Testicular Location Research Articles

Anti-Müllerian hormone as a diagnostic marker for testicular degeneration in dogs: insights from cryptorchid models.

The increasing prevalence of infertility in male dogs in clinical practice mirrors current trends seen in human medicine. Acquired infertility is notably more common in dogs compared to congenital causes, with conditions such as testicular degeneration leading to irreversible loss of fertility. Current diagnostic methods for testicular degeneration, such as histopathological and cytological examinations, rely on testicular biopsy or fine needle aspiration, making them less feasible for routine use. Anti-Müllerian hormone (AMH), produced by Sertoli cells, has emerged as a potential alternative biomarker for testicular health, which can be measured in serum. This study evaluates AMH as a potential marker for testicular degeneration, using cryptorchid dogs as models for impaired fertility and altered testicular histology. The relationship between serum AMH levels and AMH tissue expression with impaired spermatogenesis and altered histology was investigated. Serum AMH levels were determined in intact, cryptorchid, and castrated individuals using an immuno-enzymatic ELISA kit and compared between subgroups based on testicular location. Tissue AMH immuno-expression was differentially quantified in two regions of interest (ROIs), the interstitial space and the seminiferous tubule, in both descended and retained gonads. Furthermore, testicles were analyzed using histomorphometric analysis in seminiferous tubules, while spermatogenesis was evaluated using the Johnsen score. Serum AMH levels were positively correlated with AMH expression assessed in both interstitial space (ρ = 0.494, p ≤ 0.01) and seminiferous tubules (ρ = 0.610, p ≤ 0.001). Conversely, serum AMH levels showed a negative correlation with the seminiferous tubule area (ρ = -0.435, p ≤ 0.05). Smaller seminiferous tubule areas were linked to increased AMH reactivity in both seminiferous tubules (ρ = -0.774, p ≤ 0.001) and interstitial space (ρ = -0.725, p ≤ 0.001). Additionally, lower Johnsen scores were associated with higher serum AMH levels (ρ = -0.537, p ≤ 0.01) and elevated AMH expression in both seminiferous tubules (ρ = -0.756, p ≤ 0.001) and interstitial space (ρ = -0.679, p ≤ 0.001). Our results suggest that higher serum levels and tissue expression of AMH are linked to smaller seminiferous tubules and poorer Johnsen scores, reflecting degenerative changes and Sertoli cell dysfunction in retained testicles. Given the similarities in the mechanisms that increase AMH levels in both cryptorchid and non-cryptorchid testicles affected by testicular degeneration, this study recommends using AMH as a marker for diagnosing testicular degeneration in dogs.

Management of pediatric vanishing testes syndrome based on pathological diagnosis: a single-center retrospective study

This study aims to explore the optimal management strategy for pediatric vanishing testes syndrome (VTS) based on pathological characteristics. We retrospectively analyzed clinical data and pathological results of children with unilateral VTS who underwent surgical treatment at our center from July 2012 to July 2023. The children were categorized into the testicular excision group and testicular preservation group based on the surgical approach. Clinical characteristics and outcomes were compared between the two groups. Pathological examination results of excised testicular tissues were collected and analyzed, and long-term follow-up was conducted. A total of 368 children were included in this study. The age of the children at the time of surgery was 27 months (range, 6–156). Among them, 267 cases (72.6%) had VTS on the left side, and 101 cases (27.4%) on the right side. There were no statistically significant differences (P > 0.05) in age, affected side, contralateral testicular hypertrophy (CTH), testicular location, and preferred surgical incision between the testicular excision group (n = 336) and the testicular preservation group (n = 32). In the preservation group, two children experienced scrotal incision infections, showing a statistically significant difference compared to the excision group (P < 0.05). Pathological examination of excised tissues revealed fibrosis as the most common finding (79.5%), followed by vas deferens involvement (67%), epididymis involvement (40.5%), calcification (38.4%), and hemosiderin deposition (17.9%). Seminiferous tubules (SNT) was present in 24 cases (7.1%), germ cells (GC)in 15 cases (4.5%), and ectopic adrenal cortical tissue(EACT) in 1 case (0.3%). VTS belongs to a type of non-palpable testes (NPT) and requires surgical exploration. Considering the risk of scrotal incision infection after preserving atrophic testicular remnants and the unpredictable malignant potential, we recommend excision.

Surgical treatment of cryptorchidism: current insights and future directions.

Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child's age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.

Tc-99m MDP Scan with Unusual and Isolated Skeletal Metastasis in Skull Bone in a Case of Testicular Seminoma.

