The hormonal control of testicular descent.

Objective To explore the necessary of closure of the internal ring for cryptorchidism complicated with ipsilateral indirect inguinal hernia. Methods Clinical data of 50 children with cryptorchidism complicated with ipsilateral indirect henia from June 2009 to May 2016 were analyzed in this study. All the cases underwent laparoscopic orchiopexy. All testes after complete mobilization were pulled down into the scrotum through the inguinal canal. No suture was applied to close the internal ring. The operative duration, profile of testicular descending and complication were assessed. Results Patent processus vaginalis was found in all 50 cases. There were 39 cases with inguinal canal cryptorchidism, 11 cases with intra-abdominal cryptorchidism. The mean operative time was 72 minutes. Primary orchidopexy was performed in all cases. The median follow up of all cases was 3 years (9 months to 6.5 years). There were 3 cases of testicular retraction to the top of the scrotum. No case was found recurrence of a hernia in ultrasound examination. Conclusion Laparoscopic orchidopexy is a safe and effective approach for children with cryptorchidism complicated with ispilateral indirect hernia. The closure of internal ring may not be necessary. Key words: Laparoscopy; Cryptorchidism; Indirect inguinal hernia; Internal ring

100 orchiopexies were performed on 82 boys for cryptorchism from Jun.1983 to Apr.1984.The operative lengthening of the spermatic cord was measured after each step of the procedure.The 4 steps involved in the mobilization procedure are:division of the cremaster muscIe and the gubernaculum testis;(2) separation of the cord from the processus vaginalis;(3) retroperitoneal mobilization of the cord,and (4) replacing the cord behind the inferior epigastric vessels.The average lengthening of the cord achieved was 5.54 cm.Retroperitoneal mobilization alone could make the cord to get an extra length by 2.02 cm.72 testes were available for follow-up study,with all the testes descended into the scrotum,89% in a satisfactory position.

The testicular position and descent in developing human

Spigelian hernia (SH) is a rare ventral interstitial hernia occurring through a defect in the transversus abdominis aponeurosis (Spigelian fascia). Spigelian fascia is found between the lateral border of the rectus abdominis muscle and the semilunar line, which extends from the costal cartilage to the pubic tubercle. In other words, Spigelian line is where the transversus abdominis muscle ends in an aponeurosis characterized by a congenital or acquired defect in the Spigelian aponeurosis. Pediatric cases of SH are either congenital or acquired due to trauma, previous surgery or increased intra-abdominal pressure. SH in combination with ipsilateral cryptorchidism may constitute a new syndrome, as such cases are extremely rare in the literature is new syndrome is characterized by the following congenital, ipsilateral disturbances: SH, absence of inguinal canal and gubernaculum and the homolateral testis found within the Spigelian hernia sac (a hernia sac containing undescended testis). The aim of this study is to emphasize some typical findings of this specific entity, and, hence, the necessity for a thorough investigation of the origin of the SH.

In an attempt to determine whether the seminiferous tubular atrophy of the cryptorchid testis is preventable by early surgical correction of the cryptorchid state, aberrantly developed gubernacula destined to result in a cryptorchid testis in the Long-Evans cryptorchid (LE/ORL) rat were surgically reimplanted to the bottom of the scrotum on day 10 to 12 of age. Testis descent was monitored and the changes in testicular histology and in the volumes of the seminiferous tubules and Leydig cells were examined at day 60. As expected, normal testis descent occurred on or about day 25. Compared to untreated undescended testes at day 60, relative seminiferous tubular volumes (volume: % +/- SEM) were significantly increased by early surgical reimplantation of the gubemacula (89 +/- 1 vs. 66 +/- 3; P < 0.01). Absolute seminiferous tubular volumes (microliter +/- SEM) were also significantly increased by early surgical intervention when compared to undescended nontreated testes (893 +/- 27 vs. 170 +/- 12; P < 0.01). The testes of the surgically corrected cryptorchid animals were similar in all respects to those found in the descended testes of the sham-operated controls. Relative Leydig cell volume (% +/- SEM) was increased in the untreated cryptorchid testes compared to the surgically corrected testes (5.2 +/- 0.6 vs. 1.2 +/- 1.0; P < 0.05). Relative Leydig cell volumes in the surgically corrected testes were not significantly different from those found in the sham-operated descended controls. A modest but significant (P < 0.05) increase in absolute Leydig cell volume was also noted in the cryptorchid testes when compared both to normal controls or surgically corrected cryptorchid testes. From these observations, we conclude that early gubernaculopexy reverses the histologic changes normally seen in the cryptorchid rat testis to a relatively normal histologic architecture. These data provide experimental evidence to support the value of orchiopexy in the treatment of cryptorchidism.

