Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

ABSTRACT Introduction Chemotherapy and radiation therapy are considered standard treatments for stage II seminoma patients; however, these therapies are associated with long-term toxicities. Recently, retroperitoneal lymph node dissection has emerged as an alternative strategy, and the first three phase II trials were published in 2023 with promising results. The present study conducted a systematic review and meta-analysis to evaluate this surgery as an alternative treatment for stage IIA/B seminoma patients. Purpose Seminomas are the most common testicular tumors, often affecting young adult males. Standard treatments for stage II seminomas include chemotherapy and radiation therapy, but these therapies are associated with long-term toxicities. Thus, identifying alternative strategies is paramount. Herein, we conducted a systematic review and meta-analysis to appraise the efficacy and safety of retroperitoneal lymph node dissection (RPLND) for treating this condition. Methods We systematically searched the PubMed, Embase, and Cochrane databases for studies evaluating RPLND as a primary treatment for stage II A/B seminomas. Using a random-effects model, single proportion and means and pooled 2-year recurrence-free survival rates with hazard rates and 95% CI were calculated. Results Seven studies were included, comprising 331 males with stage II seminomas. In the pooled analysis, the recurrence rate was 17.69% (95% CI 12.31-24.75), and the 2-year RFS rate was 81% (95% CI 0.77-0.86). The complication rate was 9.16% (95% CI 6.16-13.42), the Clavien-Dindo > 2 complication rate was 8.83% (95% CI 5.76-13.31), and the retrograde ejaculation rate was 7.01% (95% CI 3.54-13.40). The median operative time was 174.68 min (95% CI 122.17-249.76 min), median blood loss was 105.91 mL (95% CI 46.89-239.22 mL), and patients with no evidence of lymph node involvement ranged from 0-16%. Conclusions Primary RPLNDs for treating stage IIA/B seminomas have favorable RFS rates, with low complication and recurrence rates. These findings provide evidence that this surgery is a viable alternative therapy for these patients.

Teratogenicity of Valproic Acid: Can Reverse its Possible Effects on Testicular Development with Vitamin E? / Teratogenicidad del Ácido Valproico: ¿Se Pueden Revertir sus Posibles Efectos sobre el Desarrollo Testicular con la Vitamina E?

Epilepsy is the chronic non-communicable disease of the nervous system most prevalent in the world. Valproic acid (VPA) is one of the most used drugs in the treatment of epilepsy but with various side effects. One of the organs that can be affected is the testis, where it has been seen that men treated with VPA reduce their fertility rates, in addition to causing endocrine disorders by decreasing androgens and gonadotropins. In animal models, it has been shown to reduce the weights of the glands attached to the male reproductive tract, as well as at the testicular level, decreasing sperm concentration and increasing apoptotic cell count. These effects are because VPA increases reactive oxygen species (ROS), causing damage to macromolecules and affecting all cellular processes sensitive to oxide reduction. Throughout testicular development, in utero, it has been seen that the expression of antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase, are lower during early embryonic development, as well as vitamin E (VE) is decreased. Therefore, they are not sufficient to reverse the toxic effects of ROS. The objective of this study was to review the use of VPA during pregnancy, its effect on testicular development, and to explore the potential protective role of vitamin E.

La epilepsia es una enfermedad crónica no transmisible que afecta al sistema nervioso más prevalente en el mundo. Dentro de los tratamientos, uno de los fármacos más utilizados es el ácido valproico (AVP), el que ocasiona diversos efectos secundarios. Entre los órganos que se pueden ver afectados se encuentra la gónada masculina, en donde se ha visto que hombres en tratamiento con AVP reducen sus tasas de fecundidad, además de causar trastornos endocrinos disminuyendo andrógenos y gonadotrofinas. En modelos animales, se ha visto que disminuye los pesos de las glándulas anexas al tracto reproductor masculino, como también a nivel testicular, disminuyendo la concentración espermática y aumentando el recuento de células apoptóticas. Estos efectos se deberían a que el AVP aumenta las especies reactivas de oxígeno (ROS), ocasionando daño en macromoléculas, afectando todos los procesos celulares sensibles a óxido reducción. A lo largo del desarrollo testicular, in utero se ha visto que la expresión de enzimas antioxidantes como superóxido dismutasa, catalasa y glutatión peroxidasa, son más bajos durante el desarrollo embrionario temprano, como también la vitamina E (VE) se encuentra disminuida. Por tanto, no resultan suficientes para revertir los efectos tóxicos de las ROS. El objetivo de esta revisión fue asociar el uso de AVP durante la gestación y sus efectos a nivel del desarrollo testicular y describir el potencial rol protector de la VE.

