Association of Epididymal Anomalies with Patent Processus Vaginalis in Hernia, Hydrocele and Cryptorchidism

Purpose

We performed a prospective study to assess the relationship between epididymal anomalies and patency of the processus vaginalis in boys presenting with hernia, hydrocele or cryptorchidism.

Materials and Methods

The degree of patency of the processus vaginalis (closed, partially closed or open) and morphology of the ipsilateral epididymis were recorded in 159 consecutive inguinal explorations.

Results

A closed, partially closed and open processus vaginalis was associated with an abnormal epididymis in 14, 36 and 69 percent of cases, respectively. Epididymal anomalies were more frequent in association with undescended (72 percent) than descended (34 percent) testes.

Conclusions

These data confirm the observation of a higher incidence of epididymal anomalies associated with patency of the processus vaginalis irrespective of testicular position, and they support the theory that androgenic stimulation may be required for closure of the processus vaginalis as well as epididymal development.     

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Epididymal anomalies and patent processus vaginalis are frequently found in boys with cryptorchidism or hydrocele. We conducted this study to evaluate the association between epididymal anomalies and testicular location or patent processus vaginalis in boys with undescended testis or hydrocele. Children undergoing surgery with undescended testis (group A, 136 boys and 162 testes) or communicating hydrocele (group B, 93 boys and 96 testes) were included. Testicular locations and epididymal anomalies were investigated prospectively. An anomalous epididymis was defined as anomalies of epididymal fusion that consisted of loss of continuity between the testis, the epididymis, and the long looping epididymis. The epididymis was considered normal when a normal, firm attachment between the testis, the caput, and the cauda epididymis was present. The mean ages of groups A and B were 24.6 ± 19.7 (range, 8–52 months) and 31.4 ± 20.6 months (range, 10–59 months). The incidence of epididymal anomalies was significantly higher in group A than that in group B (65.4 % vs. 13.5 %, P < 0.001). The incidence of epididymal anomalies in boys with undescended testis was significantly different according to testis location. Epididymal anomalies were observed in 100 %, 91.4 %, and 39.3 % of cases when the testis was located in the abdomen, inguinal canal, and distal to the external inguinal ring, respectively (P < 0.001). We conclude that epididymal anomalies were more frequent in boys with undescended testis than in boys with hydrocele, and that these anomalies were more frequent when undescended testis was at a higher level. These results suggest that testicular location is associated with epididymal anomalies rather than patent processus vaginalis.     

Analysis of anomalies of the epididymis and processus vaginalis in human fetuses and in patients with cryptorchidism treated and untreated with human chorionic gonadotrophin

OBJECTIVE: To analyse the incidence of epididymal anomalies and the structure of the processus vaginalis (PV) in patients with cryptorchidism treated or not with human chorionic gonadotrophin (hCG), and to compare these findings with human fetuses with testes in the scrotum. PATIENTS, MATERIALS AND METHODS: We assessed 24 fetuses with a gestational age of 23-35 weeks, and 114 cryptorchid patients (mean age 10.3 years). The patients were divided into two groups of those who used hCG (55, 65 testes) and those who did not (59, 75 testes). The sample was divided into six groups of possible anatomical relationships between the testis and the epididymis, according to a previous classification. Two situations were considered to analyse the PV: (a) total obliteration between the internal inguinal ring and the upper pole of the testis; and (b) total patency. RESULTS: Epididymal anomalies were found in 35% of patients with cryptorchidism and in only 4% of normal fetuses. Of the 47 cases of epididymal anomalies in patients with cryptorchidism 23 (49%) were treated with hCG and 24 (51%) were not. The PV was patent in 58% of patients with cryptorchidism and in only 5% of fetuses. Considering the three groups, the epididymal anomalies were more frequent when the PV was patent. CONCLUSIONS: Patency of the PV and the incidence of epididymal anomalies were more frequent in patients with cryptorchidism. The existence of epididymal anomalies did not influence testicular migration in patients treated with hCG.     

