Effect Of Orchiopexy Research Articles

Testicular Temperature and the Effects of Orchiopexy in Infants with Cryptorchidism.

Testicular temperature should remain low to maintain optimal function of germ cells; however, information regarding testicular temperature in infants and the effect of cryptorchidism and its correction, including laparoscopic staged Fowler-Stephens orchiopexy (LSFSO), is limited. A total of 82 infants with unilateral palpable cryptorchidism, 24 with nonpalpable testes who underwent unilateral LSFSO and 20 with scrotal hydrocele were included. Ultrasonographic determination of testicular volume and measurement of testicular temperature but not scrotal surface temperature using a Coretemp CTM204® (Terumo, Tokyo) were performed before and 12 months after orchiopexy. The effects of the route of testicular delivery, conventionally through a new hiatus medial to the inferior epigastric vessels or through the transinguinal approach, were investigated in the LSFSO cases. Undescended testicular volume was significantly increased after orchiopexy (0.80 ml to 0.92 ml, p <0.0001). The preoperative testicular temperature (35.1C) was significantly higher than that of the control (34.4C, p <0.0001), and significant decreases in testicular temperature occurred after orchiopexy (34.3C, p <0.0001). A multivariate analysis showed that a decrease in testicular temperature was a factor associated with postoperative testicular development. Twelve months after LSFSO, transinguinal approach was shown to be more effective in decreasing the testicular temperature than the conventional approach (34.4 and 35.3C, respectively, p <0.05). Orchiopexy is effective in correcting the high-temperature environment caused by cryptorchidism. In the case of nonpalpable testes treated by LSFSO, transinguinal fixation is more effective than the conventional approach in reducing testicular temperature, but a longer followup period is necessary to draw a final conclusion.

Anti-Müllerian hormone levels in serum 1 year after unilateral orchiopexy

The aim of this study was to determine the serum anti-Müllerian hormone (AMH levels) in a group of boys with cryptorchidism before and 1 year after surgery. Additionally, the effect of orchiopexy, based on the testicular position and morphology, was evaluated. Fifty boys who were 1-4 years old (median, 2.4 years) with unilateral cryptorchidism were evaluated before and 1 year after they underwent orchiopexy. Prior to the procedure, all of the patients had undergone karyotyping to exclude chromosomal abnormalities. Blood samples were collected while obtaining blood for standard laboratory tests routinely performed just before and 12 months after surgery. Twelve months after the orchiopexy, in most cases surgically treated testes were in the middle or lower pole of the scrotum. The descended glands were of comparable size and density in comparison with the testes on the opposite side. In the treated children, serum AMH levels measured at 12 months after orchiopexy were similar to preoperative basal levels. The authors found that AMH levels in children with unilateral undescended testes do not change significantly 1 year after surgical procedure. We still do not have trustworthy factors to predict fertility in children affected with cryptorchidism. We observed an upward trend in AMH concentration 1 year after orchiopexy, but it was statistically insignificant. Therefore, we plan further measurements of AMH in boys after orchiopexy to assess the influence of this procedure on gonadal function.

The effects of orchiopexy on serum anti-Müllerian hormone levels in unilateral cryptorchid infants

In males, serum anti-Müllerian hormone (AMH) reflects Sertoli cell function and provides an estimate of seminiferous tubular integrity. It has been suggested that comparison of AMH levels before and after surgery could be useful to determine effectiveness of the treatment. In this study, we determined the serum AMH levels in infants with unilateral cryptorchidism before and after orchiopexy procedure and compared these data with the AMH values in age-matched controls. The study population was 20 cryptorchid children with unilateral palpable testes who underwent orchiopexy as a cryptorchid group, and 20 healthy children who underwent circumcision as a control group. All children are 12 months of age. Serum AMH levels were measured at just before surgery (at 12 month old) and 6 months after surgery (at 18 month old). All undescended testes were found to be normal in size and in the superficial inguinal pouch or subcutaneous region of the groin at surgery. With regard to the preoperative serum AMH levels, there was a significant difference between the cryptorchid and the control groups (40.04 +/- 4.97 ng/ml versus 53.46 +/- 7.51 ng/ml) (P < 0.05). Similarly, the postoperative serum AMH levels were lower in cryptorchid children than in controls (39.27 +/- 4.58 ng/ml versus 52.79 +/- 6.27 ng/ml) (P < 0.05). In cryptorchid children, serum AMH levels measured at 6 months after orchiopexy were similar with preoperative basal levels (40.04 +/- 4.97 ng/ml versus 39.27 +/- 4.58 ng/ml) (P > 0.05). AMH levels in children with unilateral palpable undescended testes remain unchanged 6 months after orchiopexy performed at 1 year of age. This is the first report in literature regarding the effect of orchiopexy on the serum AMH levels.

Effects of orchiopexy on congenitally cryptorchid insulin-3 knockout mice.

