Gonadotropin and testosterone response in prepubertal boys with hypospadias

Serum levels of luteinizing hormone and follicle-stimulating hormone before and after luteinizing hormone-releasing hormone stimulation, and levels of testosterone before and after 3 days of treatment with human chorionic gonadotropin were determined by radioimmunoassay in 98 boys with hypospadias (2 to 8 years old). The doses of luteinizing hormone-releasing hormone and human chorionic gonadotropin were calculated for body surface. The basal and peak levels of serum luteinizing hormone, follicle-stimulating hormone and testosterone in patients with hypospadias were compared with 9 endocrinologically normal boys of the same age without hypospadias. Luteinizing hormone response to luteinizing hormone-releasing hormone stimulation was significantly impaired in boys with hypospadias and also simple hypospadias (no associated anomaly). Basal levels of luteinizing hormone in boys with simple hypospadias and levels of follicle-stimulating hormone in patients with hypospadias were significantly low. The maximum testosterone response to human chorionic gonadotropin stimulation was significantly decreased in boys with severe hypospadias in direct proportion to the degree of hypospadias.     

Pituitary and gonadal functions in patients with chordee without hypospadias

Pituitary and gonadal functions in 16 prepubertal boys with chordee without hypospadias by stimulation of gonadotropin releasing hormone or human chorionic gonadotropin were compared to those of age-matched normal boys. The patients with chordee without hypospadias had poor follicular stimulating hormone response but pituitary luteinizing hormone reserve function was normal. Testosterone response by stimulation of human chorionic gonadotropin was not impaired in patients with chordee without hypospadias. The results suggested that chordee without hypospadias may also be categorized into hypospadias from the aspect of its pituitary and gonadal functions in addition to the embryogenesis of chordee.     

Antisperm antibodies in prepubertal boys with cryptorchidism

The presence of antisperm antibodies in male individuals before puberty is controversial due to the lack of finally differentiated male germ cells. It was questioned whether the pathologic conditions of the male gonad may influence antisperm antibody formation in individuals before puberty. Sera samples of 76 individuals and 10 healthy boys with testicular failure (mainly uni- or bilateral cryptorchidism) were examined by means of indirect immunobead-binding test (IDIBT). The presence of antisperm antibodies was found in 3.95% of the studied subjects. Antibodies recognizing antigenic determinants present on the surface of mature sperm cells may be produced before puberty in individuals suffering from cryptorchidism or the other gonadal disorders. Antisperm antibodies that did develop in a minority of the studied male population may be proof for individual predispositions to autoimmune reactions.     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

先天性尿道下裂患者的尿流率特点及其分析

目的:研究先天性尿道下裂患者的尿流率特点。方法:笔者对22名2～6岁的先天性尿道下裂患者和22名同年龄组正常男性儿童进行尿流率测定,对比观察尿流率曲线的特点,并应用Toguri尿流率列线图对测定结果进行了分析。结果:与正常男性儿童的钟形尿流率曲线相比,尿道下裂患者的尿流率曲线呈平台形。22例尿道下裂患者中,1例(4.5%)患者的尿流率曲线与对照钟形曲线基本一致,18例(81.8%)患者的尿流率曲线呈平台形,3例(13.6%)患者尿流率曲线明显低平。在Toguri尿流率列线图上,尿道下裂患者最大尿流率坐标点位于正常人群第5百分位数曲线附近区域,明显低于正常水平。结论:先天性尿道下裂患者尿流率曲线多数呈平台形,最大尿流率明显低于正常水平。     

Prognosis of sexual maturation in prepubertal boys with micropenis

Long-term observations were made of the prognosis for sexual maturation (onset of puberty) in 15 prepubertal boys with micropenis. Testosterone levels before and after HCG administration and LH and FSH responses to LH-RH were measured at the first visit and a few years later. In the eight boys who showed significant responses to the LH-RH and HCG tests, onset of puberty occurred with the exception of one patient. The remaining seven boys who showed no positive response to either stimulation test were treated with injections of HCG. However, no signs of sexual maturation were observed. These data demonstrate clearly that both the HCG test and the LH-RH test are very useful for prognosis of sexual maturation in patients with micropenis.     