The ascending testis and the testis undescended since birth share the same histopathology.

INTRODUCTION Lateral ventral hernia (Spigelian hernia) is a rare surgical condition in children. The cases are commonly seen in adult population. It arises because of weakness in fascia. Preperitoneal fatty tissue, intraabdominal organs may herniate through hernial sac. Strangulation or incarceration may rarely occur. Frequency of undescended testis was found much higher in cases with Spigelian hernia than normal population. A one-month old boy who had testis in Spigelian hernial sac was found to have gubernaculum and inguinal canal opposing previously described “Spigelian-cryptorchidism syndrome”. The aim of this study is to describe details of this case.

Treatment of the undescended testicle (UT) after it failed to descend on hormonal therapy is surgical. Spermatic cord elongation may impair testicular function, particularly in cases in which cord integuments or veins have to be divided to provide an extra cord length. A factor that might impede testicular descent is presence of a narrowed or obliterated inguinal canal. We investigated the hypothesis that dilatation of a narrowed or obliterated inguinal canal might assist spontaneous testicular descent. Twenty-six boys (age 3.6 +/- 0.8 years) with unilateral UT and failed hormonal treatment, whose UT was located at deep inguinal ring, were included in the study. Through an inguinal incision, the inguinal canal was dilated, spermatic cord adhesions divided, hernial sac, if present, excised, and skin closed. Testicular descent into the scrotum occurred in 22 patients within 4.2 +/- 1.3 months. The remaining four patients were reoperated on by Fowler-Stephens orchiopexy after 14 months. A technique is presented for the treatment of the UT after failure to respond to hormonal treatment. It consisted of clearing the testicular pathway of any adhesions and dilating the narrowed inguinal canal. The technique is simple, easy, and does not interfere with the testicle or spermatic cord.

Objective To evaluate prospectively the scrotal incision orchiopexy (Bianchi technique) for patients with an undescended testis in the mid or distal inguinal canal or beyond the external inguinal ring. Methods A total of 67 orchiopexies were performed in 58 patients with a primary undescended testis. Scrotal incision orchiopexy (Bianchi technique) were performed in 28 patients and the traditional orchiopexy were performed in 30 patients. Results Bianchi technique required shorter operative time than the traditional orchiopexy. At 7-month follow up,both groups had the same outcomes. No hernias were identified. Conclusions A scrotal incision for a palpable primary testis is well tolerated, Prescrotal orchiopexy is a successful procedure in select patients with a low complication rate. It has the advantage of a single incision which is cosmetically pleasing. It requires shorter operative time. Key words: Cryptorchidism; Orchidopexy; Complications

Objective To evaluate the clinical efficacy of three different surgical approaches in the treatment of cryptorchidism. Methods One hundred and fifty nine patients (213 testes) diagnosed of cryptorchidism in different positions were admitted to our hospital from January 2010 to June 2017. The ages ranged from 5 months to 14 years. Three different surgical treatments (laparoscopic orchidopexy, scrotal incision surgery and open inguinal surgery) were performed in these cases according to the preoperative and intraoperative physical examination, the development of testes and so on. The effects and complications of these three treatments were compared. Results Ninety cases underwent laparoscopic orchidopexy, 61 cases underwent scrotal incision surgeries plus laparoscopic approach to find patnet processus vaginalis(PPV), and 62 cases underwent open inguinal surgeries. Among 105 patients diagnosed of unilateral cryptorchidism, 85(80.95%) were found with PPV in the same side and 40(38.10%) with CPPV. While 31 cases (57.41%) were found bilateral PPV in 54 patients with bilateral cryptorchidism. Two testes were removed because of dysplasia. The rest were fixed at the bottom of scrotum without tension. The follow-up endured for 3 months to 6 years. One case was found recurrence. No testicular atrophy or retraction was found in all patients. There was no significant difference among the three surgical approaches in the treatment of cryptorchidism (P>0.05). Conclusion Laparoscopic orchidopexy is recommended as the first choice for intra-abdominal testes, and scrotal incision surgery is better for low cryptorchidism. Open inguinal surgery still has a major value and significance in diagnosing absence or dysplasia of testes. Key words: Children, cryptorchidism; Orchidopexy; laparoscopy

