Orchiectomy Group Research Articles

Aging-related biomarkers in testicular cancer survivors after different oncologic treatments.

Testicular cancer survivors (TCS) exposed to chemotherapy have an increased expression of CDKN2A/p16INK4a and a lymphocyte phenotype associated with immunosenescence. We seek to define whether the immunosenescent phenotype is associated with chemotherapy. Case-control study of TCS, disease-free ≥3 months and stratified by primary treatment modality into orchiectomy only, chemotherapy, or bone marrow transplant (BMT). Each group was compared with age-matched healthy controls (HC). We measured the relative proportions of lymphocyte subpopulations using flow cytometry, levels of C-reactive protein, and relative expression of CDKN2A/p16INK4a quantified by qPCR. We included 65 patients; 19 were treated with orchiectomy only, 35 received different doses of chemotherapy, and 11 underwent BMT. The chemotherapy and BMT groups had decreased naïve CD4 cells compared to HC. The chemotherapy group showed increased central and effector memory CD4 cells, as well as effector and terminally differentiated CD8 cells, compared to HC. Chemotherapy (chemotherapy 1.84 vs. HC 0.92; p < 0.01) and BMT (BMT 6.96 vs. HC 1.25; p < 0.005) groups had higher expression of CDKN2A/p16INK4a compared to HC. The orchiectomy group showed no significant difference with HC (orchiectomy 1.73 vs. HC 1.01; p = 0.17). CRP levels were higher in all groups when compared with HC; in the orchiectomy group, they were only marginally increased (chemotherapy 0.22 vs. HC 0.06; p < 0.01; BMT 0.26 vs. HC 0.06; p < 0.01; orchiectomy 0.09 vs. HC 0.07; p < 0.01). Among TCS, only patients exposed to cytotoxic agents developed an immunosenescent phenotype. This finding supports the attribution of this alteration to the cytotoxic treatment.

Clinical and hematological analysis of testicular torsion in children.

Analyze the clinical manifestations, laboratory tests, and imaging data of testicular torsion to provide clinical insights for timely and accurate diagnosis and treatment of testicular torsion. A retrospective analysis was conducted on the clinical data of 67 pediatric patients suspected of testicular torsion, admitted and subjected to surgical exploration from June 2018 to June 2023. Based on whether the torsed testicle was excised during surgery, the patients were divided into orchiectomy group (40 cases) and orchidopexy group (27 cases). Combining clinical symptoms, signs, ultrasound examinations, and laboratory tests, the study aimed to summarize the influencing factors on the onset, diagnosis, and treatment of testicular torsion. The clinical manifestations of all 67 pediatric patients were generally typical. Color Doppler Flow Imaging (CDFI) and surgical exploration were performed for all cases, and the results were consistent. Testicular color doppler ultrasound suggested reduced or absent blood flow, leading to surgical treatment in all cases. All patients had unilateral testicular torsion, with 46 cases (68.66%) on the left side and 21 cases (31.34%) on the right side. Intrafunicular torsion occurred in 60 cases (89.55%), while extrafunicular torsion occurred in 7 cases (10.45%). The onset distribution was as follows: 20 cases in spring, 16 cases in summer, 16 cases in autumn, and 15 cases in winter. Univariate analysis indicated significant statistical differences in age, degree of testicular torsion, duration of symptoms, NEUT, NLR, and occurrence of tunica fluid between the two groups of patients. Multivariate logistic regression analysis showed that the duration of symptoms and the occurrence of hydrocele were independent risk factors for determining testicular viability. Testicular torsion is more common in children and adolescents, with clinical manifestations including scrotal pain, scrotal redness and swelling, abdominal pain, nausea, and vomiting. In the early stages of testicular torsion, inflammatory markers in the blood increase, and preoperative ultrasound indicates hydrocele. This suggests that the testicle is in an early twisted state, with good viability and potential for preservation.

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3months?

This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3months old. A retrospective analysis was conducted on data collected from infants under 3months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. The study included 42 cases, with 18 patients being followed up for 6-54months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.

The effects of orchiectomy and steroid on fertility in experimental testicular atrophy.