Estradiol levels in prepubertal boys and girls--analytical challenges

Increasing evidence points at an important function of low concentrations of estradiol (E2) in prepubertal boys and girls. E2 serum levels in prepubertal children are, however, often immeasurable in conventional E2 assays. This strongly hampers further investigation of the physiological relevance of E2 in children. In addition, there is an increasing concern of the potential effect of exposure to endocrine disrupters with estrogenic or antiandrogenic activity on pubertal development. A requirement of assessing the instance for this concern, adds further to the demands for applicable methodologies for the evaluation of the sensitivity of the organism to low E2 concentrations. Traditionally, E2 is measured by use of the radioimmunoassay (RIA). As an ultrasensitive alternative to the RIA, a recombinant cell bioassay has been developed. In this review, methodological aspects for these methods of analysis are examined and their applicability for evaluation of low E2 serum concentrations in children is estimated. Furthermore, available data on E2 levels in prepubertal boys and girls are evaluated and discussed, taking into consideration the limitations of the methods of analysis. In conclusion, there is a pronounced demand for new and improved methods of analysis for accurate and sensitive evaluation of low concentrations of E2.     

Results of preputial reconstruction in 77 boys with distal hypospadias

PURPOSE: There is growing interest in preputial reconstruction combined with hypospadias repair. We retrospectively analyzed its results for future developments and patient information. MATERIALS AND METHODS: We evaluated 77 boys who underwent distal hypospadias repair combined with preputial reconstruction to determine complications, risks and failures. RESULTS: At a mean followup of 2.5 years 52 patients had an anatomically normal penis with a normal retractable foreskin, while 25 (33%) presented with a complication. The most common complications were partial dehiscence, and fistula of the prepuce and urethra. There was a complication of the reconstructed foreskin only in 16 cases (21%), a combined problem with the reconstructed foreskin and reconstructed urethra in 7 (9%), and a problem with the reconstructed urethra in 2 (3%). Of the 25 patients with complications 19 underwent reoperation with closure of the fistula or dehiscence and 5 were circumcised, while in 1 the parents accepted the minor cosmetic problem and refused reoperation. CONCLUSIONS: Preputial repair combined with hypospadias repair may lead to anatomically correct reconstruction of the penis at the cost of a 33% complication rate. Parents are informed about this risk and to date in 15% of all boys with distal hypospadias the parents have elected preputial reconstruction.     

Is hormonal therapy necessary in prepubertal boys with cryptorchidism?

Three hundred and twenty-eight prepubertal boys with cryptorchidism who had orchiopexy were reviewed in regard to the attachment of the gubernaculum. Normal attachment of the gubernaculum was found in only 19 out of 240 unilateral testes (8%), and in 12 out of 176 testes (7%) of 88 patients with bilateral cryptorchidism. Abnormal attachment of the gubernaculum was found in 307 out of 338 testes (91%). These data suggest that hormonal therapy for undescended testis may be effective in only 9% of the cases with cryptorchidism, and it cannot replace surgery.     

Orchiopexy in prepubertal boys. Five-year survey.

A series of 141 prepubertal boys with undescended testes operated on in a provincial teaching hospital has been analyzed five years after operation. The main features noted at presentation were the mature age of the patients and the small number of boys referred by pediatricians. The incidence of unsatisfactory results was 36% in unilateral and 35% in bilateral operations. The majority of the patients (81%) were referred for surgery after the age of five years, commonly regarded as the most suitable time for surgical correction. Three patients required a primary orchiectomy for a small atrophic testis, while 2 patients had an orchiectomy done on a previously operated testis. The complication rate for the series was 4.5%. Testicular biopsy was not done at the time of operation, and no patients were referred for semen analysis. Eight patients underwent a second orchiopexy after the first operation failed. In 6 patients an atrophic testis developed after the second procedure. The need for more than one postoperative examination is stressed in view of the fact that an initially favorable result may not persist since the testes may be found, at a later date, to have retracted into an unsatisfactory position. The reasons for the poor results are discussed and compared briefly with previous reports.     

隐睾儿童青春期前内分泌环境和雄激素受体水平的研究

近年来，我们采用放射免疫分析法对４６例年龄为１５个月至１４岁的隐睾儿童的血清ＦＳＨ、ＬＨ、ＰＲＬ、Ｔ和Ｅ２进行了测定，其中１３例在手术时采取外阴部皮肤、进行成纤维细胞培养后，以３Ｈ－Ｒ１８８１为配体，用完整细胞测定法测定雄激素受体的特异性结合量和每个细胞的雄激素受体量。研究结果：（１）隐睾儿童血清ＦＳＨ值升高可能与早期已存在的睾丸曲精小管损害有关，（２）血清Ｅ２显著增高是本组隐睾儿童垂体－性腺轴内分泌功能最突出的改变，（３）隐睾儿童的雄激素受体的特异性结合量和每个细胞的雄激素受体量与正常对照组无显著性差异。研究表明，隐睾儿童存在高雌激素血症，可能是隐睾发生的重要致病因素之一，而靶器官雄激素受体无明显改变，表明隐睾可能不属于雄激素不敏感症的范畴     