Amelioration of Diabetes Associated Hypo-testicular Co-morbidities in Rat by Aloe vera (L.): Potent Extract Selection Study

The experiment was framed to get the most effective extract of Aloe vera (L.) leaf gel for the amelioration of hypo-functional activity of testis in diabetic model rats. Only one frequency of streptozotocin was injected through skeletal muscle at 40 mg/kg body weight for diabetes induction. Treatment with aqueous or ethanol or methanol or hydro-ethanol (40:60) or hydro-methanol (40:60) extract of Aloe vera (L.) was continued for 28 days. Rats were euthanized and sacrificed on 29th day. Fasting blood glucose level, kinetics of hexokinase, androgenic key enzymes, and markers of cellular oxidative stress were assessed. The concentration of the sperm per milliliter of epididymal washed fluid, sperm motility, serum testosterone, plasma insulin levels, lipid, and metabolic toxicity sensors were also measured. Significant amelioration (p ? 0.05) of the negatively deviated above-mentioned parameters and the disrupted histomorphology of testicles towards vehicle-treated control were noted after uninterrupted 28 days of treatment to diabetic rats with the mentioned extracts of Aloe vera (L.). The highest percentage of recovery in the adopted sensors was noted in the hydro-ethanol extract-treated diabetes group than others. Hydro-ethanol extract of the said plant part is potent among all other extracts for correcting such hypo-function of testicles in diabetes.

A Perspective on Male Contraceptive Therapeutics of Hydro-ethanol Extract of Seeds of Luffa acutangula (L.) Roxb. in Human and Albino Rat: An In-vitro Meta-Analysis Study

Traditionally Luffa acutangula (L.) Roxb. has been utilized as an herbal contraceptive. This in-vitro study has been performed to search out the male contraceptive efficacy of hydro-ethanol (60:40) extract of Luffa acutangula (LAHEE) seeds in a dose-specific manner (1, 2, and 4 mg/ml of in-vitro media). The percentages of motile, viable, hypo-osmotic swelled (HOS), and acrosomal intact of human and rat sperms were declined significantly (p<0.05) at the above-mentioned doses of LAHEE-exposed groups against the placebo group. The inhibitory concentration 50% value (IC50) of LAHEE was 2.5 mg/ml in human and 1.2 mg/ml in rat spermatozoa immobilization. The ?5,3? and 17? hydroxysteroid dehydrogenase (HSD) activities of rat’s testicular tissues were inhibited significantly at p<0.05 in LAHEE-treated groups than the placebo group. Activities of superoxide dismutase (SOD) and catalase were significantly inhibited (p<0.05) along with the significant increment (p<0.05) in the quantity of thiobarbituric acid reactive substances (TBARS) in rat’s testes and epididymis, sperm pellets of humans and rats in LAHEE-treated groups against the placebo group without any significant difference (p>0.05) in above said sensors in the liver and cardiac tissues of rats. The non-toxic nature of LAHEE was indicated by no significant alterations (p>0.05) in the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) after LAHEE exposure in said tissues of rats. The LC-MS study of LAHEE identified the presence of oleic acid, dihydroquercetin, luteolin-7-glucoside, formononetin, luteolin 8-C-pentoside-6-C-hexoside, pterosin B, boldine and berberine. These findings interpreted that the LAHEE possesses spermiological inhibitory and hypo-testicular activities, which indicate a promising possibility to develop a potent herbal male contraceptive agent from this plant extract.

Analysis of disease burden of testicular cancer in China from 1990 to 2019 / 解放军医学杂志