Despite our understanding of Sertoli cell function and the state of spermatogenesis, the underlying mechanisms remain unclear. This study was conducted to compare the effects of orchiectomy and steroid treatment on fertility in testicular atrophy occurring after testicular torsion. Thirty-three rats were divided into four groups. The atrophy, orchiectomy, and atrophy-steroid groups each contained nine rats, while the control group contained six. The left testes were rotated 720º, and atrophy was observed. In the atrophy-steroid rats, orchiectomy was performed after atrophy, and 1 mg/kg steroid was injected. Each male rat was housed with five female rats for 6 days. The fertility of the male rats was evaluated based on the pregnancy of the female rats. Left and right orchiectomies were performed to determine the tissue Johnsen score (JS) and the serum inhibin B (IB) level. JS values were significantly lower in the atrophy, orchiectomy, and atrophy-steroid groups than in the control group (p<0.05), while no significant difference was observed in JS between the atrophy and orchiectomy groups (p>0.05). Similarly, no significant differences in IB level or fertility percentage were found between the atrophy and orchiectomy rats (p>0.05). In unilateral testicular atrophy, which can occur in the prepubertal period due to various causes, orchiectomy does not appear to benefit fertility, as indicated by IB, JS, and the fertility percentage.

BS-452757-4 ANTI-ARRHYTHMIC EFFECTS OF ANDROGEN DEPRIVATION THERAPIES IN A SCN5A LOSS-OF-FUNCTION MOUSE MODEL

Sex is a major determinant of the incidence and clinical presentation in arrhythmia syndromes such as Brugada syndrome (BrS). We generated a novel SCN5A-G1408R/+ knock-in mouse model mimicking key features of human BrS regarding male predominance and susceptibility to ventricular tachycardias. This study aimed to explore the effect and molecular mechanisms of androgen deprivation on cardiac arrhythmogenicity in a mouse model of BrS. Animals were studied using surface ECG with and without flecainide challenge (10 mg/kg body weight), telemetric recordings, molecular, biochemical as well as histological analyses. To study the effect of antiandrogenic treatments on the rhythmogenic state and its influence on transcriptional alterations of cardiac ion channel genes, male G1408R/+ mice were either chronically treated with the androgen receptor (AR) blocker flutamide by subcutaneously implanted osmotic pumps or orchiectomized. Sex-dependent analysis showed that 81% (25/31 animals) of male G1408R/+ and only 14% (2/14 animals) of their female littermates developed flecainide-induced polymorphic ventricular tachycardias (VT). Only male G1408R/+ mice, previously 100% inducible for VT underwent androgen deprivation (flutamide for 4 weeks vs. orchiectomy). The arrhythmogenic phenotype was rescued in both groups of antiandrogenic therapy. VT incidence in the flutamide group was reduced to 13% (2/16), while VT in the orchiectomy group declined to 33% (3/9). At baseline, (untreated) male G1408R/+ mice exhibited reduced cardiac expression of NaV1.5 protein compared to male wild type (wt) mice, particularly in the right ventricular myocardium. Treatment with flutamide for 4 weeks resulted in increased NaV1.5 expression in male G1408R/+ mice to levels similar to male wt mice. Interestingly, orchiectomized G1408R/+ mice revealed levels of NaV1.5 protein even higher compared to wt mice, which were particularly abundant in the right ventricular free wall. We observed a significant anti-arrhythmic effect induced by androgen deprivation in the G1408R/+ mouse model mimicking human BrS. Our data indicate that the anti-arrhythmic effect is potentially driven by increasing right ventricular NaV1.5 membrane expression as a result of anti-androgenic treatment.

MP02-11 ANDROGEN AND ESTROGEN RECEPTOR CHANGES IN SCROTAL SKIN OF TRANSGENDER PATIENTS UNDERGOING GENDER AFFIRMING SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP02-11 ANDROGEN AND ESTROGEN RECEPTOR CHANGES IN SCROTAL SKIN OF TRANSGENDER PATIENTS UNDERGOING GENDER AFFIRMING SURGERY Michele Fascelli, Matthew Bury, Alex Wang, Matthias Hofer, and Daniel Dugi Michele FascelliMichele Fascelli More articles by this author , Matthew BuryMatthew Bury More articles by this author , Alex WangAlex Wang More articles by this author , Matthias HoferMatthias Hofer More articles by this author , and Daniel DugiDaniel Dugi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known regarding the molecular changes in genital skin after initiation of gender-affirming hormone therapy or gonadectomy, which is of particular interest given the use of this tissue as full-thickness skin graft in creating the neovagina in vaginoplasty. In order to learn anatomic and microscopic details of the skin, we set out to characterize androgen and estrogen receptor (AR and ER) prevalence in a cohort of patients undergoing gender affirming vaginoplasty or vulvoplasty (GAV). METHODS: Retrospective review of 48 patients who underwent GAV was performed (Table 1). Immunohistochemistry (IHC) was performed on scrotal skin collected at time of surgery. AR and ER percent expression determined by IHC was categorized into absent (<0.3%), weak (0.3-0.5) moderate (0.5-0.8), and strong expression (>0.8). Univariate and multivariate analyses were performed. RESULTS: Patients with history of prior orchiectomy had statistically lower ER and AR percent expression (Table 2). No preoperative characteristics differed between the prior orchiectomy group and the remainder of the cohort. On average, orchiectomy was performed 2.7 years before GAV (range 1-7, SD 1.8). Several patients (30/48) within the cohort had absent expression of AR in the scrotal skin. CONCLUSIONS: Patients with history of prior orchiectomy had lower ER and AR present on IHC of scrotal skin. It remains unclear if HRT or orchiectomy was responsible. Given the absence of AR expression in the cohort, we plan to re-assess a new cohort of patients as formalin fixation may limit IHC assessment. While pre-HRT and pre-orchiectomy skin samples were unavailable in our study, this work lends itself to investigate the result of hormone changes on genital skin. Further, these insights may aid in treating genital skin changes in the post-operative transgender population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e14 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michele Fascelli More articles by this author Matthew Bury More articles by this author Alex Wang More articles by this author Matthias Hofer More articles by this author Daniel Dugi More articles by this author Expand All Advertisement PDF downloadLoading ...

