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Moradi I, Finkelstein P, Paturi A, Shojai Rahnama B, O'Connor J. Bilateral Inguinal Hernias Masking Cryptorchidism: A Case Report. Cureus 2024; 16:e64103. [PMID: 39114228 PMCID: PMC11305693 DOI: 10.7759/cureus.64103] [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] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This case report discusses the uncommon occurrence of bilateral inguinal hernias masking cryptorchidism in a 47-year-old male, emphasizing the complexities and nuances of diagnosing and managing undescended testes in adults. Cryptorchidism is most often identified and treated during infancy; however, its rare adult manifestation presents significant diagnostic challenges and is fraught with serious implications for fertility and malignancy if left untreated. The subject presented with long-standing bilateral groin discomfort and was initially evaluated using clinical examination and CT imaging, which diagnosed bilateral inguinal hernias but did not initially detect cryptorchidism. During the staged surgical repairs, the testes were unexpectedly discovered within the hernia sacs, significantly altering the surgical approach and postoperative management. This necessitated an intraoperative consultation and collaboration between general surgery and urology, highlighting the critical role of multidisciplinary teamwork in managing complex surgical cases. The report underscores the importance of meticulous preoperative assessment and raises awareness about the potential for unusual findings in adult inguinal hernia repairs. This case report stresses the need for careful postoperative follow-up and regular urological surveillance to monitor for potential complications, including the development of testicular cancer. This case contributes valuable insights into the management strategies and long-term considerations for adult cryptorchidism, reinforcing the need for heightened clinical suspicion in similar presentations to ensure optimal patient outcomes.
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Affiliation(s)
- Iman Moradi
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Paige Finkelstein
- General Surgery, Columbia University Business School, New York City, USA
| | - Akil Paturi
- Orthopaedics, St. George's University School of Medicine, St. George's, GRD
| | | | - James O'Connor
- General Surgery, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, USA
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2
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Ates F, Sivri M, Durmaz MS, Sekmenli T, Gunduz M, Ciftci I. Comparison of conventional Doppler imaging techniques and superb microvascular imaging in determination of vascularization in undescended testes. J Ultrason 2023; 23:e66-e72. [PMID: 37520746 PMCID: PMC10379854 DOI: 10.15557/jou.2023.0013] [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: 12/21/2021] [Accepted: 01/31/2023] [Indexed: 08/01/2023] Open
Abstract
Aim Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes. Material and methods We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume. Results Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes. Conclusions The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes.
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Affiliation(s)
- Fatih Ates
- Department of Radiology, Medicine Faculty, Selçuk University, Konya, Turkey
| | - Mesut Sivri
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | | | - Tamer Sekmenli
- Department of Pediatric Surgery, Selçuk University Medical School, Konya, Turkey
| | - Metin Gunduz
- Department of Pediatric Surgery, Selçuk University Medical School, Konya, Turkey
| | - Ilhan Ciftci
- Department of Pediatric Surgery, Selçuk University Medical School, Konya, Turkey
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3
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Chai S, Tian R, Xu S, Ren W, Yang G. Evolution of Fertilization-Related Genes Provides Insights Into Reproductive Health in Natural Ascrotal Mammals. Front Ecol Evol 2022. [DOI: 10.3389/fevo.2021.828325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cryptorchidism is the failure of one or both testes to descend into the bottom of the scrotum. This common congenital malformation in humans and domestic animals is the best characterized risk factor for abnormal sperm functions and infertility. However, current treatment approaches for cryptorchidism do not ensure paternity in all cases. Some lineages of mammals (such as elephants and cetaceans) have natural ascrotal testes (i.e., undescended or incompletely descended testes) and normal sperm motility and fertility, providing an opportunity to understand the genetic basis of cryptorchidism. In this study, we showed that genes associated with sperm motility and competition/fertility in ascrotal mammals experienced frequent, strong selective pressure. The fixation of specific amino acids and positive selection in ascrotal mammals could affect the physicochemical properties and functions of fertilization-related proteins. In a comparison between mammals with undescended testes and incompletely descended testes, discrepancies in genes showing evidence for adaptive evolution and in functional enrichment suggested that multiple molecular mechanisms contribute to the maintenance of fertility in the challenging testicular environment. Our findings revealed substantial heterogeneity in the divergence of fertilization-related genes between natural scrotal and ascrotal mammals and provide insight into molecular mechanisms underlying normal sperm motility and competition in natural ascrotal mammals. We provide a detailed theoretical basis for understanding the pathology of cryptorchidism from a molecular evolutionary perspective. This study may contribute to the establishment of diagnostic and therapeutic targets for sperm motility and fertility disorders due to congenital cryptorchidism in humans and domestic animals.
