ABSTRACT
CONTEXT: A randomized controlled study was conducted comparing the outcome of surgery for congenital cryptorchidism at 9 months or 3 yr of age. OBJECTIVE: The aim of the study was to investigate whether surgery at 9 months is more beneficial than at 3 yr and to identify early endocrine markers of importance for testicular development. PATIENTS AND METHODS: A total of 213 biopsies were taken at orchidopexy, and the number of germ and Sertoli cells per 100 seminiferous cord cross-sections and the surface area of seminiferous tubules and interstitial tissue were analyzed. Inhibin B, FSH, LH, and testosterone were determined. Testicular volume was assessed by ultrasonography and by a ruler. RESULTS: The number of germ and Sertoli cells and testicular volume at 9 months were significantly larger than at 3 yr. The intraabdominal testes showed the largest germ cell depletion at 3 yr. At both ages, testicular volume correlated to the number of germ and Sertoli cells. None of the hormones measured during the first 6 months of life (LH, FSH, testosterone, and inhibin B) could predict the number of germ or Sertoli cells at either 9 or 36 months of age, nor could hormone levels predict whether spontaneous descent would occur or not. CONCLUSION: Morphometric and volumetric data show that orchidopexy at 9 months is more beneficial for testicular development than an operation at 3 yr of age. Testicular volume was furthermore shown to reflect germ cell numbers in early childhood, whereas endocrine parameters could not predict cellular structure of the testis or its spontaneous descent.
Subject(s)
Cryptorchidism/metabolism , Cryptorchidism/pathology , Cryptorchidism/surgery , Hormones/metabolism , Orchiopexy , Testis/physiopathology , Age Factors , Child, Preschool , Cryptorchidism/physiopathology , Follicle Stimulating Hormone/blood , Follicle Stimulating Hormone/metabolism , Hormones/blood , Humans , Infant , Infant, Newborn , Inhibins/blood , Inhibins/metabolism , Luteinizing Hormone/blood , Luteinizing Hormone/metabolism , Male , Orchiopexy/methods , Orchiopexy/rehabilitation , Organ Size , Spermatogenesis/physiology , Testis/metabolism , Testis/surgery , Testosterone/blood , Testosterone/metabolismABSTRACT
OBJECTIVE: To examine effects of nondescent of normal testis and of various orchidopexy techniques on antisperm antibody (ASA) production and histologic testicular lesions. DESIGN: Experimental cohort study. SETTING: Laboratories of surgical research and biology of reproduction, academic medical centers. PATIENT(S): Lewis rats, immature and adult. INTERVENTION(S): Eighteen-day-old rats (6 groups): intra-abdominal stay of testis after closure of inguinal canal, classic dartos pouch orchidopexy, orchidopexy by testis fixation through tunica albuginea, orchidopexy by transparenchymal testicular fixation, sham operation, and bilateral vasectomy. Adult rats (1 group): transparenchymal testicular fixation. MAIN OUTCOME MEASURE(S): The ASA--antiacrosome and antitail--were measured by indirect immunofluorescence in sera collected preoperatively, on 50th and 120th day in immature rats, and 90 days after surgery in adult rats. Testicular histology was also examined at the end of sera collection. RESULT(S): Neither intra-abdominal testicular localization nor orchidopexies induced significant ASA. Testicular nondescent and fixation (transparenchymal or transtunical) caused hypospermatogenesis; dartos pouch was harmless. Bilateral vasectomy produced significantly increased ASA, but no significant testicular lesions. Contralateral testes were unaffected. CONCLUSION(S): Intra-abdominal testicular stay and orchidopexy do not elicit autoimmune response to sperm; histologic testicular lesions might not be associated with ASA. In operated cryptorchids, ASA are probably due to other reason than testicular heat or orchidopexy trauma.
