Abdominal Testes Research Articles

Lumbar Cryptorchidism with Splenogonadal Fusion: The Odd Couple

AbstractWe present and discuss the clinical, radiological, surgical, and histopathologic findings in a 16-month-old child who presented with bilateral cryptorchidism. He was investigated radiologically with ultrasonography and magnetic resonance imaging, diagnosed with small right inguinal and an enlarged left abdominal testis, and he underwent left orchidectomy and histopathology confirmed the diagnosis of splenogonadal fusion.

Laparoscopic –Assisted Orchidopaxy in Non-Palpable Testes in Adult Population

ABSTRACT:
 
 Objectives: To present our experience of managing impalpable undescended testes in post-pubertal patients with intention of testicular preservation using laparoscopic assisted orchidopaxy. 
 
 Study Design: Descriptive Case series.
 
 Place &
 Duration of
 Study: Department of Urology, Jinnah Postgraduate Medical Center (JPMC) Karachi, between Jan 2015 to Dec 2020 with minimal 6 months follow-up.
 
 Methodology: We included all patients with clinically impalpable testes with aged 12 and above. All patients had ultrasound abdomen performed as initial screening test followed by laparoscopic assessment and definite procedure. Patients with normal or hypo-plastic testes were underwent single staged orchidopaxy, while patients with testicular atrophy were planned for orchiectomy. Intraoperative testicular biopsy and Semen analysis were not routinely performed in our study.
 
 Results: Total 36 patients with 41 impalpable testes underwent laparoscopic localization and management. Mean age of patients was 20.75+ 5.98 years. 50% of testes were on the right side, 36.1% on left sided while 3.88% were bilateral. 5 (12.1%) patients had clinical inguinal hernia.. Diagnostic yield of ultrasound was (75.6%) and 100 % in laparoscopy. 33 testis were true intra-abdominal while 4 were inguinal and 4 were vanishing testes Normal looking testes were observed in 24 testes (64.86%) followed by hypoplastic in 11(29.72%) while 2 testes (5.40%) were atrophic. Two intra-operative complications included urinary bladder injury and vas deferens injury in one patient each. Postoperatively testicular ischemic necrosis in one (2.4%) and wound infection in 2 (4.8%) patients were noted. Late follow up revealed one port site hernia (2.4%) and one testicular atrophy (2.4%). Success rate of orchidopaxy in our study was 94.6%.
 
 Conclusions: Laparoscopic has been proved as excellent diagnostic and therapeutic tool for the management of intra- abdominal undescended testes in adolescent and post-pubertal patients.
 
 
 Key words: Impalpable testes, Laparoscopic-assisted orchidopaxy, Adolescent, Adult

Dihydrotestosterone through blockade of TGF-β/Smad signaling mediates the anti-fibrosis effect under hypoxia in canine Sertoli cells

The hypoxic microenvironment of cryptorchidism is an important factor to induce the impairment of the structure and function of Sertoli cells and thus lead to spermatogenesis loss or tumorigenesis. Dihydrotestosterone (DHT), as a potent nonaromatizable 5α-reduced androgen, has both positive and negative effect on pathological fibrosis process. However, it is still unknown whether DHT can regulate hypoxia-induced fibrosis of Sertoli cells. Herein, in this study, we evaluate the DHT level, two 5α-reductase isoforms, 5α-red1 and 5α-red2, as well as HIF-1α expression pattern in canine cryptorchidism and contralateral normal testis. Results showed that the abdominal testes presented low DHT levels and 5α-red1 and 5α-red2 expression, while significantly higher HIF-1α expression and ECM production compared with the scrotum. Moreover, we established a hypoxia-induced fibrosis model in canine Sertoli cells induced by cobalt chloride (CoCl2), and found that DHT inhibited the fibrosis of Sertoli cells in a dose-dependent manner. Meanwhile, DHT interfered with the TGF-β signaling by reducing the expression of TGF-βRI and TGF-βRII and inhibiting the expression and phosphorylation of Smad2 and Smad3, while flutamide (androgen receptor inhibitor) inhibited these effects of DHT. Furthermore, use of LY2109761 (TGF-β receptor type I/II inhibitor) to interfere with the TGF-β/Smad pathway showed a similar effect with DHT suppression of the fibrosis in Sertoli cells. Our research data demonstrated that cryptorchidism is located in a hypoxic and DHT deficiency microenvironment. Moreover, supplementing DHT can alleviate the fibrosis process of Sertoli cells caused by hypoxia, which is associated with AR regulating the inhibition of TGF-β/Smad signaling.

