Abstract
BackgroundLittle is known about the histology of contralateral descended testes in boys with unilaterally absent testis. We investigated whether absence of one testis is associated with abnormal tissue architecture of the solitary contralaterally descended testis.Design, setting, and patientsFor this retrospective study, we examined the results of biopsies of the contralateral descended testis in 43 boys with monorchidism. Data from 26 control testes from boys of matching ages were selected from results published in 1977 and 2009. During surgery, any nubbins were removed. In each case, the scrotal testis was biopsied, and the testis fixed by subdartos pouch or suture.ResultsOf the 43 affected boys, 23 had normal testicular histology in the contralateral descended testis, whereas 20 (46%) had abnormal histology. Eight of the abnormal biopsies matched the criteria for high infertility risk. Samples from three boys in this latter group revealed a Sertoli-cell-only phenotype. Immunohistochemical assays were positive for steroidogenic acute regulatory (STAR) protein in Leydig cells and spermatogonia. STAR expression was stronger in the monorchid group with normal testicular histology.ConclusionsAlmost half of the patients with unilateral absent testis were at risk for subfertility or infertility. Our results emphasize the need for testicular biopsy of the solitary testis in boys with monorchidism to appropriately assess infertility risk.
Highlights
A unilaterally absent testis is thought to be caused by prenatal or antenatal testicular torsion
Our results emphasize the need for testicular biopsy of the solitary testis in boys with monorchidism to appropriately assess infertility risk
We present histopathological results showing that half of the boys with monorchidism included in our study had pathologic testicular histology
Summary
A unilaterally absent testis (monorchidism) is thought to be caused by prenatal or antenatal testicular torsion. Histological examination of descended single testes in boys with a unilateral nubbin has revealed increased germ cell proliferation and dissimilar maturation patterns compared to the contralateral descended gonad in boys with unilateral cryptorchidism [3]. These findings point to antenatal torsion resulting from a mechanical event rather than endocrinopathy as the etiology for absent testis [3, 4]. We present histopathological results showing that half of the boys with monorchidism included in our study had pathologic testicular histology This result is consistent with and may explain the increased incidence of subfertility or even infertility in males with unilateral absent testis. We investigated whether absence of one testis is associated with abnormal tissue architecture of the solitary contralaterally descended testis
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