A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or ...

Single port laparoscopic orchidopexy in children using surgical glove port and conventional rigid instruments

PURPOSE: We review the literature and describe our technique for laparoendoscopic single-site orchidopexy using a glove port and rigid instruments. We assessed the feasibility and outcomes of this procedure. MATERIALS AND METHODS: We retrospectively reviewed the case records of all children who had undergone laparoendoscopic single-site orchidopexy by use of a surgical glove port and conventional rigid instruments for a nonpalpable intraabdominal testis between January 2013 and September 2014. RESULTS: Data from a total of 20 patients were collected. The patients' mean age was 18 months. All cases had a nonpalpable unilateral undescended testis. Fourteen patients (70%) had an undescended testis on the right side and six patients (30%) had an undescended testis on the left side. Seventeen patients underwent primary orchidopexy. Three patients underwent single-port laparoscopic Fowler-Stephens orchidopexy for the first and the second stage. Average operating time was 57 minutes (range, 40 to 80 minutes). No patient was lost to follow-up. At follow-up, 2 testes were found to have retracted out of the scrotum and these were successfully dealt with in a second operation. One testis was hypoplastic in the scrotal pouch. There were no signs of umbilical hernia. CONCLUSIONS: Single-port laparoscopic orchidopexy using a glove port and rigid instruments is technically feasible and safe for various nonpalpable intraabdominal testes. However, surgical experience and long-term follow-up are needed to confirm the superiority of this technique.

Recurrence of acute myeloid leukemia in cryptorchid testis: case report / Recidiva de leucemia mieloide aguda em testículo criptorquídico: relato de caso

A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described.

Paciente de 23 anos, masculino, com antecedente de transplante de medula óssea por leucemia mieloide aguda. Há 5 anos, apresentou volumosa massa em região inguinal direita. No exame físico, foi constatada criptorquidia à direita. Os marcadores tumorais alfa-fetoproteína e beta-HCG encontravam-se dentro da normalidade, e a desidrogenase láctica estava aumentada. A tomografia computadorizada de abdomen e pelve revelou massa testicular direita com contiguidade pelo canal inguinal, até o retroperitônio ipsilateral, associada a hidronefrose direita. Devido ao alto risco de neoplasia germinativa em testículo criptorquídico, o paciente foi submetido à orquiectomia radical direita, cujo anatomopatológico revelou recidiva de leucemia mieloide aguda em testículo. Foi encaminhado para oncologia para terapia adjuvante. Nossa revisão não revelou nenhum caso semelhante na literatura.

Structural analysis of testicular appendices in patients with cryptorchidism

Objectives Report the incidence and structure of testicular appendices (TAs) in patients with cryptorchidism, comparing their incidence with epididymal anomalies (EA) and patency of the vaginal process (PVP) and analyzes the structure of TAs. Material and Methods We studied 72 testes of patients with cryptorchidism (average of 6 years), and 8 testes from patients with hydroceles (average of 9 years). We analyzed the relations among the testis, epididymis and PVP and prevalence and histology of the TAs. The appendices of 10 patients with cryptorchidism and 8 with hydrocele were dissected and embedded in paraffin and stained with Masson trichrome; Weigert and Picro-Sirius Red with polarization and immunohistochemistry analysis of the collagen type III fibers to observe collagen. The stereological analysis was done with the software Image Pro and Image J, using a grid to determine volumetric densities (Vv). Means were statistically compared using the ANOVA and unpaired T test (p < 0.05). Results Of the 72 testes with cryptorchidism, 20 (27.77%) presented EA, 41 (56.9%) had PVP and 44 (61.1%) had TAs. Of the 44 testes with cryptorchidism and appendices, 30 (68.18%) presented PVP and 11 (25%) presented EA. There was no alteration of the epithelium in the appendices of patients in both groups. Stereological analysis documented the prevalence of ESFs (mean of 1.48%), prevalence of veins (mean of 10.11%) and decrease (p = 0.14) of SMCs in the TAs of patients with cryptorchidism (mean = 4.93%). Collagen III prevailed in the TAs of patients with cryptorchidism. Conclusion The testicular appendices presented significant structural alteration in the patients with cryptorchidism, indicating that TAs present a structural remodeling. .

