Hormonal parameters and testicular volume in children and adolescents with unilateral varicocele: preoperative and postoperative findings.

Preoperative and postoperative testicular volume, serum testosterone, follicle-stimulating hormone and luteinizing hormone were determined in 25 patients 8 to 19 years old (mean age 13.2 +/- 1.63) with grades 2 and 3 unilateral varicocele. Testicular growth arrest was considered significant when volume loss was greater than 2 ml. in the ipsilateral testis compared to the contralateral side. Baseline serum testosterone, follicle-stimulating hormone and luteinizing hormone as well as post-gonadotropin releasing hormone stimulation were determined preoperatively and at 4 to 6 months postoperatively. Data are presented as mean plus or minus standard deviation. Results showed an increase in serum testosterone in Tanner's stages 1 (p < 0.028) and 2 to 3 (p < 0.008). No differences were recorded in basal luteinizing hormone and follicle-stimulating hormone, as well as maximal follicle-stimulating hormone levels before and after surgery. A decrease of maximal luteinizing hormone response to gonadotropin releasing hormone test was noted postoperatively in pubertal stages 4 to 5, when compared to preoperative values. Postoperative ipsilateral testicular volume increased in all Tanner stages (p < 0.045, p < 0.008 and p < 0.012, respectively). Our observations suggest that varicocele may be initially responsible for interstitial dysfunction with preservation of germinal function and unilateral testicular growth arrest, however reversible, after pubertal surgical correction. This study supports previous reports suggesting that varicocelectomy in children who show anatomic and functional changes is advisable.

Small kidney associated with primary vesicoureteral reflux in children. A pathological overhaul.

In this series two quite distinct pathological entities accounted for the small, often deformed, kidney found over a severe primary ureterovesical reflux. One of them is due to dysplastic abnormal metanephric differentiation, and the other is a segmental tubular atrophy with glomerular metamorphosis. In our material there is no evidence to support an inflammatory pathogenesis in these conditions. An abnormal excess vascularization is explained by an arteriovenous fistula present in both. Proper identification of the pathology underlying such cases will assist further studies on the natural history of these two diverse malformations.

Paratesticular rhabdomyosarcoma in children.

The clinicopathological features of 10 children with paratesticular rhabdomyosarcoma treated between 1965 and 1984 are reviewed. Of the patients 9 had embryonal rhabdomyosarcoma and 1 was pleomorphic. Median age was 4 years (range 2 to 11 years). Staging was based on clinical findings, chest x-ray, lymphoangiography, computerized tomography and histological studies. The disease was stage I in 5 patients, stage II in 2 and stage IV in 3. Treatment included radical orchiectomy in all patients, chemotherapy in 8 and lumboaortic radiotherapy in 5. No retroperitoneal node lymphadenectomy was performed. Of the 10 children 7 are free of disease after 2 to 19 years (median 7 years) of followup, including all of those with stages I and II disease.

Ultrastructural characteristics of collagen tissue in normal and congenitally dilated ureter.

Scanning electron microscopy is a useful method to study the organization distribution and orientation of the collagen fibers in the ureteral wall. Different collagen structural patterns have been observed in normal ureter, primary obstructive megaureter and refluxing megaureter. A pathogenic hypothesis is advanced based on the different functional characteristics of each one of these entities. Collagenous proliferation in primary obstructive megaureter and refluxing megaureter could be related to ureteric smooth muscle cell disfunction.