Malformations of the epididymis in undescended testis

Epididymal abnormalities in undescended testes are probably more common than suggested in the literature but only sporadic reports are found on this subject. For many years discussions have centered around the ideal age to operate on patients with undescended testes and consequently increase chances for future fertility. We analyzed 66 patients (82 testes) treated for undescended testis in our department, with special distinction between ectopia and cryptorchidism. Abnormalities ranged from simple epididymal elongation to more complex forms, such as complete disruption between the testis and epididymis. Among 49 ectopic testes the epididymides of 19 (38.8%) displayed more severe abnormalities in addition to elongation, while 16 (32.6%) showed only an elongated epididymis and 14 (28.6%) were normal. Among the 33 cryptorchid testes 29 (87.9%) showed the more complex anomalies and elongation, 3 (9.1%) were normal and only 1 (3%) was elongated. Our results demonstrate a much higher incidence of complex epididymal abnormalities in cryptorchidism (p less than 0.001). Elongated epididymis may present problems for sperm maturation and transportation, although with no other associated abnormality most can be regarded as patent. In our theory cases of elongation plus other major abnormalities probably are associated with severe impairment in sperm maturation and hindered transportation, with the future intrascrotal or extrascrotal position of the testis or early surgical repair being of little importance in terms of fertility.     

Epididymal abnormalities associated with undescended testis.

In a prospective study of 42 patients with undescended testes 15 (36 per cent) had epididymal abnormalities. These anomalies were divided into 3 groups, including agenesis of the epididymis, atresia of the epididymis and loop or elongated epididymis. In the second group atresia could occur at the head, body or tail of the epididymis.     

大鼠睾丸扭转复位后附睾上皮细胞凋亡及唾液酸变化

目的:探讨大鼠睾丸扭转复位后,附睾上皮细胞凋亡与唾液酸分泌的关系。方法:24只雄性SD大鼠建立左侧睾丸扭转复位模型,分为对照组、扭转2h和4h共3组,每组8只。TUNEL法检测附睾上皮细胞凋亡,5-甲基苯二酚法检测扭转侧附睾唾液酸的含量。结果:睾丸扭转2h复位后24h,扭转侧附睾上皮细胞凋亡指数与对照组相比上升不明显(P>0.05),唾液酸含量改变不明显(P>0.05);扭转4h复位后24h,扭转侧附睾上皮细胞凋亡指数与对照组相比上升极显著(P<0.001),唾液酸含量下降明显(P<0.05)。结论:睾丸扭转2h复位后24h,附睾上皮细胞未发生凋亡,其分泌唾液酸功能不受影响;扭转4h复位后24h,附睾上皮细胞凋亡严重,其分泌唾液酸功能下降。     

Congenital anomalies of the mesonephric duct and fertility

Agenesia of deferential duct and the others congenital malformations of mesonephronical duct are often encountering condition in andrological practice. This study presents the possibilities of reproductive medicine to restore the male fertility and concentrates on biological and clinical aspects of malformations of mesonephronic duct like factors for excretory male infertility. The investigations including 104 patients (mean age 30.25+/-1.91 years old) with congenital anomalies of mesonephronical duct with: Agenesia of mesonephronical derivates - case with unilateral agenesia of the deferent duct, kidney and left urether (n=1); Dysgenesia of the epididymis (n=5); Cysts of the epididymis (n=47); Agenesia of the deferential duct (n=48); Aplasia of the eja-culatorial duct (n=3). The following methods were used: open testicular biopsy by Vilar; objective findings in situ operation; bilateral epididymo - and deferentovesiculography; morphological specimens of the testicular and epididymal tissues; enzymohistochemical analysis of testicular specimens; the ejaculates and morphological analysis of spermatozoa were assessed for quality parameters by the standard protocol; enzymocytological research of spermatozoa in seminal fluid; biochemical analysis of seminal fluid fructose and citric acid concentrations; radioimmunoassay for measurements of blood FSH and testosterone concentration. RESULTS: Most often observed localization of the malformations of mesonephronic canal is bilateral at 54.81%. The testicular specimens proved preserved testicular architecture and spermatogenesis, and the epididymal slides showed dilatation of the epididymal tubules, which were overfilled with a lot of spermatozoa. The strongest expression of the enzymichistochemical NADH-TR reactions is in the Sertoli cells. We observed spermatozoa with disrup-ted configuration among which the abnormalities in sperm head and acrosome were predominated. The biochemical analysis of seminal fluid proves normal citric acid and low or lack of fructose concentration in seminal fluid. There were no breaches in endocrine regulation of the reproductive process. Patients with congenital anomalies of mesonephronic canal have preserving fertility in 31.73%. There are morpho-functional disorders of the testes, epididymis and seminal ducts in 68.27%. CONCLUSION: There are normal spermatogenesis but definite sterility. These results necessitate an application of plastic reconstructive operation for recovery of fertilizing ability of the patients, or their involvement in ICSI programme.     

