Atrophic Testis Research Articles

Case Report: Severe Gonadal Dysgenesis Causing 46,XY Disorder of Sex Development Due to a Novel NR5A1 Variant

Mutations in the nuclear receptor subfamily 5 group A member 1 (NR5A1) are the underlying cause of 10–20% of 46,XY disorders of sex development (DSDs). We describe a young girl with 46,XY DSD due to a unique novel mutation of the NR5A1 gene. An 11-year-old subject, raised as a female, was noticed to have clitromegly. She looked otherwise normal. However, her evaluation revealed a 46,XY karyotype, moderate clitromegly but otherwise normal female external genitalia, undescended atrophied testes, rudimentary uterus, no ovaries, and lack of breast development. Serum testosterone and estradiol were low, and gonadotropins were elevated. Adrenocortical function was normal. DNA was isolated from the peripheral leucocytes and used for whole exome sequencing. The results were confirmed by Sanger sequencing. We identified a novel mutation in NR5A1 changing the second nucleotide of the translation initiation codon (ATG>ACG) and resulting in a change of the first amino acid, methionine to threonine (p.Met1The). This led to severe gonadal dysgenesis with deficiency of testosterone and anti-Müllerian hormone (AMH) secretion. Lack of the former led to the development of female external genitalia, and lack of the latter allowed the Müllerian duct to develop into the uterus and the upper vagina. The patient has a female gender identity. Bilateral orchidectomy was performed and showed severely atrophic testes. Estrogen/progesterone therapy was initiated with excellent breast development and normal cyclical menses. In summary, we describe a severely affected case of 46,XY DSD due to a novel NR5A1 mutation involving the initiation codon that fully explains the clinical phenotype in this subject.

The Management of Intraabdominal Testis: A Survey of the World Federation of Associations of Pediatric Surgeons (WOFAPS) Practices.

Background and ObjectiveThe optimal treatment protocol of intraabdominal testis is still a matter of debate and until now there are a lot of areas of controversy as regards this challenging subtype. The aim of this report is to document current practice patterns among surgeons from different continents through an online Redcap survey supervised the World Federation of the Association of Pediatric Surgeons (WOFAPS).MethodsA 16-question-survey related to the management of intraabdominal testis was created and administered via RedCap. The WOFAPS headquarters sent an email to all members inviting voluntary survey participation. Data were entered using Microsoft EXCEL spreadsheet and analyzed. Descriptive statistics were performed for each survey item.ResultsThere were 436 WOFAPS members who participated in this study with a response rate of 29%, and the vast majority were pediatric surgeons. Only 13% tried to use hormone therapy aiming to induce testicular descent or to improve future fertility. The choices of various surgical techniques were noted. During laparoscopy, if vessels and cord structure were seen entering the ipsilateral internal inguinal ring, most respondents chose to explore the groin. On the other hand, should there was an absent or atrophic testis, the respondents were split on whether to perform a contralateral orchiopexy.ConclusionThis survey describes the current practices of a sample of pediatric surgeons and urologists in the management of intraabdominal testis. The use of hormonal treatment, timing of fixation and management in case of passing through vas and vessels through DIR were undisputable. However, management of low-lying and peeing testis together with the management of contralateral testis were still debatable.

P-087 Transcriptomic differences between fibrotic and non-fibrotic testicular tissue reveal possible key players in Klinefelter syndrome-related testicular fibrosis