Objective To analyze the burden and changing trend of testicular cancer in China from 1990 to 2019.Methods Based on the 2019 Global Burden of Disease Database(GBD 2019),analyze the incidence,mortality,disability-adjusted life years(DALYs),years of life lost(YLLs),years lived with disability(YLDs)and their variation trend of testicular cancer in Chinese population from 1990 to 2019.Evaluating changes in age standardized rate(ASR)by calculating annual estimated percentage change(EAPC).According to the age grouping,analyze the age distribution characteristics of testicular cancer disease burden by age group.Results In 2019,the incident cases,deaths,age-standardized incidence rate,and age-standardized mortality rate of testicular cancer in China were 17.17×103,1.21×103,2.39/105,and 0.16/105,respectively.Compared to 1990,incident cases,deaths,and age-standardized incidence rate increased obviously in China,which was consistent with the global change trend,while the increase was higher than the global level.However,both Chinese and global age-standardized mortality rate showed a downward trend.From 1990 to 2019,DALYs,YLLs and YLDs of testicular cancer increased by 29.66%,9.83%and 720.91%respectively in China.The two age groups,0-15 years group and 30-35 years group,were with highest incidence of testicular cancer,while the highest disease burden of testicular cancer was 30-35 years.Conclusion From 1990 to 2019,the disease burden of testicular cancer in China showed an upward trend.Adolescents and young adults should be the priority population for screening and prevention due to their higher incidence and disease burden.

A new type of hydrocelectomy under trans-interfascial plane surgical technique: 15 cases of experience / 现代泌尿外科杂志

【Objective】 A new type of testicular hydrocele reversal resection is described under the concept of trans-interfascial plane surgery, in order to improves the understanding of the anatomical level of testicular hydrocele surgery and to optimize the surgical approach. 【Methods】 During Jan. and June 2021, 15 patients with primary testicular hydrocele were treated with hydrocelectomy and gubernaculum preservation.Demographic information, indications of treatment, success rate and complications were collected.The anatomical structures were analyzed using intraoperative findings and photographs. 【Results】 All operations of 15 patients were successful, with the surgery time of 25-48 minutes, with an average of (34.0±6.2) minutes.No patients experienced scrotal hematoma or incision infection.There were no relapses during the 3-month follow-up after surgery.The anatomical points observed during surgery were as follows: we further confirmed that the internal spermatic fascia completely surrounded the testis, epididymis, and the spermatic cord; this layer was an avascular plane, the cremaster muscle and fascial layer between the internal and external spermatic fasciae were absent; intraoperative preservation of the gubernaculum helped to fix the testicles in its natural position. 【Conclusion】 Our novel technique of hydrocelectomy is reliable, and the precise anatomical description of the concept of trans-interfascial plane surgery can help to improve the related surgical techniques.

Expression of GDNF and AR in Testicular Peritubular Cells of Surgery-induced Cryptorchidism Mice / 中山大学学报(医学科学版)

ObjectiveTo investigate the expression of glial cell line-derived neurotrophic factor （GDNF） and androgen receptor （AR） in testicular peritubular cells （TPCs） of cryptorchidism mouse models and explore the theoretical significance of cryptorchidism-induced spermatogenesis dysfunction. MethodsA total of 30 five-week-old male ICR rats were divided randomly by using random number table method into 6 groups. Cryptorchidism was surgically induced in 3 randomly selected groups and the other 3 groups underwent sham surgery as the control groups. On days 4， 7 and 14 after surgery， we harvested the mice testes of the 3 groups and their corresponding control groups， then measured the testicular volumes， analyzed the testicular histopathology and detected the mRNA and protein expression levels of AR and GDNF in TPCs by immunofluorescence， real-time PCR and Western blot. ResultsIn normal control groups， on days 4， 7 and 14 after surgery， the testicular volumes were （125.58±19.22） mm3，（123.45±20.12） mm3， （140.09±13.62） mm3 ， respectively. Clear layers of spermatogenic cells were well arranged and abundant sperm cells were found. Peritubular cells were morphologically homogeneous， with slim-spindle appearance and normal cell thickness. The mRNA expression levels of AR were 1.00±0.05， 1.06±0.07 and 1.19±0.13； GDNF mRNA 1.00±0.04， 1.09±0.05， and 1.10±0.07. The protein expression levels of AR were 1.01±0.01， 0.79±0.02 and 1.01±0.04； GDNF protein （18.68±0.43） pg/mL， （14.39±0.36） pg/mL and （16.88±0.37） pg/mL. In cryptorchidism groups， on days 4， 7 and 14 after surgery， the testicular volumes were （115.64±3.91） mm3， （69.51±14.97） mm3 and （44.86±5.56） mm3， respectively. Spermatogenic cells were disorganized， seminiferous tubules were disrupted， peritubular cells shrank， bent and fractured. The mRNA expression levels of AR were 0.76±0.06， 0.53±0.04， and 0.29±0.02； GDNF mRNA 0.72±0.05， 0.42±0.02 and 0.30±0.03. The protein expression levels of AR were 0.54±0.02， 0.98±0.04 and 0.31±0.01； GDNF protein （8.50±0.34） pg/mL， （17.44±0.32） pg/mL and （6.83±0.34） pg/mL. Statistically significant differences （P < 0.05） were found in 7-day and 14-day testicular volumes between control and cryptorchidism groups but not in the 4-day testicular volume （P > 0.05）. Testicular volumes， AR and GDNF mRNA and protein expression in control groups had no statistically significant difference （P > 0.05）， while those in cryptorchidism groups showed a trend of gradual decline in the amount and the differences between groups were statistically significant （P < 0.05）. ConclusionsIn surgery-induced cryptorchidism mice， after the induction， the expression of AR and GDNF in TPCs showed a gradual decrease over time. AR and GDNF play a major role in mediating the TPCs damage in cryptorchidism. This study provides a theoretical basis for mechanism researches of cryptorchidism-induced spermatogenesis dysfunction.

