CLINICAL AND CYTOGENETIC STUDIES IN UNDESCENDED TESTES

Abstract. 168 boys aged 2.5–16.8 years with unilateral or bilateral undescended testes or anorchia were studied. Retention was severe (canalicular or intraabdominal) in 1/4 and moderate in 3/4 of the cases. In unilateral retention, the volume of the scrotal testis was usually normal throughout childhood whereas pubertal testicular growth was delayed. In unilateral anorchia, the scrotal testis showed compensatory hypertrophy. In all age groups examined, the mean volume of the undescended testes was abnormally small. Undescended testes were accompanied by abnormalities of the epididymis in 3.6% of cases, of the ductus deferens in 7.8% and of the spermatic vessels in 8.3%. In anorchia such abnormalities were found regularly. Inguinal hernia accompanied 62.8% of the undescended testes and was most frequent in severe cases. Patients aged 8.0–9.9 years with unilateral undescended testis had advanced bone age. Cytogenetic investigations of 167 patients revealed one case of Klinefelter's syndrome (47, XXY). Gonadotrophin treatment was tried in 50 patients and was successful in 12. Surgical results were satisfactory in 86.1% of the operated testes.     

Clinical and cytogenetic studies in undescended testes.

168 boys and 2.5-16.8 years with unilateral or bilateral undescended testes or anorchia were studied. Retention was severe (canalicular or intraabdominal) in 1/4 and moderate in 3/4 of the cases. In unilateral retention, the volume of the scrotal testis was usually normal throughout childhood whereas pubertal testicular growth was delayed. In unilateral anorchia, the scrotal testis showed compensatory hypertrophy. In all age groups examined, the mean volume of the undescended testes was abnormally small. Undescended testes were accompanied by abnormalities of the epididymis in 3.6% of cases, of the ductus deferens in 7.8% and of the spermatic vessels in 8.3%. In anorchia such abnormalities were found regularly. Inguinal hernia accompanied 62.8% of the undescended testes and was most frequent in severe cases. Patients aged 8.0-9.9 years with unilateral undescended testis had advanced bone age. Cytogenic investigations of 167 patients revealed one case of Klinefelter's syndrome (47, XXY). Gonadotrophin treatment was tried in 50 patients and was succesful in 12. Surgical results were satisfactory in 86.1% of the operated testes.     

Clinical spectrum of steroid sulfatase deficiency: X-linked recessive ichthyosis,birth complications and cryptorchidism

When boys affected with steroid sulfatase deficiency are delivered, the lack of the enzyme in the placenta may cause birth complications. In postnatal life this gene defect gives rise to X-linked recessive ichthyosis. In a series of 25 patients birth complications were reported in 9 cases. Of these boys, 4 displayed bilateral inguinal cryptorchidism and one was affected unilaterally. In a further boy we observed unilateral inguinal cryptorchidism without a history of birth complications. In one patient who had been delivered by forceps, abdominal bilateral cryptorchidism resulted in severe hypogenitalism. A review of the literature revealed 30 cases with X-linked recessive ichthyosis displaying hypogenitalism or cryptorchidism or both. In conclusion, cryptorchidism should be considered as a further clinical manifestation of steroid sulfatase deficiency.     

青春期前隐睾患儿手术前后抗精子抗体检测的意义

目的检测青春期前隐睾患儿手术前后血清抗精子抗体（AsAb），探讨AsAb与睾丸位置、手术、单／双侧和伴输精管／附睾畸形等因素的关系。方法收集隐睾患儿,50例，取腹股沟斜疝患儿和腹股沟区正常儿童各50例作为对照组。分别抽取患儿术前及术后6个月血清，采用AsAb金标免疫斑点法检测其血清AsAb IgG、IgM水平。结果隐睾组术前及行睾丸下降固定术后AsAb的阳性率分别明显高于腹股沟斜疝组术前及术后和健康对照组（Pa〈0．01）。睾丸下降固定术、单／双侧隐睾、术前睾丸位置及伴输精管和（或）附睾畸形均与AsAb无显著相关（Pa〉0．05）。结论青春期前隐睾患儿血清AsAb阳性率显著升高，与手术、术前睾丸位置、单／双侧隐睾及是否伴输精管／附睾畸形无显著关系。     