Abstract Study question Which genes are differentially expressed between patients with and without testicular fibrosis? Summary answer This study revealed three X-related genes MXRA5, DCX and VC3BX, which may be involved in Klinefelter-related testicular fibrosis. What is known already Klinefelter syndrome (KS; 47,XXY) affects 1-2 in 1000 males. Most KS men suffer from azoospermia due to a loss of spermatogonial stem cells. Additionally, testicular fibrosis is detected from puberty onwards. However, mechanisms responsible for fibrosis and germ cell loss remain unknown. Previous genomics studies on KS tissue focused on germ cell loss, however, differential gene expression analyses focused on testicular fibrosis have not been performed before. This study aimed to identify factors involved in the fibrotic remodeling of KS testes by analyzing the transcriptome of (non-)fibrotic testicular tissue. Study design, size, duration Transcriptome analysis on extracted RNA from testicular biopsies was performed. RNA scope analysis and immunohistochemistry were performed as validation for the findings of the transcriptomics study. Participants/materials, setting, methods RNA sequencing was performed to compare the genetic profile of testicular biopsies from patients with (KS and testis atrophy) and without (Sertoli cell-only syndrome and fertile controls) testicular fibrosis (n = 5, each). Next, differentially expressed genes (DEGs) between KS and testis atrophy samples were compared. To gain insight in potential functions of DEGs (significant when p < 0.01 and log2FC > 2), gene-ontology and KEGG analyses were performed. To validate the gene expression results, immunohistochemistry and RNA scope were performed. Main results and the role of chance A first transcriptomic analysis of fibrotic versus non-fibrotic testis tissue resulted in 734 significant DEGs (167 up- and 567 downregulated), of which 26 were X-linked. In the top upregulated biological functions, DEGs involved in the extracellular structure organization were found, including vascular cell adhesion molecule 1 (VCAM1). KEGG analysis showed an upregulation of genes involved in the TGF-β pathway. The second analysis of KS versus testis atrophy samples resulted in 539 significant DEGs (59 up- and 480 downregulated). One of the biological functions found though gene ontology analysis was the chronic inflammatory response. When looking at the overlap of DEGs on the X-chromosome from the first and second analysis, three genes were found: matrix-remodeling associated 5 (MXRA5), doublecortin (DCX) and variable charge X-Linked 3B (VCX3B). Through validation by immunohistochemistry and RNA scope, an overexpression of VCAM1, MXRA5 and DCX was found within the fibrotic group compared to the non-fibrotic group. Limitations, reasons for caution The study included fresh testis tissue from adult KS patients, however these are quite scarce, resulting in a low number of included patients per group (n = 5). Wider implications of the findings This study revealed genes which may play a role in testicular fibrosis, including VCAM1. In addition, fibrotic genes on the X-chromosome were revealed: MXRA5, DCX and VCX3B. Up- or downregulation of these genes may prevent testicular fibrosis and thus enhance the chances at retrieving spermatozoa from KS patients. Trial registration number NA

Risk Assessment of the Pesticide Envidor with the Active Substance Spirodiclofen

Envidor is a new product in Norway containing the active substance spirodiclofen. The product is applied for use as an insecticide and acaricide in fruit, berries and ornamentals (field, glasshouses and tunnels). The Norwegian Scientific Committee for Food Safety (VKM) was asked by the Norwegian Food Safety Authority to perform a risk assessment on human health, environmental fate and ecotoxicological effects of the active substance and the product. The risk assessment of the product was finalized at a meeting November 25, 2010, by VKM’s Scientific Panel on plant protection products (Panel 2). VKM Panel 2’s conclusion is as follows: 
 Both Envidor and the active substance spirodiclofen showed low acute oral -, dermal - and inhalation toxicities in animal studies, but showed skin sensitising properties. The estimated risk for operators is assessed as minimal provided adequate use of personal protective equipment. 
 Spirodiclofen may have endocrine disrupting effects, but the in vivo data are not sufficient to make a firm conclusion at this point. Adrenals and other organs of the endocrine system, including the reproductive system, are target organs for chronic toxicity of spriodiclofen. Males seem to be more sensitive than females for adverse reproductive effects of spirodiclofen. Decreased testes and epididymides sizes, testes atrophy and decreased number of sperm were seen both in the parental and subsequent generation of rats. No teratogenic effect of spirodiclofen was seen. 
 The disturbances in the endocrine system may account for the carcinogenic potential of spirodiclofen as evidenced by tumours in testicles, uterus and liver of animals. Spirodiclofen is not considered genotoxic. The Panel regards spirodiclofen to be carcinogenic and toxic to the reproduction in laboratory animals. 
 Both spirodiclofen and its metabolites are rapidly degraded in soil, but while spirodiclofen has a low mobility due to high soil sorption, its metabolites are highly mobile. 
 Use of Envidor with the proposed application regime implies a very high risk for adverse effects on bees and non-target arthropods due to exposure to the active substance spirodiclofen. The risk for adverse effects of spirodiclofen on other terrestrial organisms, and on aquatic organisms provided that a buffer zone of 30 m to surface water is applied, is considered to be minimal.