A RARE OCCURRENCE OF METASTATIC INFILTRATION OF TESTICULAR SEMINOMATOUS MIXED GERM CELL TUMOR CELLS INTOTHE PERITONEAL CAVITY: A CASE REPORT

Undescended testes (UDT) are a common birth anomaly. About 80% of UDT are palpable and 20% are non palpable.1 Palpable UDT are located along the inguinoscrotal descent route. The term non –palpable means that the testis was not found during the patient's examination. In that case we deal with an abdominal testis or with lack of testis. Intraabdominal testes are associated with an increased risk of malignancy. We herein present a recent case in our institution of intraabdominal testis which was histopathologically conrmed as Mixed Germ Cell Tumour (GCT) with a combination of seminoma, yolk sac tumor and embryonal carcinoma components with inltration into the peritoneal cavity.

Insights into the Evolution of Spermatogenesis-Related Ubiquitin-Proteasome System Genes in Abdominal Testicular Laurasiatherians.

During embryonic development in mammals, the testicles generally descend into the scrotum, making the testicular temperature 2–4 °C lower than the core temperature via heat exchange and clearance, and thus more beneficial for normal spermatogenesis. Failure to descend, known as cryptorchidism, carries a series of risks such as infertility and testicular cancer. However, some mammals have evolved abdominal testes while maintaining healthy reproduction. To explore the underlying molecular mechanism, we conducted comparative genomic analyses and functional assays on the spermatogenesis-related ubiquitin–proteasome system (UPS) genes essential to sperm formation in representative laurasiatherians. Here, positive selection and rapid evolution of spermatogenesis-related UPS genes were identified in the abdominal testicular laurasiatherians. Moreover, potential convergent amino acids were found between distantly related species with similar abdominal testicles and functional analyses showed RNF8 (V437I) in abdominal testicular species (437I) has a stronger ubiquitination ability, which suggests that the mammals with abdominal testes might exhibit enhanced sperm cell histone clearance to maintain sperm formation. This evidence implies that, in response to “cryptorchidism injury”, spermatogenesis-related UPS genes in the abdominal testicular species might have undergone adaptive evolution to stabilize sperm formation. Thus, our study could provide some novel insights into the reproductive adaptation in abdominal testicular mammals.

Successful Fowler-Stephens Orchiopexy for an Abdominal Testis Associated With Continuous Type of Splenogondal Fusion: A Case Report

Splenogonadal fusion (SGF) is a rare congenital anomaly in which there is abnormal adhesion between splenic tissue and gonads. Several patients with cryptorchidism associated with this anomaly have undergone orchiectomy because of the suspicion of tumors. Preoperative computed tomography (CT) is useful in differentiating between SGF and tumors, and in evaluating the vasculature of the SGF. We report a boy with an abdominal testis associated with SGF. Based on the CT findings, we successfully performed Fowler-Stephens orchiopexy. To the best of our knowledge, no SGF cases in which Fowler-Stephens orchiopexy could salvage the testis without testicular atrophy have been previously reported.

Use of chain écraseur for removal of retained abdominal testis in a bull

Banteng bullA 4 year old Banteng bull was presented to the University of Tennessee for a routine castration. On physical examination, it was determined that the bull’s right testis had not descended and thus was deemed cryptorchid. Right testis was not palpable in the inguinal canal nor visible via ultrasonography of caudal abdomen. Due to the likelihood that the testis was located in the abdomen, surgery under general anesthesia was elected. Because of its location close to right kidney, manual removal became difficult. An écraseur was successfully utilized to remove the retained testis.

Laparoscopy for Abdominal Testes: Nationwide Analysis of German Routine Data.

