Orchiectomy In Patients Research Articles

Bilateral Subcapsular Orchidectomy as Surgical Castration: A Reasonable Aesthetic Alternative to Bilateral Total Orchidectomy in Patients with Metastatic Hormone-sensitive Prostate Cancer

Background: The study highlights the historical significance of bilateral orchidectomy as the traditional 'gold standard' for surgical androgen deprivation in treating advanced prostate cancer. The study presented aims to compare total orchidectomy and subcapsular orchidectomy, considering factors such as androgen ablation, disease progression control, and patient satisfaction. Objective: This study aims to compare the effectiveness and patient satisfaction of bilateral subcapsular orchidectomy and bilateral total orchidectomy treatment in managing hormone-sensitive metastatic prostate cancer. Methods and materials: In this prospective study of 18 months at North East Medical College Hospital, 40 participants with Metastatic Carcinoma of Prostate underwent bilateral orchidectomy, among them 20 subcapsular and 20 total orchidectomy. The research focused on evaluating the impact of these treatments on serum testosterone levels, serum PSA levels, employing as outpatient procedures and a 3-month follow-up, utilizing a satisfaction scoring scale. Data, including age, Gleason Grade Group, PSA, and testosterone levels at diagnosis & at 3-month follow-up were recorded and analyzed using IBM SPSS-21 software. Result: The study compared Bilateral Subcapsular Orchidectomy and Bilateral Simple Orchidectomy for Hormone-Sensitive Metastatic Carcinoma of Prostate in 40 patients. The highest frequency was in the 71-75 age group (30%), with a mean age of 66.67 ± 2.21 years. Gleason grade group 3 dominated (40%), followed by 2 (25%). Pre-operative PSA levels were 31.14±1.27 ng/ml for Subcapsular and 35.21±1.70 ng/ml for Total Orchidectomy, decreasing post-operatively to 8.25±0.41 ng/ml and 7.32±0.80 ng/ml, respectively. Pre-operative testosterone levels were 513.21±3.01 ng/dl for Subcapsular and 498.40±2.10 ng/dl for Total Orchidectomy, decreasing post-operatively to 21.14±2.84 ng/dl and 16.90±1.08 ng/dl, respectively, with non-significant p-values. Surgery related Satisfaction scores in the Follow-Up phase were significantly higher for Subcapsular Orchidectomy, 2.91±0.31 comparing with Total Orchidectomy, 2.05±0.45. The results emphasize better patient satisfaction after subcapsular orchidectomy, while maintaining similar cancer control in the form of PSA and testosterone level changes. Conclusion: In conclusion, our study advocates for the reconsideration of bilateral subcapsular orchidectomy as a preferred method for surgical androgen ablation in metastatic prostatic carcinoma, offering comparable efficacy to traditional total orchidectomy approach while prioritizing patient satisfaction and psychological well-being. This suggests a potential paradigm shift in the landscape of cost-effective androgen deprivation therapy within the urological field.

Higher prevalence of benign tumors in men with testicular tumors and history of treated cryptorchidism

ObjectivesTo identify if surgically treated cryptorchidism correlated with testicular tumor pathology at presentation. Materials and methodsAn institutional database of patients treated for testicular cancer between 2003 and 2020 was reviewed. Inclusion criteria included orchiectomy patients. Exclusion criteria included unknown cryptorchidism history or pathology or laterality of orchiectomy. Data collection included demographics, surgical history, and tumor marker status. ResultsA total of 435 patients were included. Thirty-three of these patients had a history of UDT. There was no statistical difference in age at orchiectomy, laterality of orchiectomy, or lymphovascular invasion with regard to UDT history. There was a statistical difference in tumor pathology after orchiectomy, P = 0.03. On secondary analysis, benign pathology was significantly more common in patients with a history of UDT (15.2%) than without (4.7%), P = 0.01. Mixed GCT was also found at a significantly lower rate in patients with a history of UDT (18.2%) compared to those with no history of UDT (37.3%), P = 0.03. There were no statistically significant differences in other pathology. ConclusionPrevious studies have shown that there is a greater rate of seminoma in patients with testicular cancer in an undescended testis. This study shows that in patients with a history of UDT compared to those without a history of UDT, there is a greater percentage of patients with benign testicular masses after orchiectomy. Guideline based practices including monthly self-examination and testis-sparing surgery for appropriate patients may reduce rates of radical orchiectomy for benign tumors.