Neonatal hypogonadism due to rare testicular atrophy with congenital contralateral torsion: case report

The process of sexual differentiation involves genetic, hormonal and anatomical factors, and there may be several disorders evident at birth. Congenital testicular torsion associated with atrophy contralateral gonad in phenotypically male newborns, without alteration in development of the internal and external genital organs, is a rare condition and little reported in the literature. Thereby, we sought to report and discuss the clinical case which the presence of both clinical conditions was diagnosed in the perinatal period. Hormonal production of testicular androgens is confirmed by the development of the male genital system, both internal and external. It isn’t possible to determine whether the atrophic testis was caused by extrinsic compression of the vascular bundle due to torsion of contralateral testis, or by testicular regression syndrome, in which there in involution of the organ in utero as part of presentation of gonadal dysgenesis. The twisted testicle may have been regression, without hormone production by it, or there was hormonal production of congenitally atrophied testicle and later regressed. Regardless of this fact, early diagnosis is the cornerstone of the clinical condition, since it will invariably evolve with hypergonadotropic hypogonadism, with need for multidisciplinary follow-up.

MP11-16 PREDICTORS FOR TESTICULAR ATROPHY AFTER EMERGENCY ORCHIDOPEXY FOR TESTICULAR TORSION

You have accessJournal of UrologyCME1 May 2022MP11-16 PREDICTORS FOR TESTICULAR ATROPHY AFTER EMERGENCY ORCHIDOPEXY FOR TESTICULAR TORSION Thawatchai Mangonsrisuk, Luis Guerra, Nicholas Mitsakakis, and Melise Keays Thawatchai MangonsrisukThawatchai Mangonsrisuk More articles by this author , Luis GuerraLuis Guerra More articles by this author , Nicholas MitsakakisNicholas Mitsakakis More articles by this author , and Melise KeaysMelise Keays More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Large population-based studies report 30-40% of boys with torsion result in orchiectomy. Few studies evaluate rates of testicular atrophy in patients who do not undergo surgical removal. Our goal was to evaluate atrophy rates as well as clinical, radiographic and surgical predictors of testicular atrophy in children post-orchidopexy for testicular torsion. METHODS: Electronic health records with ICD-9 diagnosis of testicular torsion and ICD-10 procedure of urgent detorsion with orchidopexy in pediatric patients at a single pediatric hospital 2010 to 2020 were reviewed. Patients without preoperative ultrasound were excluded. Patient age, pain duration, TWIST score, ultrasound(US) findings, operative testicular colour, and post-operative US were reviewed. Predictors of testicular atrophy (>50%) were assessed with Fisher’s exact test, Mann-Whitney U and Student’s t-test, Chi-square. Multivariate logistic regression (backward stepwise method) with assessment goodness-of-fit of the model by Hosmer-Lemeshow test and Nagelkerke R2. RESULTS: 179/189 patients underwent orchiopexy for testicular torsion with post-operative follow-up were included. Overall, 22 (12.3%) patients had testicular atrophy and 157 (87.7%) had viable testes. Patients with testicular atrophy were younger than those with viable testes (10.6 vs. 14 years, p <0.001). Median hours of symptoms were significantly longer in the atrophy group (24 vs. 4.8 hrs p <0.001). TWIST score was greater in the atrophy group (5 vs. 4, p = 0.046). Use of ultrasound, time from triage to surgery was not different in both groups. Significant US predictors of testicular atrophy included presence of scrotal wall edema (OR 2.11, p = 0.026) and heterogeneous testicular parenchyma (OR 2.85, p <0.001). Surgical predictors of atrophy including previously validated colour wheel was reported in 165 cases (Chi Square p <0.001). All cases with post-detorsion black or burgundy colour underwent orchiectomy and pathologic confirmation of non-viability and were not included in study denominator. Testicular atrophy was seen in 2/3 purple (66.7%), 1/9 blue (11.2%), 13/55 mottled pink (23.2%) and 3/96 (3.1%) of pink. The multivariate logistic regression model was statistically significant, Chi-square = 46.562, p <0.001. Hosmer-Lemeshow test p-value for goodness-of-fit was 0.884. The model explained 70.5% (Nagelkerke R2) of variance in atrophic testis and correctly classified 94.7% of cases. Heterogeneous testicular parenchyma on pre-operative ultrasound was 95.34 times more likely to exhibit atrophic testis on follow up. Each additional hour of symptom duration increased odds of atrophy testis by 1.074. CONCLUSIONS: Preoperative factors including symptom duration and ultrasound heterogeneity were most significant factors to predict testicular atrophy. Non-black/hemorrhagic testicular colour has some viable cases in all subjective surgeon assessment of colours, emphasizing the importance of review of preoperative factors in surgical decision making and preoperative patient counselling. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e162 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thawatchai Mangonsrisuk More articles by this author Luis Guerra More articles by this author Nicholas Mitsakakis More articles by this author Melise Keays More articles by this author Expand All Advertisement PDF DownloadLoading ...