Research progress in diagnosis and treatment of scrotal masses / 中国基层医药

Scrotal mass is a common problem in the outpatient department of urology, accounting for 1% of all emergency patients. The diagnosis of scrotal masses is challenging due to the overlapping symptoms and signs of various scotal masses. Failure to correctly identify and treat scrotal masses, such as testicular torsion, testicular cancer, varicocele, and hydrocele, may lead to infertility, testicular loss, or even death. Misdiagnosis or missed diagnosis of scrotal masses may result in infertility, testicular loss, or even death. Therefore, we must maintain a high degree of vigilance and accurately identify scrotal masses that may affect life and testicular function. A full understanding of the manifestations and differences of various scrotal masses can help clinicians make accurate diagnoses and provide optimal treatment plans. The most critical aspect is to exclude emergency situations that may endanger life or testicular function, such as testicular torsion, testicular cancer, and necrotizing fasciitis, which require immediate medical attention. Scrotal ultrasonography is the best method for distinguishing scrotal masses based on their origin. Magnetic resonance imaging is the best tool for diagnosing scrotal hematoma. However, good clinical judgment and decision-making are still the most important factors for successful treatment of scrotal masses. The purpose of this article is to describe correct evaluation methods for scrotal masses and identify potential conditions that may threaten testicular survival, enabling accurate pathological diagnosis, evaluation, and treatment plans for each scrotal mass.

Effects of microsurgical varicocelectomy on testicular function and sexual function in patients with varicocele / 局解手术学杂志

Objective To investigate the effects of microsurgical varicocelectomy on testicular function and sexual function in patients with varicocele.Methods The clinical data of 90 patients with varicocele admitted to our hospital were retrospectively analyzed,and the patients were divided into the laparoscopic group(received laparoscopic varicocelectomy)and the microscopic group(received microsurgical varicocelectomy)according to different surgical methods,with 45 cases in each group.The testicular function and sexual function related indexes including sperm density,normal sperm ratio,rate of sperm motility(grades a+b),forward motility sperm rate,international index of erectile function-5(IIEF-5)score,and the levels of testosterone,follicle-stimulating hormone,luteinizing hormone,and androgen levels before and 6 months after surgery in the two groups were compared.The incidence of complications and recurrence 6 months after surgery in the two groups were counted.Results Compared with those before surgery,the sperm density,forward motility sperm rate,rate of sperm motility(grades a+b),normal sperm ratio,IIEF-5 score,testosterone level,and androgen level 6 months after surgery of patients in the two groups were significantly increased(P<0.05),and the levels of luteinizing hormone and follicle-stimulating hormone were decreased(P<0.05).Compared with the laparoscopic group,the levels of follicle-stimulating hormone and luteinizing hormone,and incidence of complications 6 months after surgery of patients in the microscopic group were decreased(P<0.05),and the levels of testosterone and androgens,and IIEF-5 score 6 months after surgery were increased(P<0.05).There was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion Microsurgical varicocelectomy can improve the testicular function and sexual function of patients with varicocele,with a low incidence of complications.

