The optimum cut-off value of contralateral testis size in the prediction of monorchidism in children with nonpalpable testis: A systematic review.

BACKGROUND: Contralateral Testis Hypertrophy (CTH) is a clinical marker that could be used to guide the choice of the main surgical strategy. In patients with a Non-palpable Testis (NPT), the degree of CTH as measured by testicular length or volume has been shown to be able to predict whether the undescended testis will survive. OBJECTIVE: The purpose of this study was to establish the proper cut-off for identifying non-viable testes based on the current literature. DESIGN: We systematically searched several medical databases as well as Google Scholar search engines for references and citations. All the studies that reported CTH as a result of NPT in prepubertal boys were included. Data from the included articles was gathered by two independent reviewers. The checklist developed by the Joanna Briggs Institute (JBI) was used to evaluate the methodological quality of the studies that were included. Due to the incredibly high degree of heterogeneity among the studies, no meta-analysis was done. RESULTS: The current systematic review included 17 studies that assessed the cut-off point to detect non-viable testis. The size and length of the testes were taken into consideration based on our findings. We found that different studies reported various ideal cut-off values for predicting non-viable testes, which can be brought on by various measuring techniques, evaluation ages, and patient groupings. The difference in testis volume was greater than the difference in its length, which can be attributable to the fact that some studies used an orchidometer to measure the testis's length directly or indirectly. CONCLUSION: According to the results of our study, it seems that defining a cut point for diagnosis of CTH based on the size of the testis, cannot demonstrate the absence of a non-palpable testis.

Incidence and clinical pattern of contralateral synchronous and metachronous germ cell testicular cancer.

BACKGROUND: Incidence of a second testicular tumor is higher in patients diagnosed with testicular cancer than in the general population. As incidence of unilateral germ cell cancer is increasing worldwide and most of these patients are cured, a growing number of patients at risk of developing a contralateral testis cancer is expected. OBJECTIVE: To analyze clinical and histological characteristics, as well as the absolute and cumulative incidence of a second testicular cancer in a cohort of 3,834 patients diagnosed with germ cell testicular cancer between I/1994 and I/2018 in 18 referral hospitals of the Spanish Germ Cell Cancer Group. METHODS: Patients were treated according to stage and year of diagnoses. Contralateral testis biopsy was not routinely performed, according to European Association of Urology rules. Follow-up of the contra lateral testis consists of a physical exam only and an annual optional testicular ultrasound for 10 years. RESULTS: Median age of the patients included was 32 years (18-82). With a median follow-up of 61 months (0-240), 67/3,834 patients (1.74%) were diagnosed with a second testicular tumor. The second testicular tumor was synchronic (diagnosed within 6 months of the first orchiectomy) in 19 patients, and metachronous in 48. Pathology of the second tumor was reported as a seminomatous testis tumor in 47 patients and a nonseminomatous cancer in 20. Cumulative incidence of contralateral testicular cancer was 2% at 5 years, and 4% (IC 95% 3%-5%) at 14 years. Younger age was a risk factor for developing a second testicular tumor (P = 0.006), whereas chemotherapy reduced the risk for a metachronous testicular cancer (P = 0.046). Within our cohort, 6 families with testicular cancer aggregation (more than 2 tumors in the same family) were identified. CONCLUSIONS: Incidence of second testicular neoplasm in this cohort of 3,834 patients was similar to that which has been reported in other countries. Metachronous tumors and seminomas are more common. Follow-up of the contralateral testis is mandatory, as well as adequate information for patients to prevent a second neoplasm if feasible, and to detect and treat it as soon as possible.

Contralateral testicular cancer despite negative biopsy 30 months earlier.

Contralateral testis biopsy in patients with unilateral testis germ cell cancer is a controversial topic. We present a case of a young male who develops a second testis germ cell cancer despite negative biopsy 30 months earlier. A review of the newest studies and the Scandinavian and European guidelines concerning contralateral testis biopsy is performed.

Histomorphologic Changes of the Contralateral Testis in Unilateral Inguinal Cryptorchidism / 대한비뇨기과학회지

PURPOSE: The pathogenesis of infertility in unilateral cryptorchidism remains unclear. We studied prospectively to evaluate the cause concerning potential infertility in unilateral inguinal cryptorchidism.Materials and Methods: Between Feb 1998 and July 2000, 30 specimens were taken by ipsilateral undescended and contralateral descened testicular biopsies in 15 unilateral inguinal cryptorchid boys (age range: 1-11 years, mean: 4.7 years). Control testicular biopsies were performed in 5 hydrocele boys (age range: 1-9 years, mean: 5.1 years). We performed histomorphologic analysis including spermatogonia per tubule (S/T) value, Sertoli cell index (SCI), tubular degeneration phase V-VII (TDP V-VII), mean tubular diameter (MTD), and changes of peritubular interstitial tissue (thickened tubular basement membrane and peritubular fibrosis). RESULTS: Testis volume, S/T value, and MTD were significantly different between ipsilateral cryptorchid and contralateral testes. However, there was no significant difference between ipsilateral cryptorchid and contralateral testis in SCI, TDP V-VII, and changes of peritubular interstitial tissue. We found significant difference between contralateral and control testis in testis volume, S/T value, MTD, TDP V-VII, and changes of peritubular interstitial tissue except SCI.Conclusions: Decreased testis volume, S/T value, MTD and increased TDP V-VII of contralateral testis are associated with germinal hypoplasia. These findings may explain the pathogenesis of infertility in unilateral inguinal cryptorchidism.

Comparisons of the effects of testicular torsion through a scrotal wall incision and an abdominal wall incision on the contralateral testis in prepubertal rats / 대한비뇨기과학회지

Unilateral spermatic cord torsion has been shown to cause damage to the contralateral testis in humans and animal models. In the present paper, we have examined contralateral testes of prepubertal Sprague-Dawley rats 14 days after 720 torsion to determine the effect of scrotal surgery versus abdominal approach and to determine the effect of therapeutic orchiectomy versus detorsion. Torsion periods were 2. 6 and 24 hours. Histologic examinations of contralateral testis at the end of the experiment demonstrate that all rats of both the orchiectomy and detorsion groups had a significantly reduced mean seminiferous tubular diameter compared to controls (p<0.001). But the groups of abdominal approach had a smaller reduced mean seminiferous tubu1ar diameter than the groups of scrotal approach. These results indicate that these contralateral alterations seem to be caused by generalized perineal inflammatory responses as well as immunologic responses.

The Effect of Testicular Torsion on the Contralateral Testis in Rats; Histologic Changes and its Reversibility

Unilateral torsion of the testis was experimentally induced in Sprague-Dowley rats by an incision in the scrotum and manual rotation of the testis. The testes remained torted for 3 or 24 hours and then were released by detorsion or orchiectomy. Histologic changes were evaluated 2 weeks and 4 weeks post torsion episode in order to answer the following questions:(1) Does the duration of testicular torsion affect the degree of histologic change in the contralateral testis? (2) Does the treatment of the torted testis influence the contralateral testis histologically? (3) Are there any histologic differences according to the duration of the follow-up in each group? The results indicate that when a torted testis was kept in place for at least 24 hrs, then was a marked decrease in spermatogenesis, but even this histologic change disappeared 4 weeks later. In conclusion a torted testis may present a liability to the patient's contralateral testis, but this phenomena is temporal.