Relationship between testicular size by ultrasonography and testicular function: Measurement of testicular length, width, and depth in patients with infertility

Objectives:   The relationships between simple testicular sizes, including the testicular length, width, and depth and testicular function were evaluated to determine the usefulness of measuring these simple parameters.
Methods:   The mean of right and left testicular length, width and depth were measured in 408 men with infertility (mean age, 35.9 ± 5.3 years) using ultrasonography. The ultrasonographic testicular volumes were calculated as the length x width x depth x 0.71. To evaluate the relationship between the testicular size and function, the patients were divided into seven to ten groups according to each testicular size parameter.
Results:   The mean testicular volume, length, depth, and width were 13.4 ml, 3.86 cm, 1.80 cm, and 2.59 cm, respectively. These three testicular dimensions significantly correlated with sperm density, total sperm count, total motile sperm count, serum follicle-stimulating hormone and luteinizing hormone equal to ultrasonographic testicular volume. The mean sperm density was in the oligozoospermic range in patients with a mean testicular volume below 10 ml, a mean length below 3.5 cm, a mean depth below 1.75 cm, and a mean width below 2.5 cm. The mean total sperm count was subnormal in patients with a mean testicular volume below 10 ml, a mean length below 3.5 cm, a mean depth below 1.5 cm, and a mean width below 2.25 cm.
Conclusions:   The testicular length, width, and depth measured by ultrasonography significantly correlated with the testicular function as well as the ultrasonographic testicular volume. A simple measurement of the testicular length, width, and depth is useful for evaluating the testicular function.      

Case report: Crossed testicular ectopia

Crossed testicular ectopia is a rare congenital anomaly in which both testes descend through a single inguinal canal. The typical presentation is that of ipsilateral inguinal hernia and contralateral cryptorchidism. This is a case report of crossed testicular ectopia in a 6-month-old male infant with depiction of herniorrhaphy and laparoscopic intraabdominal findings.     

Restricted lesions after testicular biopsies in young and adult rats

In order to evaluate the possible harmful effects of surgical removal of a testicular biopsy, adult and immature rats were subjected to unilateral testicular biopsy and were studied 24 months later. One group of adult rats were sham-operated. Perfusion-fixed, plastic-embedded specimens of the testes were examined by light microscopy. No morphological differences were found between rats that were immature and those that were adult at the time of biopsy. The lesions observed were focal and occurred only in the vicinity of the site of biopsy. Only about 0.5% (range 0.01–4.5) of the testis was affected. No morphological signs of any immune reaction were observed. It is suggested that the lesions are caused mainly by interference with local blood flow, and to a minor extent by disruption of the flow of seminiferous tubule fluid.     

一氧化氮在一侧睾丸扭转对侧睾丸损伤中的作用

目的 研究总抗氧化能力(T-AOC)和一氧化氮(NO)在一侧睾丸扭转对侧睾丸损伤中的作用。方法 SD雄性大白鼠建立左侧睾丸扭转模型，于扭转后6h再分为扭转睾丸复位及切除组，分别于术后1h、1d、1周、2周和4周处死4—5只，取出睾丸用于一氧化氮合酶(NOS)活性、NO、T-AOC及细胞凋亡的检查。结果 UTT复位后对侧睾丸组织NOS活性、NO含量明显升高，T—AOC显著降低。结论 NO过量产生及T-AOC的下降是UTT对侧睾丸损伤的重要原因。     

Angiography of the testicular artery as a diagnostic aid in boys with nonpalpable testis.

Selective angiography of the testicular artery was performed in 12 boys (age 3-14 yr) with nonpalpable testis. The angiographic, operative, and microscopic findings are described. True aplasia was diagnosed in seven patients. In three patients previously operated upon, the second exploration was facilitated by angiography. This method might be a valuable diagnostic aid in selected cases previously operated for gonadal disorders or inadequately explored for cryptorchism in order to avoid more extensive surgical exploration.     

Evaluation of HLA Expression on Gametogenic Cells Isolated from Human Testis/Auswertung der HLA-Expression von Keimzellen aus dem menschlichen Hoden

Human germinal cells were isolated using a combined mechanical method and enzymatic digestion of testicular tissue. The attempt to fractionate the testicular cells by centrifugation in the continuous and discontinuous Percoll gradient was undertaken. The homogeneous (100%) fraction of late spermatids and enriched fractions of spermatocytes (up to 60%) and round spermatids (approx. 66%) were obtained. Cell-binding radioimmunoassay (CB-RIA) was used to evaluate the HLA expression both on heterogeneous suspensions and enriched fractions of testicular, germ cells using mouse monoclonal antibodies directed to Class I (HLA, -A, -B, -C) and Class II (HLA, -DR) determinants of MHC (main histocompatibility complex). Consistently negative results were obtained as well for heterogenous populations of germinal cells as their fractions in respect to both Class I and Class II antigenic determinants of HLA system.     