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4
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Liu J, Xiu W, Sui B, Jin Z, Xu X, Xia N, Duan G. Open controversies on the treatment of undescended testis: An update. Front Pediatr 2022; 10:874995. [PMID: 35967583 PMCID: PMC9363670 DOI: 10.3389/fped.2022.874995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022] Open
Abstract
Cryptorchidism is a common congenital malformation in pediatric urology. Although there have been many studies on the etiology of the disease, it has not been fully clarified, and while its diagnostic and treatment models have gradually approached standardization and systematization, some controversies regarding treatment remain. Additionally, although ultrasound is a non-invasive examination without ionizing radiation, its role in the evaluation of cryptorchidism remains controversial. The main basis for treating cryptorchidism is orchidopexy, and the main view on treatment age is that treatment should be performed between 6 and 12 months after birth, but no more than 18 months after birth. The view on hormone therapy is still controversial because most scholars believe that early surgery is the key to treatment. There are many surgical treatment methods for cryptorchidism, including traditional open surgery and laparoscopic surgery, which provide satisfactory results. In conclusion, the treatment of undescended testis (UDT) had been largely standardized, apart from the treatment of high intra-abdominal testis (IAT), which remains a matter of debate.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Wenli Xiu
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, Qingdao, China.,Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Bangzhi Sui
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Zhiyuan Jin
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xudong Xu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nan Xia
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, Qingdao, China.,Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
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5
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Fertility of Cryptorchid Testis-An Unsolved Mistery. Genes (Basel) 2021; 12:genes12121894. [PMID: 34946843 PMCID: PMC8700981 DOI: 10.3390/genes12121894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 01/21/2023] Open
Abstract
Cryptorchidism (undescended testis) is one of the most common diagnoses in the pediatric urologist office. Even in the modern era, there still are a lot of debates regarding the optimal time for surgery related to the expected results in relation with the testicular function, including fertility. The review below intends to clarify issues regarding the impact of cryptorchidism on testicular histology and function, semen analysis, the relation between hormonal and surgical treatment, future fertility, and paternity rate.
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6
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Vahidi S, Horoki AZ, Talkhooncheh MH, Jambarsang S, Marvast LD, Sadeghi A, Eskandarian S. Success rate and ART outcome of microsurgical sperm extraction in non obstructive azoospermia: A retrospective study. Int J Reprod Biomed 2021; 19:781-788. [PMID: 34723057 PMCID: PMC8548745 DOI: 10.18502/ijrm.v19i9.9710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/29/2020] [Accepted: 02/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background The management of non-obstructive azoospermia (NOA) disease relies on microdissection testicular sperm extraction (micro-TESE). Few studies have assessed the role of micro-TESE in men with NOA in our country. Objective The aim of the current study was to investigate the success rate of micro-TESE. Materials and Methods This retrospective descriptive-analytical study was conducted on 463 men with NOA in Yazd Reproductive Sciences Institute during September 2017 through September 2019. Sperm were retrieved and frozen according to the rapid sperm freezing protocol. After preparing the oocyte of the male partner's spouse, sperms were thawed and then entered the intracytoplasmic sperm injection process. The clinical pregnancy of individuals was confirmed via ultrasound. Demographic data were extracted from medical records. Results The success rate of micro-TESE was 38% and successful fertilization, biochemical pregnancy, clinical pregnancy, and live birth were observed in 111 (85.4%), 29 (22.3%), 29 (22.3%) and 14 (10.7%) men, respectively. A significant difference was seen between the two groups, regarding age (p = 0.01). In addition, the mean follicle-stimulating hormone in men with positive micro-TESE was significantly lower than in men with negative micro-TESE (p = 0.02). Conclusion The success of pregnancy in couples with NOA managed via micro-TESE was significant. The study found that the success rate of micro-TESE was higher in older men and in those with lower follicle-stimulating hormone levels.
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Affiliation(s)
- Serajoddin Vahidi
- Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Zare Horoki
- Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sara Jambarsang
- Department of Bio-Statistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Laleh Dehghan Marvast
- Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Sadeghi
- Department of Surgical Technology, Faculty of Paramedical, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samane Eskandarian
- Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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7
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Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021; 106:e442-e459. [PMID: 33295608 PMCID: PMC7823320 DOI: 10.1210/clinem/dgaa781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date. EVIDENCE ACQUISITION The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail. EVIDENCE SYNTHESIS/RESULTS Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking. CONCLUSIONS Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.
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Affiliation(s)
- Aditi Sharma
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
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8
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Barbotin AL, Dauvergne A, Dumont A, Ramdane N, Mitchell V, Rigot JM, Boitrelle F, Robin G. Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes. Asian J Androl 2020; 21:445-451. [PMID: 30880688 PMCID: PMC6732891 DOI: 10.4103/aja.aja_2_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l−1vs 19.3 IU l−1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.
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Affiliation(s)
- Anne-Laure Barbotin
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Anaïs Dauvergne
- CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Agathe Dumont
- CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Nassima Ramdane
- CHU Lille, Department of Biostatistics, EA2694, Lille University, F-59000 Lille, France
| | - Valérie Mitchell
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Jean-Marc Rigot
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Florence Boitrelle
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303 Poissy, France
| | - Geoffroy Robin
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France.,CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
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9
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Black LD, Godart ES, Turek PJ, Ryan IP. Fertility Preservation for Genetic Indication. CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Jay MA, Arat A, Wijlaars L, Ajetunmobi O, Fitzpatrick T, Lu H, Lei S, Skerritt C, Goldfeld S, Gissler M, Gunnlaugsson G, Hrafn Jónsson S, Hjern A, Guttmann A, Gilbert R. Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study. BJS Open 2020; 4:1117-1124. [PMID: 32706149 PMCID: PMC7709362 DOI: 10.1002/bjs5.50329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.