Insulin-3 (Insl3) knockout mice exhibit isolated, bilateral, high intra-abdominal cryptorchidism. If left in this position until adulthood, these testes will deteriorate to the Sertoli-cell-only state, leading to infertility in 100%. We examined the effect of orchiopexy in this genetically engineered animal model. A total of 160 testes from 80 male offspring of Insl3 F crosses underwent either no orchiopexy (29 testes), sham surgery (25 testes), 1-stage Fowler-Stephens scrotal orchiopexy (57 testes) or primary orchiopexy into a low abdominal, subcutaneous pouch (49 testes). A group of postoperative mice underwent fertility testing 3 months postoperatively. At 6 to 9 months postoperatively the testes were harvested and histologically analyzed. Testes were atrophic in 100% (25 of 25) of the sham group, 91% (52 of 57) of the Fowler-Stephens orchiopexy group and 33% (16 of 49) of the subcutaneous pouch group (testis weight less than 50 mg.). Fertility testing was done in 30 mice (sham 5, Fowler-Stephens orchiopexy 17 and subcutaneous pouch 8). Infertility was secondary to bilateral testicular atrophy (sham 5 of 5, Fowler-Stephens orchiopexy 13 of 17), spermatogenic maturation arrest (subcutaneous pouch 8 of 8) and ductal obstruction [normal spermatogenesis with epididymis devoid of sperm] (Fowler-Stephens orchiopexy 2 of 17). Fertility with normal spermatogenesis was observed in 2 of 17 Fowler-Stephens orchiopexy mice, both of which were Insl3 knockout mice. Intrascrotal orchiopexy can rescue these congenitally cryptorchid Insl3 knockout testes from their intra-abdominal fate of Sertoli-cell-only and lead to fertility. The results suggest that orchiopexy has a crucial and central role in preservation of spermatogenesis.

The natural course of cryptorchidism in rats and the efficacy of orchidopexy or orchidectomy in its treatment before and after puberty

Both clinical and experimental evidence suggest that fertility is impaired in unilateral cryptorchidism. To investigate the effect of the undescended testis on the contralateral descended gonad, a new experimental model based on natural cryptorchidism in rats was designed. Seventy male Buffalo rats with an undescended right testis noted at the age of 30 days were used. Fifty healthy animals served as a controls. The natural course of cryptorchidism was investigated at the ages of 30, 90, and 180 days. The effects of orchiopexy and orchiectomy performed in cryptorchid animals before and after puberty were evaluated at the age of 180 days. Both nonoperated and operated animals were mated at the age of 150 days in order to estimate their fertility. The animals were killed at 30, 90, and 180 days of life and the testes were removed. In each excised testis testicular weight and seminiferous tubular diameters were measured and the maturity of the germinal epithelium was determined using the Johnsen testicular biopsy score. The experiment demonstrated reduced testicular weight and seminiferous tubular diameters in undescended testis already at 30 days and arrest of spermatogenesis at the spermatocytes stage at 90 and 180 days. There was no significant difference between contralateral descended testes and controls at the age of 30 and 90 days, but at 180 days the degenerative changes were identical with those in the cryptorchid testes. Cryptorchid rats were completely infertile. Both orchiopexy and orchiectomy prevented the damage to the contralateral testis. A significant improvement in size and spermatogenesis was recorded in most cases of the surgically descended testes. The fertility of operated animals and control groups was not significantly different. There was no difference between animals operated before and after puberty. The fact that degenerative changes in the cryptorchid testis were completely reversible in most cases after placing it in the scrotum is important. This model is closer to human crytorchidism and, therefore, potentially more useful in investigating and evaluating the treatment.

Undescended Testis and Orchiopexy: Recent Observations

Within the past two decades, observations from a number of sources have expanded our understanding of undescended testes in children. As neonatology has grown, the observations of infants with low birth weight and knowledge of the implications of this condition for undescended testes have also increased. Information obtained from biopsy, including that from studies using electron microscopy, has suggested decreased spermatogonia in children with abdominal testes with age, indicating a need for medical or surgical intervention soon after 1 year of age. The effects of orchiopexy and hormonal manipulations to assure fertility in adulthood have been clarified to the extent that an algorithm for patient management can be constructed. ANATOMY An undescended testis has been identified in 0.8% of male infants at 1 year of age1 and in about 0.2% of adult male military recruits. The incidence rises to 21% in premature neonates weighing less than 2,500 g. Even more striking, nearly 100% of profoundly low-birth-weight neonates (weighing approximately 900 g) exhibit bilateral undescended testes. With weight gain and age, the testes of infants who weighed 900 g at birth proceed toward descent and at 1 year of age have the same incidence as their peers. Many authors in Europe and the United States have noted that scrotal descent of the testis by 3 years of age preserves spermatogonia, implying a beneficial effect on adult fertility.

Undescended Testis and Orchiopexy: Recent Observations

Within the past two decades, observations from a number of sources have expanded our understanding of undescended testes in children. As neonatology has grown, the observations of infants with low birth weight and knowledge of the implications of this condition for undescended testes have also increased. Information obtained from biopsy, including that from studies using electron microscopy, has suggested decreased spermatogonia in children with abdominal testes with age, indicating a need for medical or surgical intervention soon after 1 year of age. The effects of orchiopexy and hormonal manipulations to assure fertility in adulthood have been clarified to the extent that an algorithm for patient management can be constructed. ANATOMY An undescended testis has been identified in 0.8% of male infants at 1 year of age1 and in about 0.2% of adult male military recruits. The incidence rises to 21% in premature neonates weighing less than 2,500 g. Even more striking, nearly 100% of profoundly low-birth-weight neonates (weighing approximately 900 g) exhibit bilateral undescended testes. With weight gain and age, the testes of infants who weighed 900 g at birth proceed toward descent and at 1 year of age have the same incidence as their peers. Many authors in Europe and the United States have noted that scrotal descent of the testis by 3 years of age preserves spermatogonia, implying a beneficial effect on adult fertility.

Morphologic effects of orchiopexy or orchiectomy on the contralateral testis in experimental unilateral cryptorchidism

Morphologic effects of orchiopexy or orchiectomy on the contralateral testis in experimental unilateral cryptorchidism