郑州地区男童阴茎和睾丸发育现状及超重/肥胖对其的影响

目的了解和评价河南省郑州地区男童的阴茎和睾丸发育现状及超重/肥胖对其的影响。方法对河南省郑州地区3 546名4~12岁男童进行身高、体重、腰围、臀围、阴茎长度及睾丸容积的测定,并将超重/肥胖组和体重正常组阴茎长度及睾丸容积进行比较。结果 9岁前,男童睾丸容积逐渐变小,而9岁后睾丸容积逐渐增加,11岁后睾丸容积迅速增加。阴茎长度在4~11岁期间增加缓慢,11岁后迅速增加。包茎(144例,4.01%)、隐睾(18例,0.51%)是常见的阴茎、睾丸发育问题。3 546名男童中,超重/肥胖639名(18.02%)。6岁、7岁时超重/肥胖组睾丸容积大于体重正常组(P0.05)。11岁时超重/肥胖组的阴茎长度小于体重正常组(P0.05)。相关分析提示4岁、5岁时超重/肥胖男童睾丸容积均与身高、体重、BMI、腰围、臀围呈正相关;7岁、8岁时超重/肥胖男童阴茎长度均与体重、腰围、臀围呈负相关,12岁时与身高呈正相关。结论郑州地区男童的阴茎、睾丸发育基本符合中国儿童性发育规律;超重/肥胖对男童的阴茎和睾丸发育产生不利影响。     

Pituitary-gonadal function following therapy of testicular relapse in boys with acute lymphoblastic leukemia

Testicular function was evaluated in 8 boys with acute lymphoblastic leukemia (ALL) and testicular relapse following another course of intensive chemotherapy with unilateral or bilateral orchidectomy and/or testicular irradiation. LH- and FSH-secretion was studied in all using a standardized LHRH-test. In addition, a HCG-test was performed in 6 boys. In prepuberty, all boys examined showed normal LH- and FSH-values. Beginning at 9 to 10 years, elevated basal and/or stimulated LH- and FSH-values were occasionally noted in contrast to the consistently elevated values after the age of 12. Using the HCG-test, we found a testosterone response only in patients receiving gonadal irradiation of 1 100 and 1 500 rads (2 patients). No response was elicited in those with radiation doses of 2 400 and 3 000 rads. We conclude that high dose gonadal irradiation and chemotherapy cause temporary and possibly permanent impairment of spermatogenesis and Leydig cell function in boys with ALL and testicular relapse.     

Inguinal hernia repair by Bianchi incision in boys: a retrospective study

Objective

Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision.

Methods

A total of 3300 boys (1–144 months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7 days, 1 month, and 1 year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated.

Results

Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0?±?2.3 min for unilateral cases and 25.2?±?4.2 min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect.

Conclusion

Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.

     

超声检查在大鼠腹腔镜Fowler-Stephens术后睾丸萎缩中的诊断价值

目的　探讨超声检查包括灰阶影像和能量多普勒在大鼠腹腔镜Fowler Stephens(F S)术后睾丸萎缩中的诊断价值。方法　 30d龄幼年Wistar大鼠行腹腔镜下右侧F S术 (精索血管腹腔内离断 ) ,术后从 9～ 5 4 0d 7个时段 (青春发育前期至中年期 ) ,分别用睾丸触诊和超声检查来判断睾丸萎缩情况 ,并与组织学检查结果进行对比。结果　腹腔镜F S术后该三种检查的睾丸萎缩检出率分别为 6 6 .7%、6 9.4 %和 84 .7% (P <0 .0 5 )。按超声诊断睾丸萎缩可分为三度 (0、Ⅰ、Ⅱ ) ,其相应组织学变化分别为正常或轻度萎缩、重度萎缩和完全萎缩。超声检查对重度和完全睾丸萎缩的检出率为 96 .0 %。用超声检查观察睾丸体积、边界、内部回声均匀情况、微结石和血流信号等指标可最早在术后 9d和 4 5d发现组织学上表现为完全萎缩和重度萎缩的睾丸。而睾丸触诊仅能发现术后 4 5d及其后的完全睾丸萎缩。结论　用超声检测睾丸体积、内部回声均匀于否、微结石和血流下降等指标能无损伤、客观地反映F S手术后不同阶段睾丸萎缩情况。F S术后的常规检查应为超声而非触诊     

Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism

BACKGROUND: Early surgical correction of an undescended testis is performed to prevent the development of male infertility. However, in boys with cryptorchidism early successful surgery cannot prevent infertility if they lack Ad spermatogonia. In this study, sperm concentrations and postpubertal hormone levels were correlated to bilateral testicular histology. The aim was to define the risk of future infertility via a testis biopsy program for boys with cryptorchidism. METHODS: Eighty-nine boys who had an orchidopexy were subjected to bilateral testicular biopsy. Histological analysis of 178 biopsies indicated three groups of high, intermediate, and low risk of infertility according to the presence of Ad spermatogonia. After puberty, sperm concentrations were analysed and correlated with plasma gonadotropin and testosterone levels. FINDINGS: In patients with unilateral cryptorchidism 70% of scrotal testes had an impaired transformation of Ad spermatogonia, indicating that cryptorchidism is a bilateral disease. Sperm concentrations correlated to the number of Ad spermatogonia found at the time of orchidopexy (p<0.001). All males in the high risk of infertility group were oligospermic (mean: 8.9x10 (6) sperm/ejaculate) and 20% were azoospermic. These patients had 25 times less sperm compared to the group with presence of Ad spermatogonia in both testes (p<0.001). Correlations between testicular histology and postpubertal hormone levels confirmed a relative gonadotropin deficiency in the majority of males with cryptorchidism. INTERPRETATIONS: Ad spermatogonia proved to be a discriminating factor for the fertility outcome in cryptorchidism. Gonadotropin treatment following orchidopexy should be considered in cryptorchidism when no Ad spermatogonia are found in undescended gonads and scrotal testis have Ad germ cell counts <0.005 per tubule.     

The effect of needle biopsy procedure on prepubertal rat testis

Testicular needle biopsies were performed in 20 prepubertal rats. Ten rats were used as a control group. Spermatohistogenesis was observed in the tubuli (mean number: 17) of each biopsy. The biopsy procedure caused tubular damage which extended to 0.2-4% of the entire testicular volume. Twenty percent of the rats had severe unilateral testicular atrophy at the site of the procedure. A significant compensatory tubular hypertrophy occurred in the contralateral testis that was observed 50 days after the procedure. Eighty percent of the rats produced the normal number of offspring, independent of the occurrence of unilateral testicular atrophy. The histology of the contralateral testis was normal in all animals; thus, no adverse effect from the biopsied testis occurred.     

Androgen receptors in boys with isolated bilateral cryptorchidism

A study was conducted in boys with bilateral cryptorchidism, who were to undergo surgical orchiopexy, to determine if target-organ androgen insensitivity might play a role in the failure of the testes to descend into the scrotum. Nine boys older than 1 year in whom bilateral undescended testes was the only genitourinary abnormality were evaluated. Each subject was administered a six-week course of human chorionic gonadotropin (hCG), 3000 U/m2 of body surface area, intramuscularly injected daily for five days and then twice per week. Basal and hCG-stimulated levels of testosterone were normal. However, hCG administration failed to induce testicular descent in all cases. At the time of surgery, scrotal skin and testicular biopsy specimens were obtained for propagation of cells in tissue culture. Androgen receptor levels and binding affinity were normal for the androgen-specific ligands dihydrotestosterone and metribolone in both skin fibroblasts and testicular cells. In addition, 5 alpha-reductase activity was normal in scrotal skin fibroblasts. Nine boys with bilateral cryptorchidism and normal testicular androgen biosynthesis had normal androgen receptor-binding activity and 5 alpha-reductase activity in cultured scrotal skin fibroblasts and testicular cells. Therefore, bilateral maldescent of the testes in these boys with cryptorchidism was not due to androgen insensitivity.     

