Evaluation of the morphologic and histologic changes in the testes after spermatic vessels division [fowler-stephens maneuver]: an experimental study

Orchiopexy with division of the spermatic vessels is a commonly used technique for correcting the high undescended testis using either one or two stage Fowler-Stephens procedure. We aimed in this study to determine early and late morphological and histological changes in the ipsilateral and contralateral testes after unilateral testicular vessels division in rat. Four groups, each of 12 prepubertal male albino rats were studied. Group I was a control group without any operative intervention and group II underwent sham operation on the left testis and spermatic cord. Group III underwent in situ left high spermatic vessels division and in group IV, the left spermatic vessels were divided at the same level as in group III, but the spermatic cord and testis were completely dissected and freed from any attachment in the abdomen and scrotum. Six prepubertal rats in each group were sacrificed one day postoperatively. The remaining 6 prepubertal rats in all groups were sacrificed 4 weeks postoperatively after reaching maturity to evaluate spermatogenesis. For each rat, the testes were harvested bilaterally and prepared for histological examination of testicular architecture and evaluation of spermatogenesis. The volume of each testis was calculated. In group III, all testes one day and 4 weeks postoperatively showed no significant changes in the size and shape compared to the control group. One day postoperatively, in-situ division of the spermatic vessels caused morphological changes in primary spermatocytes at all stages of the cycle in the ipsilateral testes. These morphological changes have become normalized after 4 weeks. In group IV, all the ipsilateral testes one day postoperatively showed no significant differences in the testicular shape, size and weight compared to the control group, however, these ipsilateral testes 4 weeks postoperatively, showed statistically significant decrease in weight compared to the control. Histologically, one day postoperatively, more histological alterations were occurred and most of pachytene spermatocytes, at all stages of the cycle, showed marked chromatin condensation and acidophilic cytoplasm. Four weeks postoperatively, two testes showed normalization of the morphological changes, however, in 3 testes; the severe alterations and cell degeneration observed after one day were amplified and the entire population of pachytene spermatocytes disappeared from most of the seminiferous tubules, although infrequent nests of complete spermatogenesis have been observed [<30%]. In one testis, the entire population of the germinal cells was eliminated and the tubules were lined exclusively by Sertoli cells. The contralateral testes in both groups III and IV showed no significant difference either macroscopically or microscopically one day and 4 weeks postoperatively. The spermatic artery and vein can safely be divided above the divergence of the vas to provide additional cord length. Division of the spermatic vessels may result in varying degrees of testicular injury. Often this injury is much greater histologically than one would expect from gross examination of the testis. It is important to divide the spermatic vessels in a separate procedure before orchiopexy. The effects of testicular injury on the sperm production in the contralateral testis are not reported in rats and did not result in any decrease in spermatogenesis

Evaluation of the toxic effect of polycyclic aromatic hydrocarbons on semen of infertile workers in diesel and engine workshops: a prospective controlled study

The purpose of this study is to prove the toxic effect of exposure to polycyclic aromatic hydrocarbons [PAHs] on semen of infertile workers in diesel and petrol engine repair workshops. Urine and semen samples from 20 male workers exposed to hydrocarbons in diesel and petrol engines repair workshops for at least 2 years were collected. Urinary excretion of urinary 1-hydroxyrene [1-OHP], the most reliable indicator for PAHs exposure, was measured. Semen analysis and annexin -V bioassay were performed for all workers [during exposure and one year after precaution against exposure] and non-exposures [control] to document the toxic effect of PAHs exposure. PAHs exposed males showed six fold increase in 1-OHP excretions as compared to the control group. While semen volume is the same in both groups, there was significant increase in the percentage of non-aggregated sperms between the exposed and the control groups [45 +/- 26.17 and 11 +/- 7, respectively]. There was significant decrease in sperm count [Million / ml] in the exposed than the control group [44.4 +/- 37.79 and 110 +/- 55, respectively]. Asthenozospermia was found either alone or in combination with other abnormalities in 55% of the ejaculates from exposed workers, whereas, it was found alone in only 15% of the control group. Normal forms of the sperms and semen's viscosity were found significantly lower in the exposed group as compared to control group. The mean value of apoptotic sperm cells that have positive annexin-V was 42.5 +/- 14.09, while; the control group has shown no apoptotic sperm cells. Moreover, necrotic sperm cells were significantly increased in semen of exposed workers when compared to semen of control group [5.5 +/- 3.8 and 1.1 +/- 0.05, respectively]. Workers who had longer duration of exposure to PAHs had higher levels of urinary 1-OHP, percentage of annexin-V cells, lower sperm counts, lower motility, increased percentage of aggregated sperms and decreased percentage of normal sperm [r: 0.48, 0.45, -0.74, -0.79, 0.46, and 0.69, respectively]. On the other hand, after one year of precaution against exposure to PAHs all the above-mentioned parameters were spontaneously improved; level of urinary 1-OHP, ejaculate volume, nonspecific aggregate, sperm count, sperm motility, normal sperm form and sperm vitality [2.4 +/- 0.9, 3.5 +/- 1.6, 15 +/- 9.6, 56.5 +/- 30, 55 +/- 15, 60 +/- 25 and 70 +/- 23, respectively]. This study documented the deleterious toxic effect of PAHs on semen of exposed males in diesel and engine workshops that could be reversed by stoppage of exposures. However a study on a bigger number of patients is required to assess the exposure time to induce changes in semen parameters and the time needed for reversal of the toxic effect of the PAHs. Furthermore, longer follow up is recommended to evaluate the fertility of those workers

Laparoscopic management of children with non-palpable testis

To show the advantages and limitations of laparoscopy in management of the non-palpable testis. Herein, we report our experience with diagnostic and interventional laparoscopic procedures in children with non-palpable testes. Between 1997 and 2001, 28 children underwent 30 laparoscopic procedures for evaluation and management of 36 non-palpable testes. Pneumoperitoneum was achieved using a Veress needle inserted infraumbilically in all cases. Examination of the abdomen and pelvis was performed with a 30°, 5 mm laparoscope. When intervention was deemed necessary, 2 to 3 additional 5 mm ports were inserted under direct visual control. For dissection, laparoscopic microscissors and electrosurgical dissection were used. The mean patient age was 3.6 years [12 months -14 years]. A total of 12 diagnostic procedures [localization] were performed on 12 patients and 15 inguinal exposures were done based on the laparoscopic findings [14 orchiopexy and 1 orchiectorny]. Tlie testes were absent in six more patients and farther surgery avoided. Twelve laparoscopic interventions were done on 10 patients: 9, one stage laparoscopically assisted orchiopexy, 1, two-staged orchiopexies, 1, laparoscopic Fowler-Stephen orchiopexy and, laparoscopic orchiectcmy. All procedures were performed on outpatient basis or with an overnight stay. There were 4 complications: injury of the spermatic vessels which did not affect the viability of the testis in one instance, two testes had atrophied at 4 weeks and 6 weeks follow-up, and one testis had retracted to the level of the pubic tubercle at 9 months. Laparoscopy is a useful tool in the management of the non-palpable testes. For an intracanalicular testis, an inguinal orchiopexy is recommended. For intra-abdominal testes, a laparoscopic orchiopexy is the technique of choice at our institution