ABSTRACT
Los niños con restricción del crecimiento intrauterino (RCIU) presentan en la vida posnatal una serie de alteraciones metabólicas y hormonales, y tienen predisposición al desarrollo de obesidad, hipertensión arterial, enfermedad cardiovascular, resistencia a la insulina y diabetes tipo 2. La exposición a un ambiente intrauterino desfavorable en fases críticas del desarrollo puede tener un efecto deletéreo sobre la gónada en formación. Se realizó una revisión bibliográfica y puesta al día sobre la posible asociación entre RCIU y alteraciones de la función gonadal en niños y adolescentes de ambos sexos. Para facilitar la actualización, se dividió por etapas en: 1, prenatal; 2, posnatal y prepuberal; 3, puberal, y 4, adulta. La mayoría de los niños que nacen muy prematuros o con muy bajo peso al nacer hacen una transición sin obstáculos desde la infancia a la edad adulta con respecto a la salud reproductiva. Sin embargo, en los varones se puede observar criptorquidia, hipospadias, cáncer testicular y menor fertilidad, y en las niñas, pubertad y menarca temprana, hiperandrogenismo y síndrome de ovario poliquístico. Existen datos controvertidos y se necesitan más estudios para aclarar la relación entre el RCIU y la función hipotálamo-hipófiso-gonadal.
Low birth weight due to intrauterine growth restriction (IUGR) is associated with an increased risk of obesity, hypertension, cardiovascular disease, insulin resistance, and type 2 diabetes during postnatal life. Exposure to an unfavourable intrauterine environment in critical phases of development may have a deleterious effect on the forming gonad. The objective was to carry out a bibliographic review and update on the possible association between IUGR and alterations of gonadal function in children and adolescents of both sexes. To facilitate the update, this was divided into stages: 1, prenatal; 2, postnatal and pre-pubertal; 3, puberal, and 4, adult. Most children born preterm or with low birth weight make a normal transition from childhood to adulthood with respect to reproductive health. However, cryptorchidism, hypospadias, testicular cancer and lower fertility could be observed in boys, and early puberty and menarche, hyperandrogenism and polycystic ovarian syndrome in girls. However, the data are controversial, and further studies are needed to clarify the relationship between IUGR and pituitary gonadal function.
Subject(s)
Humans , Male , Female , Infant, Small for Gestational Age/growth & development , Fetal Growth Retardation/physiopathology , Gonadal Disorders/etiology , Puberty, Precocious/embryology , Hyperandrogenism/embryology , Cryptorchidism/embryology , Hypospadias/embryologyABSTRACT
ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.
Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Testis/abnormalities , Cryptorchidism/complications , Epididymis/abnormalities , Fetus/embryology , Testicular Hydrocele/complications , Testis/embryology , Prospective Studies , Gestational Age , Cryptorchidism/surgery , Cryptorchidism/embryology , Epididymis/surgery , Testicular Hydrocele/surgeryABSTRACT
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.
Subject(s)
Humans , Male , Female , Pregnancy , Pregnancy Trimester, Second , Testis/anatomy & histology , Testis/embryology , Fetus/anatomy & histology , Fetus/embryology , Linear Models , Gestational Age , Crown-Rump Length , Fetal Weight , Cryptorchidism/embryology , Abdomen/anatomy & histology , Abdomen/embryology , Kidney/anatomy & histology , Kidney/embryologyABSTRACT
Objectives The objective of this review is to study the role of the gubernaculum in the testicular migration process during the human fetal period. Materials and Methods We performed a descriptive review of the literature about the role of the gubernaculum in testicular migration during the human fetal period. Results In the first phase of testicular migration, the gubernaculum enlarges to hold the testis near the groin and in the second phase the gubernaculum migrates across the pubic region to reach the scrotum. The proximal portion of the gubernaculum is attached to the testis and epididymis and the presence of multiple insertions in the distal gubernaculum is extremely rare. The presence of muscle and nerves in the human gubernaculum is very poor. The gubernaculum of patients with cryptorchidism has more fibrous tissue and less collagen and when the patients are submitted to hormonal treatment, the gubernaculum components alter significantly. Conclusions The gubernaculum presents significant structural modifications during testicular migration in human fetuses. .
Subject(s)
Humans , Male , Fetus/embryology , Scrotum/embryology , Testis/embryology , Collagen/analysis , Cryptorchidism/embryology , Cryptorchidism/physiopathology , Fetal Development/physiology , Fetus/physiology , Gestational Age , Scrotum/physiology , Testis/physiologyABSTRACT
A 36 year-old man after tests for assessing male infertility was diagnosed with primary infertility, bilateral cryptorchidism, nonobstructive azoospermia and discontinuous splenogonadal fusion. Carcinoma in situ was found in his left testicle, which was intraabdominal and associated with splenogonadal fusion. To our knowledge, this is the fourth case of splenogonadal fusion associated with testicular cancer reported. One should always bear in mind the possibility of this association for the left cryptorchid testicle.