Bilateral orchiectomy deteriorates the structure and function of seminal vesicles in a rat model.

The effects of hormone levels on ejaculation are known. In addition to thyroid hormone levels, testosterone levels are also associated with ejaculation, but no consensus has been reached on this issue. Thus, we investigated the effect of decreased testosterone levels due to bilateral orchiectomy on the chemical stimulation-induced ejaculation phases in rats. Twenty-one male Wistar rats were randomized into the orchiectomy, sham, and control groups, with seven rats in each group. Bilateral orchiectomy was performed. The ejaculation parameters were evaluated 5 days after the sham and bilateral orchiectomy operations and the waiting period in the control group. The seminal vesicle (SV) phasic contraction number and increase in basal pressure amplitude were significantly lower in the orchiectomy group (6.9 ± 3.3 and 0.6 ± 0.3 mmHg) than in the sham and control groups (11.2 ± 1.7 and 1.0 ± 0.4 mmHg, and 14.5 ± 6.6 and 1.1 ± 0.2 mmHg, respectively; p = 0.016 and p = 0.03, respectively). The interval between the SV contractions was significantly longer in the orchiectomy group (166.2 ± 104.3 s) than in the sham and control groups (76.0 ± 15.5 s and 63.1 ± 31.1 s, respectively; p = 0.014 (between groups), orchiectomy vs sham p = 0.040 and orchiectomy vs control p = 0.018). The SV weights of the rats were significantly lower in the orchiectomy group (0.14 ± 0.01 g) than in the sham and control groups (0.37 ± 0.05 g and 0.48 ± 0.03 g respectively; p < 0.0001 (between groups), orchiectomy vs sham p < 0.0001 and orchiectomy vs control p < 0.0001). The groups showed no significant differences in ejaculation time, SV basal pressure, SV maximum amplitude, and bulbospongiosus muscle contraction electromyographic activity. Our results partially clarified the relationship between decreased testosterone levels and ejaculation. Decreased testosterone levels caused statistically significant changes in SV functions and affected the ejaculation emission phase.

Conventional androgen deprivation therapy is associated with an increased risk of fracture in advanced prostate cancer, a nationwide population-based study.

Androgen deprivation therapy (ADT) is the standard of care in advanced prostate cancer. We conducted a Taiwan National Health Insurance Research Database (NHIRD) study to evaluate the association between ADT and fracture risk in patient with prostate cancer in Taiwan. Between 2001 and 2008, data from the Taiwan NHIRD was collected. We separated newly diagnosed prostate cancer patients into four groups: the injection of gonadotropin-releasing hormone agonists and antagonists group, the orchiectomy group, the oral antiandorgens group and the radical prostatectomy only group. A non-cancer matched control group was also assigned for comparison. T tests, chi-squared tests, multivariate Cox proportional hazard regression were performed. A subsequent fracture event was defined according to the appropriate diagnosis codes (ICD9-CM 800-829) with hospitalization. Patients with fracture before their diagnosis with prostate cancer were excluded. Overall, 22517 newly diagnosed patients with prostate cancer were enrolled in the study. After exclusion criteria were applied, 13321 patients were separated into the injection group (5020 subjects), the orchiectomy group (1193 subjects), the oral group (6059 subjects) and the radical prostatectomy only group (1049 subjects). The mean age of the overall study population was 74.4 years. Multi-variant analysis disclosed a significantly increased risk of fracture in the injection group, the orchiectomy group, and the oral group (hazard ratio [HR] = 1.55, 95%, confidence interval [CI] 1.36 to 1.76, p<0.001, HR = 1.95, 95%, CI 1.61 to 2.37, p<0.001, HR = 1.37, 95%, CI 1.22 to 1.53, p<0.001, respectively). In contrast, a significantly decreased fracture risk was noted in the radical prostatectomy only group (HR = 0.51, 95%, CI 0.35 to 0.74, p = 0.001). Patients receiving osteoporosis medication had a significantly decreased fracture risk (HR = 0.26, 95%, CI 0.19-0.37, p<0.001). ADT is associated with an increased risk of fracture. For patients receiving long-term prostate cancer castration therapy, doctors should always keep this complication in mind and arrange proper monitoring and provide timely osteoporosis medication.