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Affiliation(s)
- M. A. Jay
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - A. Arat
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - L. Wijlaars
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - O. Ajetunmobi
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - S. Lei
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
| | - C. Skerritt
- Bristol Royal Hospital for ChildrenBristolUK
| | - S. Goldfeld
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - M. Gissler
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Information Services DepartmentFinnish Institute for Health and WelfareHelsinkiFinland
| | - G. Gunnlaugsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - S. Hrafn Jónsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - A. Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - A. Guttmann
- Child Health Evaluative SciencesCanada
- Division of Paediatric Medicine, Hospital for Sick ChildrenCanada
- ICESCanada
- Dalla Lana School of Public HealthCanada
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - R. Gilbert
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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Alumeti Munyali D, Tetsatsi Momo AC, Bonsou Fozin GR, Deeh Defo PB, Petnga Tchatat Y, Lieunang B, Watcho P. Rubus apetalus (Rosaceae) improves spermatozoa characteristics, antioxidant enzymes and fertility potential in unilateral cryptorchid rats. Basic Clin Androl 2020; 30:8. [PMID: 32670587 PMCID: PMC7346424 DOI: 10.1186/s12610-020-00107-3] [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: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cryptorchidism (CPT) is an important cause of male infertility. Rubus apetalus is a medicinal plant with a powerful antioxidant potential. We investigated the effects of aqueous and methanolic extracts of R. apetalus on spermatozoa parameters, antioxidant enzymes and fertility potential of rats with experimental unilateral CPT. METHOD Normal (n = 15), sham-operated (n = 15) and cryptorchid rats (n = 80; distributed into 16 groups of 5 rats/group) were treated for 2, 4 or 8 weeks with either distilled water (10 ml/kg/day), vitamin E (75 mg/kg/day), aqueous or methanolic extract of R. apetalus (12 and 60 mg/kg). Sex organ weights, spermatozoa parameters, testicular proteins, sex hormones, fertility potential, morphometric characteristics of testis and oxidative stress markers were measured. RESULTS CPT significantly (p < 0.05-0.001) decreased testicular and epididymal weights, spermatozoa density, spermatozoa motility, spermatozoa normality, testicular proteins, LH, FSH and testosterone concentrations. In cryptorchid rats, peri-vascular fibrosis significantly increased (p < 0.001), while diameter of the seminiferous tube, germ cell thickness, gestation index and fertility index decreased when compared to control. Additionally, CPT induced oxidative stress by increasing lipid peroxidation and by reducing superoxide dismutase and catalase activities. These alterations were corrected by R. apetalus. For instance, a significantly increase (p < 0.05-0.001) in spermatozoa motility, normality, viability and density after 2, 4 and 8 weeks of treatment was noticed. R. apetalus also increased (p < 0.05-0.001) testicular proteins, gestation index (90-100%) and fertility index (90-100%), compared to the untreated cryptorchid rats. CONCLUSION R. apetalus boosts fertility potential in cryptorchid rats and could be considered as a promising alternative agent for the management of infertility associated with CPT.
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Affiliation(s)
- Désiré Alumeti Munyali
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
- School of Medicine and Community Health, Université Evangelique en Afrique, Bukavu, Democratic Republic of Congo
| | - Aimé Césaire Tetsatsi Momo
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
| | - Georges Romeo Bonsou Fozin
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
| | - Patrick Brice Deeh Defo
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
| | - Yannick Petnga Tchatat
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
| | - Boris Lieunang
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
| | - Pierre Watcho
- Research Unit of Animal Physiology and Phytopharmacology (URPAP), Faculty of Science, University of Dschang, Dschang, Box 67, Dschang, Cameroon
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12
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Zhao TX, Liu B, Wei YX, Wei Y, Tang XL, Shen LJ, Long CL, Lin T, Wu SD, Wei GH. Clinical and socioeconomic factors associated with delayed orchidopexy in cryptorchid boys in China: a retrospective study of 2423 cases. Asian J Androl 2020; 21:304-308. [PMID: 30632485 PMCID: PMC6498732 DOI: 10.4103/aja.aja_106_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR] = 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.
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Affiliation(s)
- Tian-Xin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Bin Liu
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yue-Xin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiang-Liang Tang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Lian-Ju Shen
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Chun-Lan Long
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Sheng-De Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Nazem M, Hosseinpour M, Alghazali A. Trans-scrotal Incision Approach versus Traditional Trans-scrotal Incision Orchiopexy in Children with Cryptorchidism: A Randomized Trial Study. Adv Biomed Res 2019; 8:34. [PMID: 31259163 PMCID: PMC6543866 DOI: 10.4103/abr.abr_26_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Although undescended testis (UDT) is the most prevalent malformation in male neonates, the best mode of UDT treatment remains controversial. This study aimed to compare trans-scrotal incision approach with traditional trans-scrotal incision orchiopexy in children suffering from cryptorchidism. Materials and Methods: This single-blind randomized clinical trial was done on 100 children with UDT who needed surgery. The participants were alternately undergoing trans-scrotal incision orchiopexy (Group I) and traditional inguinal incision orchiopexy (Group II). The success rate and incidence of postoperative complications were evaluated 1 week and 1 month and 6 months after the operation in the two groups. Results: Both the groups were similar in baseline characteristics including age and laterality (P > 0.05). There was no significant difference between the two groups in terms of the incidence of wound infection, testicular atrophy, testicular hypotrophy, and relapse (P > 0.05). In addition, the success rates were 98% in Group I and 94% in Group II (P > 0.05). Conclusion: Both surgical methods have a high success rate, and there is no significant difference in the incidence of complications; however, in terms of beauty, satisfaction, and shortening the duration of surgery and the duration of hospitalization, trans-scrotal approach was more successful than the traditional method.