Prognostic Factor Risk Groups for Clinical Stage I Seminoma: An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office

BackgroundThe relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4–30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low. ObjectiveWe aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients. Design, setting, and participantsIndividual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions. Outcome measurements and statistical analysisMultivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method. Results and limitationsAfter a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2–5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell’s C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients. ConclusionsThe risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse. Patient summaryThe risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.

Prognostic Differences Between Surveillance and Active Treatment After Initial Orchiectomy in Patients With Stage I Mixed Germ Cell Tumors of the Testis: A Propensity Score Matching Analysis

IntroductionThe prognosis and optimal treatment approach for stage I mixed germ cell cancers of the testis are not well-established. This study aimed to assess contemporary treatment rates and their correlation with the cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients with stage I testicular mixed germ cell tumors (TMGCT) who underwent orchiectomy, comparing surveillance with active treatment, including chemotherapy (CHT) and retroperitoneal lymph node dissection (RPLND). MethodsRetrospective analysis of clinical data from stage I TMGCT patients who underwent orchiectomy was conducted using the Surveillance, Epidemiology, and End Results database from 2004 to 2019. The annual percentage change (APC) in the use of surveillance, postoperative CHT, and RPLND was examined. Propensity score matching (PSM) and cumulative incidence, analyses were employed to compare differences in CSM and OCM between surveillance and active treatment, as well as between CHT and RPLND. Multivariate competing-risks regression models were utilized to investigate independent factors affecting CSM and OCM among stage I TMGCT patients. ResultsThe study included 5743 individuals with stage I TMGCT that underwent surveillance (61.6%), CHT(27.2%), or RPLND (11.2%). Among them, 82 deaths were attributed to TMGCT, and 82 deaths resulted from other causes. Surveillance rates increased over time (APC: 0.635%, P = 0.008), as did CHT rates (APC: 0.863%, P < 0.001), while RPLND rates declined (APC: −0.96%, P < 0.001). After PSM, multivariate competing-risks regression analysis showed that, active treatment, compared to surveillance, was not an independent factor for CSM and OCM. In contrast, when compared to CHT, RPLND was an independent factor associated with lower CSM (hazard ratio = 0.247, 95% confidence interval: 0.08-0.761; P = 0.015), but not OCM (hazard ratio = 0.946, 95% confidence interval: 0.377-2.37; P = 0.91). ConclusionsSurveillance and CHT rates have increased over time for patients with stage I TMGCT following initial orchiectomy, while RPLND utilization has decreased. There was no significant difference in CSM between surveillance and active treatment groups, but RPLND demonstrated significantly lower CSM than CHT in active treatment. Our findings suggest that the usage of RPLND in patients with stage I TMGCT should be reconsidered.

Factors Determining Testicular Torsion and Consequent Orchiectomy in Pediatric Patients Presenting With Scrotal Pain.

Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are not well described. We report the factors predicting TT and consequent orchiectomy in children with SP. The data on patients (aged ≤18 years) who presented with SP to PEDs at 4 branches of the Chang Gung Hospital through 10 years were analyzed. In all, 256 pediatric patients presented with SP. Their mean age was 11.60 ± 4.61 years and 72.7% (n = 186) were aged 10 to 18 years. The pain was left-sided in 54.7% (n = 140) and the interval between SP onset and PED arrival was 22.45 ± 31.27 hours. Overall, 84 (32.8%) patients needed surgery and 72 (28.1%) had TT. Of the patients with TT, 28 (38.9%) patients needed an orchiectomy. After analysis, TT and consequent orchiectomy were associated with a longer interval between SP onset and PED arrival, absent of testicular ultrasonic blood flow, interval between SP onset and surgery of more than 24 hours, and a high degree of TT. None of them experienced recurrent SP symptoms or TT again. The rate of TT in patients presenting to PEDs with an SP was 28.1%, and 38.9% of the patients with TT needed an orchiectomy. Early diagnosis and intervention helped to prevent subsequent orchiectomy in pediatric patients with TT.

TRANSGENDER FEMALE PATIENTS WHO UNDERWENT ORCHIECTOMY ARE AT INCREASED RISK OF MAJOR ADVERSE CARDIAC EVENTS (MACE)

To assess the risk of MACE after gender-affirming orchiectomy in patients undergoing male to female transition.