Introduction: Laparoscopy has been used for the evaluation of impalpable testes for more than 30 years. However, its use for intra-abdominal testes has never been evaluated in a population-based approach. Neither has the share of timely orchiopexies of intra-abdominal testes according to published guidelines. We aimed to provide this information by using nationwide administrative data for hospital reimbursements. Materials and Methods: We obtained data for procedures for exploration and orchiopexy of intra-abdominal testes in Germany from 2005 through 2018 and analyzed them with linear regression for the use of laparoscopy and timely repair. Results: In 2005, laparoscopy was already used in more than 60% of explorations, which composed 76% (95% confidence interval [CI]: 72 to 79) of children operated before their first birthday and 68% (95% CI: 65 to 70) of children up to 4 years of age. Throughout the study period, laparoscopy became increasingly popular for orchiopexy of intra-abdominal testes with a yearly increase of 1.8% (95% CI: 1.2 to 2.5, P < .001) in the first year of life and 1.3% (95% CI: 0.2 to 3.4, P < .001) until the age of 4. The share of patients treated before their first birthday increased yearly by 1.9% for explorations and 1.6% for orchiopexies (P < .001 for both) but did not exceed 30% in 2018. Conclusion: Laparoscopy is the method of choice for exploration of intra-abdominal testes and orchiopexy. In this study, more than 70% of boys were treated after their first birthday, thus not meeting the time limit set by guidelines.

Ectopic testis: an experience of a tertiary-level urology center at Upper Egypt

BackgroundTesticular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016.ResultsOut of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%).ConclusionsTesticular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

Two cases of Prune Belly Syndrome from Kagera Region Tanzania.

Prune Belly Syndrome is a rare congenital disorder with unknown aetiology, consisting of a triad of abdominal muscle wall weakness, undescended testes, and urinary tract abnormalities. We are unaware of any preceding report of Prune Belly Syndrome in Tanzania, and here we describe two cases reported in Kagera region. The first case is a 2 month old boy with the triad of Prune Belly Syndrome along with pectus carinatum who died due to septicaemia. This case posed a diagnostic challenge at birth and during the natal period. Paucity of comprehensive knowledge of congenital malformations at the peripheral health facilities may have also contributed to the diagnostic challenge in the first place.The second case is a neonate who was referred to regional referral hospital where he was diagnosed with Prune Belly Syndrome at the age of four weeks. Because of limited capacity to manage congenital malformations at the regional referral hospital, he was referred to an urologist at the zonal referral hospital. However, inadequacies in supporting systems to the parents compounded care of the neonate with Prune Belly Syndrome.High index of Prune Belly Syndrome suspicion is needed in a resource limited setting in order to timely make diagnosis. There is also a need to strengthen institutional and individual's capacity for prenatal screening to detect congenital anomalies at an early stage of foetus development. Multidisciplinary management approach is necessary in order to improve the quality of life for patients with Prune Belly Syndrome. Psychosocial and medical support systems should be put in place in order to enhance preparedness for patient care in resource limited settings including equipping the referral hospital with different specialists and ensuring availability of basic investigations for patients.

Laparoscopic Ist stage orchiopexy using antiadherent sheet for high abdominal testis

Abstract High undescended testes with short spermatic vessels are not treated with standard orchiopexy and are currently brought to scrotum prevalently after the section of spermatic vessels, according to the Fowler-Stephens procedure. The ischemic risk of that method is elevated and becomes unbearable in bilateral cases. In 2009 an original staged orchiopexy technique was proposed to elongate the whole cord with anti-adherent sheet preserving the spermatic vessels by which a normal scrotal position was successfully gained without any testis loss. Both stages were performed through inguinotomy. In the present article the successful procedure is updated with implementation of laparoscopy in the first stage in a case of extremely high bilateral 4a type abdominal testis. Laparoscopic access was confirmed as valuable both in terms of extended mobilization and coverage of the entire testis vascular supply. The method of progressive cord elongation by using an anti-adherent sheet avoids the excessive atrophy hazard deriving from the Fowler-Stephens procedure in bilateral high abdominal 4a type testes; based on our findings, the latter can benefit also of a laparoscopic approach in the first stage.

Serum concentrations and testicular expressions of insulin-like peptide 3 and Anti-Müllerian hormone in normal and cryptorchid male horses

