leydig cell tumor. CONCLUSION The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.
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22
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Arendt LH, Ramlau-Hansen CH, Wilcox AJ, Henriksen TB, Olsen J, Lindhard MS. Placental Weight and Male Genital Anomalies: A Nationwide Danish Cohort Study. Am J Epidemiol 2016; 183:1122-8. [PMID: 27257113 DOI: 10.1093/aje/kwv336] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
The most consistently reported risk indicators for the male genital anomalies cryptorchidism and hypospadias are prematurity and low birth weight. Placental dysfunction has been hypothesized as a possible underlying cause, and an association between placental weight at birth and hypospadias has been indicated. In a population-based cohort of 388,422 Danish singleton boys born alive (1997-2008), we studied the association between placental weight and cryptorchidism and hypospadias. Missing data were handled with multiple imputation, and we estimated hazard ratios by means of Cox regression models. During follow-up, 1,713 boys were diagnosed with hypospadias and 6,878 with cryptorchidism (3,624 underwent corrective surgery). We observed an association between low placental weight and risk of both genital anomalies. Boys with a placental weight in the lowest decile (<10%) had higher risks of both cryptorchidism (hazard ratio = 1.52, 95% confidence interval: 1.31, 1.76) and hypospadias (hazard ratio = 1.97, 95% confidence interval: 1.59, 2.45) than boys in the reference decile (50.0-59.9%). In conclusion, we found higher risks of both genital malformations in boys born with a low placental weight. The relationship seemed stronger for hypospadias than for cryptorchidism. Taken together, our data support a role for placental dysfunction in the etiology of these anomalies.
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Irsi C, Karacı M. Gubernaculum with a long loop vas deferens. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Daniel G, Coleman R. Staged rotation flap scrotoplasty and orchidopexy in a patient with inguinal ectopic scrotum. J Surg Case Rep 2015; 2015:rjv137. [PMID: 26518318 PMCID: PMC4626801 DOI: 10.1093/jscr/rjv137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Ectopic scrotum is a rare and unusual presentation to paediatric urology. It is usually characterized by accessory scrotum with adequate scrotum in the anatomically normal position. We describe a case of inguinal ectopia of the right hemiscrotum containing the right testis, and its staged surgical management by rotation flap scrotoplasty and subsequent orchidopexy.
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Affiliation(s)
- Gwion Daniel
- Department of Urology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Robert Coleman
- Department of Urology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
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Costa SF, Costa WS, Sampaio FJ, Favorito LA. Structural Study of Gubernaculum Testis in Fetuses with Prune Belly Syndrome. J Urol 2015; 193:1830-6. [DOI: 10.1016/j.juro.2014.06.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Suelen F. Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Waldemar S. Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciano A. Favorito
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Zhang X, Ke S, Chen KH, Li JH, Ma L, Jiang XW. Diethylstilbestrol affects the expression of GPER in the gubernaculum testis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:7217-22. [PMID: 26261617 PMCID: PMC4525951 DOI: pmid/26261617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/22/2015] [Indexed: 02/05/2023]
Abstract
Recent evidence suggested a positive correlation between environmental estrogens (EEs) and high incidence of abnormalities in male urogenital system. EEs are known to cause the abnormalities of testes development and testicular descent. Diethylstilbestrol (DES) is a nonsteroidal synthetic estrogen that disrupts the morphology and proliferation of gubernacular cells, and its nongenomic effects on gubernaculum testis cells may be mediated by G protein-coupled estrogen receptor (GPER). In this study, we detected the expression of GPER in mouse gubernacular testis and investigated the effects of DES on the expression of GPER in gubernaculum testis cells. RT-PCR analysis revealed that GPER mRNA was expressed in the gubernaculum. GPER protein was detected in the parenchymal cells of the gubernaculum early in development. Furthermore, we demonstrate that GPER inhibitor G15 relieved DES-induced inhibition of GPER expression in gubernaculum testis cell, but ER inhibitor ICI 182780 had the converse effects on DES-induced inhibition of GPER expression in these cells. These data suggest that the effects of DES on mouse gubernaculum testis cells are mediated at least partially by the regulation of GPER expression.