ENDOCRINOLOGICAL STUDIES IN UNDESCENDED TESTES

Abstract. A cross-sectional study was carried out on 168 boys aged 2.5–16.8 years with unilateral or bilateral testicular maldescent. Urinary excretion of testosterone, Δ₄-androstenedione, LH and FSH was investigated. The results were related to chronological age, bone age and sexual maturation stage. Urinary testosterone excretion was elevated in unilateral and bilateral cases of undescended testis under 9 years of age. The pubertal increase of testosterone excretion seemed to be moderately delayed in the patients. In pubertal stage V the testosterone excretion was normal. The mean testosterone/androstenedione relationship was normal in all age groups up to 14.9 years and increased in patients above this age. After HCG stimulation, the testosterone excretion increased at all ages studied whereas the androstenedione excretion increased only in bilateral cases under 11 years of age. Urinary LH excretion was diminished in bilateral cases aged 6.0–7.9 years and elevated in unilateral cases in pubertal stage V. Urinary FSH excretion was normal below 8 years of age, moderately elevated in bilateral cases aged 8.0–11.9 years and increased in unilateral cases in pubertal stage V. Patients with bilateral anorchia in pubertal stage I, had normal basal testosterone and androstenedione excretion while the LH and FSH levels were increased. The findings in this study indicated that disturbances in the pituitary-gonadal function of cryptorchids might be operative from early childhood and throughout pubertal years.     

The Palomo procedure in the treatment of boys with varicocele: a retrospective study of testicular growth and fertility

The Palomo procedure has often been criticized with regard to possible atrophy of the testis. Measuring the testicular volume is mainly used in pre- and postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had any disturbance of their testicular growth and/or fertility. Out of 79 patients operated upon with Palomo's procedure between 1979 and 1990, 33 could be evaluated. They all had grade II or III left-sided varicoceles. Investigations consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6–17 years after surgery. No recurrence of grade II varicoceles was observed. Only 1 of the 33 patients might have had testicular atrophy, yet he had already fathered 3 children! Twenty-three had a normal sperm count and 24/27 showed normal sperm motility. Eight hydroceles were either present at the time of investigation or had been operated upon in the past. Estimations of testicular volume by OM and US showed significant differences between the two methods concerning volume and relation of right to left side. In general, the volume was overestimated by the OM. The study shows that in boys the simple surgical technique proposed by Palomo has – in the long run – no disadvantages for testicular development and sperm production. Fertility should therefore not be compromised. Accepted: 8 April 1998     

Inguinal approach for the management of unilateral non-palpable testis: Is diagnostic laparoscopy necessary?