Histomorphological Trends of Testicular Lesions : A Retrospective Study

Aims: Testis is affected by a variety of non-neoplastic and neoplastic lesions. Our study was undertaken to analyze the spectrum of all testicular lesions and clinical correlation with age-wise distribution, laterality, and clinical presentation of all testicular lesions.&#x0D; Study Design: A retrospective descriptive study.&#x0D; Place and Duration of Study: Saveethe Medical College and Hospitals, over three years from January 2018 to December 2020.&#x0D; Methodology: All testicular lesions sent to the Department of Pathology during this period are taken for the study. Histopathological slides were retrieved and all testicular lesions were reviewed.&#x0D; Results: Out of 70 cases studied, 64 cases were non-neoplastic (91.42%) and 6 cases were neoplastic (8.57%). Right testis was more commonly involved in our study. Age distribution of non-neoplastic lesions showed the highest incidence in the 2nd decade of life (18.7%) followed by the 6th decade of life (15.6%) in our study. In neoplastic lesions, the 3rd and 4th decade of life shows higher incidence (33.4% respectively). Among non-neoplastic lesions, the most common histologic type is atrophic testis (31.2%). Among neoplastic lesions, the most common lesion is seminoma (50%).&#x0D; Conclusion: Non- neoplastic lesions are seen in all age groups, whereas testicular neoplastic lesions are more commonly seen in the younger age group.

A case report of vanishing testicle: radiological diagnosis and short review

BackgroundVanishing testicular syndrome is also known as testicular regression syndrome (TRS) is due to atrophy and disappearance of testis in the fetal life after the formation of the normal testis. It is a spectrum of disorders; clinical features are depending upon the stage of fetal or early neonatal life at which function of testicles ceases.Case presentationYoung 40-year-old male patient came for a routine master health checkup. On clinical examination he had a nonpalpable left testis, Rest of the clinical examinations are unremarkable. Referred to ultrasound (USG), for testis localization reveals the absence of left testis in the left scrotal sac and inguinal canal. Further MRI of the scrotum reveals the feature of TRS.ConclusionTRS in the 4th-decade adult is rarely reported in the literature. The asymptomatic presentation shows the least possibility of neoplasm in TRS patients.

