Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer

Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.     

新生儿睾丸扭转8例诊治分析

目的 探讨新生儿睾丸扭转临床特点及诊治方法.方法 回顾性分析我院近5年收治的8例睾丸扭转新生儿的临床资料并复习相关文献.结果 新生儿睾丸扭转共8例;年龄7h~8d;左侧3例,右侧5例;入院查体均发现阴囊肿大呈暗红色或黑紫色,内可及质硬包块,触痛阳性;超声检查示患睾增大、密度不均、血流信号减少或消失;均行阴囊探查术,术中均发现精索睾丸扭转并已坏死,7例行患睾切除;病理结果示睾丸大片出血坏死,5例择期行对侧睾丸固定术.所有患儿随诊3~12月,1例家长拒绝切除患睾的患儿3月时B超复查已经萎缩,超声检查均未发现对侧睾丸异常.结论 新生儿睾丸扭转的睾丸坏死率极高;当发现新生儿阴囊色泽改变、肿大触痛等改变,在不能除外睾丸扭转时应尽早行阴囊探查术.     

老年前列腺癌患者去势后性激素水平变化及对凝血和纤溶系统的影响

目的探讨老年前列腺癌患者去势后性激素水平变化及对血液凝血和纤溶系统活性的影响。方法27例早期前列腺癌经手术去势的患者作为研究组,39例非前列腺癌老年患者作为正常对照组。分别测定黄体生成素(LH)、卵泡刺激素(FSH)、总睾酮(TT)、游离睾酮(FT)、雌激素(E2)、部分凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、凝血酶原活动度(PA)、纤溶酶原(PLG)活性、α2-抗纤溶酶(α2-PI)活性、抗凝血酶-Ⅲ(AT-Ⅲ)活性、二磷酸腺苷(ADP)活性、D-二聚体(DD)含量、血小板聚集率和黏附率、组织型纤溶酶原激活剂(t-PA)及组织型纤溶酶原激活剂抑制物(PAI-1)抗原浓度。结果研究组中患者TT、FT、E2水平显著降低,E2降低幅度小于TT,LH、FSH、FT/TT、E2/TT显著升高;PT、APTT显著缩短,Fib及DD含量显著增加,血小板聚集率、黏附率及ADP活性均显著升高,PLG、α2-PI活性显著增强,t-PA抗原含量及t-PA/PAI-1显著下降,PAI-1含量显著增加。AT-Ⅲ活性无显著变化。结论前列腺癌患者去势后性激素比例严重失调;血小板活性及血液凝血活性显著增强,纤溶活性显著抑制,提示去势患者存在发生动脉硬化的高度危险性。     

Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought?

Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long‐term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.     

睾丸恶性肿瘤的临床治疗分析——附26例报告

目的：研究睾丸恶性肿瘤的治疗原则、方法的选择以及瘤标监测的临床意义。方法：对２６例不同类型的睾丸恶性肿瘤应首选行根治性睾丸切除术，术后并配合进行化疗或放疗术后定期检测β-hCG和AFP以观察肿瘤是否有复发趋势。结果：本组26例中，25例获得随访（96.2%)。12例T1期11例获得随访未发现肿瘤复发和转移。T2-T4期13例均获得随访经过化疗1-6疗程。放疖000cGY以上，完全缓解8例（CR为61.5%)，部分缓解5例（PR为38.5%)。术前β-hCG升高6例，AFP升高1例，治疗后β-hCG和AFP均下降至正常（其中4例为胚胎癌）。另有1例T1期精原细胞瘤在治疗过程中β-hCG正常，而在随访期中升高，经2个疗程化疗后β-hCG下降至正常。结论：隐睾症是睾丸恶性肿瘤的常见病因之一，本组占30.8%，对隐睾患儿应尽早手术固定。睾丸肿瘤手术应常规行根治性睾丸切除术。     

Is there a relationship between physical performance and orchiectomy?