Increasing utilization of the TWIST score in workup of patients with acute scrotal pain: Role in diagnosis and risk stratification

The TWIST score is a 5-component physical examination score used to aid in diagnosis of testicular torsion (TT) and could lessen need for radiologic testing in certain clinical scenarios. TWIST use was not previously widespread at our institution. The primary objective of this quality improvement study was to achieve 100% compliance in TWIST utilization among urology and ED residents and to assess for score concordance between ED and urology assessments. Secondary goals were correlation of TWIST components with need for orchiectomy. ED staff were educated about the TWIST score and asked to complete assessment for patients presenting with acute scrotal pain. Simultaneously, an electronic medical record-based dot phrase was introduced for urology trainees to complete an independent TWIST evaluation. Spearman correlation was performed to assess association between ED and Urology TWIST scores. Multivariable logistic regression was performed to assess association of TWIST score components and need for orchiectomy. 103 patients presented to the ED from 3/2018-11/2020 with a complaint of acute scrotal pain; 47 were diagnosed with torsion. As compared to our retrospective cohort, the documentation rate of complete TWIST score components on exam rose from 9% to 98% (P<0.001) on ED evaluation and 16%-66% on urology evaluation (P<0.001). Rates of repeat ultrasound for patient's transferred between facilities was similar (58% vs. 63%; p=0.66) as was median time to OR (160min vs. 145min; p=0.5). Using TWIST cutoff of >5 yielded a specificity of 94.5% for diagnosis of torsion, with corresponding strong correlation between ED and urology scores (rho=0.71). A firm testicle was noted on urology evaluation in 100% of orchiectomy patients (vs. 61% of salvage patients) with persistent association after controlling for duration of symptoms (OR 28.1; P=0.016). Through two-pronged quality improvement efforts, we significantly improved utilization of the TWIST score by ED and urology staff for workup of patients with acute testicular pain. We confirmed the high sensitivity and specificity of the TWIST score and demonstrated inter-rater reliability between ED and urology assessments. On prospective analysis, testicular firmness on exam was predictive of need for orchiectomy. The TWIST score is an accurate diagnostic tool for both ED and urology providers in workup of children with acute scrotal pain, with a normal score essentially ruling out the condition. Future work should aim at minimizing unnecessary testing in patients demonstrated to be at high risk for torsion.

Mean platelet volume is the most valuable hematologic parameter in differentiating testicular torsion from epididymitis within the golden time.

BackgroundWe aimed to assess the diagnostic value of hematologic parameters in the differential diagnosis of testicular torsion and epididymitis within and after the golden time.MethodsWe retrospectively reviewed the records of 250 patients aged <25 years who were diagnosed with epididymitis (n=119) or testicular torsion (n=131). The characteristics and hematologic parameters of patients in the two groups were analyzed. Receiver operating characteristic (ROC) curves were used to assess the validity of hematologic parameters as differential diagnostic tools with respect to the golden time (defined as 6 h of symptom duration). Further, we evaluated the predictive factors associated with orchiectomy in patients with testicular torsion.ResultsThe mean patient age was 14.4 years. Among patients with testicular torsion, 91.40% (53 of 58) underwent detorsion and orchiopexy within the golden time, whereas only 27.40% (20 of 73) of the affected testes were preserved after the golden time. Within the golden time, mean platelet volume (MPV) seemed to be the most valuable hematologic parameter [area under the curve (AUC) 0.855, 95% confidence interval (CI): 0.778–0.932]. In a multivariate analysis, symptom duration (symptoms beyond the golden time) was associated with orchiectomy in patients with testicular torsion.ConclusionsMPV showed the greatest hematologic value in the early stage of testicular torsion and epididymitis, suggesting its potential use for the differential diagnosis of these two conditions within the golden time.

MP37-13 MEAN PLATELET VOLUME IS THE MOST VALUABLE HEMATOLOGIC PARAMETER IN DIFFERENTIATING TESTICULAR TORSION FROM EPIDIDYMITIS WITHIN THE GOLDEN TIME