Seminomas are common germ cell tumors (GCT) that may arise in the testes as well as in extra testicular locations such as mediastinum with/without testicular tumor. Testicular tumors are usually detected early due to their location and presentation as testicular mass. The overall prognosis of the seminomatous GCTs is good with surgery as the mainstay of treatment in localized disease. Bone metastases, especially when present in isolation are exceedingly rare in seminoma. Here, we present a rare case of skull bone metastasis in a case of testicular seminoma which was detected on technetium-99m labeled methylene diphosphonate bone scintigraphy with single-photon emission computed tomography with computed tomography.

Factors affecting testicular volume after orchiopexy for undescended testes.

Children with undescended testes (UDTs) undergoing orchiopexy at a later age reportedly experience more negative effects on post-orchiopexy testicular volume (TV). This study aimed to investigate the effect of orchiopexy according to the age at operation. We included 93 patients (127 testes) who underwent orchiopexy between 2008 and 2020. According to their age at orchiopexy, they were divided into Group 1 (< 24months; n = 36, median follow-up: 17 [14-39] months) and Group 2 (≥ 24months; n = 57, median follow-up: 16 [13-34] months). TV was measured with ultrasonography preoperatively and postoperatively. In unilateral UDTs, the testicular volume rates (TVR) were calculated as diseased-side TV/intact-side TV × 100%. A TVR < 50% indicated preoperative testicular atrophy (pre-op TA), whereas volume loss ≥ 50% from baseline indicated postoperative testicular atrophy (post-op TA). Only seven patients experienced pre-op TA. The TV of these 14 atrophic testes improved after orchiopexy (TVR: 100% (7/7) in Group 1 and 85% (6/7) in Group 2). Furthermore, the median TVR significantly improved after orchiectomy, from 27 to 58% (p < 0.01) and from 32 to 61% in Groups 1 and 2 (p < 0.05), respectively. Post-op TA was found in four testes (8%) in Group 1 and three testes (4%) in Group 2. Multivariate analysis showed that only preoperative testicular location predicted post-op TA. Post-orchiopexy TA may occur regardless of the patient's age at orchiopexy, and orchiopexy is recommended irrespective of age at diagnosis.

Microdissection testicular sperm extraction outcomes in azoospermic patients with bilateral orchidopexy.

Cryptorchidism is considered to be one of the most common causes of non-obstructive azoospermia. There are several surgical techniques to retrieve sperm in these patients. Microdissection testicular sperm extraction (m-TESE) is a recent sperm retrieval technique which is considered to be a safe, non-blind, and feasible method. This study aimed to investigate sperm retrieval rate (SRR) by the mTESE method in patients who have undergone orchidopexy due to bilateral cryptorchidism. In this retrospective study, 56 ex-cryptorchid patients, who underwent mTESE due to post orchidopexy azoospermia, were included. Patients with hypogonadotropic hypogonadism, Klinefelter syndrome, azoospermia factors (AZF) microdeletion, or chromosomal translocation were excluded from the study. Data were obtained from medical files. SRR in this study was 46%. Patients were divided into two groups of negative (n=30) and positive (n=26) based on the sperm extraction outcomes. There was no statistically significant difference between two groups regarding the mean age at mTESE, mean age at orchidopexy, testicular size, and serum testosterone concentration. However, testicular location, histological patterns, FSH, and LH level showed to have statistically significant relation with sperm retrieval results. But, according to our logistic regression, none of the included variable in the model including FSH, LH, histopathology, and testis location have a significant effect on the presence of the sperm. In the present study, SRR was significantly higher in patients with scrotal testis and low level of FSH and LH. Performing mTESE could be recommended in ex-cryptorchid patients with post orchidopexy NOA. Preoperative testicular biopsy seems to be unnecessary while clinical criteria can perfectly define NOA.

The role of the resistive index in predicting testicular atrophy after orchiopexy in unilateral undescended testis

One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT. The data of 215 patients aged < 15years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded. TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy. Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.

Pseudotumoral Testicular Tuberculosis: -A Potential Diagnostic Pitfall-

Extrapulmonary presentation of tuberculosis TB is unfrequent, but testicular location is quite rare and can mimics testicular tumor. Herein, we report a case of a 50 years old man presented to urology department with a painless swelling of the left testis. Examination revealed a hard non tender mass of the testis that was initially managed as a testicular tumor, but later confirmed to be TB orchitis by histology. This report highlights the presentation similarity of the two entities, which may only be differentiated by histology therefore creating a diagnosis and managing challenge. Keywords: Testis, Tuberculosis, Tumor

Incidence of testicular microlithiasis after orchidopexy for cryptorchidism and its risk factors: A retrospective cohort study