Um homem de 36 anos, depois de ser submetido a exames para avaliação de infertilidade masculina, foi diagnosticado com infertilidade masculina primária, criptorquidia bilateral, azoospermia não obstrutiva e fusão esplenogonadal descontínua. Carcinoma in situ estava presente no testículo esquerdo, que tinha localização intra-abdominal e estava associado à fusão esplenogonadal. Esse é o quarto caso de fusão esplenogonadal associada a câncer testicular, segundo nossa avaliação. Deve-se sempre ter em mente a possibilidade dessa associação em testículos criptorquídicos à esquerda.
Subject(s)
Humans , Male , Adult , Carcinoma in Situ/diagnosis , Cryptorchidism/etiology , Spleen/abnormalities , Testicular Neoplasms/diagnosis , Testis/abnormalities , Atrophy , Azoospermia/etiology , Calcinosis/etiology , Carcinoma in Situ/etiology , Carcinoma in Situ/pathology , Cryptorchidism/embryology , Cryptorchidism/surgery , Disease Susceptibility , Incidental Findings , Magnetic Resonance Imaging , Orchiectomy , Orchiopexy , Spleen/embryology , Testicular Diseases/etiology , Testicular Neoplasms/etiology , Testicular Neoplasms/pathology , Testis/embryologyABSTRACT
OBJECTIVES: To assess if there is an age group where the occurrence of persistent processus vaginalis is more frequent in patients with cryptorchidism. MATERIALS AND METHODS: We studied 24 fetuses with gestational age between 23 and 35 weeks postconception (control group) and 102 patients (137 testes) with cryptorchidism aged between 1 and 33 years (mean 10.3 years). We considered 2 situations for analysis of the processus vaginalis: a) complete persistence of processus vaginalis and, b) complete obliteration of the processus vaginalis between the internal inguinal ring and the upper pole of the testis. RESULTS: Of the 137 cases of cryptorchidism, the processus vaginalis was patent in 79 (57.6 percent) and obliterated in 58 (42.4 percent). Of the 55 patients between 1 and 4 years old, 37 (67.2 percent) had a patent processus vaginalis and 18 (32.8 percent) an obliterated one. Of the 37 patients between 5 and 8 years, 17 (45.9 percent) had patent processus vaginalis and 20 (54.1 percent) had an obliterated processus. In the 45 patients over 9 years of age, in 25 (55.5 percent) the processus vaginalis was patent and in 20 (44.5 percent) it was obliterated. In the fetuses, we found 4 cases (8.3 percent) of persistence of the processus vaginalis. CONCLUSIONS: There was no difference in the occurrence of patent processus vaginalis between the various age ranges under study. Patent processus vaginalis was more frequent in patients with cryptorchidism than in fetuses.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pregnancy , Cryptorchidism/pathology , Testis/abnormalities , Age Factors , Cryptorchidism/embryology , Fetus , Gestational Age , Testis/embryologyABSTRACT
The epididymal anomalies and patent processus vaginalis are frequently seen in patients with cryptorchidism or hydrocele. We performed a prospective study on the relationship between the epididymal anomalies and the patency of the processus vaginalis in boys with hydrocele (190 cases) or cryptorchidism (89 cases) who were treated from August 1997 to February 2000 (mean age, 51 months; range, 12 to 152 months). The epididymal anomalies were observed with an overall frequency of 48%. Closed, partially closed, and open processus vaginalis were associated with an epididymal anomaly in 14, 38, and 65% of cases, respectively. The epididymal anomalies were more common in association with undescended (61%) than with descended (43%) testes without statistical significance (p=0.415). Incomplete attachment of the caput epididymis was the most common anomaly (35%), followed by detachment of caput and cauda epididymis (31%), cauda epididymis (24%), and long looping epididymis (10%). These data showed that the epididymal anomalies were strongly associated with the patency of the processus vaginalis irrespective of testicular descent (p<0.001), and they provide further evidence for the hypothesis that a common stimulus, possibly androgens, may be required for the epididymal development and obliteration of the processus vaginalis.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Infant , Male , Cryptorchidism/embryology , Epididymis/abnormalities , Prospective Studies , Testicular Hydrocele/embryology , Testis/abnormalitiesABSTRACT
El poliorquidismo es una anomalia congénita poco frecuente que se caracteriza por aspectos controvertidos. Los autores describen un caso de poliorquidismo con testículo supernumerario en el conducto inguinal. Ambos testículos del lado izquierdo estaban hipoplásicos y sin pruebas de espermatogénesis, y el tratamiento consistió en orquiectomía radical de los testículos. El testiculo derecho era normal. Se propone una nueva clasificación basada en el origen embriológico
Subject(s)
Humans , Male , Adolescent , Cryptorchidism/diagnosis , Cryptorchidism/embryology , Cryptorchidism/surgery , Orchiectomy , Testis/abnormalities , Testis/surgery , Testis/embryologyABSTRACT
Se reporta una caso de Síndrome de la Triada: deficiencia o ausencia de los músculos abdominales; anomalías renales y urinarias, y criptorquidia; asociado a megacolon con canal fistulizado en vejiga; en un recién nacido a término de parto podálico, de sexo masculino, que fallece a los 45 minutos accediéndose a la autopsia. Se revisa la literatura