Ectopic aberrant adrenals with epididymal abnormality.

We report a rare case of ectopic aberrant adrenals associated with epididymal abnormality found during exploration for a left undescended testis. Two ectopic adrenals were found, one on the epididymis and the other adjacent to the spermatic cord. We believe the simultaneous occurrence of epididymal abnormality and ectopic aberrant adrenals has not been reported before.     

Polyorchidism: a case report and review of the literature

Polyorchidism is defined as the presence of two or more testes. It is a rare anomaly with approximately 77 cases reported in the literature. Polyorchidism is frequently associated with additional urological pathologies such as undescended testis, inguinal hernia, testicular torsion, hydrocoele, malignancy and infertility. Differential diagnosis includes spermatocoele, hydrocoele, epididymal cysts or aberrant epididymis. We report on an interesting case of polyorchidism in a 15-year-old man diagnosed on ultrasound and we review the literature and current management of polyorchidism.     

Polyorchidim: a case report and review of the literature

A 28-year-old male presented with a small painless lump in his left hemiscrotum. A physical examination revealed a non-tender mass that was palpable on the tail of left epididymis, and the testis and spermatic cord were normal. Ultrasonography showed an isoechoic round shaped tumor, 16 mm in diameter. An exploration of the scrotum was performed, based on a preoperative diagnosis of a left epididymal tumor. The tumor was located below the tail of epididymis, and had a whitish capsule, which looked similar to tunica albuginea testis. A frozen section revealed testicular tissue without any malignant change, and therefore polyorchidism was diagnosed. The accessory testis was resected because there was no connection with the epididymis and vas deferens. Polyorchidism is a rare congenital anomaly with 24 cases reported in the Japanese literature. The indications for the resection of an accessory testis are controversial. Patients with intrascrotal polyorchidism might be recommended to undergo a resection of the accessory testes if there are signs of dysplasia during an intraoperative biopsy. Patients must be followed up with regular clinical and ultrasonic examinations when accessory testes are preserved. However, extrascrotal supernumerary testes should be managed by an orchiectomy because of the increased risk of malignancy.     

Effect of acute androgen withdrawal by GnRH antagonist on epididymal sperm motility and morphology in the cynomolgus monkey

Hormonal male contraception requires an induction phase before azoospermia and contraceptive safety are achieved. The nature of spermatozoa that may be ejaculated during this induction phase was studied in a nonhuman primate. The GnRH antagonist Cetrorelix was administered daily to five cynomolgus monkeys to induce testicular regression, and the vehicle was given to five control animals. Within 16 days, the antagonist reduced androgens by 80% in the serum and by 50% in the epididymis. Sperm were obtained by mincing different epididymal regions and were examined for morphology (subjectively) and motility (objectively) after removal of the organs 16 and 25 days after continuous treatment. Spermatozoa entering the epididymis of monkeys undergoing regression differed from those of vehicle-treated controls in their greater susceptibility to disruption during preparation for morphological staining. The acquisition of motility by sperm in the epididymides attached to regressing testes occurred in the same epididymal region as controls but did not achieve the median velocities attained by sperm in controls during epididymal passage. Values for most sperm motion parameters developed as in the controls, and, during epididymal passage, sperm developed resistance to stresses encountered during preparation for morphological analysis. These observations suggest that spermatozoa ejaculated before spermatogenesis ceases may be potentially fertilizing because epididymal maturation continues in an androgen-deprived organ. From these preclinical studies, it can be concluded that in men, applying hormonal contraception precautions against pregnancy must be recommended before azoospermia is induced, since the epididymis can partially compensate for poor-quality sperm produced by a regressing testis even when levels of circulating androgens and tissue androgens are low.     