Testicular microlithiasis (TML) is detected using scrotal ultrasound (US) and is characterized by hyperechoic non-shadowing foci 1-3mm in diameter within the testicular parenchyma. Although a history of orchidopexy is a known risk factor for TML, and TML is a relatively common condition in postoperative cryptorchidism patients, no previous report has focused on risk factors for TML after orchidopexy. The aims of this study were to evaluate the time-dependent incidence of TML after orchidopexy for cryptorchidism and to identify risk factors for TML. This study included patients who underwent primary orchidopexy for cryptorchidism between 2004 and 2018 and could be evaluated using scrotal US before and after the procedure. Patients with chromosomal abnormalities and those with preoperative TML were excluded. The Kaplan-Meier method was used to assess postoperative TML appearance. The Cox proportional hazard model was used to evaluate three potential risk factors for postoperative TML: higher testicular position (proximal to the external inguinal ring), delayed orchidopexy (after 18 months of corrected age), and bilateral cryptorchidism. A total of 214 testes from 163 patients were eligible for inclusion (operative age and follow-up time: 2.2 years±18 months and 6.3 years±46 months, respectively). TML was found in 14/163 patients (8.6%) and 17/214 testes (8.1%). No testicular tumors were discovered during follow-up. The time-dependent TML incidence was 6.0% at 5 years and 11.2% at 10 years after surgery (Summary figure). A higher testicular location proximal to the external inguinal ring was found to be an independent risk factor in the Cox proportional hazard model (hazard ratio 6.18, 95% confidence interval 1.37-27.9, Summary figure). Our findings show that the incidence of postoperative TML increases for approximately 10 years following orchidopexy and is associated with a higher testicular location proximal to the external inguinal ring at surgery. In the adult population, TML with a history of cryptorchidism is a known risk factor of testicular malignancy. Given that more than 20% of boys with a higher testicular position developed TML, US evaluation to detect TML during pubety is feasible for the patients with a history of orchidopexy. The incidence of postoperative TML in boys with cryptorchidism rises until puberty and is strongly associated with a higher testicular position at orchidopexy.

Retroperitoneal Teratoma in Infants: About a Case in the Medical Imaging Department of the Mother and Child Hospital Center “Luxembourg”

Introduction: Retroperitoneal teratoma is a rare congenital tumour, representing only 1% to 10% of primary retroperitoneal tumors in children, far behind ovarian and testicular locations. There is a clear female predominance with a sex ratio of 3.4/1. The purpose of this study is to review the clinical manifestations, the mode of revelation of retroperitoneal teratoma, the diagnostic means and the anatomopathologic aspect of retroperitoneal teratoma, then to show the contribution and the limits of the various imaging examinations: ultrasound, CT and MRI in the diagnosis of retroperitoneal teratoma. Observation: We report the case of a mature retroperitoneal teratoma discovered in a 10-month-old male infant. The diagnosis evoked by ultrasound and abdominal CT was confirmed by histological study of the excised specimen. The postoperative evolution after 3 months was favorable in particular with no signs of recurrence. Conclusion: Retroperitoneal teratoma is a rare congenital tumour. The complete imaging assessment including ultrasound and computed tomography is necessary preoperatively in order to make the diagnosis and to clearly determine the relationship with the various organs. The anatomopathological study confirms the diagnosis of retroperitoneal teratoma. Tumor excision must be radical to avoid recurrence, which readily occurs in a malignant form. Even if the tumor appears benign, postoperative monitoring based on clinical, biological and radiological examination is essential.

Para Testicular Pseudotumeurs of Calcified Gait: A Case Report from the Nianankoro Fomba Segou Hospital (Mali)

Fibrous tumors of para testicular location are extremely rare benign tumors. The diagnosis of benignity, which allows a conservative treatment, will be made intraoperatively in front of the macroscopic aspect with well enucleable nodules and confirmed by the extemporaneous anatomopathological examination. We report a case of multiple calcified paratestinal pseudotumors in a 25-year old patient with no particular history, whose benignity was proven by the histology of the operative parts. Our objective was to discuss, from this observation and a review of the literature, the diagnostic and therapeutic aspects of these tumors.