Proportion of Testicular Absence and Position of Testis in Unilateral Nonpalpable Undescended Testis in a Tertiary Teaching Hospital in South India

Introduction: Undescended testis is a common surgical problem in children which needs to be treated by one and a half year of age. When testis is non palpable, it could be either absent, and when present intra-abdominal or inguinal. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with nonpalpable undescended testis from January 2016 to June 2021. Results: Mean age of intervention was 43.7 months (range 7 to 153 months). Incidence of absent testis was 30.97%. in 156 children who had ipsilateral undescended testis, 92 had intra-abdominal testis and 43 had inguinal testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy were suggestive of absent ipsilateral testis (p &lt;0.001). Testis is absent in 11.3% only when ipsilateral hemi scrotum is under developed. Conclusion: Proportion of absent testis is 30.97% in children with unilateral undescended testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy are predictive of ipsilateral testicular absence. Keywords: Undescended testis, atrophic testis, Contralateral hypertrophy.

Non-invasive approach for sterilization in male dogs using therapeutic ultrasound

The objective of this study was to evaluate the efficacy of noninvasive technique of sterilization in male dogs using therapeutic ultrasound. Twelve male dogs were randomly divided into two equal groups subjected to therapeutic ultrasound application with frequenciesl MHz (group B) and 3MHz (group B) performed on days 0, 2, 4, 6 and 8, for 5 minutes in animals of both groups. Sterilization by therapeutic ultrasound application was confirmed by atrophy of testes grossly and by testicular histopathology microscopically. It was concluded that the therapeutic ultrasound sterilization technique is satisfactory in dogs as sufficient testicular degeneration, considerable decline in testosterone levels and azoospermia was evident during post-therapeutic period. Treatment with therapeutic ultrasound with frequency of 1 MHz had better results than 3 MHz.

To determine the sensitivity, specificity, and diagnostic accuracy of diffusion-weighted MRI in localization of non-palpable undescended testes taking laparoscopic findings as the gold standard: A cross-sectional study from Pakistan

BackgroundCryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. MethodsA cross-sectional study was conducted in the radiology department of a tertiary care hospital from September 27, 2018 to September 26, 2019. A total of 416 patients were included. Abdomen-pelvic and scrotal ultrasound were performed. Preoperative abdominal and pelvic DW-MRI was performed with a 1.5-T MRI system using a body coil. All study patients underwent laparoscopic exploration. Intra-abdominal atrophic testes were treated with laparoscopic orchiectomy and orchiectomy samples were taken for histopathologic examination. DW-MRI findings were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW-MRI taking laparoscopy as the gold standard. ResultsThe mean age was 17.08 ± 7.99 years and the mean BMI was 19.36 ± 4.96 kg/m2. In our study, 34.1% of cases were diagnosed as undescended testes localized by DWI-MRI and 51% of cases were diagnosed as undescended testes localized via laparoscopy. Sensitivity, specificity, PPV, NPV and accuracy were 65.1%, 98%, 97.2%, 73% and 81.3% respectively. ConclusionDW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes.

Malignant Mixed Germ Cell Tumor of the Testis with Associated Nephroblastoma: A Rare Entity

Abstract Introduction/Objective While nephroblastoma is the most common primary childhood renal malignancy, it rarely occurs at extra-renal sites. Testicular nephroblastoma is exceedingly rare, with only 5 previously reported cases arising in association with primary testicular teratoma (4 of which arising in non-atrophic, and 1 arising in atrophic testis). We report a case of testicular nephroblastoma with multiple associated germ cell components. Methods/Case Report The case is that of a 28-year-old male presenting with an enlarging, painless right scrotal swelling. Laboratory results showed elevated serum AFP with normal LDH and beta-HCG, and imaging confirmed the presence of a heterogenous testicular mass. A radical orchiectomy was performed, revealing a tan-white, fleshy, nodular 5.5 cm mass almost entirely replacing the testicular parenchyma. Microscopically, the tumor consisted of multiple components. The nephroblastoma component was associated with teratoma with immature elements and consisted of epithelial tubular structures, small blue blastemal cells, and pale mesenchymal stroma which demonstrated pan-cytokeratin and patchy WT1 expression by immunohistochemistry. Additional components included yolk sac tumor and minor component of seminoma. Foci of germ cell neoplasia in-situ were also identified, supported by immunohistochemical stains for PLAP and OCT3/4. The patient’s post-resection tumor markers normalized, and further assessment for metastasis and chemotherapy is pending. Results (if a Case Study enter NA) NA Conclusion Malignant mixed germ cell tumors of the testis with associated nephroblastoma are exceedingly rare, further studies nand followup are required to determine prognostic values and achieve a more complete understanding of this combination of entities.