You have accessJournal of UrologyCME1 May 2022MP37-13 MEAN PLATELET VOLUME IS THE MOST VALUABLE HEMATOLOGIC PARAMETER IN DIFFERENTIATING TESTICULAR TORSION FROM EPIDIDYMITIS WITHIN THE GOLDEN TIME Chung Ho Seok, Yu Seong Hyeon, Hwang Eu Chang, Kim Sun-Ouck, Oh Kyung Jin, Jung Seung Il, Kang Taek Won, Kwon Dongdeuk, and Park Kwangsung Chung Ho SeokChung Ho Seok More articles by this author , Yu Seong HyeonYu Seong Hyeon More articles by this author , Hwang Eu ChangHwang Eu Chang More articles by this author , Kim Sun-OuckKim Sun-Ouck More articles by this author , Oh Kyung JinOh Kyung Jin More articles by this author , Jung Seung IlJung Seung Il More articles by this author , Kang Taek WonKang Taek Won More articles by this author , Kwon DongdeukKwon Dongdeuk More articles by this author , and Park KwangsungPark Kwangsung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002591.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to assess the diagnostic value of hematologic parameters in the differential diagnosis of testicular torsion and epididymitis within and after the golden time. METHODS: We retrospectively reviewed the records of 250 patients aged <25 years who were diagnosed with epididymitis (n=119) or testicular torsion (n=131). The characteristics and hematologic parameters of patients in the two groups were analyzed. Receiver operating characteristic curves were used to assess the validity of hematologic parameters as differential diagnostic tools with respect to the golden time (defined as 6 h of symptom duration). Further, we evaluated the predictive factors associated with orchiectomy in patients with testicular torsion. RESULTS: The mean patient age was 14.4 years. Among patients with testicular torsion, 91.40% underwent detorsion and orchiopexy within the golden time, whereas only 27.40% of the affected testes were preserved after the golden time. Regardless of symptom duration, white blood cell count, neutrophil count, neutrophil ratio, mean platelet volume (MPV), and neutrophil-to-lymphocyte ratio could differentiate testicular torsion from epididymitis. Within the golden time, MPV seemed to be the most valuable diagnostic parameter (area under the curve 0.855, 95% confidence interval: 0.778–0.932). In a multivariate analysis, symptom duration (symptoms beyond the golden time) was associated with orchiectomy in patients with testicular torsion. CONCLUSIONS: MPV showed the greatest diagnostic value in the early stage of testicular torsion and epididymitis, suggesting its potential use for the differential diagnosis of these two conditions within the golden time. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e613 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chung Ho Seok More articles by this author Yu Seong Hyeon More articles by this author Hwang Eu Chang More articles by this author Kim Sun-Ouck More articles by this author Oh Kyung Jin More articles by this author Jung Seung Il More articles by this author Kang Taek Won More articles by this author Kwon Dongdeuk More articles by this author Park Kwangsung More articles by this author Expand All Advertisement PDF DownloadLoading ...

Decision-making Regarding Orchiectomy in Patients with 17β-Hydroxysteroid Dehydrogenase Type 3 Deficiency: Clinical Considerations

Background: Patients with 46,XY differences of sex development (DSD) due to 17β-hydroxysteroid dehydrogenase type 3 (17βHSD3) deficiency are generally assigned female at birth. With known future virilizing puberty, orchiectomy is often discussed with patients and their families. Decision-making and factors to consider around orchiectomy are complex and challenging. We report two patients who presented at different ages to highlight the considerations and complexities surrounding gonad management, including the likelihood of gonadal malignancy, the possibility of fertility and options for preservation, and the current knowledge of gender identity outcomes.

High platelet distribution width can independently predict testicular survival in testicular torsion among patients with steady-state sickle cell anemia.

This study aimed to evaluate the predictive value of platelet volume indices (PVI), such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), as prognostic indicators of testicular viability in torsion patients with steady-state sickle cell anemia (SCA) who underwent surgical exploration. Forty-eight patients with SCA with testicular torsion and 46 male control subjects were enrolled in the study. All patients underwent scrotal color Doppler ultrasonography before surgery, and PVI (MPV, PDW, and PCT) values were measured in all participants. Symptom duration and testicular volume were also recorded. The testicular salvage rate in patients with SCA was 73% after surgery. Analyses showed that MPV, PDW, and PCT values were significantly higher in torsed SCA as compared with controls (p<0.05). Orchiectomy in patients with SCA showed significantly higher MPV, PDW, and PCT values than the orchiopexy group (p<0.05). The MPV values of orchiectomy patients showed a higher significant cut-off of ≥11.5 fL, which is higher than in torsed patients without SCA, as an indicator of testis survival. PDW also demonstrated a higher significant cut-off of ≥12.7 fL for detorsion outcomes in patients with SCA. Symptom duration of less than 7 hours was also significantly correlated with orchiopexy (p≤0.001). Univariate analysis showed that higher MPV, increased PDW, and symptom duration were indicative of the outcome of testicular detorsion in SCA. Multivariable analysis showed that increased PDW and symptom duration are prognostic parameters for testicular viability in SCA. Increased PDW and symptom duration can be used as parameters for predicting testicular detorsion outcomes in patients with steady-state SCA.