Azoospermia and Sperm Retrieval in Post-Pubertal Testicular Torsion; Benefits and limitations

To assess the risk of azoospermia development and the value of sperm retrieval in post-pubertal testicular torsion (TT). This prospective study included patients with post-pubertal TT. Surgical exploration was urgently performed with either orchiopexy or orchiedectomy and contralateral orchiopexy. With the intention of cryopreservation, all cases underwent conventional testicular sperm extraction. Patients were followed-up after 1, 3, and 6 months with semen analysis and hormonal assay (FSH, LH and testosterone). Sperm retrieval rate (SRR), azoospermia rate and changes in hormonal profile were evaluated. The study included 62 patients with a median (IQR) age of 19 (18-20.7) years and duration of testicular torsion of 32.5 (18.3-48) hours. Testicular salvage was successful in 20 (32.3%) while orchiedectomy was performed on 42 patients. The duration of torsion [OR, 95% CI=0.75 (0.61-0.93), P=.008] was the independent predictor of testicular salvage. Successful SR was achieved in 58 patients (93.5%); (40 from the affected testis and 18 from the contralateral side). After 6 months, 21 patients (33.8%) developed azoospermia [19 (45.2%) in orchidectomy group and 2 (10%) in orchiopexy group, P=.006]. Abnormal contralateral testis was the independent predictor of azoospermia [OR, 95% CI=92(8.4-101.5), P < .001]. Azoospermia patients showed a statistically significant increase in FSH and LH and decrease in testosterone level as compared to the non-azoospermia group (P < .001). Azoospermia is not rare in post-pubertal TT patients; therefore, SR at time of intervention seems to be a good option for them to preserve their fertility potentials.

Conventional androgen deprivation therapy is associated with an increased risk of cardiovascular disease in advanced prostate cancer, a nationwide population-based study.

PurposeAndrogen Deprivation Therapy (ADT) is the mainstay treatment in advanced prostate cancer. We conducted a nationwide population-based study to evaluate the association of ADT and cardiovascular diseases.MethodsBetween 2005 and 2009, patient data from the National Health Insurance database were obtained. We divided newly diagnosed prostate cancer patients into four groups, injection of gonadotropin-releasing hormone agonists and antagonists, oral antiandrogens, orchiectomy and radical prostatectomy only. Another matched non-cancerous control group was also assigned for comparison purposes. Study outcomes were newly onset Cardiovascular Diseases (CVD) and hospital admissions. Multi-variant Cox proportional regression analysis and the Kaplan–Meier method for cumulative incidence were performed.ResultsA total of 17,147 newly diagnosed prostate cancer patients were found. After exclusion criteria was considered, the 2,565 remaining patients were then divided into 1,088 subjects in the injection group, 286 in the orchiectomy group, 812 in the oral group and 379 in the radical prostatectomy only group. The mean age of all the patients was 71.2 years. Multi-variant analysis showed a significantly increased risk of CVD in the injection group, orchiectomy group, oral group and radical prostatectomy group (HR = 2.94, 95% CI 2.51 to 3.45, p<0.001, HR = 3.43, 95% CI 2.69 to 4.36, p<0.001, HR = 2.87, 95% CI 2.42 to 3.39, p<0.001, HR = 1.93, 95% CI 1.5 to 2.48, p<0.001, respectively). A time dependent increased risk of CVD was also observed amongst the study groups (p<0.001).ConclusionsADT is associated with an increased risk of CVD. For long-term prostate cancer castration therapy, doctors should be aware of this complication and arrange for proper management.

