Abdominal testicular vessel distribution in human fetuses - basis for Fowler-Stephens surgery

ABSTRACT Purpose: To analyze the histology and distribution of abdominal testicular vessels in human fetuses Patients and Methods: We studied 19 fetuses (34 testes) ranging in age from 12 to 19 weeks post-conception. The fetuses were evaluated regarding crown-rump length (CRL), total length (TL) and body weight immediately before dissection. Each testis was dissected and embedded in paraffin, from which 5 µm thick sections were obtained and stained with Masson's trichrome and Anti-CD31 antibody to quantify the vessels. The stereological analysis was carried out with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the unpaired T-test (p<0.05). Results: The fetuses presented mean weight of 222.5g, mean CRL of 15.3 cm and mean TL of 23.2 cm. All testes were in the abdominal position. The mean percentage of vessels (Vv) in the upper portion of the testis was 7.6% (4.6 to 15%) and in the lower portion the mean was 5.11% (2.3 to 9.8%), with a significant difference (p=0.0001). In the analysis between the upper portion of the right and left testes (p=0.99) and in the analysis of the lower portion of the right and left testes (p=0.83), we did not observe significant differences. Conclusion: The upper portion of the abdominal testis in human fetuses had a higher concentration of vessels than the lower portion. These results suggest that manipulation of the lower end of the testis during Fowler-Stephens surgery should be avoided in order to preserve the collateral circulation.

Histomorphological Features Of Human Gubernaculum In The Male

Background: Gubernaculum and the events related to the descent of testis have been studied since17th century,from the time of John Hunter onwards. Most of the studies were done in the animals and there is paucity ofinformation regarding gubernaculum in the humans . Present study is an attempt to throw light on the morphologicalfeatures and histological structure of gubernaculum in human male fetuses.Aims: to study the appearance, extent and microscopic structure of gubernaculum testis and to explore the roleof gubernaculums in causing cryptorchidism.Materials and Methods: The study was conducted on 35 spontaneously aborted male fetuses and on 10 tissuesamples of gubernaculum from children who have come for orchiopexy, obtained from PSG Hospital.Results and Discussion: Gubernaculum was extended from the lower pole of testis and epididymis to pubicsymphysis. Gubernaculum testis was made up of collagen fibres, elastic fibres, muscle fibres and loosemesenchyme with lymphocytes, macrophages and fibroblasts embedded within it. Collagen undergoes changesas the foetal age advances and this could contribute to the role of gubernaculumin testicular descent.Conclusion: Gubernaculum testis possibly could play a significant role in the descent of the testis, by creating thechannel for the passage of the testis and do not actively pull the testis down into the scrotum as thought earlier.KEY WORDS: Gubernaculum, Mesenchymatous Tissue, Collagen Fibres, Fibroblast, Elastic Fibres, Skeletal andSmooth Muscle, Trimester of Pregnancy.

Evaluation and management of the infant with abnormalities in the area of inguinal canal and scrotum / 中华实用儿科临床杂志

The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.

Impacts of DES on the expressions of related genes in the gubernaculums testis of newborn mice / 中华男科学杂志

Objective@#To investigate the influence of diethylstilbestrol (DES) on the mRNA expressions of the androgen receptor (AR), estrogen receptor α (ERα), proliferating cell nuclear antigen (PCNA), and actin alpha 1 (ACTα1) in the gubernaculums testis of newborn mice and explore their action mechanisms.@*METHODS@#A total of 140 male Kunming mice were randomly divided into a blank control, a dimethyl sulfoxide (DMSO) control, and 5 experimental groups to be treated subcutaneously with normal saline, DMSO, and DES at 0.02, 0.1, 0.5, 10 and 50 μg per kg of the body weight per day, respectively, at gestation days 9－17. On the first day after birth, the animals were sacrificed and the gubernaculums testis collected for detection of the mRNA expressions of AR, ERα, PCNA and ACTα1 by RT-PCR.@*RESULTS@#Compared with the DMSO control, the experimental groups, particularly the DES 10 and 50 μg groups, showed significant increases in the mRNA expression of ERα (RE2 = 0.825, P <0.05), but remarkable decreases in those of AR, PCNA and ACTα1 (RA2 = 0.713, RP2 = 0.946, RT2 = 0.960, P <0.01), all in a dose-dependent manner.@*CONCLUSIONS@#The AR, ERα, PCNA, and ACTα1 mRNA are expressed in the gubernaculum testis of normal newborn mice, and their expression levels may be influenced by intervention with different concentrations of DES during the gestation. Exogenous estrogens may affect the proliferation and contraction of gubernaculum testis cells and consequently the normal development of the testis or even the whole male reproductive system by influencing the metabolism of ER and/or AR.