The state of the testicle and the epididymis associated with exstrophy of the bladder in undescended testes

In undescended tests, the large number of testicular dysplasias/hypoplasias and of that of the fusion abnormalities of the epididymis, and the joint occurrence of the two, can achieve even 50%. The frequency of the above anomalies were studied in undescended testes associated with exstrophy of the bladder. Bilateral undescended testes were observed in 5 out of 26 boys born with vesical exstrophy. In 3 of them bilateral orchiopexy had already been performed. In 5 of the 6 operations intact testicles and intact epididymis were found. Fusion abnormality was observed only in one case, but the testicle was intact also in that case. This can be attributed to the fact that in exstrophy of the bladder, the testicles have failed to descend not due to the insufficient effect of fetal androgen, but due to anatomical causes. This is also supported by the fact that where the disorder of descension has been caused by mechanical factors, there was a much lower ratio of testicular-epididymal fusion abnormality.     

Effects of abdominal location and epididymal or vasal obstructions either individually or in association on ipsilateral and contralateral testes. A histologic and DNA flow cytometric analyses

OBJECTIVE: An experimental study was conducted to evaluate the damages in ipsilateral and contralateral testes in individual or associated presences of abdominal location and vasal or epididymal obstructions. METHODS: Six groups each consisting of 8 rats were established. The groups included sham operation, ligation of the vas deferens, detachment of the epididymis from testis, abdominal placement of the testis, abdominal placement of the testis with vas deferens ligation, and abdominal placement of the testis with detachment of epididymis from testis. After 30 days, bilateral orchidectomy was performed. Mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were obtained for each testis. Relative proportions of haploid, diploid and tetraploid cells were determined by DNA flow cytometry. MSTD, MTBS and the proportions of haploid cells were compared through one-way analysis of variance. RESULTS: While vas deferens ligation has diminished MSTD only in the contralateral testes, abdominal testis and detachment of epididymis have diminished MSTD in both ipsilateral and contralateral testes. MTBS were depressed only in the ipsilateral testes in groups of abdominal testis, vas deferens ligation and detachment of epdidymis. However, ratios of haploid DNA were depressed in both ipsilateral and contralateral testes. Abdominal testis together with vas ligation or detachment of epididymis has further depressed the ratios of haploid DNA in both ipsilateral and contralateral testes. CONCLUSION: Compared to their individual presence, the associated presence of abdominal testis and vasal or epididymal obstructions may augment the damages encountered within the ipsilateral and contralateral testes.     

The sex reversal syndrome (the XX male patient)

Prenatal amniocentesis performed for advanced maternal age demonstrated a 46XX female karyotype. At birth, however, the infant was noted to be a phenotypic male with descended testes and severe chordee without hypospadias. Chromosomal analysis confirmed a female karyotype, while later surgical exploration revealed normal internal wolffian duct structures.     

Changes in Angiotensin Converting Enzyme in Testes and Epididymes of Rat Due to Serotonin Administration

Effect of exogenous serotonin and blockade of its endogenous production on Angiotensin Converting Enzyme (ACE) in testes and epididymis was studied. Serotonin (30 mg/kg) and p-chlorophenylalanine (100 mg/kg) were injected for 4 and 3 days respectively. Serotonin reduced the weights of testes, seminal vesicle and ventral prostate whereas epididymal weight increased due to fluid accumulation. ACE was significantly reduced in tissue and fluid fractions of testes and epididymis of serotonin treated rats. pCPA had no effect on ACE levels. Serotonin seems to have direct effect on epididymis also.     

附睾相关的抗生育研究及进展

虽然至今尚没有一种直接作用于附睾并可供临床试验用的男性避孕药 ,但对附睾功能和精子在附睾成熟的研究表明 ,附睾极有可能成为男性抗生育最理想的靶器官。相关的动物试验包括直接作用于附睾精子如磺胺水杨嗪类、影响能量代谢与精子活动的氯化甘油和氯化糖苷类化合物、影响附睾环境如雷公藤单体和铜粉等。对附睾特异蛋白研究 ,可望发现免疫学途径的靶抗原 ,用于制备避孕疫苗。近年国内外对附睾特异表达基因的研究取得某些进展 ,如SC342、bin1基因的克隆和功能研究 ,有助于临床附睾炎和不育症的诊治 ,同时有望成为干扰附睾精子成熟达到避孕目的的新靶点。     