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Affiliation(s)
- Xuan Zhang
- Department of Pediatric Surgery, The Affiliated Maternal and Child Health Hospital of Shenzhen University Medical CollegeShenzhen, Guangdong, China
| | - Song Ke
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong, China
| | - Kai-Hong Chen
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong, China
| | - Jian-Hong Li
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong, China
| | - Lian Ma
- Department of Pediatric, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong, China
| | - Xue-Wu Jiang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong, China
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Cryptorchidism and infertility in rats with targeted disruption of the Adamts16 locus. PLoS One 2014; 9:e100967. [PMID: 24983376 PMCID: PMC4077762 DOI: 10.1371/journal.pone.0100967] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022] Open
Abstract
A Disintegrin And Metalloproteinase with ThromboSpondin motifs16 (ADAMTS-16) is a member of a family of metalloproteinases. Using a novel zinc-finger nuclease based gene-edited rat model harboring a targeted mutation of the Adamts16 locus, we previously reported this gene to be linked to blood pressure regulation. Here we document our observation with this model that Adamts16 is essential for normal development of the testis. Absence of Adamts16 in the homozygous Adamts16mutant males resulted in cryptorchidism and male sterility. Heterozygous Adamts16mutant males were normal, indicating that this is a recessive trait. Testes of homozygous Adamts16mutant males were significantly smaller with significant histological changes associated with the lack of sperm production. Temporal histological assessments of the testis demonstrated that the seminiferous tubules did not support active spermatogenesis, but progressively lost germ cells, accumulated vacuoles and did not have any sperm. These observations, taken together with our previous report of renal abnormalities observed with the same Adamts16mutant rats, suggest an important mechanistic link between Adamts16 and the functioning of the male genitourinary system.
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Arslan Y, Karaman K, Altintoprak F, Kahyaoglu Z, Zengin I, Uzunoglu MY, Demir H. Indirect inguinal hernia sac containing testis and spermatic cord in an adult patient with cryptorchidism. J Surg Case Rep 2014; 2014:rju017. [PMID: 24876399 PMCID: PMC4197921 DOI: 10.1093/jscr/rju017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sliding hernias are those in which part of the sac wall is formed by a retroperitoneal organ and/or its mesentery protruding outside the abdominal wall cavity. The hernia sac may contain jejunum, ileum, vermiform appendix, Meckel's diverticulum, stomach, ovary, fallopian tube or urinary bladder. Our report features an adult case with cryptorchidism in which testis and spermatic cord constitute a component of the indirect inguinal hernia sac.
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Affiliation(s)
- Yusuf Arslan
- Department of General Surgery, Sakarya Teaching and Research Hospital, Sakarya, Turkey
| | - Kerem Karaman
- Department of General Surgery, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Zeynep Kahyaoglu
- Department of Pathology, Sakarya Teaching and Research Hospital, Sakarya, Turkey
| | - Ismail Zengin
- Department of General Surgery, Sakarya Teaching and Research Hospital, Sakarya, Turkey
| | | | - Hakan Demir
- Department of General Surgery, Sakarya Teaching and Research Hospital, Sakarya, Turkey
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Szarek M, Li R, Vikraman J, Southwell B, Hutson JM. Molecular signals governing cremaster muscle development: clues for cryptorchidism. J Pediatr Surg 2014; 49:312-6; discussion 316. [PMID: 24528975 DOI: 10.1016/j.jpedsurg.2013.11.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND/AIM Cryptorchidism affects 2-4% of newborn boys. Testicular descent requires the gubernaculum to differentiate into cremaster muscle (CM) during androgen-mediated inguino-scrotal descent, but the cellular mechanisms regulating this remodeling remain elusive. β-Catenin, a marker of canonical Wnt signaling, promotes myogenic genes and cellular adhesion. We aimed to determine if androgen receptor (AR) blockade altered β-catenin and its downstream myogenic proteins within the CM. METHOD Gubernacula from male rats (n=12) and rats treated with anti-androgen, flutamide (n=12) at E19, D0, D2 were processed for immunohistochemistry. Antibodies against β-catenin, embryonic myosin, and myogenin were visualized by confocal microscopy. RESULTS At E19, β-catenin immuno-reactivity (IR) localized to the CM membrane. By D2, cytoplasmic β-catenin-IR was noted with overall β-catenin-IR decreasing. Myogenic proteins resided primarily in cells containing β-catenin on their plasma membrane. Embryonic myosin-IR was high at E19 and then decreased by D2, while myogenin-IR increased. AR blockade increased cytoplasmic β-catenin at D2 and reduced levels of both myogenic proteins. CONCLUSION Myogenic proteins are present in CM cells containing β-catenin. AR blockade did not alter cellular adhesion via β-catenin. In contrast, blocking AR prevented β-catenin entering the nucleus and impaired CM myogenesis. Mutations in this pathway may result in idiopathic cryptorchidism.
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Affiliation(s)
- Maciej Szarek
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Anatomy and Neuroscience, University of Melbourne, Australia
| | - Ruili Li
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jaya Vikraman
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Bridget Southwell
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - John M Hutson
- Douglas Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Anatomy and Neuroscience, University of Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Urology Department, Royal Children's Hospital, Melbourne, Australia.