Testicular torsion - symptomatology and outcomes of 101 scrotal explorations.

Objective:The objective was to study the symptomatology of testicular torsion of patients operated in our hospital and their operative results in relation to the duration of symptoms.Materials and Methods:Data of all patients operated for acute scrotum at all ages over a 14 months’ time were collected from hospital records. Symptomatology and operative results were studied.Results:Out of 101 consecutive scrotal explorations done in this time, 63.4% of all scrotal explorations were testicular torsion (n = 64). 22.8% were appendage torsion (n = 23) and 13.9% were epididymo-orchitis (n = 14). The peak age of testicular torsion was in the 11–15 years range and the left side is more common (65.6%). Symptoms of scrotal pain (92.2%), abdominal pain (18.8%), nausea/vomiting (18.8%), fever (9.4%), and urinary symptoms (3.1%) were seen in decreasing order of frequency. Among acute scrotum patients who had symptoms of nausea/vomiting or abdominal pain, testicular torsion was found to be significantly higher compared to those who did not have these symptoms (χ2 = 0.044, P < 0.05). In all cases presented within 6 h of symptom onset, testicles were saved and salvage rates reduced with delay in presentation. The testicular salvage rates were 28.1% (18 out of 64 torsions). Patients below 18 years had more chance of going for orchiectomy than others (75% vs 66.7%). Patients who presented after 24 h had a statistically significantly lower salvage rate of 7.7% compared to those who presented within 24 h duration, 52.2%(χ2 = 0.001, P < 0.05). Those with orchiopexy had a median duration of symptom of 6.5 h and the same for orchiectomy patients were 72 h. Our median symptom duration for testicular torsion was 36 h and it is higher than many other countries.Conclusions:Delay in presentation to the health-care facility is the major cause of poor salvage rates in the state and its improvement requires public health interventions and health education.

Testicular involvement of acute lymphoblastic leukemia in children and adolescents: Diagnosis, biology, and management.

Acute lymphoblastic leukemia (ALL) in children and adolescents can involve the testes at diagnosis or upon relapse. The testes were long considered pharmacologic sanctuary sites, presumably because of the blood-testis barrier, which prevents the entry of large-molecular-weight compounds into the seminiferous tubule. Patients with testicular involvement were historically treated with testicular irradiation or orchiectomy. With the advent of contemporary intensive chemotherapy, including high-dose methotrexate, vincristine/glucocorticoid pulses, and cyclophosphamide, testicular leukemia present at diagnosis can be eradicated, with the risk of testicular relapse being 2% or lower. However, the management of testicular leukemia is not well described in the recent literature and remains relevant in low- and middle-income countries where testicular relapse is still experienced. Chemotherapy can effectively treat late, isolated testicular B-cell ALL relapses without the need for irradiation or orchiectomy in patients with an early response and thereby preserve testicular function. For refractory or early-relapse testicular leukemia, newer treatment approaches such as chimeric antigen receptor-modified T (CAR-T) cell therapy are under investigation. The control of testicular relapse with CAR-T cells and their penetration of the blood-testis barrier have been reported. The outcome of pediatric ALL has been improved remarkably by controlling the disease in the bone marrow, central nervous system, and testes, and such success should be extended globally. LAY SUMMARY: Acute lymphoblastic leukemia (ALL) in children and adolescents can involve the testes at diagnosis or upon relapse. Modern intensive chemotherapy has largely eradicated testicular relapse in high-income countries. Consequently, most current clinicians are not familiar with how to manage it if it does occur, and testicular relapse continues to be a significant problem in low- and middle-income countries that have not had access to modern intensive chemotherapy. The authors review the historical progress made in eradicating testicular ALL and use the lessons learned to make recommendations for treatment.

The role of partial orchidectomy in the management of small testicular tumours: Fertility and endocrine function.