Insulin-like peptide 3 (INSL3) is an important hormone for testicular descent during embryonic development and a factor for assessing functional status of Leydig cells of testes, but there is limited number of equine studies. Anti-Müllerian hormone (AMH) is a useful diagnostic marker for cryptorchidism in horses. This study aimed to compare serum concentrations and testicular expression intensity of INSL3 and AMH in intact and cryptorchid male horses. Serum INSL3 concentrations in intact (n = 9; mean ± SEM, 19.9 ± 5.9 ng/mL) and noncastrated unilateral cryptorchid (UC) male horses (n = 16; mean ± SEM, 16.8 ± 4.1 ng/mL) were higher compared with hemicastrated unilateral cryptorchid (HCUC) male horses (n = 9; mean ± SEM, 3.8 ± 0.7 ng/mL) (P < 0.05). And serum INSL3 in bilateral cryptorchid (BC) male horses (n = 4; 1.9 ± 0.4; mean ± SEM, ng/mL) were lower compared with intact male horses (P < 0.05). Serum AMH concentrations in BC male horses (n = 3; mean ± SEM, 30.6 ± 4.8 ng/mL) were higher compared with intact male horses (n = 5; mean ± SEM, 12.2 ± 3.9 ng/mL) (P < 0.05). Immunostaining of scrotal and cryptorchid testis showed that Sertoli cells were positive for AMH, and Leydig cells were positive for INSL3. Staining intensity of AMH was higher in cryptorchid testis than in scrotal testis (P < 0.05). Furthermore, AMH expression intensity was higher in abdominal testis than in inguinal testis (P < 0.05). Immunostaining intensity of INSL3 in the testis was positively correlated with serum INSL3 (r, 0.7; P < 0.01), seminiferous tubule area (r, 0.727; P < 0.01), and Johnsen score for spermatogenesis (r, 0.604; P < 0.05), whereas immunostaining intensity of AMH in the testis was negatively correlated with seminiferous tubule area (r, −0.814; P < 0.01) and Johnsen score for spermatogenesis (r, −0.807; P < 0.01). Our findings suggested that AMH is a good biomarker for diagnosing cryptorchidism in male horses, in addition to INSL3 values to assess the testis of intact and cryptorchid male horses.

Evaluation of Human Chorionic Gonadotropin (HCG) Therapeutic Results in Patients With Unilateral cryptorchidism (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.

Immediate Post-Operative Course Following Open and Laparoscopic Orchiopexy of Abdominal Testes: Is There A Difference?

Laparoscopic and open approaches are considered equivalent surgical options for the management of abdominal undescended testes, the choice of which is dependent upon surgeon experience and preference. We questioned whether immediate post-operative complications were equivalent.

Prune-belly syndrome in Africa: An analysis and systematic review of cases, etiology, treatment, and outcomes

Background:Prune-belly syndrome is a rare congenital disorder characterized by a spectrum of three anomalies: bilateral undescended testes, dilated urinary tract, and anterior abdominal muscle deficiency.Objectives:In developing countries, inadequate access to health care may affect treatment and outcomes of prune-belly syndrome. This study’s goal was to review the anatomical features, etiology, genetics, management, and outcomes of cases in Africa.Methods:PubMed was searched to identify case reports and case studies describing prune-belly syndrome in Africa. Data collected from each study included the number of cases, age at diagnosis, sex, description of the abdominal muscles, testes, and urinary tract, as well as associated anomalies, management, and long-term outcomes.Results:A total of 16 publications that reported 58 cases in African countries were included. The prevalence of female patients (15.5%) was higher than in developed countries (3%). The abdominal muscles were deficient in all cases, and bilateral cryptorchidism was present in nearly all males (96%). Distension of the bladder was common, with normal anatomy reported in only one case. Bilateral hydroureters and hydronephrosis also were present in the majority of cases. Only six cases (10.3%) had no associated anomalies, such as musculoskeletal or cardiovascular. Karyotyping was performed in only three cases (5.2%) because of limited hospital facilities. Six parents (10.3%) declined treatment for their children, 12 cases (20.7%) were managed conservatively, and 25 (43.1%) received surgical intervention. Patients’ mortality rate was higher than in developed countries.Conclusion:Diagnosis and treatment of prune-belly syndrome remains a challenge in Africa, in which multiple factors, such as access to health care and cultural beliefs, affect mortality rates and outcomes. Patient education and support groups may improve compliance with treatment.Level of evidence:Not applicable for this multicenter audit.

Non-palpable testis: is management consistent and objective?