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Alagaratnam S, Nathaniel C, Cuckow P, Duffy P, Mushtaq I, Cherian A, Desai D, Kiely E, Pierro A, Drake D, De Coppi P, Cross K, Curry J, Smeulders N. Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy. J Pediatr Urol 2014; 10:186-92. [PMID: 24045121 DOI: 10.1016/j.jpurol.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO). PATIENTS AND METHODS Retrospective review of 94 children (aged 0.75-16 years, median 2.75 years), who underwent L2(nd)FSO for 113 intra-abdominal testes between January 2000 and May 2009: 75 unilateral, 19 bilateral (11 synchronous; 8 metachronous). Follow-up (range 3 months-10.9 years, median 2.1 years) was available for 88 children (102 testes: 71 unilateral, 31 bilateral). RESULTS Testicular atrophy occurred in 9 out of 102 (8.8%), including 8 out of 71 (11.3%) unilateral and 1 out of 31 (3.2%) bilateral intra-abdominal testes (multivariate analysis: p = 0.59). Testicular ascent ensued in 9 out of 102 (8.8%), comprising four (5.6%) unilateral and five (16.1%) bilateral testicles (multivariate analysis: p = 0.11). Of the 18 bilateral testes brought to the scrotum synchronously none atrophied and four (22.2%) ascended, compared to one (7.7%) atrophy and one (7.7%) ascent among the 13 testes brought to the scrotum on separate occasions (Fisher exact test: p = 0.42 and p = 0.37, respectively). Mobilization of the testis through the conjoint tendon tended towards less ascent (multivariate analysis p = 0.08) but similar atrophy (p = 0.56) compared to mobilization through the deep-ring/inguinal canal. Logistical regression analysis identified no other patient or surgical factors influencing outcome. CONCLUSIONS This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.
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Affiliation(s)
- Swethan Alagaratnam
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Calvin Nathaniel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Peter Cuckow
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Patrick Duffy
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Abraham Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Divyesh Desai
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Edward Kiely
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Agostino Pierro
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - David Drake
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Kate Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
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Hutson JM, Southwell BR, Li R, Lie G, Ismail K, Harisis G, Chen N. The regulation of testicular descent and the effects of cryptorchidism. Endocr Rev 2013; 34:725-52. [PMID: 23666148 DOI: 10.1210/er.2012-1089] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The first half of this review examines the boundary between endocrinology and embryonic development, with the aim of highlighting the way hormones and signaling systems regulate the complex morphological changes to enable the intra-abdominal fetal testes to reach the scrotum. The genitoinguinal ligament, or gubernaculum, first enlarges to hold the testis near the groin, and then it develops limb-bud-like properties and migrates across the pubic region to reach the scrotum. Recent advances show key roles for insulin-like hormone 3 in the first step, with androgen and the genitofemoral nerve involved in the second step. The mammary line may also be involved in initiating the migration. The key events in early postnatal germ cell development are then reviewed because there is mounting evidence for this to be crucial in preventing infertility and malignancy later in life. We review the recent advances in what is known about the etiology of cryptorchidism and summarize the syndromes where a specific molecular cause has been found. Finally, we cover the recent literature on timing of surgery, the issues around acquired cryptorchidism, and the limited role of hormone therapy. We conclude with some observations about the differences between animal models and baby boys with cryptorchidism.
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Affiliation(s)
- John M Hutson
- Urology Department, Royal Children's Hospital, Parkville 3052, Victoria, Australia.
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Campion S, Catlin N, Heger N, McDonnell EV, Pacheco SE, Saffarini C, Sandrof MA, Boekelheide K. Male reprotoxicity and endocrine disruption. EXPERIENTIA SUPPLEMENTUM (2012) 2012; 101:315-60. [PMID: 22945574 DOI: 10.1007/978-3-7643-8340-4_11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mammalian reproductive tract development is a tightly regulated process that can be disrupted following exposure to drugs, toxicants, endocrine-disrupting chemicals (EDCs), or other compounds via alterations to gene and protein expression or epigenetic regulation. Indeed, the impacts of developmental exposure to certain toxicants may not be fully realized until puberty or adulthood when the reproductive tract becomes sexually mature and altered functionality is manifested. Exposures that occur later in life, once development is complete, can also disrupt the intricate hormonal and paracrine interactions responsible for adult functions, such as spermatogenesis. In this chapter, the biology and toxicology of the male reproductive tract is explored, proceeding through the various life stages including in utero development, puberty, adulthood, and senescence. Special attention is given to the discussion of EDCs, chemical mixtures, low-dose effects, transgenerational effects, and potential exposure-related causes of male reproductive tract cancers.
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Affiliation(s)
- Sarah Campion
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912, USA
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