Efficacy of two-staged laparoscopic Fowler-Stephens surgery through the Hay's triangle approach for the treat-ment of high cryptorchidism in children / 局解手术学杂志

Objective To analyze the efficacy of two-staged laparoscopic Fowler-Stephens surgery through the Hay's triangle approach for the treatment of high cryptorchidism in children.Methods The clinical data of 116 children with high cryptorchidism in our hospital were retrospectively analyzed,among which 43 children who underwent laparoscopic testicular extraction and fixation through the Hay's triangle approach were selected as the control group,and 73 children who underwent two-staged laparoscopic Fowler-Stephens surgery through the Hay's triangle approach were selected as the study group.The changes of sex hormone levels and testicular function before and after surgery were compared between the two groups.All patients were followed up for 6 months,and the testicular volume was reviewed and the occurrences of complications were recorded.Results There was no significant difference in the testicular volume before and after surgery between the two groups(P>0.05),and there was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).After surgery,the levels of serum follicle-stimulating hormone(FSH),estradiol(E2)and luteinizing hormone(LH)in the two groups were significantly lower than those before surgery(P<0.05),and the levels of serum testosterone(T),anti-Mullerian hormone(AMH),inhibin B(INHB)and INHB/FSH were significantly higher than those before surgery(P<0.05).However,there was no significant difference between the two groups(P>0.05).Conclusion The two-staged Fowler-Stephens surgery is effective in the treatment of high-risk cryptorchidism.It can establish a good collateral circulation by disconnection of spermatic cord vessels and gubernaculum testis,and the testis can be lowered to a satisfactory position in the scrotum.

Role of Gubernaculum testis inervation during the process of testicular migration in human fetuses

ABSTRACT Purpose: The gubernaculum seems to be the most important anatomical structure in the testicular migration process. The objective of this paper is to review current literature regarding the role of gubernaculum testis nerves in testicular migration. We conducted a comprehensive literature review about the gubernaculum testis innervation. A PubMed database search was performed in April 2024, focusing on gubernaculum testis and cryptorchidism and genitofemoral nerve (GFN) and calcitonin gene-related peptide (CGRP) gene. The gubernaculum has its own nerve supply, the GFN, descending on the anteromedial surface of the psoas muscle from L1-L2 segments. The second phase of testicular descent is regulated by androgens and CGRP, released from the sensory nucleus of the GFN. The GFN doesn't directly play a role in testicular migration but there is a theory that shows a regulatory function of this nerve in hormonal action during this process. The gubernaculum testis has important structural alterations during the testicular migration and the genitofemoral nerve and CGRP gene are of great importance in this process. The genitofemoral nerve provides motor innervation to the cremaster muscle and gubernaculum, which helps regulate the position of the testes within the scrotum.

A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects / Um caso raro de múltiplas variações vasculares viscerais ao redor dos rins: aspectos morfológicos e clínicos

Abstract Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

Resumo O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos.

Oncological outcomes in non-seminomatous testicular tumors and residual mass after cisplatin-based chemotherapy / Resultados oncológicos en tumores testiculares no seminomatosos y masa residual posquimioterapia con cisplatino

Objective: The aim of our study is to describe the progression-free survival (PFS) in patients with clinical stage (CS) II and III NSGCT with an RM after primary or secondary CT with negative serum markers (NSM). A residual mass (RM) in non-seminomatous germ cell tumors (NSGCT) after chemotherapy (CT) is defined as a mass >1 cm in greatest diameter. The preferred treatment for RM is retroperitoneal lymph node dissection (RPLND), with a cure rate greater than 80%. Methods: We identified 60 patients with NSGCT, RM, and NSM between 2007 and 2020. Data regarding clinical and oncological outcomes as well as pathological information were obtained in a retrospective fashion from our electronic database. Results: A total of 60 patients were included. 50% of cases were CS II, and 50% CS III. About 90% of the patients had undergone RPLND. Teratoma was found in 73.6% of these patients. PFS and OS were better in CS II patients, compared to CS III. The patients treated with observation were found to have a shorter PFS compared to patients who underwent RPLND. Patients with viable tumors after RPLND had shorter OS compared to patients with teratoma and fibrosis. Conclusions: RPLND continues to be the treatment of choice to patients with RM after CT and NSM

Objetivo: Nuestro objetivo es describir la supervivencia libre de progresión (SLP) en pacientes con TCGNS en estadio clínico (CS) II y III con masa residual tras QT primaria o secundaria con marcadores séricos negativos (MSN). Métodos: Se incluyeron pacientes con TCGNS, MR y MSN atendidos entre 2007-2020. Los datos se obtuvieron de forma retrospectiva de nuestra base de datos electrónica. Resultados: Se identificaron 60 pacientes, el 50% eran CS II y el 50% CS III, y el 90% de los pacientes fueron sometidos a DGLRP. Se evidenció teratoma en el 73,6% de los pacientes. La SLP y la supervivencia global (SG) fue mejor en pacientes con CS II, frente a CS III. Los pacientes observados tuvieron una SLP menor frente a los que se sometieron a DGLRP. Los pacientes tratados con DGLRP y evidencia de tumor viable en la patología tenían una SG más corta comparado con teratomay fibrosis. Conclusión: La DGLRP sigue siendo el tratamiento de elección para las MR posterior a QT y MSN.