L-肉碱在奥硝唑所致大鼠睾丸和附睾损伤中的保护作用

目的:探讨L-肉碱(LC)在奥硝唑(ORN)所致大鼠附睾和睾丸损伤中的的保护作用。方法:40只雄性SD大鼠(200～230g)随机均分为5组:①A组:给予0.5%的羧甲基纤维素钠(溶剂)灌胃;②B组:每天给予400mg/kgORN灌胃;③C组:每天给予800mg/kgORN灌胃;④D组:每天给予[ORN(400mg/kg)+LC(100mg/kg)]灌胃;⑤E组:每天给予[ORN(800mg/kg)+LC(100mg/kg)]灌胃。上述各组均连续灌胃20d,末次给药24h后,所有大鼠麻醉后处死,分别取睾丸、附睾,进行称重和HE染色,计算睾丸、附睾系数并观察睾丸和附睾病理组织学改变。结果:①与A组相比,B组睾丸、附睾系数明显降低(P<0.05);而C组睾丸、附睾系数为极显著性降低(P<0.01);D组与A组相比无差异,E组与A组相比有极显著性差异(P<0.01);②HE染色显示,与A组相比,B组睾丸生精小管内各级生精细胞排列基本整齐,部分生精小管管腔内有脱落的生精细胞,附睾管腔中精子数目下降,有时可见散在的生精细胞;C组大鼠睾丸生精小管管腔内均可见坏死脱落的生精细胞,附睾管腔中精子数目明显减少,且有较多的非精子细胞成分。D组睾丸生精小管无明显改变,附睾管腔中精子数目也未见明显下降;E组睾丸生精小管管腔内精子数目减少,可见坏死脱落的生精细胞,附睾腔中精子数目明显减少,并伴有较多的非精子细胞成分。结论:奥硝唑(ORN)可导致雄性大鼠附睾和睾丸病理组织学改变,LC对ORN引起大鼠附睾和睾丸损伤具有一定的保护作用。     

The role of the epididymis in testicular descent

In 54 patients with 70 undescended testes hospitalized for orchiopexy epididymal anatomy was examined intraoperatively. Of the testes 66 per cent had abnormal epididymides, which suggests a possibly significant role for the epididymis in the process of testicular descent.     

Antispermatogenic/antiandrogenic properties of solasodine (C27H43O2N) obtained from solanum xanthocarpum berries on the male genital tract of dog (Canis-familiaris). A Histophysiological approach

Chronic administration of solasodine (20 mg/kg alt. day for 30 days) caused testicular lesions resulting in a severe impairment of spermatogenic elements. The epididymides were devoid of spermatozoa. Total protein, sialic acid and glycogen contents of the testis and epididymis were reduced significantly whereas the testicular cholesterol was elevated. Acid Phosphatase enzyme activity of the testes was low after solasodine treatment. Serum enzymes (SGPT, alkaline phosphatase) serum protein, triglycerides, non esterified fatty acid levels were in normal range when compared with their own controls. Cholesterol and phospholipid levels were elevated after solasodine treatment to intact dogs. Reduced androgen production was reflected in low levels of sialic acid in the testes and epididymides and reduced Leydig cell nuclei. Castration alone brought about reduction in size of the epididymis. Castration followed by solasodine treatment caused epididymal degeneration. Simultaneous administration of TP to solasodine treated castrated dogs failed to stimulate the epididymal growth. Antispermatogenic/antiandrogenic activity of the compound solasodine is discussed. Solasodine administration in dogs definitely rendered the male infertile as evidenced by the absence of sperms in the cauda epididymis and ductus deferens.     

输精管结扎术后附睾瘀积综合征发病机制、诊断与治疗探讨

为了阐明输精管结扎术后附睾瘀积综合征的发病机制，探讨诊断与治疗方法，收集１０例病人，行血清及精浆抗精子抗体测定及Ｂ超、Ｃ超、ＭＲＩ等项硷查。手术采用附睾一近睾端输精管。结扎结节整块切除术。术中取附睾液行细菌培养及睾丸活检，标本行光镜和电镜检查。术后随访，９例治愈，１例无效。瘀积附睾的组织学检查表明是附睾对外漏精子的无菌性炎症反应。睾丸活检，生精过程正常２侧，其同侧结扎断端有精子肉芽肿形成，提示输精管结扎断端精子肉芽肿的形成对睾丸有保护作用。