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Affiliation(s)
- Masoud Nazem
- Department of Pediatrics Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Hosseinpour
- Department of Pediatrics Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdulhakim Alghazali
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Gegenschatz-Schmid K, Verkauskas G, Stadler MB, Hadziselimovic F. Genes located in Y-chromosomal regions important for male fertility show altered transcript levels in cryptorchidism and respond to curative hormone treatment. Basic Clin Androl 2019; 29:8. [PMID: 31171972 PMCID: PMC6545630 DOI: 10.1186/s12610-019-0089-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/24/2019] [Indexed: 01/27/2023] Open
Abstract
Background Undescended (cryptorchid) testes in patients with defective mini-puberty and low testosterone levels contain gonocytes that fail to differentiate normally, which impairs the development of Ad spermatogonia and ultimately leads to adult infertility. Treatment with the gonadotropin-releasing hormone agonist GnRHa increases luteinizing hormone and testosterone and rescues fertility in the majority of pathological cryptorchid testes. Several Y-chromosomal genes in the male-specific Y region (MSY) are essential for spermatogenesis, testis development and function, and are associated with azoospermia, infertility and cryptorchidism. In this study, we analyzed the expression of MSY genes in testes with Ad spermatogonia (low infertility risk patients) as compared to testes lacking Ad spermatogonia (high infertility risk) before and after curative GnRHa treatment, and in correlation to their location on the Y-chromosome. Results Twenty genes that are up- or down-regulated in the Ad- group are in the X-degenerate or the ampliconic region, respectively. GnRHa treatment increases mRNA levels of 14 genes in the ampliconic region and decreases mRNA levels of 10 genes in the X-degenerate region. Conclusion Our findings implicate Y-chromosomal genes, including USP9Y, UTY, TXLNGY, RBMY1B, RBMY1E, RBMY1J and TSPY4, some of which are known to be important for spermatogenesis, in the curative hormonal treatment of cryptorchidism-induced infertility.
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Affiliation(s)
| | - Gilvydas Verkauskas
- 2Children's Surgery Centre, Faculty of Medicine, Vilnius of University, 01513 Vilnius, Lithuania
| | - Michael B Stadler
- 3Friedrich Miescher Institute for Biomedical Research, Basel, Switzerland.,4Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Faruk Hadziselimovic
- Cryptorchidism Research Institute, Kindermedizinisches Zentrum Liestal, 4410 Liestal, Switzerland
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15
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Matuszczak E, Komarowska MD, Debek W, Hermanowicz A. The Impact of Bisphenol A on Fertility, Reproductive System, and Development: A Review of the Literature. Int J Endocrinol 2019; 2019:4068717. [PMID: 31093279 PMCID: PMC6481157 DOI: 10.1155/2019/4068717] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/19/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022] Open
Abstract
Bisphenol A (BPA) has been used since the 1950s, in food packaging, industrial materials, dental sealants, and personal hygiene products. Everyone is exposed to BPA through skin, inhalation, and digestive system. BPA disrupts endocrine pathways, because it has weak estrogenic, antiandrogenic, and antithyroid activities. Despite the rapid metabolism, BPA can accumulate in different tissues. Many researchers proved the impact of BPA on human development, metabolism, and finally reproductive system. There is increasing evidence that BPA has impact on human fertility and is responsible for the reproductive pathologies, e.g., testicular dysgenesis syndrome, cryptorchidism, cancers, and decreased fertility in male and follicle loss in female.
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Affiliation(s)
- Ewa Matuszczak
- Pediatric Surgery Department, Medical University of Bialystok, Poland
| | | | - Wojciech Debek
- Pediatric Surgery Department, Medical University of Bialystok, Poland
| | - Adam Hermanowicz
- Pediatric Surgery Department, Medical University of Bialystok, Poland
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Yi W, Sheng-de W, Lian-Ju S, Tao L, Da-Wei H, Guang-Hui W. Management of undescended testis may be improved with educational updates and new transferring model. Ital J Pediatr 2018; 44:58. [PMID: 29793548 PMCID: PMC5968483 DOI: 10.1186/s13052-018-0499-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background To investigate whether management of undescended testis (UDT) may be improved with educational updates and new transferring model among referring providers (RPs). Methods The age of orchidopexies performed in Children’s Hospital of Chongqing Medical University were reviewed. We then proposed educational updates and new transferring model among RPs. The age of orchidopexies performed after our intervention were collected. Data were represented graphically and statistical analysis Chi-square for trend were used. Results A total of 1543 orchidopexies were performed. The median age of orchidopexy did not matched the target age of 6–12 months in any subsequent year. Survey of the RPs showed that 48.85% of their recommended age was below 12 months. However, only 25.50% of them would directly make a surgical referral to pediatric surgery specifically at this point. After we proposed educational updates, tracking the age of orchidopexy revealed a statistically significant trend downward. Conclusions The management of undescended testis may be improved with educational updates and new transferring model among primary healthcare practitioners.