Carcinoma testicular de células germinales no seminomatoso estadio I, supervivencia global en pacientes posterior a tratamiento primario / Testicular non-seminomatous germ cell carcinoma stage I, overall survival in patients following primary treatment

Objetivo: Caracterizar la supervivencia global (SG) y la supervivencia libre de recurrencia (SLR) de pacientes con carcinoma testicular de células germinales no seminomatoso (NSGCT) estadio I derivados a diferentes opciones de adyuvancia. Método: Búsqueda de pacientes con NSGCT estadio I llevados a orquiectomía radical del 2010-2022. La descripción se hizo con medidas de tendencia central. Resultados: En el modelo de regresión no hubo diferencias. Conclusiones: No se encontraron diferencias en SG o SLR. Se requieren estudios prospectivos para corroborar hallazgos

Objective: To characterize overall survival (OS) and recurrence-free survival (RFS) in patients with stage I testicular non-seminomatous germ cell carcinoma (NSGCT) referred to different adjuvant treatment options. Method: Patient search included individuals with stage I NSGCT who underwent radical orchiectomy from 2010 to 2022. The statistical description was conducted using measures of central tendency. Results: In the regression model, no differences were observed. Conclusions: No differences were found in OS or RFS. Prospective studies are needed to confirm these findings

Fertility outcomes in microdissection testicular sperm extraction for non-obstructive azoospermia

Background: The objective of this study was to evaluate outcome of micro dissection testicular sperm extraction (micro TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non-obstructive azoospermia (NOA).Methods: We retrospectively analysed data of 96 consecutive patients with clinical NOA who were treated with micro TESE by single surgeon, between January 2022 and December 2022, in Lifeline superspeciality hospital Adoor, Kerela. Embryological and clinical outcomes were demonstrated based on ICSI-IVF cycles using fresh or frozen sperms, different etiologies of NOA and various counts of sperms retrieved.Results: 96 men underwent micro TESE and 72.9% (70/96) of them had sperms retrieved. ICSI performed in 64 couples. Of those, 41 reached the stage of embryo transfer (ET). Of the couples who underwent embryo transferred, 18 (43%) resulted in biochemical pregnancies and 7 (17%) clinical pregnancies. There was a significant difference in the testicular volume and serum FSH levels between micro-TESE positive and negative groups (p=0.000). Retrieval rates were higher in group of men with normal testicular volume and FSH<12. Clinical pregnancy rate was around 11% in couples who had sperms retrieved by micro TESE. The sperm retrieval rates were higher in men with age <40 years. Similarly younger the female age more was the pregnancy rate. Out of various etiologies idiopathic NOA and Klinefelter syndrome had better sperm retrieval rate in our study which was statistically significant. Total fertilization rate and blasts rates were 79.7% and 51.6% out of ICSI.Conclusions: Microdissection testicular sperm extraction is an effective treatment for NOA with higher rate of sperm retrieval and pregnancy rate. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.

Tumor de Testículo / Testicular tumor

Introducción: los tumores testiculares representan el 4% de las neoplasias urogenitales, de las cuales el seminoma es el tumor maligno más frecuente del testículo en los varones jóvenes. El pronóstico es bueno con la orquiectomía total, llegando a una sobrevida del 95% en 10 años. Presentación de Caso: paciente de sexo masculino de 28 años con tumoración no dolorosa en región escrotal de 10 años de evolución, acude al servicio de urología por molestias y aumento importante de la tumoración en el último año. Conclusión: el tumor testicular tiene un muy buen pronóstico si es detectado a tiempo, teniendo en cuenta que con la exploración física ya se puede tener el diagnostico.

Introduction: testicular tumors represent 4% of urogenital neoplasms, of which seminoma is the most common malignant tumor of the testicle in young men. The prognosis is good with total orchiectomy, reaching a survival of 95% in 10 years. Case Presentation: a 28-year-old male patient with a non-painful tumor in the scrotal region of 10 years of evolution, went to the urology service due to discomfort and a significant increase in the tumor in the last year. Conclusion: the testicular tumor has a very good prognosis if it is detected in time, taking into account that with the physical examination the diagnosis can already be made.

