Timing of pubertal development in boys born with cryptorchidism and hypospadias: a nationwide cohort study / 亚洲男科学杂志(英文版)

Pubertal development may be altered in boys with cryptorchidism and hypospadias, but existing knowledge is inconsistent. Therefore, we investigated the association between cryptorchidism and hypospadias and pubertal development in a large cohort study. Boys in the Puberty Cohort, a cohort nested within the Danish National Birth Cohort, were included in this study. Information on cryptorchidism and hypospadias was retrieved from the Danish National Patient Register. From 11 years until 18 years or full pubertal development, information on physical markers of pubertal development was provided biannually, including Tanner stages, axillary hair, acne, voice break, and first ejaculation. In multivariate regression models for interval censored data, the mean (95% confidence intervals [CIs]) differences in months in obtaining the pubertal markers between boys with and without the anomalies were estimated. Among 7698 boys, 196 (2.5%) had cryptorchidism and 60 (0.8%) had hypospadias. Boys with hypospadias experienced first ejaculation and voice break 7.7 (95% CI: 2.5-13.0) months and 4.5 (95% CI: 0.3-8.7) months later than boys without hypospadias. The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher, though not statistically significant. Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism. In conclusion, hypospadias may be associated with delayed pubertal development, but pubertal development seems unaffected by cryptorchidism. The relation between hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.

The importance of the gubernaculum in testicular migration during the human fetal period

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. .

Histopatologia do conduto peritônio-vaginal em crianças com criptorquia / Histopathology of processus vaginalis in children with undescended testes

Introdução: existem algumas dúvidas relacionadas à criptorquia, como aspectos etiofisiopatológicos do testículo críptico, e de outras estruturas adjacentes que poderiam estar relacionadas com a não descida testicular.Uma dessas estruturas seria o conduto peritônio-vaginal, presente na maioria dos casos. Com intenção de conhecer melhor a morfologia desse conduto em crianças com criptorquia, decidiu-se pelo estudo histológico. Métodos: foram colhidos 45 fragmentos de conduto peritônios-vaginais de 43 meninos com criptorquia, operados no Serviço de Cirurgia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais, durante os anos de 2001 a 2003. As amostras foram coradas pela técnica de hematotoxilina-eosina e tricrômico de Gomori e analisadas por microscopia óptica, sendo examinadas pela mesma patologista. A análise estatística dos principais achados e variáveis foi realizada pelo software Epi-Info. Calcularam-se as médias e desvios-padrão e para as proporções utilizou-se o intervalo de confiança 95 por cento, pelo método Fleiss Quadrático. Resultados: os principais achados histológicos encontrados encontrados nos CPV foram: filetes nervosos (100 por cento), tecido conjutivo (100 por cento), revestimento mesotelial (66 por cento), musculatura lisa (57 por cento) musculatura estriada (13 por cento) e remanescentes de túbulos mesonéfricos (7 por cento). Conclusões: associando os achados dessa pesquisa a dados da literatura sobre histologia de sacos herniários de criança com hérnia inguinal indireta, aventou-se a possibilidade de o CPV apresentar histologia diferente do saco herniário. Considera-se importante a realização de outros trabalhos histológicos de CPV, comparativos e com uso de métodos mais específicos – imuno-histoquímicos.

Current concepts and controversies in undescended testes.

Cryptorchidism, or undescended testis, is the most common genital anomaly identified at birth in males that continues to challenge the pediatric specialist. The last two decades have seen rapid improvements in understanding the complex mechanisms underlying the genesis of cryptorchidism. Yet, despite years of study, answers to questions relating to controversies surrounding undescended testes remain elusive. This article presents an overview of the controversies and current understanding of this challenging problem.