Evaluation and management of the infant with abnormalities in the area of inguinal canal and scrotum / 中华实用儿科临床杂志

The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.

Is there a trans-abdominal testicular descent during the second gestational trimester? Study in human fetuses between 13 and 23 weeks post conception

ABSTRACT Objectives To confirm if a real inner descend of testis occurs, correlating the testicular position with fetal parameters and analyzing the position of the testes relative to the internal ring. Material and Methods Twenty nine human fetuses between 13 and 23 weeks post conception (WPC) were studied. The fetuses were carefully dissected with the aid of a stereoscopic lens with 16/25X magnification and testicular position observed. With the aid of a digital pachymeter the distance between the lower pole of the kidney and the upper extremity of the testis (DK-T) was measured to show the position of the testis. During the dissection we also indicated the position of the testes relative to the internal ring. Means were statistically compared using simple linear regression and the paired T-test. Results The 58 testes had abdominal position. The DK-T in the right side measured between 0.17 and 1.82cm (mean=0.79cm) and in the left side it was between 0.12 and 1.84cm (mean=0.87cm), without statistically differences (p=0.0557). The linear regression analysis indicated that DK-T in both sides correlated significantly and positively with fetal age. All fetuses with more than 20 WPC, heavier than 350g and with CRL over 22cm had a greater distance than the average DK-T. We xobserved that the 58 testis remains adjacent to the internal ring throughout the period studied. Conclusions The testes remains adjacent to the internal ring throughout the period studied, indicating that there is no real trans-abdominal testicular descent during the second gestational trimester.

Penile Ectopic Testis: An Uncommon Cause of an Empty Scrotum

An ectopic testis is any testis that presents outside the line of its normal descent after exiting the external inguinal ring. Sites for ectopic testes include the superficial inguinal pouch of Denis Browne, femoral, suprapubic, contralateral hemiscrotum, perineum and pubopenile region. This case describes yet another rare site of ectopic testis in an 11 year boy. The diagnosis was essentially clinical complimented by ultrasonography. Scrotal repositioning was successfully achieved.

Anatomical Study on the Descent of Testis in Prenatal Goat (Capra hircus) / Estudio Anatómico del Descenso Testicular Prenatal en la Cabra (Capra hircus)

A study was conducted on 70 embryo/ foetii of goats to observe the descent of testis. These foetii were grouped into I (0-30 days), II (31-60 days), III (61-90 days), IV (91-120days) and V (121 days up to term, having 14 embryos/ foetii in each group. The genital ridge was observed at 1.2cm CRL (23 day) on the ventromedial aspect of mesonephros. At 42nd day, the genital ridge developed into cylindrical structure, the testis, located in the middle of metanephros. The abdominal migration was completed upto 88th day. The testes were situated in the inguinal canal from 89th to 95th day. From 90th day onward, scrotal migration had been observed, however the testis did not reach the base of the scrotum up to term. During the descent of testis, a peritoneal fold detached from the caudal end of the gonad and extended up-to the abdominal floor on 42nd day, known as gubernaculum. In the initial stages of pregnancy it was thin, whitish, jelly like. On 70th day it was enveloped by processus vaginalis. In group V, it became hardened, longer and cord like.

Para observar el descenso de los testículos se realizó un estudio en 70 embriones/fetos de cabra. Estos fetos se agruparon en 5 grupos: I (0-30 días), II (31-60 días), III (61-90 días), IV (91 120 días) y V (121 días hasta término, con 14 embriones / fetos en cada grupo. La cresta genital se observó a 1,2cm CRL (23 días) en la cara ventromedial del mesonefros. En el día 42 día, la cresta genital se convirtió en estructura cilíndrica y los testículos se encontraban en el centro del metanefros. La migración abdominal se completó en 88 días. Los testículos están situados en el canal inguinal entre los 89 y 95 días. Del día 90 en adelante, se observó la migración escrotal, sin embargo, el testículo no llegó a la base del escroto hasta el término del desarrollo. Durante el descenso de los testículos, a los 42 días, un pliegue peritoneal (gubernaculum testis) separado del extremo caudal de la gónada, se extendió hacia el suelo-abdominal. En las etapas iniciales de la preñez la gónada era delgada, blanquecina, gelatinosa. En el día 70 el testículo fue envuelto por el proceso vaginal. En el grupo V, el testículo se había endurecido y alargado asemejándose a una cuerda.