In vivo Gonadoprotective Effects of Myricetin on Cisplatin- Induced Testicular Damage via Suppression of TLR4/NF-kB Inflammation Pathway and Heat-Shock Response / Efectos Gonadoprotectores in vivo de la Miricetina sobre el Daño Testicular Inducido por Cisplatino Mediante la Supresión de la Vía de Inflamación TLR4/NF-kB y la Respuesta al Choque Térmico

SUMMARY: The aim of this study is to reveal the gonadoprotective effects of myricetin (MYC), which has many biological properties, on cisplatin (CP)-induced testicular damage in rats. For this purpose, 40 male Wistar albino rats were divided into 4 groups as Control (group given no treatment), MYC (group given 5 mg/kg/i.p myricetin for 7 days), CP (group given 7 mg/kg/i.p cisplatin at 7th day) and MYC + CP (group given 5 mg/kg/i.p myricetin for 7 days before 7 mg/kg/i.p cisplatin injection). After administrations, testicular tissues of animals were extracted and processed according to tissue processing protocol. Hematoxylin & Eosin staining were performed to evaluate the histopathological changes and Johnsen'sTesticular Biopsy Score (JTBS) was applied and mean seminiferous tubule diameters (MSTD) were measured to compare experimental groups in terms of histopathological changes. Moreover, TLR4, NF-kB, HSP70 and HSP90 expression levels were detected by immunohistochemical staining and the density of immunoreactivity were measured to determine the difference in the expression levels of these factors among groups. Additionally, testicular apoptosis was detected via TUNEL assay. JTBS and MSTD data were significantly lower in CP group compared to other groups and MYC administrations significantly protects testicular tissue against CP-induced damage. Moreover, TLR4, NF-kB, HSP70 and HSP90 expressions and apoptotic cells significantly increased in the CP group (p<0.05). However, MYC administrations exerted a strong gonadoprotective effect on testicular tissue in terms of these parameters in MYC+CP group (p<0.05). According to our results, we suggested that MYC can be considered as a protective agent against cisplatin-induced testicular damage.

El objetivo de este estudio es revelar los efectos gonadoprotectores de la miricetina (MYC), que tiene muchas propiedades biológicas, sobre el daño testicular inducido por cisplatino (CP) en ratas. Para este propósito, se dividieron 40 ratas albinas Wistar macho en 4 grupos: Control (grupo que no recibió tratamiento), MYC (grupo que recibió 5 mg/kg/i.p de miricetina durante 7 días), CP (grupo que recibió 7 mg/kg/i.p de cisplatino al séptimo día) y MYC + CP (grupo que recibió 5 mg/ kg/i.p de miricetina durante 7 días antes de la inyección de 7 mg/ kg/i.p de cisplatino). Después de las administraciones, se extrajeron y procesaron tejidos testiculares de animales según el protocolo de procesamiento de tejidos. Se realizó tinción con hematoxilina y eosina para evaluar los cambios histopatológicos y se aplicó la puntuación de biopsia testicular de Johnsen (JTBS) y se midieron los diámetros medios de los túbulos seminíferos (MSTD) para comparar los grupos experimentales en términos de cambios histopatológicos. Además, los niveles de expresión de TLR4, NF-kB, HSP70 y HSP90 se detectaron mediante tinción inmunohistoquímica y se midió la densidad de inmunorreactividad para determinar la diferencia en los niveles de expresión de estos factores entre los grupos. Además, se detectó apoptosis testicular mediante el ensayo TUNEL. Los datos de JTBS y MSTD fueron significativamente más bajos en el grupo CP en comparación con otros grupos y las administraciones de MYC protegen significativamente el tejido testicular contra el daño inducido por CP. Además, las expresiones de TLR4, NF-kB, HSP70 y HSP90 y las células apoptóticas aumentaron significativamente en el grupo CP (p<0,05). Sin embargo, las administraciones de MYC ejercieron un fuerte efecto gonadoprotector sobre el tejido testicular en términos de estos parámetros en el grupo MYC+CP (p<0,05). Según nuestros resultados, sugerimos que MYC puede considerarse como un agente protector contra el daño testicular inducido por cisplatino.

