Undescended testicle: An update on fertility in cryptorchid men.

Cryptorchidism or undescended testis is one of the most common anomalies encountered in paediatric urology and is estimated to affect 1 to 4 per cent of full term and upto 30 per cent of preterm male neonates. The associated problems of sub-fertility or infertility and malignant transformation have been recognized for long. Fertility is impaired after both unilateral and bilateral cryptorchidism. The reported paternity rates in adults are about two-third for unilateral undescended testis and less than one-third for bilateral disease. Over the last five decades, the concepts related to cryptorchidism have changed dramatically as knowledge about its effects has accrued from research conducted worldwide. The recommended age of orchidopexy has fallen progressively from adolescence to less than one year. The realization that the infantile testes are not in a state of ‘suspended animation’ and the recognition of the defect in the androgen dependent transformation of gonocytes into adult dark spermatogonia in cryptorchidism have been recognized as the primary cause of sub-fertility in these patients. This has paved the way for hormone therapy in an attempt to simulate the ‘post-natal gonadotropin surge’ or ‘mini-puberty’. This review summarizes the current knowledge about the various factors affecting the fertility status in cryptorchidism with a particular focus on the derangements in the development and maturation of the germ cells and the role of surgery, hormone therapy and antioxidants in reversing these changes.

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 ...

La cryptorchidie : aspects epidemio-clinique et therapeutique au service de chirurgie pediatrique du CHU Gabriel Toure

Objectifs : Decrire les aspects epidemio-cliniques et analyser les resultats de la prise en charge des cryptorchidies. Materiels et methode : Il s'agissait d'une etude retro et prospective qui s'est deroulee du 1er Janvier 2005 a 31 Decembre 2009 et qui a porte sur tous les enfants de 1 a 15 ans traites pour cryptorchidie dans le service de chirurgie pediatrique du CHU Gabriel Toure. Resultats : En 5 ans nous avons collige 42 cas de cryptorchidie (8;4 cas/an). L'age moyen de nos patients a ete 6;48 ans. Trente et huit (90;5) patients ont ete recus pour vacuite scrotale et 4 patients (9;5) pour tumefaction inguinale. La cryptorchidie etait droite chez 24 malades (57;2); gauche chez 15 malades (35;7) et bilaterale chez 3 malades (7;1). L'orchidopexie conventionnelle a ete realisee chez 36 patients et la technique de Fowler- Stephens chez 6 autres. Apres 6 mois une retraction testiculaire a ete notee chez 2 malades (4;7). Apres 1 an elle a ete notee chez 6 malades (14;3) et une atrophie testiculaire chez 2 malades (4;7). La decouverte de la cryptorchidie est tardive dans nos pays. Un diagnostic et un traitement precoces assureraient un avenir fonctionnel et esthetique du testicule

Un caso de criptorquidia / A case of cryptorchism

Tomando como excusa un caso de criptorquidia, los autores describen la epidemiología, el pronóstico y las dos alternativas terapéuticas de esta condición clínica (quirúrgica y hormonal). Se explayan sobre la eficacia del tratamiento en términos de disminuir las principales complicaciones de la criptorquidia -infertilidad y cáncer testicular- y del mejor momento de instituirlos.

Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism

OBJECTIVE: To clarify the role of peritoneography in assessing the patency of processus vaginalis (PV) in pediatric patients diagnosed with cryptorchidism. MATERIALS AND METHODS: We designed a prospective clinical trial to evaluate the patency of PV in boys presenting cryptorchidism. Herniography was performed in 310 prepubertal boys. Data about the morphology of PV was compared with operative findings in those surgically treated patients. Retractile and ectopic testes were excluded from the study. RESULTS: Of the 376 undescended testes (310 patients), 281 cases were associated with an obliterated PV. Herniography revealed 95 cases of open PV in cryptorchid boys. The 244 normally descended testes had associated patent processus vaginalis in only 31 cases. CONCLUSIONS: Herniography is the most relevant procedure for accurate diagnosis of persistent PV. The persistence of PV was significantly more frequent when the position of the testes is more cranial. The incidence of an open PV decreases with age.