Gubernacular Contractile Response to Testosterone and Calcitonin Gene-related Peptide in Rat / 대한비뇨기과학회지

PURPOSE: It was known that the gubernaculum contract by release of calcitonin gene-related peptide(CGRP) and androgens may control gubernacular migration indirectly via release of CGRP from the genitofemoral nerve in the inguinoscrotal region. To determine the direct effect of testosterone to the testicular descent and usefulness of polygraph for detecting the contractility of the gubernaculum, current study was designed. MATERIALS AND METHODS: Twenty four Sprague-Dawley male rats were used in this experiment after 3, 5, 7days and 2weeks of birth. Gubernaculums were mounted in organ baths and bathed in oxygenated Tyrode`s solution under 200mg of isotonic tension. The contractile response in vitro of testosterone(4.8x10(-3)M) and CGRP(10(-7)M) were monitored via an FT .03 force transducer and recorded on a Grass 7D polygraph. The recorded tension was expressed as mg tension per 10mg of gubernacular tissue. RESULTS: Both exogenous testosterone and CGRP increased isotonic tension and the degree of gubernacular contractility declined significantly with age(p<0.05). Testosterone and CGRP increased minimal spontaneous contraction of the gubernaculum. CONCLUSIONS: These results suggest that testosterone may directly act as one of the neurotransmitters for the contraction of the gubernaculum as well as CGRP and measuring the contractility using polygraph is a useful method for the study of testicular descent.

Effect of Antiandrogen on Calcitonin Gene-related Peptide Receptor of the Rat Gubernaculum / 대한비뇨기과학회지

PURPOSE: We attempted to investigate whether calcitonin gene-related peptide binding to receptors in the gubernaculum is different between normal and flutamide-treated rats or pups and whether calcitonin gene-related peptide(CGRP) binding is androgen dependent. MATERIALS AND METHODS: Timed pregnant Sprague Dawley rats were injected with flutamide or vehicle alone once daily on gestational days 15-19. Weight, anogenital distance and distance from testicle to symphisis pubis of pups of gestational day 20 and rats of neonatal day 1 and 7 were measured. Gubernacular sections from rats of neonatal day 7 were incubated with [125I]human CGRP with various concentrations of unlabeled hCGRP, and those from pups of gestational day 20 and rats of neonatal day 1 were incubated only with [125I]human CGRP. After exposure of gubernacular sections to imaging plate (BAS 2500), the images from the plate were quantified by computerized densitometry (TINA). RESULTS: Weight and anogenital distance of flutamide-treated pups or neonatal rats were significantly smaller and shorter than those of normal pups or neonatal rats (P< 0.01). Though the distance from testicle to symphisis pubis was not significantly different between normal and flutamide-treated pups or neonatal 1 day rats, that of flutamide-treated neonatal 7 day rats was significantly longer than that of normal neonatal 7 day rats (P< 0.01). The total binding counts of [125I]human CGRP on gubernacular sections of normal pups, neonatal 1 day rats and neonatal 7 day rats were 56.3 +/- 24.74, 68.2 +/- 24.90, 78.4 +/- 17.25 (dpm/mg polymer), respectively, and those of flutamide- treated pups, neonatal 1 day rats and neonatal 7 day rats were 43.7 +/- 12.54, 35.1 +/- 8.25, 57.5 +/- 16.27, respectively. There were significant differences between normal and flutamide-treated neonatal 1 day and 7 day rats (P< 0.01). The binding in normal rats was consistently increased from gestational day 20 to neonatal day 7, and it showed weak correlation (r = 0.398, P< 0.05). The binding analysis showed that concentrations of CGRP receptors were 20.0+/- 4.78 amol/mg polymer, 13.3 +/- 3.87 amol/mg polymer for normal and flutamide treated neonatal 7 day rats, respectively, and there was significant difference between normal and flutamide-treated rats (P< 0.01). However there was no significant difference in the dissociation constant between 2 models. The images from the plate in flutamide-treated neonatal 7 day rats looked smaller than those in normal 7 day rats. CONCLUSIONS: These results suggest that the inguinoscrotal descent of testicle occurs after the gubernacular eversion, CGRP binding in the gubernaculum is androgen dependent, and androgen may not influence CGRP release from genitofemoral nerve because of down regulation of CGRP receptor by antiandrogen. However, the role of CGRP in testicular descent is still obscure and the mechanism of down regulation of CGRP receptor by antiandrogen needs further investigation

