The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

Testicular Torsion as an Overlooked Cause of Acute Abdomen

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.

Clinical Significance of National Institutes of Health Classification in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome

PURPOSE: We determined the effects of alpha-blockers and quinolone in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) classified by National Institute of Health (NIH) consensus group. MATERIALS AND METHODS: Data from a total of 111 patients who were diagnosed with CP/CPPS between June 2010 and June 2012 were analyzed retrospectively. The patients were classified into group 1 (category IIIA, n=40) and group 2 (category IIIB, n=71). Treatment using alfuzosin and levofloxacin was given to both groups for 6 weeks. International Prostate Symptom Score (IPSS) and NIH Chronic Prostatitis Symptom Index were measured before and after therapy. RESULTS: Group 1 had a significant decrease in total IPSS score, CPSI pain score, CPSI quality of life (QoL) score, and total CPSI score (p=0.043, p=0.006, p=0.015, and p=0.006, respectively). Group 2 had a significant decrease in IPSS voiding symptom score, IPSS storage symptom score, total IPSS, CPSI pain score, CPSI voiding score, CPSI QoL score, and total CPSI score (p=0.002, p=0.004, p=0.001, p=0.001, p=0.006, p=0.001, and p=0.001, respectively). The CPSI score was reduced by 6 points or more in 50.0% of patients (n=18) in group 1 and in 51.6% of patients (n=32) in group 2. However, there was no statistically significant difference between the changes in IPSS and CPSI scores across the 2 groups. CONCLUSIONS: Although combination treatment reduced the CPSI score in both groups, there was no significant difference between the groups after combination treatment. We suggest that factors other than inflammation also contribute to symptoms associated with CP/CPPS.

Testicular Torsion as an Overlooked Cause of Acute Abdomen

Acute scrotal pain is a common urologic presentation and critical pathology due to the possibility of organ loss in the emergency department. Referred pain in the lower quadrant of the abdomen may accompany testicular torsion. Of 58 patients with testicular torsion between January 2001 and March 2011, three visited the emergency department with abdominal pain alone. The median age of the patients was 16 years (range, 13-19). Median duration of abdominal pain to first medical examination and proper diagnosis by an urologist was 14 hours (range, 2-168) and 77 hours (range, 57-240), respectively. All patients underwent orchiectomy. Due to symptomatic variations for testicular torsion, all clinicians providing emergency care to patients who have referred pain in the lower abdomen without scrotal pain should consider the constellation of symptoms in order to avoid superfluous diagnostic delay.