Tumor de células de Leydig, en criptocridia bilateral / Leydig cell tumour, in bilateral cryptorchidism

Se presenta un caso de tumor de células de Leydig oculto en un pciente con criptorquidia bilateral. El diagnóstico de tumor se estableció por ecografía testicular, no presentando manifestaciones endocrinas. Se discute la fisiopatología y el manejo de esta rara neoplasia

Cirugía laparoscópica en pacientes adultos con testículo intraabdominal / Laparoscopic surgery in adults patients with intra-abdominal testis

La criptorquidia es la anomalía de la diferenciación sexual masculina más frecuente. Es detectar principalmente en el recién nacido y durante el primer año de vida, sin embargo, puede encontrarse en la edad adulta con riesgo de degeneración maligna en el testículo criptorquídico, mayor aún si se encuentra a nivel abdominal. El propósito de este informe es dar a conocer la experiencia inicial en el tratamiento de la criptorquidia de localización intraabdominal por medio de cirugía laparoscópica en cuatro pacientes con edad promedio de 36 años, ubicación testicular en el anillo inguinal interno o cercana a él. Se identificó atrofia testicular severa en tres pacientes y seminoma en uno. Todos fueron resecados por laparoscopia, sin complicaciones y con evolución posoperatoria satisfactoria

Leydig cell function in prepubertal boys with cryptorchidism before and after orchidopexy

To determine the Leydig cell function in cryptorchidism at a prepubertal age, and the effect of orchidopexy on this function, 23 boys with cryptorchidism [unilateral in 16 boys and bilateral in 7] with ages ranging from 28 4/12 to 11 years were studied. LH, FSH and testosterone were estimated in serum. Serum testosterone was also measured after three consecutive daily injections of 1500 IU HCG. These studies were repeated 6 to 10 weeks after successful orchidopexy in 12 of these boys. The results were compared to those in 10 healthy children of similar age. In unilateral and bilateral cryptorchid groups, serum LH, serum FSH, and serum testosterone [before and after HCG] were comparable to those in healthy boys. Following orchidopexy, no changes were observed in these parameters. Biopsy of the cryptorchid tests revealed normal Leydig cell morphology, and atrophic changes in the seminiferous tubules especially in older boys. It was concluded that and rogen dynamics are normal in unilateral and bilateral cryptorchidism, and that they are not influenced by orchidopexy

Estudio y manejo de la criptorquidia: gonadotropina y orquidopexia / Study and management of cryptorchism: gonadotropin and orchidopexy

En el tratamiento del testículo criptoquídico ha habido siempre controversia para decidir la conducta que puede preservar la fertilidad del órgano y evitar repercusiones psicológicas y la degeneración maligna, todo lo cual fundamentalmente gravita sobre la edad en que debe aplicarse orquidopexia y el uso de la gonadotropina coriónica. Este estudio presenta una serie de 105 pacientes tratados desde los dos años de edad con gonadotropina coriónica y orquidopexia en la cual se obtienen resultados muy satisfactorios, semejantes a los que han descrito otros autores siguiendo una conducta parecida. Es importante difundir este criterio de manejo integral para evitar la atrofia testicular y confirmar que la gonadotropina coriónica puede provocar el descenso a escroto o facilitar la orquidopexia quirúrgica

Incidencia del testículo no descendido en el recién nacido a término y su evolución en el primer año de vida / Undescended testis ocurrence in newborn term and evolution in the firsth year

Se examinaron 1000 recién nacidos varones a término para determinar la incidencia del testículo no descendido al nacimiento en nuestro medio. Encontramos 2.6 por ciento de descenso testicular incompleto. Estos recién nacidos fueron examinados nuevamente a las edades de 1, 3, 6, 9 y 12 meses para evaluar la migración del testículo hacia la bolsa escrotal. Al año de edad el 69.3 por ciento lograron el descenso y el 30.7 por ciento persistieron con el problema. La mayoría de testículos no descendidas se presentaron en recién nacidos con peso por debajo de 3,500 gramos. En el recién nacido el testículo no descendido derecho es casi el doble que el izquierdo y el bilateral se presentó en 15 por ciento. Al momento del nacimiento el testículo no descendido es más frecuentemente impalpable que localizado en el canal inguinal. Al mes de edad esta relación se invierte. Hallamos 19.2 por ciento de recién nacidos con alguna anomalía congénita asociada evidente