PD51-04 MEDIUM TO LONG TERM HEALTH-RELATED QUALITY OF LIFE AND TREATMENT-RELATED SIDE-EFFECTS IN PATIENTS TREATED WITH A SINGLE DOSE OF ADJUVANT CARBOPLATIN FOR HIGH-RISK SEMINOMA – RESULTS FROM A PILOT STUDY

You have accessJournal of UrologyCME1 May 2022PD51-04 MEDIUM TO LONG TERM HEALTH-RELATED QUALITY OF LIFE AND TREATMENT-RELATED SIDE-EFFECTS IN PATIENTS TREATED WITH A SINGLE DOSE OF ADJUVANT CARBOPLATIN FOR HIGH-RISK SEMINOMA – RESULTS FROM A PILOT STUDY Walter Cazzaniga, Adam Pearce, Chandran Tanabalan, Prabhakar Rajan, Netty Kinsella, Alison Reid, Robert Huddart, and David Nicol Walter CazzanigaWalter Cazzaniga More articles by this author , Adam PearceAdam Pearce More articles by this author , Chandran TanabalanChandran Tanabalan More articles by this author , Prabhakar RajanPrabhakar Rajan More articles by this author , Netty KinsellaNetty Kinsella More articles by this author , Alison ReidAlison Reid More articles by this author , Robert HuddartRobert Huddart More articles by this author , and David NicolDavid Nicol More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002622.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medium and long-term side effects of a single dose of adjuvant carboplatin AUC 7 for high-risk stage 1 seminoma are thought to be rare. Persisting symptoms and quality of life impact of treatment for patients have yet to be defined. Here, we study the medium-long term Health-related quality of life (HRQoL) and treatment-related symptoms of testicular cancer (TC) patients treated with 1xCarboplatin following orchidectomy for high-risk stage 1 seminoma. METHODS: Data obtained from 32 patients divided into 2 treatment groups were analysed (1: Orchidectomy alone – reference group; 2: Orchidectomy + 1xCarboplatin AUC 7). HRQoL was assessed using the validated EQ-5D-5L metric together with a TC specific questionnaire, the EORTC TC26, that has been previously used to study post-treatment side effect severity. To evaluate the medium to long term side effects of treatment all patients included in the study had completed TC treatment 12 to 24 months prior to the administration of the questionnaire. RESULTS: Using the EQ-5D-5L metrics, patients treated with 1xCarboplatin exhibited low and comparable proportions of impairment in the mobility, self-care, and usual activities domains, as compared to the orchidectomy group (0% Vs 0%; 0% Vs 0%; 0% Vs 5.6%; respectively). In contrast, the 1xCarboplatin group, were more prone to report pain or discomfort problems (30.8% Vs 21%).Patients treated with orchidectomy alone however reported twice the rate of anxiety/depression issues compared to 1xCarboplatin group (58% Vs 30%).With the EORTC TC26 questions, both 1xCarboplatin and orchidectomy alone demonstrated identical medium to long term side effects profiles. Patients who received adjuvant treatment reported almost half the rate of uncertainty concerning their future (39% Vs 69%) and identical self-perceived Health status (81.53% Vs 81.15%), compared to those who had orchiectomy alone. CONCLUSIONS: The addition of 1xCarboplatin for high-risk stage1 seminoma does not increase the medium to long term side effects compared to patients with low-risk disease who underwent orchidectomy alone. Furthermore, adjuvant carboplatin is associated with higher levels of patient perception of care and also reduces anxiety and uncertainty about possible cancer recurrence. Further studies are needed to verify these findings as this information may be a necessary addition to the information provided to patients in contemplating their treatment decision for high-risk stage1 seminoma. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e843 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Walter Cazzaniga More articles by this author Adam Pearce More articles by this author Chandran Tanabalan More articles by this author Prabhakar Rajan More articles by this author Netty Kinsella More articles by this author Alison Reid More articles by this author Robert Huddart More articles by this author David Nicol More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long-term effects of orchiopexy and orchiectomy on the testes of rats with testicular torsion

