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Ramirez-Fort MK, Kardoust-Parizi M, Flannigan R, Bach P, Koch N, Gilman C, Suarez P, Fort DV, McClelland S, Lange CS, Mulhall JP, Fort M, Schlegel PN. Preservation of male fertility in patients undergoing pelvic irradiation. Rep Pract Oncol Radiother 2024; 28:835-845. [PMID: 38515820 PMCID: PMC10954274 DOI: 10.5603/rpor.98731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/04/2023] [Indexed: 03/23/2024] Open
Abstract
As the number of cancer survivors increases, so does the demand for preserving male fertility after radiation. It is important for healthcare providers to understand the pathophysiology of radiation-induced testicular injury, the techniques of fertility preservation both before and during radiation, and their role in counseling patients on the risks to their fertility and the means of mitigating these risks. Impaired spermatogenesis is a known testicular toxicity of radiation in both the acute and the late settings, as rapidly dividing spermatogonial germ cells are exquisitely sensitive to irradiation. The threshold for spermatogonial injury and subsequent impairment in spermatogenesis is ~ 0.1 Gy and the severity of gonadal injury is highly dose-dependent. Total doses < 4 Gy may allow for recovery of spermatogenesis and fertility potential, but with larger doses, recovery may be protracted or impossible. All patients undergoing gonadotoxic radiation therapy should be counseled on the possibility of future infertility, offered the opportunity for semen cryopreservation, and offered referral to a fertility specialist. In addition to this, every effort should be made to shield the testes (if not expected to contain tumor) during therapy.
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Affiliation(s)
- Marigdalia K. Ramirez-Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Mehdi Kardoust-Parizi
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Flannigan
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Phil Bach
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | - Nicholas Koch
- Department of Medical Physics, CONE Health, Greensboro, NC, United States
| | - Casey Gilman
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Paula Suarez
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Digna V. Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
| | - Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Christopher S. Lange
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
- Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
| | - John P. Mulhall
- Department of Sexual and Reproductive Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Migdalia Fort
- Life Sciences & BioDefense, BioFort Corp, Guaynabo, Puerto Rico, United States
| | - Peter N. Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
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Yurtsever I, Yıldız S, Amirjanov S, Yozgat CY, Balsak S, Peker AA, Atasoy B, Erol AB, Toluk O, Aydoğdu İ. Diagnostic role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study. J Ultrason 2024; 24:1-7. [PMID: 38343787 PMCID: PMC10850941 DOI: 10.15557/jou.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/11/2023] [Indexed: 04/26/2024] Open
Abstract
Aim Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes. Material and methods Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group. Results Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group's echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes. Conclusion The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.
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Affiliation(s)
- Ismail Yurtsever
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Seyma Yıldız
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Samil Amirjanov
- Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Can Yılmaz Yozgat
- Faculty of Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Bahar Atasoy
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Berk Erol
- Faculty of Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Toluk
- Biostatistics, Bezmialem Vakif University, Istanbul, Turkey
| | - İbrahim Aydoğdu
- Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Murine model indicates 22q11.2 signaling adaptor CRKL is a dosage-sensitive regulator of genitourinary development. Proc Natl Acad Sci U S A 2017; 114:4981-4986. [PMID: 28439006 DOI: 10.1073/pnas.1619523114] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The spectrum of congenital anomalies affecting either the upper tract (kidneys and ureters) or lower tract (reproductive organs) of the genitourinary (GU) system are fundamentally linked by the developmental origin of multiple GU tissues, including the kidneys, gonads, and reproductive ductal systems: the intermediate mesoderm. Although ∼31% of DiGeorge/del22q11.2 syndrome patients exhibit GU defects, little focus has been placed on the molecular etiology of GU defects in this syndrome. Among del22q11.2 patients exhibiting GU anomalies, we have mapped the smallest relevant region to only five genes, including CRKLCRKL encodes a src-homology adaptor protein implicated in mediating tyrosine kinase signaling, and is expressed in the developing GU-tract in mice and humans. Here we show that Crkl mutant embryos exhibit gene dosage-dependent growth restriction, and homozygous mutants exhibit upper GU defects at a microdissection-detectable rate of 23%. RNA-sequencing revealed that 52 genes are differentially regulated in response to uncoupling Crkl from its signaling pathways in the developing kidney, including a fivefold up-regulation of Foxd1, a known regulator of nephron progenitor differentiation. Additionally, Crkl heterozygous adult males exhibit cryptorchidism, lower testis weight, lower sperm count, and subfertility. Together, these data indicate that CRKL is intimately involved in normal development of both the upper and lower GU tracts, and disruption of CRKL contributes to the high incidence of GU defects associated with deletion at 22q11.2.
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Okpe GC, Ezeasor DN. Influence of naturally unilateral cryptorchidism on the histomorphometry of the testes and daily sperm production in West African Dwarf goats. IRANIAN JOURNAL OF VETERINARY RESEARCH 2016; 17:13-19. [PMID: 27656223 PMCID: PMC4898014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/28/2015] [Accepted: 11/17/2015] [Indexed: 06/06/2023]
Abstract
Quantitative histology of the descended testis of unilateral cryptorchid bucks was compared with testis of normal bucks to evaluate the reproductive potentials of the scrotal testis in unilateral cryptorchids, using light microscopy techniques. The contralateral scrotal testes of the unilateral cryptorchids and the testes of the normal bucks contained profiles of seminiferous epithelium and each showed histological evidence of normal activity. The mean heights, lengths, lumen diameter, diameter of the seminiferous tubules were significantly higher in the contralateral scrotal testes when compared to the retained testes of the unilateral cryptorchid bucks (P<0.05). Population of spermatogenic cells per testis, and ratio of germ cells to Sertoli cells were not significantly different between both groups. The percentage of the testes occupied by various germ cells did not differ between the scrotal testis of the cryptorchid bucks and those of the normal bucks. The volume occupied by the seminiferous tubules and Leydig cells in the contralateral scrotal testis of the unilateral cryptorchid bucks were significantly greater than those of the testis of normal bucks (P<0.05). From the findings, it appears that the spermatogenic efficiency of the scrotal testes of the unilateral cryptorchid bucks was significantly higher than those of the normal bucks.
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Affiliation(s)
- G. C. Okpe
- Correspondence: G. C. Okpe, Department of Veterinary Anatomy, University of Nigeria, Nsukka, 410001, Nigeria. E-mail:
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