ObjectiveDuring the last decade laparoscopy has increasingly been advocated as the primary investigative procedure for the management of the non-palpable testis. We reviewed the medical records in a consecutive series of boys with non-palpable testis to examine the contribution of the initial inguinal approach in the management of unilateral non-palpable testis.Materials and methodsAmong the 183 consecutive patients with cryptorchidism from 2003 to 2012, there were 21 patients with unilateral and three with bilateral non-palpable testes. All unilateral patients then underwent inguinal and scrotal exploration through an inguinal incision. For those patients with an intra-abdominal peeping testis, the gonad was placed into the scrotum after meticulous cranial mobilization of the spermatic cord.ResultsPatient age ranged from 11 months to 144 months (mean age: 23 months). Among the 21 unilateral cases, testicular absence or atrophy was confirmed in seven patients with a scrotal nubbin in six, and blind-ending vas and vessels at the external inguinal ring in one patient. Among the remaining 14 patients with sizeable testes, 12 testes were intra-abdominal peeping testes and two testicles were seen within the distal inguinal canal, which may be missed on physical examination owing to patient obesity. The intra-abdominal peeping testicle had the opened processus vaginalis entering the internal ring in which testicle was found. These were fixed into the scrotum successfully by cranial mobilization of spermatic vessel sometimes cutting the internal oblique muscle and by Prentiss and Fowler-Stephen's maneuver. Diagnostic laparoscopy was done on three patients with bilateral cases.ConclusionsGiven the result that most of nubbins are within the scrotum and testes with intra-abdominal peeping testes are fixed down safely into the scrotum, the inguinal approach may suffice for the management of unilateral non-palpable testis. Laparoscopy should be reserved for patients with bilateral non-palpable undescended testes.     

Hip joint instability in breech pregnancy

222 consecutive fetuses found by ultrasound to be in breech presentation in the 33rd gestational week were followed with repeated examinations in weeks 35 and 38. Ninety-one of these fetuses persisted in breech presentation until delivery, while cephalic version occurred in 131. The frequency of hip joint instability was 21% in the breech delivered group and 1.5% in the vertex delivered group. The position of the fetal legs was established at each ultrasound examination. The intrauterine fetal attitude was classified as extended when the fetuses had extended knees and maximally flexed hips at all ultrasound examinations. This occurred in 30 breech delivered fetuses, 47% of which developed hip joint instability. Only 8% of the breech born infants with flexed legs in utero developed hip joint instability. It is concluded that instability of the hip joint is a consequence of the intrauterine attitude, rather than of the breech delivery per se.     

Oxidative,inflammatory and immunologic status in children with undescended testes

Background: In order to better understand the pathogenesis of risk of future sub‐/infertility in children with undescended testes (UDT), we designed this prospective study to examine the oxidative stress, inflammatory response and autoimmunity in children with UDT. We examined the concentrations of malondialdehyde (MDA), interleukin‐6 (IL‐6) and antisperm antibodies (ASA) in children with UDT and healthy controls. Methods: The UDT group consisted of 88 boys (aged 1–14 years, unilateral in 67 and bilateral in 21 cases), and 44 boys with normal descended testes served as a control group. Clinical evaluation revealed no testicular or other system abnormalities. MDA was used as lipid peroxidation index. IL‐6 levels were measured using a commercial enzyme‐linked immunosorbent assay kit. ASA was determined with an anti‐human spermatozoa immunoglobulin G test. Results: Mean age values ± SD were 4.6 ± 3.2 in the UDT group and 4.7 ± 3.4 in the control group (P= 0.872). MDA and IL‐6 results for the UDT and control groups were significantly different (P= 0.003 and P= 0.019, respectively), but those for ASA were not (P= 0.473). The mean MDA and IL‐6 values were significantly higher in bilateral cases than the respective values in the unilateral cases (MDA: 4.03 ± 3.68 vs 3.49 ± 5.22, P= 0.015; IL‐6: 7.70 ± 6.86 vs 3.48 ± 6.50, P= 0.001) (P= 0.015). Conclusion: The results indicate that children with UDT are exposed to high levels of oxidative stress and inflammatory reaction. This could negatively affect the future fertility in these children.     

Endocrinological studies in undescended testes.