Diagnóstico e tratamento do criptorquismo / Cryptorchidism: diagnosis and treatment

O criptorquismo corresponde à localização extra-escrotal do testículo, atingindo cerca de 3 por cento dos recém-nascidos e 0,5 a 1,0 por cento dos adultos. Geralmente é um achado clínico isolado, porém em 10 por cento dos casos pode estar associado a disfunções hipotalâmico-hipofisárias, doenças genéticas ou embrionárias, e sua associação com outras anormalidades genitais, como a hipospádia e o micropênis, aumenta a probabilidade de se tratar de um estado intersexual. A exata descrição da localização testicular em repouso e sua mobilidade durante o exame físico são essenciais para o adequado diagnóstico, tratamento e prognóstico evolutivo. O diagnóstico é clínico, exigindo cuidadoso exame físico. O diagnóstico complementar por exames de imagem tem valor limitado. A avaliação gonadotrófica e da secreção hormonal testicular pode ser informativa nos primeiros 6 meses de vida ou na época puberal, períodos em que o eixo hipotálamo-hipofisário encontra-se ativado. O tratamento clínico é indicado em pacientes com testículo retido ou com grande retratilidade, utilizando-se a gonadotrofina coriônica humana na dose de 50UI/kg/semana durante 6 semanas. O tratamento clínico está contra-indicado na presença de hérnia inguino-escrotal comprovada, varicocele ou cisto de cordão espermático. A cirurgia é indicada na falha terapêutica clínica ou nos testículos ectópicos. A precocidade terapêutica (1-2 anos vida) tem sido apontada como um aspecto decisivo na prevenção das principais complicações do criptorquismo, como a esterilidade e o maior risco neoplásico gonadal.

Undescended testis at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria : a ten year audit

Introduction: Undescended testis is a global problem; and late diagnosis and treatment can lead to disastrous consequences. We undertook this study to evaluate our management protocol and see how it fits into changing trends in management and compare our results with those obtained in other centers. Material and Methods: A retrospective study of all patients with undescended testes seen and operated at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria during a 10-year period (1993-2003) was carried out. Results: Twenty-seven patients were analysed. 66.7of them were above 2 years of age. Eighteen patients had unilateral crypt-orchidism and 12 patients (44.4) had associated inguinal hernia. The undescended testis was found predominantly in the inguinal region (17 patients) and orchidopexy was done in 16. Half of our patients (51.7) were lost to follow up immediately after the intervention. Conclusion: The late presentation and inability to follow up these patients make the monitoring of such patients very difficult. We suggest that thorough examination of the external genitalia should form part of the normal post-natal check up and that a mass education campaign be undertaken

Testículo no descendido / Cryptorchidism

Testículo no descendido es la falta de descenso testicular en el saco escrotal. Si esto ocurre en cualquier punto del trayecto normal de descenso recibe el nombre de criptorquidia y si ésta se ubica por fuera se denomina testículo ectópico. El testículo retráctil o en ascensor es aquel testículo no descendido que desciende fácil a nivel escrotal y permanece en éste durante el examen, constituyendo una condición normal frecuente durante la infancia, especialmente entre los 2 y 7 años, por un acentuado reflejo cremasteriano

Criptorquidismo: uma visäo atual / Cryptorchidism: an update

O criptorquidismo é uma das patologias testiculares mais frequentes em todas as raças, apresentando distribuiçäo global e podendo ter consequências desastrosas quando näo diagnosticado e tratado adequadamente. Os autores revisam as principais características epidemiológicas, etiológicas e diagnósticas desta patologia, dando especial atençäo às tendências terapêuticas atuais

light microscopic investigation on the naturally unilateral abdominal cryptorchid and scrotal testes in baladi goat