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Affiliation(s)
- Wei Yi
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China. .,Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, China. .,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.
| | - Wu Sheng-de
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China. .,Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, China.
| | - Shen Lian-Ju
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Lin Tao
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - He Da-Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
| | - Wei Guang-Hui
- Department of Urology, Children's Hospital of Chongqing Medical University, Room 806, Kejiao Building (NO.6 Building), No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing City, 400014, China.,Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
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17
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Toliczenko-Bernatowicz D, Matuszczak E, Tylicka M, Szymańska B, Komarowska M, Gorodkiewicz E, Debek W, Hermanowicz A. Overexpression of ubiquitin carboxyl-terminal hydrolase 1 (UCHL1) in boys with cryptorchidism. PLoS One 2018; 13:e0191806. [PMID: 29401475 PMCID: PMC5798757 DOI: 10.1371/journal.pone.0191806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/11/2018] [Indexed: 11/18/2022] Open
Abstract
Background The ubiquitin-proteasome system regulate p53, caspase and Bcl-2 family proteins, and is crucial for the degradation of the defective germ cells in testes. Purpose: to evaluate the concentration of ubiquitin carboxyl-terminal hydrolase 1 (UCHL1) in the blood plasma of boys with cryptorchidism and if there is any correlation with patient age. Methods Patients—50 boys aged 1–4 years (median = 2,4y.) with unilateral cryptorchidism. Exclusion criteria were: previous human chorionic gonadotropin treatment, an abnormal karyotype, endocrine or immunological disorders or any long-term medication. The control group—50 healthy, age matched boys (aged 1–4 years, median = 2,1y.), admitted to the Pediatric Surgery Department for planned herniotomy. To investigate UCHL1 in blood plasma of boys with cryptorchidism, we used a novel technique Surface PLASMON RESONANCE Imaging (SPRI). Results The median concentration of UCHL1 in the blood plasma of boys with cryptorchidism, was 5-folds higher than in boys with inguinal hernia, whose testicles were located in the scrotum. We also noticed statistically significant difference between UCHL1 levels in boys with cryptorchidism up to 2 years old, and above 2 years old. Older boys, whose testicles since birth were located in the inguinal pouch or in the abdominal cavity, had higher concentration of UCHL1 in their blood plasma, than boys from younger group. In the group of cryptorchid boys, we also found slightly lower concentrations of INSL3, without statistical significance and no correlation with UCHL1 levels. Conclusions Uchl1 concentrations in the blood plasma of boys with cryptorchidism, may reflect the heat-induced apoptosis of germ cells. Higher UCHL1 concentrations in older boys with undescended testicles, probably express intensity of germ cell apoptosis, more extensive when testicles are subjected to heat-stress for longer period. Further analyses of UCHL1 may help to elucidate its role in mechanisms influencing spermatogenesis.
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Affiliation(s)
| | - Ewa Matuszczak
- Paediatric Surgery Department,Medical University of Bialystok, Bialystok, Poland
- * E-mail:
| | - Marzena Tylicka
- Biophysics Department Medical University of Bialystok, Bialystok, Poland
| | - Beata Szymańska
- Electrochemistry Department, University of Bialystok, Bialystok, Poland
| | - Marta Komarowska
- Paediatric Surgery Department,Medical University of Bialystok, Bialystok, Poland
| | - Ewa Gorodkiewicz
- Electrochemistry Department, University of Bialystok, Bialystok, Poland
| | - Wojciech Debek
- Paediatric Surgery Department,Medical University of Bialystok, Bialystok, Poland
| | - Adam Hermanowicz
- Paediatric Surgery Department,Medical University of Bialystok, Bialystok, Poland
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18
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Chinya A, Ratan SK, Aggarwal SK, Garg A, Mishra TK. Association of Levels of Serum Inhibin B and Follicle-stimulating Hormone with Testicular Vascularity, Volume, and Echotexture in Children with Undescended Testes. J Indian Assoc Pediatr Surg 2017; 22:3-8. [PMID: 28082768 PMCID: PMC5217136 DOI: 10.4103/0971-9261.194609] [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] [Indexed: 11/26/2022] Open
Abstract
Aims: The aim of our study was to assess the association between reproductive hormones (inhibin B [inh B], follicle-stimulating hormone [FSH]) with testicular volume, echogenicity, and blood flow (resistive index [RI]) in children with undescended testis (UDT). Settings and Design: This was a prospective study of 1-year study duration. Materials and Methods: A total of 33 patients (16 unilateral and 17 bilateral) UDTs aged 5–12 years with palpable UDT were included in the study. Morning fasting blood samples were taken for estimation of serum inh B and FSH as well as inh B/FSH ratio. Testicular ultrasound was done to compute testicular volume, testicular echogenicity, and testicular vascularity in terms of RI. Results: The mean age of patients enrolled in the study was 8.29 years for unilateral UDT and 7.97 years in bilateral UDT and it was comparable. The study groups were further subdivided into two age-wise subgroups school goers (5–8 years) and prepubertal (9–12 years). The values of inh B, FSH, and inh B/FSH ratios as well as mean testicular volume were comparable between both groups and subgroups. Overall mean testicular volume had a positive correlation with FSH, inh B, and inh B/FSH, but statistical significance was reached only for inh B (P < 0.001) in children with both unilateral and bilateral UDT. Apart from five patients with hypoechogenicity within the testis, all remaining testes were of homogenous echotexture with no instances of irregular echogenicity or tumor. Children with RI >0.6 were separately studied. The incidence of high RI (>0.6) was also comparable in unilateral or bilateral disease. These subjects had unfavorable biochemical parameters in terms of low inh B levels and high FSH levels. Conclusions: Our findings hint to the fact that palpable UDT forms a homogenous group, whether unilateral or bilateral, whereas impalpable testes may form a separate category and need further studies to substantiate this hypothesis.