Study of undescended testes by high frequency ultrasound / Estudio por ultrasonido de alta frecuencia de los testículos no descendidos

Undescended testes or cryptorchidism in the most common congenital anomaly of male reproductive system. The descent is multifactorial with gubernaculums playing major role. The failure of descent can be at trans-abdominal or inguino-scrotal phase. Locating undescended testes is important in view of low fertility and high rate of occurrence of neoplasm in them. Ultrasound is the standard imaging technique of choice in children with a non-palpable testis as it is non-invasive and does not use ionizing radiation. Position of testis is also important in deciding whether patient will need abdominal or inguinal exploration. The aim was to study the position of undescended testes by high frequency ultrasound and its embryonic explanation. Total 41 boys with undescended testes underwent high frequency ultrasound. The location of testis was noted followed by its size and echotexture. Thirty patients had unilateral and 11 had bilateral undescended testes. The prevalence was more on right side (16 out of 30). Out of total 52, 46 (88 percent testis were located by ultrasound. Six (12 percent) testes could not be located. Five (10 percent) were retractile testes. Out of remaining 41, 26 (63 percent) were located in inguinal canal and 15 (37 percent) were located in abdomen. Out of 15 abdominal testes 9 were located just proximal to inguinal canal and 6 were located in deep pelvis. High frequency ultrasound was able to locate the position of undescended testes in majority (88 percent of the cases...

La criptorquidia o testículos no descendidos es la anomalía congénita más común del sistema reproductivo masculino. El descenso es multifactorial, donde el gubernaculum testis juega un rol fundamental. El fracaso de descenso puede ocurrir en fase trans-abdominal o inguino-escrotal. Conocer la localización de los testículos no descendidos es importante en vista de la baja fertilidad y alta tasa de incidencia de neoplasia en ellos. La ecografía es la técnica imagenológica estándar y de elección en niños con testículos no palpables, ya que no es invasiva y no utiliza radiación ionizante. La posición del testículo también es importante para decidir si el paciente necesita exploración abdominal o inguinal. El objetivo fue estudiar la posición de los testículos no descendidos por ultrasonido de alta frecuencia y su explicación embrionaria. Un total de 41 niños con testículos no descendidos se sometieron a ultrasonido de alta frecuencia. Se estudió la ubicación, tamaño y ecotextura del testículo no descendido. Treinta pacientes presentaron el testículo no descendido de manera unilateral y 11 bilateral. La prevalencia fue mayor en el lado derecho (16 de 30). Del total de 52 de testículos, 46 (88 por ciento) fueron localizados por ultrasonido. Seis (12 por ciento) no pudieron ser localizados. Cinco (10 por ciento) fueron testículos retráctiles. De los 41 testículos no descendidos, 26 (63 por ciento) se localizaron en el canal inguinal y 15 (37 por ciento) en el abdomen. De los 15 en posición abdominal, 9 se encontraron justo proximal al canal inguinal y 6 en la pelvis profunda. El ultrasonido de alta frecuencia fue capaz de localizar la posición de los testículos no descendidos en la mayoría (88 por ciento) de los casos...

Sertoli cell tumors associated with feminizing syndrome and spermatic cord torsion in two cryptorchid dogs

The association of cryptorchidism, functional Sertoli cell tumors, and spermatic cord torsion has been rarely reported in the literature. Two dogs were admitted for bilateral skin alopecia and weight loss. Both animals were cryptorchid and displayed a pendulous preputial sheath, prostate hypertrophy, and increased levels of circulating oestrogen. Transabdominal palpation and ultrasonography revealed the presence of neoplastic retained gonads. During surgery, spermatic cord torsion was also detected in the enlarged neoplastic testes of both dogs. Histologic examination confirmed the presence of Sertoli cell tumors that were primarily responsible for the feminizing syndrome. Complete remission of all symptoms occurred within 3 months after orchiectomy.

Structural analysis of gubernaculum testis in cryptorchid patients submitted to treatment with human chorionic gonadotrophin