Testosterone concentrations in spermatic venous blood plasma of prepubertal boys

Testosterone concentration has been measured in spermatic and peripheral venous plasma obtained during surgery from a total of 25 prepubertal boys affected either by inguinal hernia (Group I; N = 6; age range 2–8 years) or unilateral undescended testis (Group II; N = 19; age range 5–11 years). Median spermatic venous testosterone level was 58.7 ng/dl) (range 14.0–120.8 ng/dl) in Group I and 43.2 ng/dl (range 12.2–267.5 ng/dl) in Group II: median peripheral testosterone level was 4.9 ng/dl (range 2.3–15.4 ng/dl) and 5.6 ng/dl (range 1.1–89.3 ng/dl) in Group I and II, respectively. The difference between the spermatic and peripheral level was statistically significant in both groups ( P < 0.01 in Group I and P < 0.001 in Group II). These results indicate that the prepubertal human testis secretes testosterone, even if in a very low amount. It is also suggested that this secretion can be responsible for LH inhibition in prepubertal boys.     

Changes in the volume and histology of retractile testes in prepubertal boys

Testicular development was studied in prepubertal boys with retractile testes. Testicular volume, the diameter of the seminiferous tubules and the number of spermatogonia in the tubules were decreased in cases of unilateral retractile testis, when compared with values for the contralateral normally descended testis. On the other hand, in patients with a unilateral retractile testis and contralateral inguinal testis, there was no difference in the developmental parameters between the two testes. These results suggest that the retractile testis has developmental failures characteristic of a cryptorchid testis and therefore requires orchiopexy.     

Pituitary and testicular function in adolescents with varicocele

The LH and FSH responses post GnRH, and the sex steroid hormone responses post hCG stimulation were evaluated in a group of 41 adolescents (mean age 15.09 +/- 2.27) with unilateral varicocele to study the relation between the pituitary gonadotropin and sex steroid hormone responses to the patients' age and pubertal stages. Twenty-two normal boys (mean age 14.90 +/- 1.97) also were studied. In both groups a GnRH stimulation test was performed. Besides this, an hCG test was performed in 7 patients and 7 controls. No significative differences in the LH and FSH responses to the GnRH stimulus were observed in 14 patients at Tanners' pubertal stages 3 to 4 compared to the controls. Twelve (44.44%) patients at Tanners' pubertal stage 5 presented an excessive LH response at 30 and 60 min after GnRH stimulation compared to 12 age- and pubertal stage-matched controls (p < .001 and p < .05, respectively). They also presented an excessive FSH response at 30 min (p < .05) post-GnRH stimulation. Correlation analysis in these 12 patients revealed a tendency toward a positive association between the patients' age and the LH response post-GnRH stimulation. In this group of adolescents with varicocele the gonadotropin response to the GnRH stimulus was influenced by the patients' age and by their pubertal stage of development independently of the venous dilatation.     

Chordee without hypospadias: report of 79 Chinese prepubertal patients

A series of Chinese prepubertal patients with congenital chordee without hypospadias is presented and the clinical data described. From July 1999 to September 2006, 79 boys with congenital chordee without hypospadias were treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, China. The ages ranged from 21 months to 14 years, with a mean of 76.8 months (6.4 years). The patients were categorized according to structural defect into 4 groups, with the aid of intraoperative artificial erection. Group I included those with skin tethering (28 cases, 35.4%); group II, fascial chordee (22, 27.8%); group III, corporal disproportion (10, 12.7%); and group IV, urethral tethering (19, 24.1%). Chordee-related structural defect was considered the only criterion for classification, and urethral dysgenesis influenced the choice of surgical procedure. The chordee in group I patients was corrected with penile degloving; group II, release of dense fibrous tissue in addition; group III, dorsal-midline-plication-based correction; and group IV, longitudinal-island-flap-urethroplasty-based repair. At a mean follow-up of 14.8 months (range, 2 to 63), all patients had penile straightening except 1 group III patient with residual curvature that was managed upon reoperation. Glans dehiscence occurred in 1 group II patient who underwent a tubularized incised plate urethroplasty. Urethrocutaneous fistula and urethral stricture were found in 2 group IV patients who underwent island flap urethroplasty. With the categorization based on structural defect, chordee without hypospadias may be managed well with minimized complications.