Efecto de la Vitamina E en Células Peritubulares de Testículos de Ratones Mus musculus Tratados con Ácido Valproico Durante el Estado Fetal y Pubertad / Effect of Vitamin E on Peritubular Cells from Testis of Mus musculus Mice Treated with Valproic Acid During the Fetal Stage and Puberty

El ácido valproico (VPA) es un fármaco antiepiléptico teratógenico que, al ser administrado durante etapas tempranas del embarazo, puede producir alteraciones en el desarrollo embriofetal, las que se manifiestan tanto a nivel del sistema nervioso como del testículo. No obstante, se ha reportado que la administración de vitamina E (VE) podría revertir dichas alteraciones. El objetivo del presente estudio fue determinar el efecto protector de la VE a nivel testicular en fetos y ratones púberes expuestos a VPA durante la fase embrionaria de su desarrollo. Se utilizó un total de 30 ratones hembra adultas gestantes (Mus musculus) cepa BALB/c, las cuales se dividieron en 6 grupos. El estudio contempló el análisis de fetos machos a los 17,5 días post-coital (dpc) y machos juveniles a las 6 semanas post-natal. A los grupos 1 y 4 se les administró 0,3 mL de solución fisiológica (grupos control para 17,5 dpc y 6 semanas postnatal, respectivamente). A los grupos 2 y 5 se les suministró la cantidad de 600 mg/kg de VPA (grupos VPA), en tanto que a los grupos 3 y 6 se les aplicó la misma dosis de VPA complementada con 200 UI de VE (grupos VPA+VE). Se describió la histología normal y patológica del compartimento peritubular del testículo. En los grupos VPA se evidenció una degeneración de la pared peritubular, y atrofia de túbulos seminíferos, así como exfoliación de las células germinales. Por el contrario, en los grupos VPA+VE tales signos no fueron observados y la morfología presentó aspecto normal solo con algunas alteraciones focales. Estos resultados corroboran el hecho que la administración de VE contrarresta en parte, los efectos deletéreos que ocasiona el VPA.

SUMMARY: Valproic acid (VPA) is a teratogenic antiepileptic drug that, when administered during the early stages of pregnancy, can produce alterations in embryo-fetal development, which manifest both at the level of the nervous system and the testicle. However, it has been reported that the administration of vitamin E (VE) could reverse these alterations. The study aimed to determine the protective effect of VE at the testicular level in fetuses and pubertal mice exposed to VPA during the embryonic phase of their development. 30 pregnant adult female mice (Mus musculus) BALB/c strain were used, which were divided into 6 groups. The study included the analysis of male fetuses at 17.5 days post-coital (dpc) and juvenile males at 6 weeks post-natal. Groups 1 and 4 were administered 0.3 mL of physiological solution. Groups 2 and 5 were given 600 mg/kg of VPA (VPA groups), while groups 3 and 6 were given the same dose of VPA supplemented with 200 IU of VE (VPA+VE). The normal and pathological histology of the peritubular compartment of the testis was described. In the VPA groups, degeneration of the peritubular wall, and atrophy of the seminiferous tubules, as well as exfoliation of the germ cells, were evident. On the contrary, in the VPA+VE groups such signs were not observed and the morphology presented a normal appearance with only some focal alterations. These results corroborate the fact that the administration of VE partially counteracts the deleterious effects caused by VPA.

Tumor de Testículo

Introducción: los tumores testiculares representan el 4% de las neoplasias urogenitales, de las cuales el seminoma es el tumor maligno más frecuente del testículo en los varones jóvenes. El pronóstico es bueno con la orquiectomía total, llegando a una sobrevida del 95% en 10 años. Presentación de Caso: paciente de sexo masculino de 28 años con tumoración no dolorosa en región escrotal de 10 años de evolución, acude al servicio de urología por molestias y aumento importante de la tumoración en el último año. Conclusión: el tumor testicular tiene un muy buen pronóstico si es detectado a tiempo, teniendo en cuenta que con la exploración física ya se puede tener el diagnostico.

Introduction: testicular tumors represent 4% of urogenital neoplasms, of which seminoma is the most common malignant tumor of the testicle in young men. The prognosis is good with total orchiectomy, reaching a survival of 95% in 10 years. Case Presentation: a 28-year-old male patient with a non-painful tumor in the scrotal region of 10 years of evolution, went to the urology service due to discomfort and a significant increase in the tumor in the last year. Conclusion: the testicular tumor has a very good prognosis if it is detected in time, taking into account that with the physical examination the diagnosis can already be made.