OBJECTIVES: To make a histological and stereological analysis of gubernaculum testis elastic system fibers, collagen and striated muscle cells in patients with cryptorchidism treated with human chorionic gonadotrophin (hCG). MATERIALS AND METHODS: Gubernacula tissue samples were obtained from 12 patients with cryptorchidism. Patients' ages ranged from 1 to 3 years (mean 1.8). Of the 12 patients, 6 were treated with hCG. The samples were stained with Masson's trichrome to highlight muscle fibers and collagen, and Weigert's resorcin-fuchsin to highlight the elastic system fibers. The volumetric density of these components was determined by stereological methods. RESULTS: The volumetric density of collagen was increased in patients treated with hCG, ranging from 85.62 percent to 94.48 percent, while in patients not submitted to hCG treatment the volume density ranged from 52.12 percent to 89.46 percent (p = 0.0052). The volumetric density of the elastic system fibers was higher in patients treated with hCG, ranging from 9.62 percent to 19.62 percent, while patients not submitted to hCG treatment the volume density of elastic system fibers was between 10.38 percent and 12.38 percent (p = 0.0030). The volume density of striated muscle fibers in patients treated with hCG ranged from 4.76 percent to 39.16 percent, while and in patients not treated hCG it ranged from 3.24 percent to 11.14 percent (p = 0.0052). CONCLUSION: Gubernacular components alter significantly when submitted to treatment with hCG. Patients who underwent hCG treatment and had no complete testicular migration had an increase in the concentration of elastic and striated muscle fibers and a decrease in the volumetric density of collagen.

morphology of the testicular tissue of unilateral inguinal cryptochid testes in children: electron microscopic study

The aim of this study is to review the ultrastructural changes of the inguinal cryptochid testes of children at different ages. Children between one and sixteen years old with inguinal cryptochid testes, referred for surgical correction were biopsied. The testicular tissue obtained was processed for electron microscopical examination. Princess Basmah Teaching Hospital in Irbid-Jordan. Prospective study. The process of cellular differentiation in the seminiferous tubules was slow or embryologically arrested. There were progressive degenerative changes and increased thickening of the basement membrane as the duration of testicular retention in the inguinal region increased. The ultra-structural changes of the inguinal cryptochid testes were advanced time wise. Further studies to define the time needed for irreversible changes to take place to help in better timing of the surgical correction without losing fertility

Stereological and morphometric analysis of collagen and seminiferous tubules in testes of patients with cryptorchidism submitted or not to treatment with human chorionic gonadotrophin

OBJECTIVES: Quantify the distribution of collagen and analyze the seminiferous tubules diameter in the testis of patients with cryptorchidism, to verify if the previous use of human chorionic gonadotrophin (hCG) affects these structures. MATERIALS AND METHODS: Samples of parenchymal tissue of cryptorchid testis obtained during peroperative biopsies were collected from 26 patients. Sixteen samples were embedded in paraffin and stained with picrosirius red to evidence fibers of collagen system. The quantification of these fibers was determined by stereological methods, using a test system M-42. To obtain seminiferous tubules diameter we used 10 of the 26 samples. These samples were embedded in Epon and the analyses were carried out in semi-thin sections, stained with toluidin blue. The selected results of each group were statistically analyzed and compared by the student's t and Tukey-Kramer's tests. RESULTS: The testicular interstitium and lamina propria of patients treated with hCG showed statistically significant less collagen system fibers, when compared to the testes of patients nontreated (0.30 percent versus 0.39 percent, p = 0.0079). The seminiferous tubules diameters were not statistically significant different between the testes of patients treated and nontreated with hCG (67.5 versus 59.35 µm, p = 0.0609). CONCLUSIONS: hCG use in the cryptorchidism could delay, at least temporarily, a progressive growth of fibers of collagen system. We did not find statistically significant difference in the seminiferous tubular diameters between treated and nontreated patients.

Germ cell death and their removal during initial stages of testicular ischemia and cryptorchidism: a comparative analysis.

Germ cell death and their removal from the seminiferous epithelium are common in the affected testis in conditions of unilateral ischemia or cryptorchidism; the similarities and differences, however, have not been studied between these two conditions. The present study was designed to examine the severity of the effect on testicular germ cells during the initial stages of both ischemia and cryptorchidism, which have significant implications on the restoration of fertility following surgical repair. Complete absence of spermatids was observed following 12 hr of ischemia as compared to 7 days of cryptorchidism. Germ cell removal in either case was in the direction of lumen to basement membrane leaving only a single layer of cells by 24 hr of unilateral ischemia as compared to 15 days of cryptorchidism. Levels of intratesticular testosterone was found lower in cryptorchidism (7 days) but not in ischemia till 24 hrs. Giant cells frequently observed in cryptorchid testis were absent in the ischemic seminiferous epithelium. There was a gradual increase in the number of apoptotic and non-viable cells; the latter was more than 95% by 24 hr of ischemia. In contrast, approximately 85% testicular cells were nonviable till 15 days of cryptorchidism. The 1c peak representing the population of haploid cells was significantly reduced in cryptorchidism (7 days), while the peak was completely abolished by 24 hr of ischemia. Rise in the levels of oxidative stress in the affected testis was observed identically during the initial stages. These findings indicate that coupled with the rise in tissue oxidative stress, the number of apoptotic/nonviable germ cells was alarmingly high (> 80%) by 15 days of cryptochidism or 24 hr of ischemia. Restoration of complete spermatogenesis following surgical repair may not be possible in such cases because of these acute adverse effects.