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Affiliation(s)
- Abhishek Chinya
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish K Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - T K Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Niedzielski JK, Oszukowska E, Słowikowska-Hilczer J. Undescended testis - current trends and guidelines: a review of the literature. Arch Med Sci 2016; 12:667-77. [PMID: 27279862 PMCID: PMC4889701 DOI: 10.5114/aoms.2016.59940] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/26/2015] [Indexed: 11/17/2022] Open
Abstract
The best mode of undescended testis (UDT) treatment remains controversial. However, knowledge gained from randomized controlled studies and meta-analyses allowed different groups of researchers to set out guidelines on management of patients with UDT. The authors reviewed recent literature and came to the following conclusions: (1) Hormonal treatment is not recommended, considering both the immediate results (only 15-20% of retained testes descend) and the possible long-term adverse effects on spermatogenesis. (2) Surgery is the treatment of choice; orchiopexy is successful in about 95% of UDT, with a low rate of complications (about 1%). (3) Orchiopexy should be performed between 12 and 18 months of age, or at first contact if diagnosed later.
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Affiliation(s)
- Jerzy K. Niedzielski
- Department of Pediatric Surgery and Urology, Medical University of Lodz, Lodz, Poland
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20
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Maxwell F, Izard V, Ferlicot S, Rachas A, Correas JM, Benoit G, Bellin MF, Rocher L. Colour Doppler and ultrasound characteristics of testicular Leydig cell tumours. Br J Radiol 2016; 89:20160089. [PMID: 27072392 DOI: 10.1259/bjr.20160089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the colour Doppler and ultrasound features of testicular Leydig cell tumours (LCTs) in a population of 38 surgically proven lesions. METHODS From August 2008 to March 2015, we retrospectively included 38 surgically proven LCTs in 36 patients. Clinical data, scrotal colour Doppler, B-mode ultrasound and videos images were reviewed for each patient. The volume, echotexture of the testis, size, shape, echogenicity and the vascularization pattern of the lesion were evaluated. The tumour margins were categorized as either smooth or lobulated. The vascularization was classified as intense, moderate or without any hypervascularization. We defined the vascularization pattern groups as central, peripheral and mixed (the latter meaning both central and peripheral). RESULTS 26 patients were referred for infertility [5 patients were subsequently diagnosed with Klinefelter syndrome (KS) and 5 patients with cryptorchidism]. 28 patients underwent testis-sparing surgery, while 8 patients underwent a radical orchiectomy. The LCTs were mostly infracentimetric (68.4%), with a median size of 7.0 mm (ranging from 4.0 to 11 mm). 50% of the lesions had lobulated margins, and these were significantly larger than the smooth lesions (p < 0.05). The content of the lesions was markedly homogeneous and hypoechoic. All lesions had sharp demarcations from the adjacent pulp. 36/38 lesions exhibited moderate-to-intense hypervascularization, with a mixed intrinsic and peripheral rim pattern. Larger lesions were more hypervascularized (p < 0.05). LCTs in patients with KS had atypical features. CONCLUSION Typical sporadic LCTs appeared as isolated hypoechoic, infracentimetric masses, with a clear demarcation from the adjacent pulp. They presented intrinsic and peripheral rim hypervascularization. ADVANCES IN KNOWLEDGE By undertaking the largest imaging series of LCT to date (to our knowledge), we reassessed the typical sonographical aspects of LCTs, so as to provide guidance in regard to opting for testis-sparing surgery and for follow-up. LCTs present both intrinsic and rim vascularization detectable by colour Doppler ultrasound. Intrinsic vascularization and lobulated margins are common findings in testicular LCTs.
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Affiliation(s)
- Florian Maxwell
- 1 Department of Radiology, Bicêtre University Hospital, Paris, France
| | - Vincent Izard
- 2 Department of Urology, Bicêtre University Hospital, Paris, France
| | - Sophie Ferlicot
- 3 Department of Pathology, Bicêtre University Hospital, Paris, France
| | - Antoine Rachas
- 4 Department of Public Health and Epidemiology, Bicêtre University Hospital, Paris, France
| | | | - Gérard Benoit
- 2 Department of Urology, Bicêtre University Hospital, Paris, France
| | | | - Laurence Rocher
- 1 Department of Radiology, Bicêtre University Hospital, Paris, France
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Abstract
Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or specific to aid in management decisions. Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. This allows testes to descend spontaneously if they are to do so while facilitating early intervention to decrease the risk of subfertility and testicular malignancy for those patients in whom spontaneous descent does not occur. The surgical approach is often dependent on the location of the testis on physical exam. Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. Finally, patients with bilateral non-palpable UDTs require a more extensive preliminary evaluation to rule out congenital adrenal hyperplasia (CAH) and disorders of sexual development (DSD). This involves serum electrolytes, karyotype analysis and hormonal testing including a serum müllerian inhibiting substance (MIS), in order to determine if testicular tissue is present and functional.