Radical orchidectomy in patients who are subsequently diagnosed with benign testicular tumours represents an overtreatment due to the deleterious effects on endogenous testosterone, fertility and body image. For these reasons, the option of partial orchidectomy (PO) should be considered in certain groups of patients. Patients with bilateral tumours (synchronous or metachronous) or a solitary testis where the lesion is no greater than 30% of the volume of the testis could be considered for a PO. Evidence has shown that PO is effective for small testicular masses with excellent survival and recurrence rates. Highlight the feasibility of maintaining post-operative fertility or normal semen parameters and endocrine function following PO. Data for this review were obtained through a search of the PubMed database. Papers were required to be in English and focus on adult human males. Eligible and relevant papers were assessed for data regarding fertility, semen parameters and endocrine function following PO for a small testicular mass (STM). It is possible to preserve both fertility and endocrine function after PO. Although patients may still require adjuvant radiotherapy for concomitant intratubular germ cell neoplasia (ITGCN) which results in subfertility, endocrine function is still conserved. However, it is possible to postpone radiotherapy and continue with clinical surveillance for the purposes of fertility preservation.

Effect of unilateral testicular torsion at different ages on male fertility.

ObjectiveTo investigate the effect of early-life unilateral testicular torsion on adult male fertility.MethodsClinical information was collected for 122 patients who had experienced unilateral testicular torsion at a median age of 15.5 years. The recent pregnancy rate and time to pregnancy experienced by the patients’ female partners were assessed by structured interviews. Data were analyzed by the chi-squared test and Student’s t-test.ResultsSeventy-two patients with testicular torsion met the criteria for inclusion in our analyses; 49 had undergone orchiectomy, while 23 had undergone surgical repositioning/orchiopexy. The pregnancy rate and median time to pregnancy were 83.67% (41/49) and 1.6 years, respectively, in the orchiectomy group, whereas they were 91.30% (21/23) and 0.75 years, respectively, in the repositioning/orchiopexy group. The recent pregnancy rate was higher in patients with torsion in childhood than in patients with torsion in adolescence; it was lowest in patients with torsion in adulthood. Surgical repositioning/orchiopexy yielded a significantly better recent pregnancy rate among the three groups, based on age at the time of torsion, and a shorter time to pregnancy than orchiectomy in patients with torsion in adolescence.ConclusionOnset of unilateral testicular torsion early in life has a negligible effect on adult male fertility.

Gonadal end organ effects in male to female transgender patients on hormonal therapy

The objective of this study is to investigate changes in spermatogenesis as a consequence of the quantitative reduction in testosterone production and action and/or possible direct effects of estrogen on seminiferous epithelium. This unique patient population provides this unusual opportunity because of the high volume of individuals undergoing gender confirmation surgery. An IRB-approved retrospective review of 35 neovaginoplasty patients and 21 patients who underwent bilateral orchiectomy as a stand-alone procedure was conducted. Testicular histology of 56 patients (112 testicles) was examined by the investigators, and predominant patterns of spermatogenic disruption were defined. Presently, a prospective, IRB-approved analysis is being conducted on these same two patient populations to correlate testicular histology, intraoperative wet prep analysis to identify fully formed spermatozoa, medication type and dosage, and serum levels of Estradiol, Testosterone (T), Luteinizing hormone (LH), and Follicle Stimulating hormone (FSH) obtained immediately prior to surgery. This is in an effort to refine or define an explanation for the negative effect of these medications on spermatogenesis. Between January 2017 to September 2018, 35 transgender women underwent neovaginoplasty, and seminiferous tubule histology was retrospectively examined. In addition, in 2017, 21 patients underwent bilateral orchiectomy as a stand-alone procedure. Classification included complete absence of germ cells, spermatocytic maturation arrest (SMA), hypospermatogenesis (mild, moderate, and severe), and normal histology. As part of the early prospective cohort, 6 patients underwent bilateral orchiectomy, and 2 patients underwent neovaginoplasty. Intraoperative testicular wet prep findings were recorded as number of spermatozoa per high powered field. Retrospectively, of the 35 neovaginoplasty patients, the following histology was seen: 2 with complete absence of germ cells, 3 with mild hypospermatogenesis, 8 with SMA only, and the remaining with a combination of SMA with mild (4), moderate (5), and severe (11) hypospermatogenesis. Of the 21 orchiectomy patients, the following histology was seen: 4 with SMA only, and the remaining with a combination of SMA and mild (4), moderate (6), and severe (7) hypospermatogenesis. In our early prospective data set, 2 out of 8 patients had spermatozoa seen on intraoperative wet prep (T:70, E2:168 ; T:18, E2:120). Estrogen therapy and testosterone blockers (spironolactone) are routinely used in combination in MTF individuals to suppress testosterone and its androgenic effects while promoting welcome estrogenic bodily changes. The consequent reduction in spermatogenesis is quite variable, as clearly demonstrated by the unexpected results of the retrospective review—meiotic progression was uniformly impaired while a decrease in the total number of germ cells per tubule was not uncommon. We envision our nascent prospective study to allow us to formulate some mechanistic models of biological causality.