Relationship between the persistence of the processus vaginalis and age in patients with cryptorchidism

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.

First Turkish Patient with Floating Harbor Syndrome with Additional Findings: Cryptorchidim and Microcephaly

We report the first Turkish patient with Floating Harbor Syndrome (FHS). The 12-year old male patient exhibited classical dysmorphic features of FHS, mental retardation, celiac disease and additional undescribed findings: microcephaly and cryptorchidism.

Testículo no palpable: características y tratamiento / Undescended non palpable testis: characteristics and treatment

Objetivo: describir los resultados del manejo quirúrgico abierto en pacientes con testículos no descendidos. Pacientes y métodos: se registraron los características macroscópicas de los testes, su ubicación y los resultados operatorios en 1866 niños con testículos no descendidos, operados en un centro estadounidense entre 1986 y 1994. Resultados: en 447 casos los testículos eran no polpables, en 58 por ciento el izquierdo, el derecho en 35 por ciento o ambos en 7 por ciento. En la operación no se encontraron testículos o eran atróficos en 181 (41 por ciento) pacientes, en 136 (30 por ciento) estaban en el canal inquinal, en 92 (21 por ciento) estaban en el interior del abdomen y en 38 (8 por ciento) se ubicaban en otros lugares. En 38 de los 92 pacientes con testes introabdominales se usó el método operatorio de Fowier-Stephens, que dio buen resultado en 28; en otros 33 se usó la disección intraperitoneal y movilización del testículo sin sección de vasos espermáticos, con buen éxito en 31 casos; en 6 se utiliza el procedimiento en dos etapas, logrando llevar el teste al escroto en cinco. En 15 pacientes fue necesario la orquiectomía, por atrofia testicular, que en 10 de ellos, se acompañaba de disociación epidídimo testicular completa. Conclusión: sólo uno fracción relativamente pequeño de los pacientes, cuyos testes son de localización introabdominal, se podrían haber beneficiado con el diagnóstico laparoscópico. La exploración inguinal con extensión abdominal siempre fue suficiente para localizar el testículo, vasos o deferente cuando el testículo estaba ausente. En la mayoría de los casos de testículos no palpable no atróficos, se logra descenderlos satisfactoriamente al escroto

Tumor de testículo criptorquídico / Cryptorchid testicular tumor

Os autores apresentam um caso de tumor de testículo criptorquídico que se manifestou por massa abdominal volumosa em paciente de 43 anos. São analisados os aspectos epidemiológicos, diagnósticos e terapêuticos da doença.

Fertilidad masculina en Chile: estudio dirigido en poblaciones de alto riesgo de disfunción germinal / Masculine fertility in Chile: study in population of high risk of germinal disfunction

Numerosos reportajes han sido publicados acerca de la disminución en la calidad seminal durante las últimas décadas. Para conocer esta situación en nuestra población conducimos un estudio prospectivo evaluando el estado del epitelio germinal en grupos de pacientes de conocido alto riesgo de disfunción germinal. Presentamos nuestros hallazgos e intentamos analizar los resultados respecto a lo comunicado por diferentes autores extranjeros

Citofotometria de imagem na analise do DNA de testiculos distroficos / DNA image cytophotometry in maldescended testes

Durante a infancia, a distopia testicular e uma situacao nao rara, onde o(s) testiculos(s) se encontra(m) fora da bolsa escrotal. Este fato parece contribuir com infertilidade durante a vida adulta, bem como com risco aumentado de desenvolvimento de neoplasias. E grande o interesse de diversos pesquisadores no encontro de minimas alteracoes citomorfologicas ou funcionais que possam servir de causa ou consequencia de tal entidade...

Persistent mullerian duct syndrome with mixed germ cell tumour

Persistent mullerian duct syndrome [PMDS] is a rare disorder of sexual development, it is characteristically associated with undescended tests testicular tumours are not uncommon in this group of patients. We report a case of PMDS with mixed germ cell tumour in the left undescended testis