Cryptorchidism: medium- and long-term follow-up

AIM

Cryptorchidism represents the most frequent male genital anomaly in paediatric population and may potentially interfere with fertility and determine neoplastic testicular diseases. We wanted to evaluate the correlation between age at orchiopexy and follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone levels in adulthood, determining the long-term complications of surgical treatment.

METHODS

Fifty-seven patients (mean age 19 years, range 18-27) surgically treated for cryptorchidism in pediatric age were included in a medium and long-term follow-up (10-19 years). We divided this population into four groups: A) monolateral cryptorchidism operated on before 36 months of age (15); B) monolateral cryptorchidism operated on over 36 months (32); C) bilateral cryptorchidism operated on before 36 months (5); and D) bilateral cryptorchidism operated on over 36 months (5). All patients underwent andrological examination, testosterone, FSH and LH dosage, measurement of testicular volume and spermiogram.

RESULTS

Significant different FSH levels were found between group A and C and between A and D (P<0.01), while groups A and D presented also different mean testicular volume (P<0.01). In addition group D showed an abnormal morphology of spermiogram. The main complications found in follow-up were hydrocele (17,5%), varicocele (8,7%) and epididymal cysts (3.6%).

CONCLUSION

Monolateral cryptorchidism is associated with normal fertility when treated early (group A). Subjects in Group D, on the contrary, have a rise of FSH, a reduction of testicular volume and semen abnormalities. The long-term follow-up of these patients can also detect associated.

[Epididymal cyst in von Hippel-Lindau syndrome: clinicopathologic analysis of 3 cases]

OBJECTIVE

To investigate the clinicopathologic features of epididymal cyst in von Hippel-Lindau (VHL) syndrome.

METHODS

We reviewed the clinical data of 3 epididymal cyst patients treated by surgery, and detected the expressions of HIF-1alpha, VEGF, alpha-SMA and CD34 in the epididymal tissue samples by the immunohistochemistry SP method.

RESULTS

All the 3 patients underwent surgical removal of the epididymal cyst. Immunohistochemistry of the epididymal tissues showed HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive. All the 3 cases were confirmed to be VHL syndrome, 1 right after surgery, and the other 2 within 8 years postoperatively.

CONCLUSION

Epididymal cyst is a usual benign disease, which may occur independently of or be complicated by VHL syndrome. If immunohistochemistry of epididymal tissues shows HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive, VHL syndrome should be considered, and further clinical examinations and post-operation follow-up are necessitated.

Spermatocele: a rare complication of rectal surgery and radiotherapy. Case report

A 47-year-old man developed a presacral mass after abdominoperineal resection, which is combined with pre and postoperative radio-chemotherapy for carcinoma of the rectum. CT-guided biopsy and cytological examination of the mass revealed no malignancy but spermatocele, which is a very unusual complication of rectal surgery.

[Bilateral spermatocele developed after vasectomy: a case report]

A rare case of bilateral spermatocele developed 17 years after vasectomy was presented. A forty-seven year old man visited to our hospital with a chief complaint of swelling of bilateral intrascrotal contents. Sonographic findings demonstrated multilocular lesions of the bilateral intrascrotal contents. Operative procedure revealed bilateral cysts originating from the caput of the epididymis. Bilateral epididymectomy were performed. It was diagnosed as spermatocele because of demonstration of spermatozoa in the cystic fluid. We concluded that bilateral spermatocele has been induced by prolonged increased pressure of the intraepididymal duct following vasectomy 17 years ago.

Episodic scrotal mutilation with concurrent bilateral sperm granuloma in a dog

Bilateral sperm granuloma with diffuse spermatocele was found to be the cause of infertility in a young Golden Retriever. Anamnesis indicated that the dog had intermittent episodes of self-inflicted ulcerative scrotal dermatitis, beginning when it was 4 to 5 months old and regardless of season or environment. A complete breeding soundness examination produced consistently azoospermic ejaculates in the presence of bilaterally firm, distinct swellings of the epididymides. Because of the poor reproductive prognosis, the owner requested castration and scrotal ablation. Although scrotal trauma was initially thought to be associated with the onset of sperm granuloma formation, evaluation of the history and physical examination and laboratory findings indicated that a bilateral congenital anomaly was the most likely cause of infertility.

Retrovesical rare tumor: the schistosomial spermatocyst

A case of large retrovesical tumor in a 50 year-old man is reported here. The diagnosis of schistosomial spermatocyst was made by histopathology. The authors underline the difficulty of the topographic diagnosis in large retrovesical masses.

[A case of bilateral spermatocele]

A case of bilateral spermatocele is reported. A 46-year-old man was admitted to our hospital complaining of bilateral scrotal swelling. We obtained a colorless, opalescent fluid which contained numerous spermatozoa. The fluid volume, pH and gravity obtained from right spermatocele were 85 ml, 6.8 and 1.005, respectively, and those obtained from left side were 40 ml, 6.8 and 1.006, respectively. Spermatocelectomy was done under lumbal anesthesia. Both spematocele were found near the body of the epididymis. The wall of spermatocele had on epithelial lining of cuboidal cells. Twenty two cases of spermatocele reported in Japan since 1951 are reviewed.

"Spermatocele" following abdominoperineal resection and radiotherapy

A 60-year-old man developed repeated spermatic fluid collection in the small pelvis following abdominoperineal resection and radiotherapy for carcinoma of the rectum. The "spermatocele" was due to a fistula originating in the vasoseminal vesicle junction. This complication has not been described previously.

The effects of ligation of vas deferens, corpus epididymidis and vasa efferentia on the testicular function in rats

The effects of ligation of the vas deferens, the corpus epididymidis and the vasa efferentia on the testicular function were studied in sexually mature rats. The significant decrease in the testicular weight was observed after ligation of the corpus epididymidis and the vasa efferentia. However, neither the weight of the ventral prostate and of the seminal vesicle, nor the plasma testosterone level showed significant changes. The results suggest that the ligation at the three locations would not affect the endocrine function of the testis. The changes in the testis would mainly affect the spermatogenesis. The effects of sperm stasis on the testicular function were also discussed.

Spermatic granulomas of ischemic origin in the rat epididymis

The sequelae of the permanently reduced blood flow through the testes of rats, in which stenosis of the abdominal aorta had been produced by inserting an incomplete ligature between the two renal arteries, were studied. In a high proportion of animals, spermatic granulomas occurred unilaterally or bilaterally in the epididymides. Their development was proceded by an ischemic injury; the contents of the canaliculi penetrated into the interstitium, producing a marked macrophagic reaction, which developed after the 5th day. Simultaneously, ischemic lesions were observed in the testes.