Asymmetric Phenotypes of Sterile Hybrid Males From Reciprocal Crosses Between Species of the Anopheles gambiae Complex

Haldane’s rule of speciation states that sterility or inviability affects the heterogametic sex of inter-species hybrids. Darwin’s corollary to Haldane’s rule implies that there are asymmetric phenotypes in inter-species hybrids from reciprocal crosses. Studying the phenotypes of F1 hybrids among closely related species of malaria mosquitoes can assist researchers in identifying the genetic factors and molecular mechanisms of speciation. To characterize phenotypes of sterile hybrid males in the Anopheles gambiae complex, we performed crosses between laboratory strains of An. merus and either An. gambiae or An. coluzzii. The reproductive tracts had normal external morphology in hybrid males from crosses between female An. merus and male An. gambiae or An. coluzzii. Despite being sterile, these males could copulate with females for a normal period of time and could transfer a mating plug to induce female oviposition and monogamy. In contrast, the entire reproductive tracts in hybrid males from crosses between female An. gambiae or An. coluzzii and male An. merus were severely underdeveloped. These males had atrophic testes and reduced somatic organs of the reproductive system including male accessary glands and ejaculatory duct. In addition, hybrid males with underdeveloped reproductive tracts displayed a shorter copulation time with females and failed to induce female oviposition and monogamy due to their inability to form and transfer a plug to females during mating. The asymmetry of the phenotypes associated with hybrid male sterility suggests that different genetic factors and molecular mechanisms are responsible for reproductive isolation in reciprocal crosses among species of the An. gambiae complex.

P1078 - Laparoscopic staged management of high Intrabdominal testis: A prospective randomized study

Abstract Objective To prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). Materials and Methods Forty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO). Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage. Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. Results Staged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery. At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). Conclusions Both staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.

The fat anchor orchiopexy technique: results and outcomes from 150 cases surgical experience

PurposeThe purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as “fat anchor orchidopexy” (FAO), for the treatment of palpable low inguinal undescended testis.Materials and methodsWe retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli’s technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient’s age, operative times and complications.ResultsA total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient’s age was 21 months (range: 14–28 months). All the procedures were planned in a day-surgery setting. Trans-scrotal orchiopexy was successful in all cases and no patients required an additional groin incision. No intraoperatively and postoperatively major complications were observed. Patients’ post-operative pain was mild (mean pediatric visual analog scale = 2). In all cases, the healing process was rapid and no surgical wounds infections were reported during the post-operative period, referring excellent cosmesis results. During a mean 48-month follow-up period, no testicular retraction, recurrence or testis atrophy was reported.ConclusionThe original Spinelli’s technique (FAO) proves to be a safe and effective method for the treatment of palpable or distal-to-external-inguinal-ring testes. No immediate and delayed post-surgery complications were reported. In all cases, the anchored testicle remained in the scrotal position with normal vascularization. This novel surgical technique could give better options for scrotal fixation in case of low-lying cryptorchid testes.