Ischemia/reperfusion injury occurs after testicular torsion, levels of free oxygen radicals and inflammatory cytokines are increased in both the torsional and contralateral testis, leading to testicular injury. The present study investigated whether orchiopexy or orchiectomy after testicular torsion was superior in terms of fertility potential in the long term. Following 720°, 4h left testicular torsion, orchiectomy or orchiopexy was performed on 84 rats, which were then sacrificed and evaluated for testicular function at day 1, at 3 months and 6 months (n=14 per group). An additional 14 rats were in the control group. Follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were significantly lower in the orchiopexy group than the orchiectomy and control groups after 3 months. However, there were no significant differences in hormone parameters among the three groups after 6 months. The hormone levels, Johnsen score, seminiferous tubule diameter, and inducible nitric oxide synthase (iNOS) expression at 3 and 6 months were not significantly different between the orchiectomy group and controls. Histopathological analyses at 3 and 6 months indicated significant decreases in Johnsen score and seminiferous tubule diameter in the ipsilateral testis in the orchiopexy group. At 3 months, the level of iNOS expression in the contralateral testis was significantly lower in the orchiopexy group than in other groups. At 6 months, however, it was not significantly different between the orchiopexy and control groups. There were no significant differences in iNOS expression at 3 or 6 months in the orchiectomy group compared to controls. The ipsilateral testis in the orchiopexy group began to atrophy at 3 months, and the degree of atrophy became more evident at 6 months. The level of iNOS expression was low in the bilateral testis at 3 months in the orchiopexy group, and sperm in the contralateral testis were not yet functionally healthy. The level of iNOS expression in the ipsilateral testis decreased further at 6 months in the orchiopexy group, while that in the contralateral testis returned to the normal level. Testicular functions were restored faster after orchiectomy compared to orchiopexy following testicular torsion. However, follow-up of the rats for 6 months demonstrated that orchiopexy or orchiectomy procedures conducted on the testicular torsion had no effect on future fertility potential after 4h of torsion.

Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies?

The aim of this study was to determine discriminative role of haematological inflammatories between acute scrotal pathologies and malignancies. In addition, it was aimed to search for a predictive marker of testicular survival in the TT group. Medical data of 141 patients with acute scrotal pathology and 63TTm patients who presented to our clinic between January 2015 and July 2019 were retrospectively reviewed and compared in terms of haematological values and demographic parameters following the inclusion of 92 healthy controls. In the TTm group, NLR was the discriminative parameter with a median of 2.42 (0.25-8.42), whereas discriminative median values of MCV for TT and CRP for EO were 83.65 (56.9-98.16) and 59.5 (2.9-337) respectively. NLR, PLR, MER and RDW values were statistically lower in the control group compared to the patients groups. In TT subgroup analysis, monocyte count, MER and CRP were found to be statistically higher in the orchiectomy group, while multivariate logistic regression analysis performed for testicular viability revealed monocyte count to be the only significant variable (Odds Ratio [95% Confidence Interval]=0.046 (0.006-0.366), p<0.004). While our study demonstrated both diagnostic and discriminative values of haematological parameters, it also showed that monocyte count could predict testicular salvage in TT patients. However, further prospective studies are required.

Long-term follow-up results of testicular torsion in children.

A retrospective cohort study was conducted at the Children's Hospital of Chongqing Medical University from November 2004 to December 2020 to investigate the long-term follow-up results after testicular torsion (TT) in children. Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group, and the baseline characteristics, ultrasonographic indications, intraoperative findings, testicular volumes, and adverse events during follow-up were compared. A total of 145 cases were included in this study. Approximately 56.6% of patients who underwent salvage orchiopexy had testicular atrophy (TA), and the median testicular volume loss of the testes was 57.4%. Age less than 6 years, delayed surgery, and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy. Most atrophied testes appeared within 3-6 months after surgery. Compared with the corresponding age-matched healthy controls, the contralateral testicular volumes were larger in the orchiopexy (P = 0.001 without TA, and P = 0.042 with TA) and orchiectomy groups (P = 0.033). The adverse events were comparable in patients with orchiectomy or orchiopexy. In summary, follow-up before 3 months after surgery may not offer sufficient clinical value, while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring. The contralateral testes of patients with TT showed compensatory hypertrophy. We suggest performing orchiectomy when torsed testes are surgically assessed as Arda grade III or inviable.

Laparoscopic Castration Using Bipolar Forceps vs. Orchiectomy in Dogs: A Comparison of Two Techniques

Simple SummaryCastration of dogs is one of the most often performed surgeries in veterinary medicine. Minimally invasive techniques used in human medicine are now being used in animals. We compared the feasibility and effects on pain and inflammation of a new laparoscopic technique with the classical castration technique. The animals in which the new technique was applied showed less pain and inflammation then the other group. Our results suggest that this is a feasible alternative to classical castration.This paper aimed to study the feasibility of a new laparoscopic castration technique in male dogs, evaluate the pain associated with it, and compare it with the classical orchiectomy. Surgical times, pain scores, blood and salivary cortisol, and CRP were recorded and compared between the two groups. The use of high-frequency bipolar forceps allowed quick and uneventful laparoscopic procedures. The laparoscopic group had significantly lower pain scores, cortisol, and PCR values than the orchiectomy group. No complications were seen in any group. Our results suggest that this laparoscopic castration is a safe and beneficial surgical alternative to traditional orchiectomy in dogs.