Inguinal hernia in infants: the fate of the testis following incarceration

In the years from 1971 to 1980 inclusive, 511 infants under 1 year of age presented with inguinal hernia. Of these, 158 (31%) (149 boys and 9 girls) had incarcerated inguinal hernia. In 151 (95.5%) infants the incarcerated inguinal hernia was reduced by taxis and herniotomy performed 48 to 72 hours later. Seven infants (4.5%) required emergency operation. Of the 142 boys whose incarcerations were reduced by taxis 87 (61%) were contacted and examined. They were aged 10 months to 10 years, 9 months at the time of follow-up. Two boys had testis in the groin presumably hitched up at operation. Testicular volume was assessed in 87 boys using Prader's orchidometer. Two boys had unilateral testicular atrophy. In the remaining 85 boys testicular volume was not different from that of age-matched controls. Our data show that the danger of testicular infarction from an incarcerated inguinal hernia, although real, has been much over-emphasized.     

睾丸假体植入术治疗睾丸缺失的安全性与有效性临床观察(附18例报告)

目的:探讨采用国产中空硅胶睾丸假体实施睾丸假体植入术,治疗睾丸缺失的安全性和有效性。方法:自2009年1月至2011年3月,选择18例睾丸缺失者行睾丸假体植入术,包括:前列腺癌睾丸去势术10例、先天无睾症3例、单侧睾丸萎缩2例、两性畸形2例、隐睾症1例。睾丸假体为YH-G1型国产中空硅橡胶假体,睾丸假体的大小根据患者阴囊可容纳的空间及参照对侧睾丸的体积来选择。结果:18例中有13例一期行假体植入,另5例植入时间在睾丸切除6个月后。平均睾丸假体植入术的手术时间为(22.6±4.6)min(15～30 min),所有患者术后留院观察12 h后即出院,住院时间(1.3±0.4)d。17例术后无感染、出血和排异等并发症发生。1例前列腺癌去势术患者在睾丸假体植入术后3个月时出现排异,最终取出睾丸假体。术后6个月随访:15例对假体的大小感到非常满意,2例认为植入的假体偏小;14例对植入假体的重量感到非常满意,3例认为植入的假体偏轻;17例患者对植入假体后阴囊的形状和假体的位置表示满意;12例患者反映无论是在活动后还是在睡眠中睾丸假体的舒适度良好,5例患者认为植入的假体偏硬。结论:新型YH-G1型国产中空硅胶睾丸假体治疗男性睾丸缺失能满足患者外观及心理的需要,临床实验表明安全有效,并发症少。长期生活质量及并发症还需进一步观察,设计更舒适及有功能的缓释型睾丸假体还需进一步研究。     

Testosterone Propionate Induced Changes in Testicular Phosphatases of Musk Shrew (Suncus murinus L.)/Testosteronpropionatinduzierte Veränderungen der Hoden-Phosphatasen von Bisammaus (Suncus murinus L.)

In order to investigate the role of testosterone (TP) on the physiology of the testis of the musk shrew, activities of acid phosphatase, alkaline phosphatase and adenosine triphosphatase, and DNA, protein and phospholipid contents ot the testis were compared under high and suppressed testosterone conditions. The result indicates that testosterone propionate administration to intact shrews resulted in a significant increase in the activities of testicular enzymes. Following TP the testis phospholipid: DNA ratio increased, whilst no change was observed in the enzyme activities in response to aminoglutethimide phosphate. The role of testosterone in regulating testis function of this non-scrotal primitive eutherian mammal is discussed.     

Relationship between testicular volume and testicular function： comparison of the Prader orchidometric and ultrasonographic measurements in patients with infertility

Aim： To evaluate the relationship between testicular function and testicular volume measured by using Prader orchidometry and ultrasonography （US） to determine the critical testicular volume indicating normal testicular function by each method. Methods： Total testicular volume （right plus left testicular volume） was measured in 794 testes in 397 men with infertility （mean age, 35.6 years） using a Prader orchidometer and also by ultrasonography. Ultrasonographic testicular volumes were calculated as length x width x height x 0.71. To evaluate volume-function relationships, patients were divided into 10 groups representing 5-mL increments of total testicular volume by each method from below 10 mL to 50 mL or more. Results： Mean total testicular volume based on Prader orchidometry and US were 36.8 mL and 26.3 mL, respectively. Semen volume, sperm density, total sperm count, total motile sperm count, and serum FSH, LH, and testosterone all correlated significantly with total testicular volume measured by either method. Mean sperm density was in the oligozoospermic range in patients with total testicular volume below 35 mL by orchidometry or below 20 mL by ultrasonography. Mean total sperm count was subnormal in patients with total testicular volume below 30 mL by orchidometry or under 20 mL by ultrasonography. Conclusion： Testicular volume measured by either ultrasonography or Prader orchidometry correlated significantly with testicular function. However, critical total testicular volume indicating normal or nearly normal testicular function was 30 mL to 35 mL using Prader orchidometer and 20 mL using ultrasonography. Prader orchidometry morphometrically and functionally overestimated the testicular volume in comparison to US. （Asian JAndro12008 Mar; 10： 319-324）     