Effect of antiandrogens upon the morphological development of gubernaculum and the testicular descent in rats / 대한비뇨기과학회지

We evaluated the effect of antiandrogens on both fetal and adult rats, noting especially the morphological changes in the gubernaculum and testicular descent. Two antiandrogens, flutamide and 5a-reductase inhibitor 4-methyl-4-aza-5-pregnane-3-one-20[s] carboxylate (4-MAPC) produce gross and histological changes in the gubernaculum, as well as having an effect on testicular descent. While the gubernacula of controls were like full water-drop at day 20 of gestation. the gubernacula of fetuses treated with flutamide were thin and elliptical and the gubernacula of fetuses treated with 4-MAPC were thin and elliptical or like small water-drop. The position of the gubernaculum was near the bladder neck and lower border of pelvic cavity, regardless of the antiandrogen treatment. But, the degree of invagination of gubernaculum into abdominal wall tended to be less in fetuses treated with either antiandrogen. The muscular layer of gubernaculum treated with either anti-androgen tended to be thinner than controls. In adult rats treated from embryo to adult with flutamide, atrophy of the sex accessory glands and hypospadias were occurred and the scrotums were bifid or undeveloped on one side which the testis remained in the abdomen. We feel that flutamide and 4-MAPC cannot interfere with trans-abdominal testicular descent, but can induce the morphological changes in gubernaculum with failure of the trans-inguinal testicular descent. Also, it would be suggested that the gubernaculum has not Wolffian duct like testosterone dependency shown in differentiation of epididymis, vas deferens and seminal vesicle, because of the presence of the effect of both flutamide and 4-MAPC on gubernaculum.

Genitofemoral nerve and undescended testis / 대한비뇨기과학회지

The gubernaculum testis, which has an important role to play in transinguinal testicular descent, is richly by the genitofemoral nerve through its scrotal attachment. In neonatal rats the genitofemoral nerve overlying the psoas muscle was divided before transinguinal descent would normally occur, and the effect of this procedure on subsequent testicular descent was observed and compared with the effect of division of psoas muscle and gubernaculectomy. Selective division of the genitofemoral nerve could not cause undescended testis and testicular atrophy which was caused by the division of the psoas muscle or gubernaculectomy. However denervation of the gubernaculum shortened the length of the spermatic cord and vas deference. This effect tended to be obvious in group or earlier neonatal denervation. The significance of this finding in the rat is that an intact genitofemoral nerve is an essential prerequisite for normal transinguinal descent perhaps by allowing the gubernaculum to evert and to differentiate.

THE DYNAMIC ANATOMY OF TESTICULAR DESCENT OF CHINESE FETUS / 解剖学报

The testis and its relative structures of 101 normal male fetuses (fetal-age 12-33 weeks) have been studied in this paper. The results were as follows: 1. The data of fetal growth of testis, epididymis and gubernaculum were given. 2. It has been found that there is no scrotum ligament existed. The gubernaculum is a mesenchyme tissue and is cylindrical pyramid in shape. Objectively, we cannot find any anatomical structure acted as a tractor in testis descending. 3. It has been found that the testis descends in chinese fetus between the 21th and the 25th week of fetal-age. It was completed in all of them after the 26th week. The time is more advanced than that of the traditional conception which referred to be between 7 th and 8 th month. 4. It has been confirmed that once the descent started, the testis run through inguinal canal rapidly. Generally, it seems that the testicular descent in left side is earlier than that in the right. From the above findings, the author suggests that it be necessary to correct the traditional conception in the Chinese anatomy book.