A cross-sectional study was carried out on 168 boys aged 2.5-16.8 years with unilateral or bilateral testicular maldescent. Urinary excretion of testosterone, delta4-androstenedione, LH and FSH was investigated. The results were related to chronological age, bone age and sexual maturation stage. Urinary testosterone excretion was elevated in unilateral and bilateral cases of undescended testis under 9 years of age. The pubertal increase of testosterone excretion seemed to be moderately delayed in the patients. In pubertal stage V the testosterone excretion was normal. The mean testosterone/androstenedione relationship was normal in all age groups up to 14.9 years and increased in patients above this age. After HCG stimulation, the testosterone excretion increased at all ages studied whereas the androstenedione excretion increased only in bilateral cases under 11 years of age. Urinary LH excretion was diminished in bilateral cases aged 6.0-7.9 years and elevated in unilateral cases in pubertal stage V. Urinary FSH excretion was normal below 8 years of age, moderately elevated in bilateral cases aged 8.0-11.9 years and increased in unilateral cases in pubertal stage V. Patients with bilateral anorchia in pubertal stage I, had normal basal testosterone and androstenedione excretion while the LH and FSH levels were increased. The findings in this study indicated that disturbances in the pituitary-gonadal function of cryptorchids might be operative from early childhood and throughout pubertal years.     

A study of warm testicular ischaemia and paternity in rats

The effect of testicular ischaemia on fertility as assessed by paternity rate was studied in seven groups of male Sprague-Dawley pubertal rats. Transient unilateral occlusion of the testicular artery and venous outflow was performed for 30, 60, 90, and 120 min using non-crushing microvascular clamps in groups 1–4 (n = 6). Group 5 (n = 12, Fowler-Stephens) had division of both the testicular artery and vein, whereas group 6 (n = 12, Refluo) had division of the testicular artery only. Group 7 (n = 6) consisted of controls upon whom a sham operation was performed. Testicular biopsy 6 weeks after transient testicular ischaemia of 30, 60, and 90 min showed tubular atrophy in 20%–33% of the testes. Ischaemia of 120 min led to tubular atrophy in 84% of testes. Division of only the testicular artery caused tubular atrophy in 58% of testes. Division of both testicular artery and venous outflow was associated with total tubular destruction and necrosis in 78% of testes and 22% had variable tubular atrophy. A paternity rate of 50%–80% was noted in groups 1–4 following transient unilateral testicular ischaemia and contralateral vasectomy. This compared well with the expected 75% paternity rate for a control rat population. Chronic ischaemia (group 5) together with testicular venous interruption was associated with observably lower fertility and a paternity rate of 18%. However, when venous outflow was preserved (group 6), chronic ischaemia after testicular artery division did not affect the paternity rate (50%) significantly. Offprint requests to: A. Bianchi     

儿童精索静脉曲张患病情况的调查

目的　研究儿童精索静脉曲张的患病规律。方法　对山东省四地区4 274名男性儿童及青少年进行专科检查,计算精索静脉曲张的患病率,并对患病儿童的双侧睾丸大小进行比较。结果　山东省四地区4 274名在校儿童及青少年中共检出精索静脉曲张患儿 460人,总患病率为10.76%。青春前期组1 248人,检出患儿 70人,患病率为5.61%;青春期组3 026人,检出患儿 390人,患病率为12.89%。两组患病率进行χ2 test,P<0.05,差异具有显著性意义。所有患病儿童双侧睾丸大小进行比较,差异没有显著性意义。结论　精索静脉曲张发生于儿童期及青春期,且患病率随着青春期的到来而明显升高。在儿童及青春期,精索静脉曲张患儿两侧睾丸容积差异无显著性意义。     

CT and MRI characteristics of intracranial hemorrhage complicating breech and vacuum delivery

The CT/MRI brain findings and sequelae of intracranial hemorrhage resulting from traumatic breech and vacuum delivery of 16 term newborn infants are presented. Eleven infants were vacuum extracted, while the remaining five infants were delivered breech. Except for three breech-delivered infants who had intraventricular hemorrhage, the location and nature of hemorrhage were similar in both groups. Nine of the 11 vacuum-extracted babies showed complete resolution of hemorrhage on follow-up examination. None of the breech cases had a normal outcome. All five of the latter group had hydrocephalus, and one case each demonstrated porencephaly and encephalomalacia.Presented as a poster at the 38th Annual Meeting of the Society for Pediatric Radiology, Washington, DC, 27–30 April 1995