Paternity in a patient with testicular seminoma and contralateral testicular intraepithelial neoplasia

A 32-year-old patient with unilateral βhCG-positive seminoma and contra-lateral testicular intraepithelial neoplasia (TIN; so-called carcinoma- in-situ ) with no metastases (clinical stage I) received one course of adjuvant carboplatin therapy. He refused further treatment of TIN in his remaining testis. His wife became pregnant by him 4 months later and delivered a healthy child at term. This case shows that patients with TIN in their remaining solitary testis are not necessarily infertile, and testes afflicted with TIN must also contain tubules that retain normal spermatogenic potential. Surveillance may be an treatment option for patients with TIN in their remaining testis in cases where there is a strong desire for paternity.     

非梗阻性无精子症三步法取精术及其临床意义(附73例报告)

目的:探讨非梗阻性无精子症应用三步法取精术获取睾丸精子的方法及其临床意义。方法:73例非梗阻性无精子症患者按步骤依次行睾丸细针抽吸术、睾丸活检术、睾丸显微取精术,并将每次获取的睾丸组织在倒置显微镜(×400)下寻找精子,如该步操作查见精子则终止手术,若未查找到则依次进行。同时取睾丸组织送病理行组织学检查。结果:73例患者行睾丸细针抽吸术,28例(38.4%)获得精子;行至睾丸活检术时,38例(52.1%)获得精子;行至睾丸显微取精术时,47例(64.4%)获得精子。病理学检查结果为唯支持细胞综合征型25例,其中10例查到精子,精子成熟阻滞型21例,其中14例查找到精子,精子发生低下型27例,其中23例查到精子。结论:三步法取精术能够有效地提高患者精子获得率;其精子获得率与睾丸组织学类型相关,其中精子发生低下型精子获得率较高。     

小儿睾丸卵黄囊瘤合并鞘膜积液诊治分析(附7例报告)

目的:提高小儿睾丸卵黄囊瘤的诊治水平,探讨小儿睾丸卵黄囊瘤合并鞘膜积液的临床特点及其中关联。方法:回顾性分析2008年9月至2012年4月收治7例睾丸卵黄囊瘤合并大量鞘膜积液患儿的临床资料。7例均初步诊断为睾丸卵黄囊瘤,临床Ⅰ期。术中快速病理证实为卵黄囊瘤后,行根治性高位精索睾丸切除术。7例术后随访时间3⁴1个月,按术后第1年每个月;第2年每3个月;第3年每6个月随访。内容包括常规体检、血清甲胎蛋白(AFP)、胸片、B超及CT。结果:7例术后病理均证实为睾丸卵黄囊瘤,未累及精索切缘端。6例术后1个月内血清AFP降至正常,诊断为临床Ⅰ期,未行化疗,无复发、转移;1例术后1个月血清AFP116μg/L,诊断为临床Ⅱ期,予PVB方案化疗,术后3个月失访。结论:小儿睾丸卵黄囊瘤合并鞘膜积液易于误诊,应常规检查B超。Ⅰ期患儿可单纯行根治性高位精索睾丸切除术,术后需密切随访;Ⅱ期患儿术后辅以联合化疗。目前尚无证据支持小儿睾丸卵黄囊瘤与鞘膜积液存在关联,其预后与同期病例相仿。     

Distribution pattern of testicular sulphydryloxidase immuno-activity in the djungarian hamster (Phodopus sungorus) during photoperiodically induced involution and recrudescence

The distribution pattern of testicular sulphydryloxidase (SOx) immuno-activity was investigated in the djungarian hamster during photoperiodically induced testicular involution and recrudescence. SOx immuno-activity, indicating functional integrity of labelled cells, did not change in pachytene spermatocytes and spermatids as long as these cells were present in the seminiferous epithelium. Its disappearance coincided with the degeneration of spermatocytes in phases IV and V of involution and reappeared during recrudescence, when the first spermatogenic wave had reached the pachytene stage. In tubules at phase VI of involution (showing maximal regression), the apical cytoplasm of Sertoli cells showed immuno-activity. This immuno-activity disappeared during recrudescence prior to the differentiation of pachytene spermatocytes. Changes in SOx immuno-activity resembled those of lactate dehydrogenase-X (LDH-X) in photo-inhibited testes or during puberty, indicating a close functional relationship which still remains to be elucidated. The data suggest that the hamster exposed to different photoperiods can be used as a suitable model to study the relationship between testicular morphology and function in different states of gonadal activity.     