Incidence of Orchiectomy in Patients with Testicular Torsion Treated in the Urology Department in Hilla Teaching Hospital

Acute torsion of the testicle(s) is one of the common emergencies in the field of urology; it results in either decrease or complete disruption of testicular blood flow, it affects about 4.5/100000 less than 25 years male. The golden period of testicular saving intervention is the first 6 – 8 hours from the onset of symptoms. The aim of this study is to obtain a statistic about patients with testicular torsion treated at our center, concentrating on patients ended with orchiectomy. A total number of 25 patients presented to our center during the study period (2 years). After taking a full history and scrotal examination, all patients sent to Doppler scrotal ultrasonography to confirm the diagnosis and assess vascularity, and then all patients un- derwent scrotal exploration through a scrotal incision. Orchiopexy or orchiectomy was done depending on viability of the testis. Contralateral orchiopexy was done in all patients. Forty percent of our patients ended with orchiectomy, the incidence of orchiectomy was higher in patients lived in rural areas (70 %), there also was strong relationship between cold weather and the incidence of orchiectomy. The most important factor in detecting testis salvageability was the duration of symptoms before the presentation.

Comparison of Subcapsular and Total Orchiectomy in Patients with Prostate Cancer

Comparison of Subcapsular and Total Orchiectomy in Patients with Prostate Cancer

Controversies in the management of clinical stage I testicular seminoma.

IntroductionFollowing orchiectomy patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (AS) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, mainly second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as adjuvant therapy for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches – AS versus adjuvant chemotherapy (ACT) on survival in patients with CSI testicular seminoma.Material and methodsThe cross-sectional study analyzed a total of 106 patients collected at a single centre between 4/2008–8/2015, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches.ResultsIn group A (low-risk), consisting of 84 patients, who underwent AS, relapse occurred in 10 (11.9%) patients after a mean follow-up of 13.8 months. In group B (high-risk), consisting of 22 patients, who were treated with ACT, relapse occurred in two (9.1%) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100% with a mean follow-up of 25.3 months. The statistically significant difference in progression-free survival (PFS) between these two groups was not found.ConclusionsACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

Epididymal Sparing Bilateral Simple Orchiectomy: Cost-Effectiveness and Aesthetic Preservation for Men with Metastatic Prostate Cancer

IntroductionIn the last 2 decades medical androgen deprivation therapy has replaced surgical castration for the treatment of metastatic prostate cancer. We assessed costs and patient satisfaction associated with epididymal sparing bilateral simple orchiectomy in an underinsured, immigrant population. MethodsWe performed epididymal sparing bilateral simple orchiectomy in patients with metastatic prostate cancer between January 2003 and September 2014 at our institution. Procedures were performed in the operating room with the patient under general anesthesia and later under conscious sedation. Associated material and facility costs were calculated and compared to costs of androgen deprivation therapy with leuprolide or degarelix. Medication costs were calculated using wholesale acquisition costs. Patient satisfaction and body image perception were evaluated using a survey questionnaire. ResultsA total of 108 orchiectomies were performed in the operating room and 12 in the outpatient unit. The total cost of bilateral simple orchiectomy in the operating room was $4,118. By performing orchiectomy in the outpatient unit we reduced the cost to $2,101. The cost of orchiectomy in the operating room is the equivalent of 4 months of leuprolide and 7.8 months of degarelix. When performed in the outpatient clinic the cost of bilateral simple orchiectomy is equivalent to 2.1 months of leuprolide and 4 months of degarelix. Overall 95% of participants surveyed were pleased with the surgical results. ConclusionsThe average life expectancy of men with metastatic prostate cancer is 30 months and, thus, a onetime surgical cost offers significant cost savings. Further cost reductions are achieved by performing bilateral simple orchiectomy in the outpatient setting. By sparing the epididymis, patients are left with a sense of testicular preservation. Epididymal sparing bilateral simple orchiectomy is a cost-effective and cosmetically acceptable method of androgen deprivation therapy for patients with metastatic prostate cancer.