Endothelial dysfunction after androgen deprivation therapy and the possible underlying mechanisms.

Androgen deprivation therapy (ADT) is a key treatment modality in the management of prostate cancer (PCa), especially for patients with metastatic disease. Increasing evidences suggest that patients who received ADT have increased incidence of diabetes, myocardial infarction, stroke, and even mortality. It is important to understand the pathophysiological mechanisms on how ADT increases cardiovascular risk and induces cardiovascular events, which would provide important information for potential implementation of preventive measures. Twenty-six 12-week-old male SD rats were divided into four groups for different types of ADTs including: the bilateral orchidectomy group (Orx), LHRH agonist group (leuprolide), LHRH antagonist group (degarelix), and control group. After treated with drug or adjuvant injection every 3 weeks for 24 weeks, all rats were sacrificed and total blood were collected. Aorta, renal arteries, and kidney were preserved for functional assay, immunohistochemistry, western blot, and quantitative reverse-transcription polymerase chain reaction. In vascular reactivity assays, aorta, intrarenal, and coronary arteries of all three ADT groups showed endothelial dysfunction. AT1R and related molecules at protein and messenger RNA (mRNA) level were tested, and AT1R pathway was shown to be activated and played a role in endothelial dysfunction. Both ACE and AT1R mRNA levels were doubled in the aorta in the leuprolide group while Orx and degarelix groups showed upregulation of AT1R in the kidney tissues. By immunohistochemistry, our result showed higher expression of AT1R in the intrarenal arteries of leuprolide and degarelix groups. The role of reactive oxygen species in endothelial dysfunction was confirmed by DHE fluorescence, nitrotyrosine overexpression, and upregulation of NOX2 in the different ADT treatment groups. ADT causes endothelial dysfunction in male rats. GnRH receptor agonist compared to GnRH receptor antagonist, showed more impairment of endothelial function in the aorta and intrarenal arteries. Such change might be associated with upregulation and activation of AngII-AT1R-NOX2 induced oxidative stress in the vasculature. These results help to explain the different cardiovascular risks and outcomes related to different modalities of ADT treatment.

Abstract MP20: Pd-1 Pathway Upregulation By Orchiectomy Attenuates The Aldosterone And High Salt Induced Aortic Aneurysms In Male Mice

Objective: Male sex is a well-established risk factor for abdominal aortic aneurysms (AAA) but the underlying mechanisms remain to be fully understood. Using an aldosterone and high salt (Aldo/salt) induced AAA mouse model, we have demonstrated that androgen and its receptor mediate the high susceptibility to Aldo/salt induced AAA. The current study further investigates the mechanisms downstream of androgen. Approaches and Results: - To dissect the mechanisms connecting androgen and AAA, aortas were collected for RNA sequencing from 3 groups of 10-month-old wild-type mice #1 intact mice; #2 orchiectomized mice; and #3 orchiectomized mice plus DHT. All mice were given Aldo/salt for 7 days. Differentially expressed genes were analyzed using DESeq2 in R. We filtered genes that were upregulated in group #2 compared to group #1 and the up-regulation was reversed in group #3 by the DHT, or vice versa (fold change &gt;1.5 and padj &lt;0.05). Selected genes were run for gene ontology analysis in Enrichr (database Bioplanet 2019). Many pathways related to T cell activity were significantly enriched, particularly PD-1 signaling was one of the top pathways upregulated in orchiectomy group #2. PD-1 is known for its role as an immune checkpoint, and inflammation is a major hallmark for AAA development. Therefore to explore the role of PD-1, we first confirmed the PD-1 mRNA changes in aorta by qPCR. Secondly, IHC staining also showed PD-1 protein was significantly increased in the spleen of orchiectomized mice compared to intact controls. Finally, to investigate the potential causal role of PD-1 in the androgen-mediated aortic aneurysms formation, we injected αPD-1 antibody or control IgG antibody to orchiectomized mice 3 days before and during the 8 weeks of Aldo/salt administration. Results showed that 5 out of 12 αPD-1 mice, while none of the 8 control mice developed aortic aneurysms (p&lt;0.05). Conclusions: PD-1 pathway is involved in the androgen associated high susceptibility of Aldo/salt induced aortic aneurysms in mice.