促卵泡成熟激素与睾丸生精功能（附100例分析）

血清FSH是判断睾丸生精功能的重要实验室指标之一。本实验结果发现：当FSH大于正常值上限1．5倍时,临床上多数患者表现为无精子,部分患者仅1－2个精子／HP,睾丸基本丧失生精功能,处于早期衰竭状态,且这一结果是不可逆的。当FSH大于正常值上限2倍时,曲细精管闭锁,间质纤维化,睾丸容积开始缩小,无生精功能。同时患者性欲下降,出现高促性腺激素性性腺功能低下症。     

Onco‐testicular sperm extraction: testicular sperm extraction in azoospermic and very severely oligozoospermic cancer patients

An increased risk of testicular cancer in men with infertility and poor semen quality has been reported. In view of the high cure rates for testicular germ cell tumours, increasing clinical importance is being placed on the protection of fertility. High‐dose cytostatic therapy may be expected to cause long‐term infertility. Thus, the standard procedure for fertility protection is the cryopreservation of ejaculated spermatozoa or testicular tissue before therapy. Four male patients with azoospermia and two patients with very severe oligozoospermia underwent onco‐testicular sperm extraction (TESE). We attempted onco‐TESE in patients with azoospermia and very severe oligozoospermia after orchiectomy. Of the patients with testicular germ cell tumours, four had spermatozoa in their testicular tissues. Sertoli cell‐only syndrome was found in one patient, and one patient showed maturation arrest without the detection of spermatozoa. Three of six showed seminomatous germ cell tumour, two of six had nonseminomatous germ cell tumour and one patient showed no malignancy. Two patients achieved clinical pregnancy. Fertility challenges in men with cancer are the most straightforward because of the relative ease of obtaining and cryopreserving sperm. Testicular sperm extraction is a useful technique for obtaining spermatozoa before cytotoxic therapy in azoospermic and very severely oligozoospermic cancer patients.     

Testicular microlithiasis: analysis of prevalence and associated testicular cancer in central-eastern Sicilian andrological patients

The aim of this retrospective study was to determine the prevalence of testicular microlithiasis (TM) in central-eastern Sicilian men and to evaluate the association between TM and testicular tumour or infertility. A total of 1056 Sicilian patients underwent scrotal US between 2005 and 2010. TM was found in 106 men with an overall prevalence of 10%; roughly about four times the median prevalence reported in the previous studies (0.6-18.1%). Forty men (3.8%) had a classic TM, whereas 66 (6.2%) had a limited TM. The prevalence of testicular tumour in this cohort was 2.4% (25/1056). At the moment when the testicular tumour was diagnosed, 15 patients (60%) had TM. There was a significant difference (P < 0.01) between the rate of malignancy in men with TM (15/106; 14.2%) and that in men without TM (10/950; 1.1%) with an odds ratio = 16. The prevalence of TM among infertile patients was 18.8%. These data may relate to an increased awareness towards scrotal US examination and/or to the use of more sensitive equipments. The elevated rate of testicular malignancy in men with TM suggests that this US feature may be regarded as a risk factor for testicular tumour.     

Testicular sperm extraction in patients with persistent azoospermia after chemotherapy for testicular germ cell tumor

Sperm cryopreservation before chemotherapy in young males is recommended because of chemotherapy's gonadotoxic effects. However, many patients miss sperm banking, and consequently are often sterile. Two azoospermic patients presented to us after chemotherapy, and we obtained sperm from them by testicular sperm extraction (TESE). One patient was 32 years old and had been treated with six cycles of cisplatin, etoposide and bleomycin (BEP) chemotherapy and one cycle of high-dose chemotherapy for stage III non-seminoma. Histopathology of the testicular specimen showed germinal aplasia with focal islands of full spermatogenesis. Although two intracytoplasmic sperm injection (ICSI) cycles were performed, pregnancy was not achieved. The other patient was 33 years old who was treated with four cycles of BEP chemotherapy for stage II seminoma. Histopathology of the testicular specimen showed Sertoli-cell-only syndrome. Ongoing pregnancy was achieved after one ICSI cycle. TESE should be considered in patients with persistent azoospermia after chemotherapy if frozen sperm samples are not available.