Histological and some histoenzymological studies were carried out on six cases of naturally unilateral cryptorchid testes of adult Baladi goat in this investigation and they were compared with the scrotal ones. Morphologically, the cryptorchid abdominal testes showed testicular hypoplasia, their seminiferous tubules were surrounded by a coarse fibrous connective tissue stroma, the lining epithelium of these seminiferous tubules was formed of one or two layers of degenerated epithelial cells. Spermatogonia and Sertoli cells were detected in the seminiferous tubules of the abdominal cryptorchid testes, in addition to the interstitial Leydig cells. The scrotal testes in this study exhibited a normal histological appearance where the seminiferous tubules were lined with the spermatogenic cells series at different stages of maturation, as well as the Leydig cells showed a normal picture. Both the alkaline and acid phosphatase enzymes were observed in more intense reactivity in the abdominal cryptorchid testes in comparison to the scrotal ones

Respuesta al tratamiento con hormona gonadotropina coriónica, según la edad, en niños con criptorquidea / Response to Chorionic gonadotropin hormone treatment in children with cryptorchid, according to age

Se trató a 282 pacientes con criptorquidea (178 unilateral y 104 bilateral con edades entre los 18 meses y los 12 años de edad; a todos se les aplicó hormona gonodatropina coriónica (HGC) 1500 U IM en días alternos 9 dosis (dosis total 13.500 UI), obtivimos respuesta positiva (descenso testicular) en 33,7% de los niños con criptorquidea unilateral (60/178) y en 33,7% de los niños con criptorquidea bilateral (33/104) siendo mayor el número de niños con respuesta positiva en pacientes entre los 18 meses y cuatro años de edad (62% en criptorquidea unilateral, 55% con criptorquidea bilateral

Testículo no descendido en niños: estudio de 226 casos / Undescended testicule in children: study of 226 cases

Se presentan 226 casos de Testículo no Descendido, tratados en el Servicio de Cirugía Pediátrica del Hospital Universitario de Maracaibo durante un período de 17 años, comprendidos entre febrero de 1965 y agosto de 1982.Se investigaron los siguientes parámetros:Edad gestacional, edad del paciente al momento de la intervención, lado afectado, diagnóstico definitivo, incidencia de la persistencia del conducto peritoneo vaginal, técnica quirúrgica utilizada y los resultados obtenidos. 154 pacientes se les registró en historia clínica embarazo a término (95%). Las edades encontradas fueron las siguientes:2 años 15 casos (6.7%), de 2 a 4 años 33 casos (14.7%), de 4 a 6 años 58 casos (25.7%), de 6 a 8 años 37 casos (16.3), de 8 a 10 años 41 casos (18.1%) y de 10 a 12 años 42 pacientes (18.5%). 178 pacientes (78.7%) tenían más de 4 años en el momento de la intervención. En 125 pacientes la lesión estaba del lado derecho (55.5%); del lado izquierdo 75 casos (33.2%) y 26 casos (11.5%) eran bilaterales. En 211 pacientes (93.6%) existía persistencia del conducto peritoneo vaginal; en diez pacientes no se encontró el conducto (4.2%) y en 5 pacientes (22%) no se registró el dato en la historia clínica. Del total de la serie 212/226 correspondieron a Testículo no Descendido Verdadero (94%); 13/226 Agenesia Testicular (5.6%) y 1 caso correspondió al diagnóstico de Testículo Ectópico (0.4%). De las intervenciones practicadas 212/226, a 164 se realizó Orquidopexia Unilateral (77.3%); 25 procedimientos bilaterales (11.9%) y 23 (10.8%) se practicó Orquidectomía Primaria. Se presentan los resultados comparativos entre las técnicas Unilater...

Hallazgos clínico quirúrgicos de la criptorquidia

Se realiza prospectivamente y bajo protocolo, un estudio descriptivo del examen preoperatorio y los hallazgos quirúrgicos del tratamiento del testículo no descendido, realizándose en 43 pacientes 52 exploraciones inguinales. Al examen preoperatorio el testículo fue más frecuente palpado a nivel preescrotal (46 por ciento), y clínicamente no se determinó la presencia de saco herniario en el 34 por ciento y atrófico en tres casos: el gobernáculo testis se catologo como delgado y corto en 53 por ciento, delgado y largo 17 por ciento, ancho y largo 19 por ciento, ancho y corto 11 por ciento; la implantación del gobernáculo se determinó a nivel preescrotal en 45 por ciento y en el trayecto del conducto inguinal 26 por ciento...