核素血流灌注显像和B超诊断腹股沟隐睾的对比

目的探讨核素睾丸血流灌注显像诊断腹股沟隐睾的诊断价值,并与超声检查结果比较.方法45例未能触及型隐睾患者,术前分别行核素睾丸血流灌注显像和B超检查,术后与病理检查结果对照,比较两组结果.另10例正常对照者行睾丸血流灌注显像.结果核素显像及B超对腹股沟隐睾诊断的灵敏度分别为91%和53%,准确率分别为93%和62%,两者均有极显著性差异(P＜0.01).核素显像和B超检查诊断腹股沟隐睾与病理诊断的阴性符合率分别为90%和33%,两者有显著性差异(P＜0.05),阳性符合率分别为93%和100%,两者未见显著性差异(P＞0.05).结论睾丸血流灌注显像可作为继B超之后诊断腹股沟隐睾的有效检查方法.     

Congenital bilateral cryptorchidism in an infant conceived after maternal breast cancer treatment: A case report

BACKGROUNDThe incidence of breast cancer among women of reproductive age is increasing, as well as the desire for children at late childbearing age. Identifying factors that may be associated with fetal malformation and maternal and fetal prognosis has gained importance. We describe a 32-year-old woman with breast cancer who gave birth to a son with congenital bilateral cryptorchidism after treatment, with a literature review performed.CASE SUMMARYA 32-year-old woman with breast cancer who had been treated by surgery and radiotherapy experienced recurrence and underwent a second surgery, adjuvant chemotherapy, and targeted therapy. Her tumor cells were negative for estrogen receptor (ER) α, progesterone receptor (PR), and p53; positive for ERβ, human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR), and Ki67. She had pathogenic BRCA gene mutations. She became pregnant within 2 years and delivered a boy with congenital bilateral cryptorchidism. The boy underwent bilateral orchidopexy. As of this writing, the woman and her son are both healthy.CONCLUSIONHER2 overexpression, positivity for EGFR, Ki67, and ER, and PR negativity are associated with a poor prognosis in breast cancer. While no link has been established statistically between treatment for breast cancer and cryptorchidism in a subsequent pregnancy, this case suggests the possibility that ERβ and gene mutations may be contributing factors.     

79例隐睾手术治疗后不育患者的抗精子抗体的检测

目的观察隐睾患者手术治疗时机的选择与术后抗精子抗体发生率之间的关系。方法通过回访1024例曾行手术治疗的隐睾患者的生育能力状况的调查,应答信访有422,其中符合设计标准有405例,其中不育患者有79例,根据患者手术时的年龄将其分为四组,检测患者抗精子抗体并用统计学方法进行分析。结果隐睾手术治疗的年龄对双侧隐睾固定术组患者的生育能力有明显的影响,手术年龄越早,不育率越低;随着手术年龄的增加,患者抗精子抗体的检出率明显增高。结论隐睾应选择早期手术治疗,早期治疗减少远期免疫性不育的发生率,手术时机的选择应引起足够的重视。     

Does chemical sympathectomy alter the ontogeny of gubernacular migration in vivo?

Background

Testicular descent occurs in several stages, but the exact mechanism remains obscure. Sympathetic nerves have been proposed to have a role by a possible action on developing cremaster muscle, following observations of sympathetic dysfunction in cremaster from boys with cryptorchidism. This study aimed to see if chemical sympathectomy affected testicular descent in rats.

Methods

Sprague-Dawley dams were injected with 6-hydroxydopamine (days 15-19; 75 μg/kg) or control vehicle alone, and male pups examined at 0 to 10, 20, 30, and 60 days of age. The length of the processus vaginalis was measured and sections taken for histology.

Results

No difference in processus vaginalis growth was found between experimental and control groups, both macro- and microscopically. Chemical sympathectomy was confirmed by loss of adrenergic fibres in the adrenal cortex of experimental, but not control, animals.

Conclusions

These studies suggest that sympathetic innervation is not an important part of testicular descent in the rat but does not exclude a pathologic role in undescended testes or effects in humans only.     

Cryptorchidism: the veracity of online information accessible to the public

Purpose

The objective of this study is to assess the quality of information regarding cryptorchidism using common Internet resources.

Methods

Five common search engines were queried with the string “cryptorchidism OR undescended testicle OR undescended testes OR retractile testes OR retractile testicle.” The first 30 sites retrieved via each engine were reviewed, and the content veracity of the following components was assessed independently by 2 pediatric urologists: natural history, diagnosis, treatment, complications, and long-term outcome. Components were scored 0 to 2 based on whether topics were addressed and in accordance with accepted practice patterns.