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Affiliation(s)
- David Kurz
- Urology Resident, University of Pennsylvania Perelman School of Medicine
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22
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Sowande OA, Talabi AO, Etonyeaku AC, Adejuyigbe O. Groin exploration for the nonpalpable testes: a single center experience. Niger J Surg 2015; 21:56-9. [PMID: 25838769 PMCID: PMC4382645 DOI: 10.4103/1117-6806.153195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Management of non-palpable testes in Nigeria can be difficult due to late presentation and poor resources. Surgical exploration is often required for diagnosis and treatment. AIM This study reviews the management outcome of clinically non-palpable testeis in a tertiary center in Nigeria. MATERIALS AND METHODS Ten years retrospective review of all clinically non-palpable testes in children aged 2-15years managed at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria. RESULTS Thirty two children with 44 testicular units were managed. The right side was involved in 12 (37.5%); left in 8 (25.0%) and bilateral in 12 (37.5%) patients. Pre-operative ultrasound was done in 12 patients with localization in just 4 patients (33.3% success rate). At groin exploration, 34 (77.32%) testicular units were located in the inguinal canal. Eight patients with 10 The remaining 10 (22.7%) testicular units required additional mini-laparotomy for which six (13.6%) and 4 (9.1%) testicular units respectively were either in the retroperitoneum or not found. Of the testes in the groin, twenty two (64.7%) testicular units were normal while 12 (35.3%) were atrophic. Four of the retroperitoneal testes were normal while 2 were atrophic. Eight (22.5%) testicular units among the inguinal group had multi-staged orchidopexy; while 2 each of the retroperitoneal group had orchidectomy, one stage orchidopexy, two staged Fowler Stephens (F-S) procedure or lost to follow up after first stage of F-S procedure. Mean follow up period was 2 months. 2 testicular units each had retracted or vanished respectively during follow up. CONCLUSION Groin exploration still offers a viable approach Surgical exploration is still useful in to the management of non-palpable testes in low resource environment despite the lack of laparoscopy.
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Affiliation(s)
- Oludayo A Sowande
- Department of Sugery, Obafemi Awolowo University Teaching Hospitals Complex, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Ademola O Talabi
- Department of Sugery, Obafemi Awolowo University Teaching Hospitals Complex, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Amarachukwu C Etonyeaku
- Department of Sugery, Obafemi Awolowo University Teaching Hospitals Complex, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Olusanya Adejuyigbe
- Department of Sugery, Obafemi Awolowo University Teaching Hospitals Complex, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
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23
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Yang S, Ping P, Ma M, Li P, Tian R, Yang H, Liu Y, Gong Y, Zhang Z, Li Z, He Z. Generation of haploid spermatids with fertilization and development capacity from human spermatogonial stem cells of cryptorchid patients. Stem Cell Reports 2014; 3:663-75. [PMID: 25358793 PMCID: PMC4223697 DOI: 10.1016/j.stemcr.2014.08.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022] Open
Abstract
Generation of functional spermatids from azoospermia patients is of unusual significance in the treatment of male infertility. Here, we report an efficient approach to obtain human functional spermatids from cryptorchid patients. Spermatogonia remained whereas meiotic germ cells were rare in cryptorchid patients. Expression of numerous markers for meiotic and postmeiotic male germ cells was enhanced in human spermatogonial stem cells (SSCs) of cryptorchidism patients by retinoic acid (RA) and stem cell factor (SCF) treatment. Meiotic spreads and DNA content assays revealed that RA and SCF induced a remarkable increase of SCP3-, MLH1-, and CREST-positive cells and haploid cells. Single-cell RNA sequencing analysis reflected distinct global gene profiles in embryos derived from round spermatids and nuclei of somatic cells. Significantly, haploid spermatids generated from human SSCs of cryptorchid patients possessed fertilization and development capacity. This study thus provides an invaluable source of autologous male gametes for treating male infertility in azoospermia patients. Spermatogonia remain whereas meiotic male germ cells are rare in cryptorchid patients Human SSCs of cryptorchid patients differentiate into phenotypic haploid spermatids Round spermatids derived from human SSCs have fertilization and development capacity Distinct gene profiles exist in embryos from round spermatid and somatic cell nuclei
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Affiliation(s)
- Shi Yang
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China
| | - Ping Ping
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China
| | - Meng Ma
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China
| | - Peng Li
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China
| | - Ruhui Tian
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China
| | - Hao Yang
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China
| | - Yang Liu
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China
| | - Yuehua Gong
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China
| | - Zhenzhen Zhang
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China
| | - Zheng Li
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China; Shanghai Key Laboratory of Reproductive Medicine, Shanghai 200025, China; Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai 200001, China.
| | - Zuping He
- Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 845 Linshan Road, Shanghai 200135, China; State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Shanghai 200127, China; Shanghai Key Laboratory of Reproductive Medicine, Shanghai 200025, China; Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai 200001, China.
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24
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Abstract
An undescended testis may be associated with abnormal testicular development and function. A number of testes that are undescended at birth have been observed to descend spontaneously. The goal of orchidopexy remains to place those testes in the scrotum that would not have descended spontaneously. How long should the surgeon wait for spontaneous descent? By what age should the testis be positioned in the scrotum to avert further damage? Does earlier intervention result in a better functioning testis? Do different surgical techniques differ in their success in retaining the testis in the scrotum when dealing with the palpable undescended testis? This article reviews the current information on the timing and types of surgical intervention of the palpable undescended testes and their outcomes.
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Affiliation(s)
- Reju J Thomas
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
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Cobellis G, Noviello C, Nino F, Romano M, Mariscoli F, Martino A, Parmeggiani P, Papparella A. Spermatogenesis and cryptorchidism. Front Endocrinol (Lausanne) 2014; 5:63. [PMID: 24829558 PMCID: PMC4013472 DOI: 10.3389/fendo.2014.00063] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/14/2014] [Indexed: 12/24/2022] Open
Abstract
Cryptorchidism represents the most common endocrine disease in boys, with infertility more frequently observed in bilateral forms. It is also known that undescended testes, if untreated, lead to an increased risk of testicular tumors, usually seminomas, arising from mutant germ cells. In normal testes, germ cell development is an active process starting in the first months of life when the neonatal gonocytes transform into adult dark (AD) spermatogonia. These cells are now thought to be the stem cells useful to support spermatogenesis. Several researches suggest that AD spermatogonia form between 3 and 9 months of age. Not all the neonatal gonocytes transform into AD spermatogonia; indeed, the residual gonocytes undergo involution by apoptosis. In the undescended testes, these transformations are inhibited leading to a deficient pool of stem cells for post pubertal spermatogenesis. Early surgical intervention in infancy may allow the normal development of stem cells for spermatogenesis. Moreover, it is very interesting to note that intra-tubular carcinoma in situ in the second and third decades have enzymatic markers similar to neonatal gonocytes suggesting that these cells fail transformation into AD spermatogonia and likely generate testicular cancer (TC) in cryptorchid men. Orchidopexy between 6 and 12 months of age is recommended to maximize the future fertility potential and decrease the TC risk in adulthood.