Bilateral Orchidectomy Revisited in Management of Metastatic Hormone-Sensitive Prostate Cancer.

Androgen deprivation therapy (ADT) is a well-established treatment for metastatic hormone-sensitive prostate cancer (mHSPC). It includes either bilateral orchiectomy or medical castration in form of luteinizing hormone-releasing hormone (LHRH) agonist or antagonist. We conducted this study to compare surgical and medical castration in terms of time to progression (TTP) to castration resistant prostate cancer. Patients with mHSPC underwent either bilateral orchidectomy or medical castration by either LHRH agonist or by antagonist from November 2016 to May 2018 in our institution. Initial PSA and baseline imaging either magnetic resonance imaging (MRI) or positron emission tomography-computed tomography (PET CT) finding were recorded. Serum PSA, testosterone, and FSH were repeated every 3months till 1year. All enrolled patients were followed up with a bone scan/MRI/ PET CT at 6months and 12months. End point of study was progression of disease and death of patient. Mean nadir PSA (ng/ml) after treatment was 4.7 and 9.8 in surgical and medical group respectively, whereas mean time to the nadir PSA was 8.7 and 8.8 respectively with no statistically significant difference. Mean TTP was 13.9months in bilateral orchidectomy group and 13.8months in medical castration group (chi-square 0.003, p value 0.958). There was no significant difference in time to progression between bilateral orchidectomy and medical castration. Considering nadir PSA level, better quality of life, patient compliance, reduced hospital visit, and decrease in cost of treatment, bilateral orchidectomy may be a better treatment option especially in developing countries.

Testicular torsion in adults: Demographics and 30-day outcomes after orchiopexy or orchiectomy.

Background:Most often studied in the pediatric population, testicular torsion also affects the adult male population. Little data exists on demographics, patient risk factors, and associated outcomes for the surgical management of testicular torsion. This study sought to describe differences in demographics and outcomes for those patients requiring orchiopexy or orchiectomy.Materials and methods:An analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2015–2018) was performed, capturing patients with a postoperative diagnosis of testicular torsion. Patients were stratified into 2 groups if they received orchiopexy or orchiectomy. Demographics, perioperative variables, surgeon specialty, and outcomes were analyzed.Results:A total of 769 patients undergoing surgical treatment of testicular torsion were captured. Most of these patients were White (46.81%) and young adults (28.33 ± 12.04 years) and 28.8% required orchiectomy. Those undergoing orchiectomy were more likely to be older, have more comorbidities, and have a systemic inflammatory response syndrome. Mean operative time was longer in the orchiectomy group (48 ± 23 vs. 44 ± 20 minutes, p < 0.0124). There were no deaths at 30 days. Length of stay and rate of superficial wound infection were higher in the orchiectomy group and discharge to home was more likely in the orchiopexy group.Conclusions:Adult testicular torsion should be considered in an acute scrotum differential. Adult patients requiring orchiectomy for testicular torsion are more likely to have confounding medical conditions compared to those undergoing orchiopexy. Clinically, rates of complications between the 2 procedures are small, making the decision to perform orchiopexy or orchiectomy based on the scenario.

The effect of testosterone replacement therapy on bladder functions, histology, apoptosis, and Rho-kinase expression in bladder outlet obstruction and hypogonadism rat model

Background/aimThe effect of testosterone replacement therapy was investigated on bladder functions, histology, apoptosis as well as Rho-kinase expression in the rat bladder outlet obstruction (BOO) and hypogonadism models. Materials and methods30 mature male rats divided into 4 groups: sham group (n = 8), BOO group (n = 8), BOO + orchiectomy group (n = 7), BOO + orchiectomy + testosterone (T) treatment group (n = 7). Cystometric findings, apoptosis index, Rho-kinase (ROCK-2) expression, and smooth muscle/collagen ratio were compared. Results BOO did not change ROCK-2 expression level, compared to sham group (P > 0.05). However, when compared to BOO group (P < 0.01), BOO + orchiectomy led ROCK-2 increase. The testosterone treatment failed to reverse the up-regulation of ROCK-2 induced by orchiectomy although it tended to lower ROCK-2 level. Compared to sham group (P = 0.002), changes in maximal bladder capacity and leak point pressure were higher (P = 0.026, P = 0.001), and bladder compliance was lower in BOO group. Also, the apoptosis index was different between the two groups (P = 0.380). Smooth muscle/collagen ratio was higher in BOO + orchiectomy + T group than in BOO + orchiectomy group (P = 0.010).ConclusionsThe research draws attention to alternating treatment approaches in case of the presence of hypogonadism and BOO.