Results

Of the 124 of 150 links accessible, 84% were oriented toward laypeople. Only 43 (35%) had endorsement by a nonprofit accreditation organization, but 76 (61%) had affiliation with a medical institution/professional. Authors were mostly pediatric urologists/surgeons (36%) or unspecified (48%). Median total scores were only 16 of 44 primarily because of incomplete information rather than misinformation. High scoring components included natural history, surgical options, long-term outcomes for fertility, and malignancy. Components scoring poorly included future sexuality, imaging, hormonal use, and treatment complications. Multivariate analysis demonstrated that only accreditation status was associated with high quality (P = .05).

Conclusions

Online information, when available to the public, is generally of good quality. However, many Web sites fail to adequately address all aspects of the condition.     

Mature teratoma arising from an intraabdominal testis in a 2-month-old boy: case report and review of intraabdominal testicular tumors in children

Tumors arising in an undescended testis are rare in infants. We report a mature teratoma in an intraabdominal testis of a 2-month-old boy. He presented with a large left-sided abdominal mass and nonpalpable left testis. Abdominal ultrasound and computed tomography showed a well-defined, sizable cystic tumor with focal calcification in the lower abdomen. Tumor markers were all within normal limits. Surgical resection revealed a large tumor arising from an intraabdominal left testis, and histologic analysis identified a mature teratoma. The tumor was completely removed, and there was no recurrence at follow-up 3 years later. The histologic condition of prepubertal intraabdominal testicular (IAT) tumors is quite different from that of testicular tumors in childhood descended testes and postpubertal IAT tumors. A total of 30 cases of IAT tumors in children, including our case, were reviewed to elucidate this issue.     

Evaluation of preoperative testicular volume in Japanese children with unilateral cryptorchidism

Objectives  We measured the testis volume of patients with unilateral cryptorchidism preoperatively and compared with a unilateral hydrocele testis to assess testicular development in these patients. Patients and methods  The present study included 129 children (ranging in age from 10 months to 5 years) with unilateral cryptorchidism who were treated from 2000 to 2006 at our institution. We evaluated the correlation between testicular volume and the location of testes or the age of these children. We also examined the testicular volume of 50 children with unilateral hydrocele testis (range, 8 months to 5 years). Results  There was no difference in testicular volume among each position of the undescended testis. The volumes of both undescended testes and hydrocele testes did not change until 5 years of age. There was a significant difference in testicular volume between undescended and hydrocele testes. The average testicular volume of cryptorchidism is significantly smaller than that of hydrocele testes both under and over 2 years old. Conclusions  From the viewpoint of undescended testicular volume, cryptorchid children should be operated on as early as possible.     

The migrating gubernaculum grows like a "limb bud"

Background

The gubernaculum is crucial for testicular descent, and in the second, or inguinoscrotal, phase of descent it has no caudal attachments. Cranially, it is attached to the testis, but its caudal free tip migrates to the scrotum controlled by the genitofemoral nerve. Recent studies show active proliferation in the tip. We hypothesized that the gubernacular tip may grow like a limb bud.

Methods

We performed whole-mount in situ hybridization studies on male and female fetal mice (ages, E14.5-E18.5; n = 162) looking for limb bud regulatory factors.

Results

Our results showed that a member of the fibroblast growth factor (Fgf) family, Fgf10, and Hoxa10 were both expressed in the male gubernaculum at E14.5, and Hoxa10 was also expressed in the E16.5 mice. Weak staining was seen in the female gubernaculum for Hoxa10 on days E14.5 and E16.5, whereas no staining for Fgf10 was seen in the female gubernaculums.

Conclusions

These studies, although preliminary, suggest limb bud regulators are essential for gubernacular growth. Hox genes and Fgfs may be fruitful areas of research to unravel the molecular control of gubernacular migration during testicular descent.     

Germ Cell Adenylyl Cyclase Activity in the Human Undescended Testis and the Effect of HCG-Treatment

In the present study we have examined the soluble Mn²⁺ dependent, germ cell specific adenylyl cyclase (AC) activity and germ cell morphology in testicular biopsies from twenty-three boys, aged 2—17 years, with undescended testes and three adult men with normally descended testes. Eight of the boys were treated with hCG immediately before surgery. Germ cell AC-activity (3.2—3.4 pmoles cAMP/mg protein/min) was found in the adult testes with normal germ cell morphology. Furthermore, low but significant AC-activity (0.2—0.8 pmoles cAMP/mg protein/min) was noted in biopsies containing only primary spermatocytes. There was no Mn^2- dependent AC-activity in Sertoli cell only testes or in testes where only spermatogonia were observed. Treatment with hCG did not influence germ cell maturation or soluble Mn²⁺ dependent AC-activity.