Diagnostic laparoscopy is recommended for boys with non-palpable testis (NPT) by American and European guidelines with the decision to pursue inguinal exploration based upon testicular vessel appearance. We hypothesized that management decisions are not consistent with the guidelines, and that assessment of vessels is subjective. Pediatric urologist management decisions were evaluated via an electronic survey to determine impact of contralateral testicle size, sonographic findings, surgeon region, and years in practice. In a digital image survey, surgeons were asked to interpret gonadal vessel status of 32 consecutive cases of NPT with absent abdominal testis as normal, atretic, or blind-ending to determine intra- and inter-rater reliability. Of the 339 participants, more Europeans (49%) chose sonography as the first management step for NPT compared to US surgeons (12%). Regardless of sonographic findings, over 80% chose laparoscopy as the first step. In the presence of normal, atretic, and blind-ending vessels, the decisions to proceed with inguinal/scrotal exploration were 88%, 68%, and 17%, respectively. Contralateral hypertrophy and sonography findings had no significant impact on the decision to proceed with inguinal/scrotal exploration. The visual gonadal vessel survey showed surgeon interpretation of normal or blind-ending vessels had moderate inter-rater reliability. Surgeons did not agree on normal status 37% of the time and did not agree on atretic status 66% of the time. There was no statistical difference between European and US respondents (P=0.23). Intra-rater reliability was fair for blind-ending vessels. When the first interpretation was blind-ending, the same surgeon changed interpretation of the same image 39% of the time. There was no statistical difference by years of practice. Non-visualization of NPT on sonography and contralateral testis size had no significant impact upon management decisions. Surgeons chose to pursue inguinal/scrotal exploration based upon laparoscopic gonadal vessel status. However, these interpretations were subjective with low inter- and intra-rater reliability.

Sperm handling in aquatic animals for artificial reproduction

Artificial reproduction involves collection and handling of gametes in a way that secures their quality and maximizes the fertilization outcome. In addition to initial sperm quality, numerous steps can affect the final result of fertilization, from the sperm collection process until gamete mixing (or co-incubation) when the spermatozoon enters or fuses with the oocyte. In this review, we summarize the whole process of sperm handling, from collection until fertilization for fish, penaeid shrimp, bivalve mollusks and marine mammals. To obtain sperm from captive animals, techniques vary widely across taxa, and include stripping by abdominal massage or testis surgical removal in fish, spermatophore collection in penaeid shrimps, gonadal scarification or temperature shock in bivalve mollusks, and voluntary collection via positive reinforcement in mammals. In most cases, special care is needed to avoid contamination by mucus, seawater, urine, or feces that can either activate sperm motility and/or decrease its quality. We also review techniques and extender solutions used for refrigerated storage of sperm across the aforementioned taxa. Finally, we give an overview of the different protocols for in vivo and in vitro fertilization including activation of sperm motility and methods for gamete co-incubation. The present study provides valuable information regarding breeder management either for animal production or species conservation.

Surgery for no palpable testis before the age of one year: a risk for the testis?

Surgery for undescended testisis now commonly recommended before the age of one year. However, the risk of testicular atrophy or miss location after surgery at a young age has not been clearly evaluated. The objective of this study is to evaluate the rate of testicular atrophy after surgery for non-palpable testis before the age of one year. Fifty-five patients operated between 2005 and 2014 for non-palpable testes were reviewed for clinical and ultrasound (US) evaluation. Median follow-up after surgery was of 68.5 months (range 26-130 months). The median age at surgery was ofmonths (5-12 months). Eight patients (14.5%) had bilateral non-palpable testis; thus, 63 testes were evaluated. At surgery, 38 (60%) testes were located in the high inguinal canal; 25 (40%), in the abdominal cavity. Orchiopexy was performed with preservation of the testicular vessels for 58 testes. Fowler-Stephens (FS) procedure was performed for 5 testes. Testicular location was clinically evaluated, and testicular volume was measured using a standard sonogram technique in our pediatric radiology department. Ratio comparing the volume of the descended testis to the spontaneously scrotal located testis was calculated in unilateral forms. After surgery, testes had scrotal location in 62 cases and inguinal location in one case. Seven cases of atrophy were confirmed after US control (11%), more frequently (odds ratio, OR 11.68 [1.9-72.5]) in abdominal testis (24%) than in inguinal testis (2.6%). Atrophy testicular was more frequent with FS technique (OR 7.1 [1.3-40.1]), but the population was weak (N=5). Median volume ratio for unilateral form was 0.88 [0-1.8]; 14 patients presented a ratio greater than 1. The influence of the young age at surgery and the risk of post operative testicular atrophy had not been clearly evaluated. The term of 'no palpable testis' supports an heterogeneous group mixing abdominal and extra-abdominal testis sharing a uniform clinical presentation. Our rate of atrophy in the group of abdominal testes (24%) and inguinal testes (2.6%) is similar to the literature, which concerns older patients. The long-term sonogram assessment demonstrated a good development of the testis after surgery, especially in inguinal cases. Surgery for no palpable testis before the age of one year does not lead to a superior risk of testicular atrophy compared with surgery at an older age and allows a good development of the testis.