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Affiliation(s)
- Giovanni Cobellis
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
- *Correspondence: Giovanni Cobellis, Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Via Corridoni, Ancona 11, Italy e-mail:
| | - Carmine Noviello
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Fabiano Nino
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Mercedes Romano
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Francesca Mariscoli
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Ascanio Martino
- Paediatric Surgery, Salesi Children’s Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Pio Parmeggiani
- Paediatric Surgery, Department of Paediatrics, Faculty of Medicine, Second University of Naples, Naples, Italy
| | - Alfonso Papparella
- Paediatric Surgery, Department of Paediatrics, Faculty of Medicine, Second University of Naples, Naples, Italy
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26
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Omu AE. Sperm parameters: paradigmatic index of good health and longevity. Med Princ Pract 2013; 22 Suppl 1:30-42. [PMID: 24051979 PMCID: PMC5586815 DOI: 10.1159/000354208] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 07/09/2013] [Indexed: 12/19/2022] Open
Abstract
Since the discovery of spermatozoon by Anton van Leeuwenhoek in 1677, there has been an ever increasing understanding of its role in reproduction. Many factors adversely affect sperm quality, including varicocele, accessory gland infection, immunological factors, congenital abnormalities, and iatrogenic systemic and endocrine causes, such as diabetes mellitus, obesity, metabolic syndrome, and smoking. The mechanisms responsible for the association between poor sperm parameters and ill health may include oxidative stress, low-grade inflammation, low testosterone, and low sex-hormone-binding globulin. Oxidative stress in the testicular microenvironment may result in decreased spermatogenesis and sperm DNA damage, loss of sperm motility, and abnormal sperm morphology. Low testosterone caused by advanced age, visceral obesity, and inflammation is associated with the development of cardiovascular disease. Hence, semen analysis has an important role in the routine evaluation of idiopathic male infertility, usually manifested as low sperm counts, impaired sperm motility, or absence of sperm, and remains the most common single diagnostic tool. Several studies have shown an inverse relationship between semen quality and medical disorders. This review elucidates the effect of medical disorders and social habits on sperm quality, the mechanisms that are involved in the impairment of sperm quality, and whether or not sperm quality can be used as an index of good health and longevity in a man.
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Affiliation(s)
- Alexander E. Omu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait
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27
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Abacı A, Çatlı G, Anık A, Böber E. Epidemiology, classification and management of undescended testes: does medication have value in its treatment? J Clin Res Pediatr Endocrinol 2013; 5:65-72. [PMID: 23748056 PMCID: PMC3701924 DOI: 10.4274/jcrpe.883] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Genetic, hormonal, and anatomical factors are believed to be involved in the etiology of undescended testes. Due to increased risk of infertility, testicular cancer, torsion and/or accompanying inguinal hernia (>90%) as well as cosmetic concerns, all these patients require treatment. In this review paper, we aimed to evaluate the success rates of treatment modalities used in undescended testes, beginning from 1930 to the present, and to draw attention to the possible risks and benefits and also the efficacy of hormonal therapy in the management of the disorder, which is still a controversial issue. Hormonal therapy may lead to penile growth, painful erection, and behavioral changes while on treatment. In recent years, it has been reported that human chorionic gonadotropin (hCG) treatment was associated with interstitial edema due to increased vascular permeability, inflammation-like changes, and several adverse effects on germ cells by increasing pressure and apoptotic process. It has also been reported that LHRH analogues have positive effects on germ cells by increasing fertility in patients undergoing unilateral or bilateral orchiopexy. In some studies, the success rate of hCG treatment was reported to be higher following buserelin. In some other studies, hCG treatment was recommended before orchiopexy to reduce the risk for surgical ischemia. There are a limited number of randomized controlled studies, so evidence showing the efficacy of hormonal therapy is insufficient. According to the 2007 Consensus Report of Nordic countries, it is recommended that surgery is the first-line treatment modality in undescended testes and that it should be performed by pediatric surgeons and urologists at the age of 6-12 months.
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Affiliation(s)
- Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey.
| | - Gönül Çatlı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ahmet Anık
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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28
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Abstract
When presented with an azoospermic patient, a thorough history and careful, considered physical examination often leads to a definite or presumptive diagnosis. An algorithmic, logical thought process is important to have in mind when embarking on the evaluation. Adjunctive laboratory tests, such as hormonal assays or genetic studies, are often complementary and/or additive and allow a very precise determination to be made as to the etiologies, either genetic or acquired. It is only with this information that a therapeutic plan can be made for the patient. As will be discussed, a targeted approach to testing is far more satisfying and cost-effective than a blind, shotgun approach.
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Affiliation(s)
- Robert Oates
- Boston University School of Medicine, MA 02118, USA.
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