Objective To investigate the expression levels and the clinical significance of INSL3 and LGR8 in patients with unilateral cryptorchidism.Methods The expression levels of INSL3 and LGR8 were evaluated using RTRCR in gubernaculum and perididymis in 42 unilateral cryptorchidism (high position 4 cases; middle 31 cases; low 7 cases).Controls were taken from 40perididymis in 40 hydrocele patients and 40 hernia sacs in female indirect inguinal hernia patients.Results The expression levels of INSL3 and LGR8 in perididymis tissues and gubernaculums of different type of unilateral cryptorchidism showed no significant difference (P＞0.05).The expression levels of INSL3 and LGR8 in gubernaculums were lower than those in perididymis tissues (P＜0.05) ; and the expressions of INSL3 and LGR8 in perididymis tissues in unilateral cryptorchidism were lower than those in hydrocele testis (P＜0.05).The expressions of INSL3 and LGR8 in hemia sac of female indirect inguinal hernia were lower than those in perididymis of hydrocele testis (P＜0.05).Conclusions The expression levels of INSL3 and LGR8 in perididymis tissues and gubernaculums of different type of unilateral cryptorchidism have no significant difference.It would imply that INSL3 and LGR8 might have a role in different stages of testicular descent.Lower levels of INSL3 and LGR8 may be associated with altered gubernacular development and cryptorchidism. Key words: Insulin like factor-3; Receptors,G-protein-coupled; Cryptorchidism

Male infertility is a common side effect of aggressive cancer chemotherapy. One possible approach to decreasing gonadal injury in this setting is the production of artificial cryptorchidism (elevating the testes into the inguinal canal) to produce reversible germ cell loss and cytoprotective hemodynamic changes in the testes. This approach to preserving male germ cell production was explored in a rat model combining experimental cryptorchidism and 2,5-hexanedione intoxication. Rats were protected from irreversible germ cell loss produced by 2,5-hexanedione only when the testes were cryptorchid during the time of intoxication. Sham-operated rats and rats made cryptorchid following intoxication were not protected from 2,5-hexanedione-induced testicular germ cell loss. Decreased delivery of the toxic agent to the cryptorchid testis is the likely explanation of the protective effect.

Long-Term Outcome of Scrotal Incision Orchiopexy for Undescended Testis

Background: Cryptorchidism or undescended testis is an evolutionary defect where one or both testes fail to descend into the scrotum. HCG causes the testes to fail, possibly due to weight gain, an increase in testicular vasculature, and stimulating the testosterone and di-hydro-testosterone. The present study has been conducted to evaluate the therapeutic effects of HCG on patients with unilateral cryptorchidism. Methods: In a prospective descriptive study, 211 patients of 8 months to 7 years old with unilateral cryptorchidism whose parents refused surgery received HCG therapy. The patients were followed up 1 month, 3months, and 12 months after the first injection. They were examined in terms of the location of testes, possible relapses, sides of undescended testes, treatment complications, and HCG therapeutic results. Results: Four weeks after the first injection, 160 patients (75.12%) out of 211 cases had the descent of testes into the inguinal canal and the scrotum. 69.5% of non-palpable abdominal testes descended into the inguinal canal, 69.7% of patients with inguinal testes, 78% of patients with supra inguinal testes and 100% of patients with retractile testis experienced the descent of testes into the scrotum. Conclusion: The therapeutic response to HCG was successful in more than 50% of the cases in all the groups. Therefore, the need for performing surgical procedures on children with unilateral cryptorchidism would be decreased and they can be treated by a cost-effective and less invasive method. Moreover, at least one-year follow-up of the patients is required to ensure outcomes of the treatment.

Objectives To assess the incidence of testicular appendices (Tas), epididymal anomalies (EAs), and processus vaginalis (PV) patency in patients with undescended testis (UT) according to testicular position and to compare them with human fetuses. Methods We studied 85 patients (108 testes) with cryptorchidism and compared the features with those of 15 fetuses (30 testes) with scrotal testes. We analyzed the relationships among the testis and epididymis, patency of PV, and the presence of TAs. We used the Chi-square test for statistical analysis (p < 0.05). Results In 108 UT, 72 (66.66%) had PV patent, 67 (62.03%) had TAs, and 39 (36.12%) had EAs. Of the 108 UT, 14 were abdominal (12.96%; 14 had PV patency, 9 TAs, and 7 EAs); 81 were inguinal (75%; 52 had PV patency, 45 TAs, and 31 EAs), and 13 were suprascrotal (12.03%; 6 had PV patency, 13 TAs, and 1 EAs). The patency of PV was more frequently associated with EAs (p = 0.00364). The EAs had a higher prevalence in UT compared with fetuses (p = 0.0005). Conclusions Undescended testis has a higher risk of anatomical anomalies and the testes situated in abdomen and inguinal canal have a higher risk of presenting patency of PV and EAs.