Bilateral orchiectomy is indicated for the treatment of patients with testicular cancer or advanced prostate tumours. The influence of hypogonadism on physical performance is still not known. The purpose of this work was to verify the effect of bilateral orchiectomy on physical performance. Sixteen rats were divided into two groups: Group 1 (Control), in which only skin incision and suture were made (n = 5) and Group 2, in which the rats were submitted to bilateral orchiectomy (n = 11). The animals ran on a treadmill at the speed of 20 m min^?1 until they were fatigued and felt once, during 10 s, when the experiment was interrupted. Time to running and weight of animals were verified. The results were compared using the Mann–Whitney test. There was no difference on time to running – minutes – (P = 0.14) and weight – grams – (P = 0.25) between the animals submitted to orchiectomy (100 ± 44 min and 359 ± 38 g) and the control Group (81 ± 40 min to run and 327 ± 25 g). Bilateral orchiectomy does not affect the physical performance of the rat.     

MOLECULAR BIOLOGY OF MALE INFERTILITY

About 15% of couples have reduced fertility and in approximately one-half of all cases the reason is male infertility, usually of genetic origin. Thus, in the context of research in genes involved in reproduction and sex determination, genetic anomalies in gametogenesis are being extensively studied. The most frequent pathogenic causes of male infertility are Y-chromosomal microdeletions (8-15%) in the long arm of the Y chromosome, which, by loss of specific DNA segments, leads to loss of vital genes for sperm production. Infertile men, who attend infertility clinics, rise to 15% among those with azoospermia or spermatogenesis problem. The new technique of intracytoplasmic sperm injection has allowed many infertile men to achieve their dreams of fatherhood. However, the spermatogenic defect is genetic anomalies, which might be a potential risk of transmitting this defect to future offspring. Therefore, genetic counseling of all couples with the diagnosis of male infertility is recommended before their enrolment in intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. The important role of genetic abnormalities in the causation of human male infertility is increasingly recognized. While much remains to be learned in this fast-moving field, considerable progress has been made in the clinical delineation of genetic forms of male infertility and in the characterization of the responsible genes and their mutations or deletions. This review should provide insight into the understanding of parthenogenesis of male infertility in the human.     

Pharmacologic treatment of male breast cancer

Male breast cancer is an uncommon condition. It often occurs in settings in which there is an imbalance between androgens and oestrogens. Genetics plays an important role, as many cases are associated with mutations in BRCA2 or other genes. Male breast cancer occurs at an older age than female breast cancer and is frequently diagnosed at a later stage. Tumors are predominantly oestrogen and progesterone positive. Prognosis is approximately equivalent to that of breast cancer in females when matched for age, stage and hormonal receptors. The recommended treatment for male breast cancer is similar to that for breast cancer in postmenopausal females. However, the presence of androgens in males has a strong effect on the hormonal milieu and the ability of male patients to respond to hormonal agents. When pharmacologic treatment is required, tamoxifen is effective for first-line therapy. Other hormonal approaches such as orchiectomy, aromatase inhibitors and androgen ablation may be useful in later lines of therapy.     

Testicular carcinoid tumor: A case report and literature review

We present a case of a 46-year-old man with an incidental finding of a right testicular tumor on magnetic resonance imaging. He received radical orchiectomy, and the pathological report showed a testicular carcinoid tumor. He has remained in a stable condition 3 years after the operation. Carcinoid tumors of the testis are extremely rare and account for less than 1% of testicular tumors and carcinoids. A painless mass or prominent testis enlargement is the most distinctive presentation. Less than 1–3% of patients demonstrate carcinoid syndrome. Nuclear scintigraphy scan and computed tomography scan have a diagnostic value in excluding carcinoid from other sites. Radical orchiectomy is the treatment of choice, and the prognosis is good for localized carcinoid tumors after resection. Adjuvant chemotherapy or radiotherapy for advanced disease shows only minimal benefits.