ABSTRACT
Cryptorchidism is one of the common diseases in children’s genitourinary system. Surgery is the first choice for clinical treatment. Testicular atrophy is a serious complication after operation. The related risk factors of testicular atrophy include the age of operation, the position of testis before operation and the mode of operation. At present, the possible treatments for testicular atrophy are hormone therapy, stem cell therapy and so on. This article reviews the related risk factors, fertility, diagnosis and treatment of testicular atrophy after orchiopexy in children.
ABSTRACT
Objective:To investigate the correlation between hematological parameters and testicular viability, and to identify potential indicators of intraoperative testicular viability or postoperative testicular atrophy.Methods:Clinical data of 173 children with testicular torsion treated by emergency operation in the Department of Urology, Beijing Children′s Hospital, Capital Medical University from January 2006 to January 2020 were retrospectively analyzed.According to the surgical methods, 90 and 83 cases were included in the orchiectomy group and orchiopexy group, respectively.The duration of onset, spermatic cord torsion degree and hematological parameters of the 2 groups were compared by the independent-samples t test, χ2 test and Mann- Whitney U test.Risk factors for testicular resection were analyzed by multivariate Logistic regression.In addition, 30 children in the orchiopexy group were followed up for bilateral scrotal ultrasound at 6 months postoperatively.They were sub-grouped into testicular atrophy group (13 cases, 43.3%) and non-atrophy group (17 cases). Differences between 2 subgroups were compared by the independent-samples t test and Mann- Whitney U test.Receiver operating characteristic (ROC) curves were plotted to analyze the prognostic potentials of indexes with significant differences in children with the duration of onset of >6-<51 h. Results:Duration of onset (9.3 h vs.51.0 h)( Z=-8.293, P<0.001), spermatic cord torsion degree (360.0° vs. 540.0°)( Z=-5.267, P<0.001), mean platelet volume (MPV) (9.8 fL vs.10.1 fL)( Z=-2.018, P=0.044) and age (147.5 months vs. 143.0 months)( Z=-2.165, P=0.030) were significantly different between the orchiopexy group and the orchiectomy group.The multivariate Logistic regression analysis suggested that the duration of onset ( OR=1.033, P<0.001), spermatic cord torsion degree ( OR=1.004, P<0.001) and MPV ( OR=1.662, P=0.044) were positively correlated with testicular resection.For patients with the duration of onset of >6-<51 h, the area under the curve (AUC) of duration of onset, spermatic cord torsion degree and MPV was 0.753, 0.755 and 0.629, respectively.MPV was significantly different in the postoperative testicular atrophy group and the non-atrophy group [(10.2±0.5) fL vs.(9.8±0.5) fL]( t=2.426, P=0.022). The ROC curve analysis showed that the cut-off value of MPV for predicting testicular atrophy was 9.9 fL, and its sensitivity and specificity were 83.3% and 70.6%, respectively, the AUC was 0.752. Conclusions:The duration of onset, spermatic cord torsion degree and MPV can be used as predictors of intraoperative testicular viability, which are helpful for clinicians to predict and judge the testicular necrosis caused by testicular torsion before operation.In addition, 43.3% of children with testicular torsion eventually developed testicular atrophy after orchiopexy, and only MPV may be used as a predictor of postoperative testicular atrophy.
ABSTRACT
Varicoceles adversely impact semen quality and sperm DNA fragmentation, which typically improve with surgical repair. Some men with varicoceles have ipsilateral testicular atrophy due to damage from the varicocele. This study assessed semen quality and the sperm DNA fragmentation index (DFI) response to varicocele repair in men with ipsilateral testicular atrophy (TA) versus men with no testicular atrophy (NTA). Semen parameter values and DFI in both groups were compared preoperatively and postoperatively. The Mann-Whitney U test and the Wilcoxon signed-rank test were used where appropriate. There were 20 men in the TA group and 121 men in the NTA group with no difference in age, varicocele grade, or preoperative semen parameter values between the two groups. The NTA group had a higher preoperative DFI than the TA group. Both groups showed improvement in semen quality postoperatively, only the TA group showed a significant improvement in DFI, whereas the NTA group showed significant improvements in several parameter values and DFI. The change from preoperative to postoperative parameter values when comparing the two groups revealed a difference in total sperm motile count and DFI, with a larger mean improvement in the NTA group than in the TA group. Both TA and NTA groups showed improved semen quality and DFI after varicocele repair, but the NTA group had more improvement than the TA group. However, only total motile count (TMC) and DFI had a significantly greater mean change in preoperative to postoperative response in the NTA group than in the TA group.
ABSTRACT
Objective By analyzing the cases of cryptorchidism owing to dysplasia in children to explore how to apply orchidectomy in the treatment of children with cryptorchidism. Methods Two hundred and seven cryptorchi-dism patients with dysplasia who underwent surgical treatment were collected in the Department of Urology,Anhui Province Children′s Hospital Affiliated to Anhui Medical University from July 2005 to May 2016. All the patients were true cryptorchidism,aged from 0. 6 to 11. 4 years [(4. 7 ± 1. 2)years]. There were 78 cases of left cryptorchidism,104 cases of right cryptorchidism and 25 cases of bilateral cryptorchidism. All cases underwent ultrasound examination be-fore surgery,showing that there were no testis in 53 cases,testicular atrophy or dysplasia in 154 cases. All cases under-went surgical treatment,including 149 cases of inguinal incision alone,groin incision combined with laparoscopic explo-ration in 47 cases and simple laparoscopic surgery in 11 cases. Communication with the parents of all the children was conducted during operation. One hundred and sixty - seven cases of mild and moderate testicular dysplasia underwent testicular descending fixation. Forty cases of severe dysplasia or testicular atrophy,including 16 cases of intrahepatic unilateral cryptorchidism and 22 cases of unilateral cryptorchidism outside the abdomen which underwent testicular resection,while 2 cases of bilateral cryptorchidism with severe dysplasia underwent bilateral testicular descent fixation after communication with the parents of the children during operation. All the specimens were sent for pathological examination after the operation. One hundred eighty - six cases were followed up from 1 to 128 months [(53 ± 8) months],and 21 cases were lost. Ultrasound examination was performed from 3 to 6 months after the operation to observe the development of bilateral testis and whether testicular dysplasia or testicular atrophy existed. Results All the children successfully underwent the operation and discharged from hospital. The group who underwent testicular had confirmed slim blood vessels in spermatic cord and poor testicular development through operation,while another group in postoperative follow up ultrasound showed that there was no obvious testicular - like structure in 6 cases,complete atrophy in 12 cases and partial atrophy in 48 cases and no atrophy in 93 cases. No patients had testicular resection again and no canceration after the operation. The healthy sides of the testicular resection in another group all had normal development. Conclusions Mild and moderate testicular dysplasia in children can choose testicular descending fixation,while severe dysplasia or testicular atrophy should select a reasonable surgical approach after communication with families.