Segmental Unilateral Epididymal Agenesis in a Two Years Old Pekingese

Epididymal agenesis is described as the complete or partial lack of the epididymis. In this paper, a two-year-old Pekingese dog with epididymal agenesis is reported during routine castration. The dog was presented to a private pet hospital for conventional castration. Anatomically unilateral epididymal agenesis was observed during orchiectomy. Also, pathologically segmental unilateral epididymal agenesis and atrophy of testis were implied. The dog was neutered. Epididymal agenesis is a highly rare phenomenon in all breeding dogs. To the authors’ knowledge, this is the first report of epididymal agenesis in small breeding dogs. This kind of animal should not use for breeding programs and practitioners pay attention to this anomaly while encountered infertility in dogs.

The effect of intratesticular dexpanthenol on experimentally-induced testicular ischaemia/reperfusion injury

Testis torsion is a urological emergency and a serious situation that may cause testis atrophy, testicular dysfunction and infertility due to ischaemia/reperfusion(I/R) injury even with early intervention. To assess the protective effect of dexpanthenol administered intratesticular after detorsion against testis I/R injury. Twenty-seven rats were randomly divided into 3 groups containing 9 rats each. The 1st group comprised the sham group with no procedure performed. The 2nd group had only torsion applied, while the 3rd group had torsion+dexpanthenol applied. Rats had 720° clockwise rotation applied to the left testis. After 2h of ischaemia, testes were de-torsioned and the dexpanthenol group had 500mg/kg dexpanthenol administered intratesticular after detorsion. After 4h of reperfusion, rats had blood samples taken and orchiectomy was performed for histologic assessment. A significant difference was detected in all parameters [necrosis(p:<0.001), Cosentino grade (p<0.001), congestion (p:0.005), fibrosis (p:<0.001), interstitial oedema (p:0.017), JTBS score (p:<0.001), apoptosis (p<0.001) and testosterone levels (p:0.006)] when the sham, torsion, and torsion+dexpanthenol groups were compared. Significant differences were observed for fibrosis (p:0.010), Cosentino score (p<0.001), JTBS score (p:<0.001), apoptosis (p:0.001) and total testosterone levels (p:0.013) when torsion and torsion+dexpanthenol groups were compared. The torsion+dexpanthenol group was identified to have more preservation of testis function observed histologically and hormonally compared to the torsion group. Dexpanthenol is used in many areas due to both epithelizing and antioxidant effects and lack of clear side effects. In spite of use of many chemical and biological agents to protect against testis I/R injury, none have entered routine use. This study showed that dexpanthenol, which can be easily injected intratesticular during detorsion surgery, has protective effect against histological and functional injury that may develop linked to testis I/R injury. The main limitations of the study are short duration of follow-up due to being a rat experiment and lack of comparison of lipid peroxidation products. This study identified that dexpanthenol with clinically easy use by intratesticular injection after detorsion during surgery had a protective effect against histological and functional injury that will develop linked to I/R injury in the testis.

AB145. SOH21AS087. Preservation of fertility potential in a solitary testis with germ cell tumour and prior azoospermia by utilising on table sperm extraction

Background: Currently, cryopreservation of semen prior to commencement of anti-cancer therapy is the method of choice for preserving male fertility. Success of this technique depends on the presence of sperm/spermatozoa in semen, and so is not suitable in azospermic patients. In non-germ cell tumour (GCT) patients, specialised facilities and time to treatment permits the use of testicular sperm extraction (TESE) to collect appropriate sperm/spermatozoa prior to definitive management. It becomes a significant challenge, where patients have tumour in solitary testis, bilateral testicular tumours, or significantly atrophic contralateral testis. In such situations, there is risk that fertility preservation can be overshadowed by the urgent treatment of GCT. We share our experience of Onco-TESE to preserve fertility in an azospermic patient with GCT in solitary testis.

A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis.

BackgroundThere have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables.MethodsWe performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018.ResultsA total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5−11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851.ConclusionsIn patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.

Laparoscopic staged management of high intrabdominal testis: A prospective randomized study

ObjectiveTo prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). Materials and MethodsForty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO).Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage.Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. ResultsStaged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery.At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). ConclusionsBoth staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.