Early Clinical Outcome of Staged Laparoscopic Traction Orchidopexy for Abdominal Testes.

To assess the short-term clinical outcome of the novel Shehata technique of laparoscopic traction-lengthening for abdominal testes in a single center over a 12-month period (January-December 2014). An ethics approval of the study and appropriate consents were obtained for all patients before inclusion in our study. A total of 47 consecutive boys presented with impalpable testes in the ipsilateral hemiscrota, 3 of them were bilateral summing up to a total of 50 U of impalpable testes to a single center over 12 months (January-December 2014). Those boys underwent a preoperative ultrasound (US) Doppler scan for the ipsilateral and contralateral testes. They then proceeded to a first-stage laparoscopic exploration for the testes in which the cranial testicular artery and the caudal vas deferens were traced to their meeting point to locate the abdominal testes that were either found (peeping at the internal inguinal ring [IIR] or more cranially) or otherwise vanishing (intraabdominally blind-ending vas and vessels or extra-abdominally passing through the IIR). All 50 testes failed to stay at the contralateral IIR when brought there mandating a preliminary lengthening of the testicular vessels by lateral dissection, traction, and fixation to a point 1-2 cm superolateral to the contralateral anterior superior iliac spine (ASIS), essentially a mobile traction point. After 12 weeks, all underwent a second-stage laparoscopic-assisted ipsilateral subdartos orchidopexy for the testes under traction. Occasional slippage of the testis under traction mandated an otherwise second-stage retraction and a third-stage orchidopexy. All underwent US Doppler scan 3 and 6 months after orchidopexy. The 47 cryptorchid boys presented at a mean age of 3 years 2 months (range: 6 months-8 years). Out of the 50 impalpable testes, 9 were nonvisualized on preoperative US Doppler scan and 16 were vanishing on laparoscopic exploration: 5 abdominally (in utero vascular accident) and 11 scrotally (perinatal torsion). The remaining 34 testes were fixed loosely near the contralateral ASIS in the first-stage laparoscopic exploration. Out of which, 3 had slipped traction at the second stage. The 12-week traction interval went uneventfully and a predefinitive US Doppler scan confirmed viability of all testes under traction. All 34 elongated testes were mobilized and fixed in the ipsilateral hemiscrota inside a created subdartos pouch (of de Netto). All 34 fixed testes were confirmed viable on US Doppler scan 1, 3, and 6 months after orchidopexy. The novel Shehata technique of staged laparoscopic traction-lengthening for abdominal testes is safe, easy, and convenient as evidenced by our limited early experience. Neither internal herniation complicated the traction period nor testicular atrophy (by undue tension) complicated the traction or follow-up periods. We believe it is a good alternative to the Fowler-Stephens staged orchidopexy that entails risky division of the testicular vessels.

Identification and characterization of doublesex from the pumpkin fruit fly, Bactrocera tau (Diptera: Tephritidae)

The sex determination cascades in insects are diversified at the top of the cascade, where different primary molecular signals are employed, while at the bottom of the cascades, particularly the doublesex genes, are highly conserved. Here, we identified the doublesex ortholog (Btau-dsx) of Bactrocera tau, a pumpkin fruit fly, and found that Btau-dsx is composed of six exons and five introns with an additional short "m" exon located in the second intron. Btau-dsx is different from its orthologs in most dipteran insects: Its pre-mRNA is sex-specifically spliced to yield three (two male and one female) instead of two transcript variants. The two deduced proteins produced by the male-specific transcripts are a functional (Btau-DSXM1) and a truncated (Btau-DSXM2) protein, while the female-specific transcript produces the functional Btau-DSXF protein. These three proteins contain all conserved domains except Btau-DSXM2 which has no OD2 domain. The female-specific transcript is detected in both fertilized and unfertilized eggs and in both somatic and germ cells of the adult females, while the male-specific transcript is detected only in fertilized eggs and in the abdominal tissues and testes of adult males. The presence of the Btau-dsxM1 transcript in fertilized eggs at the early syncytium stage suggests that in XY embryos, the Y-linked M factor gene may function quite soon after fertilization to alter the splicing pattern of Btau-dsx pre-mRNA from the female-specific to the male-specific mode. Injection of Btau-dsxF dsRNA into recently emerging females can reduce the expression of vitellogenin (Btau-Vg) and causes some defects in the ovaries, indicating that Btau-dsxF works upstream of Btau-Vg.