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

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

The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience

Early orchidopexy has been linked to improved long term outcomes of fertility and reduced malignancy rates. However, the optimal age of intervention has been subject to change over the years. This study aims to study males aged 6 months or less who undergo laparoscopic assisted orchidopexy for intraabdominal testes to establish the safety, efficacy, and benefit in the defined age group. We prospectively assessed 19 boys at or below 6 months of age, who had laparoscopic assisted orchidopexy for intraabdominal undescended testes at Salmaniya Medical Complex in Bahrain between January 2014 and December 2018. We examined: demographics, laterality, testicular locations, testicular volumes, operative time, complications, and durations of hospitalization and follow-up. Ultrasound-derived testicular volumes were assessed before and after orchidopexy. They were calculated using the Hansen formula (Testicular volume=0.52×length [L]×width [W]2 [1]. They were then compared with reference ranges from a Dutch cohort study of 769 healthy boys. Successful outcomes were correct intrascrotal position with minimal complications and normal testicular volumes. A total of 19 males were operated at a mean age of 5.6 months and followed for a mean of 2.35 years. Of these, 7 had left-sided and 12 had right-sided cryptorchidism. Testicular locations were noted intra-operatively; 10 were above the internal ring, 5 near the iliac vessels, and 4 close to the kidney. The mean operative time was 59.58minutes. Only 2 minor complications occurred and no cases of testicular atrophy. None of the patients required hospital-stay beyond 24hours. The success rate was 89.46% in achieving correct scrotal position. Testicular volumes were normal before and after orchidopexy. They significantly increased after orchidopexy (P≤0.05). The testicular growth rate after 24 months was slightly higher than normal. In line with previous studies we were 89.46% successful in re-positioning testes [2]. In contrast to studies intervening at older ages which associated intra-abdominal testes with greater risks of complications, we found few minor complications and no testicular atrophy [3,4]. Testicular volumes in the affected testes were normal, contrary to decreased volumes found by other researchers [5]. Limitations of this study are the small number of patients and short follow-up which limits assessment of long-term outcomes. Early orchiopexy is safe and effective. Laparoscopic assisted orchidopexy at an early age was beneficial and resulted in normal testicular volumes before and after surgery.

Testicular Metastasis ofPrimary NK / T Nasal Type Lymphoma:A Case Report

Testicular lymphoma is an aggressive disease with a very poor prognosis. Nasal-type natural killer/T-cell lymphoma (NKTCL-N) in particular is very uncommon and has a rapidly progressive fatal course. We report a case of a young patient who presented a primary NK/T cell nasal type lymphoma with a secondary testicular location.

Long-term outcome of Fowler-Stephens surgical treatment in intraperitoneal cryptochidism: single center report

Fowler-Stephens (FS) Surgical treatment is used widely in intraperitoneal cryptorchidism. There is limited long-term follow up data which is necessary to evaluate the efficacy of FS laparoscopic surgeries. Methods: 19 patients with 28 cryptorchid testes managed by two stage FS orchidopexy at the urology department of Children’s Hospital of CQMU from January 2009 to March 2019 were reviewed. Average age was 5.5 years old. All patients were treated with laparoscopic FS stage 1 surgery, and Stage 2 surgery was performed 3-10 months later. Average time between the two stages was 6.4 months. Testicular volume, blood supply, testicular location, adolescent semen analysis, sex hormone levels and secondary sexual characteristics were reviewed at follow up. All surgeries were successful and all testes could be palpated in the scrotum after surgery. All patients were followed up from 1 month to 10 years, except 5 lost to follow-up. Average time of follow up was 2.8 years. During follow up, growth and good blood supply were detected in all testes except one. There was no significant change in testicular volume compared with average level of the respective ages, and no testicular malignant change was observed. 5 children were reviewed after puberty. They showed normal levels of sex hormone and normal secondary sexual characteristics. FS staged surgery is an effective and safe treatment for high cryptorchidism with a high success rate.

Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism.

Background Insulin-like 3 hormone (INSL3) is involved in the process of testicular descent, and has been thoroughly studied in cryptorchidism. However, INSL3 allelic variations found in the human genome were heterozygous and only a few of them were found exclusively in patients with cryptorchidism. Under this perspective, we aimed to study the presence of INSL3 allelic variations in a cohort of patients with cryptorchidism and to estimate their potential consequences. Methods Blood samples were collected from 46 male patients with non-syndromic cryptorchidism and from 43 age-matched controls. DNA extraction and polymerase chain reaction (PCR) were performed for exons 1 and 2 of the INSL3 gene in all subjects. Sequencing analysis was carried out on the PCR products. All data were grouped according to testicular location. Results Seven variations of a single nucleotide (SNVs) were identified both in patients with cryptorchidism and in controls: rs2286663 (c.27G > A), rs1047233 (c.126A > G) and rs6523 (c.178A > G) at exon 1, rs74531687 (c.191-30C > T) at the intron, rs121912556 (c.305G > A) at exon 2 and rs17750642 (c.*101C > A) and rs1003887 (c.*263G > A) at the untranslated region (UTR). The allelic variants rs74531687 and rs121912556 were found for the first time in the Greek population. The novel homozygotic combination of the three allelic variants rs1047233-rs6523-rs1003887 seemed to present a stronger correlation with more severe forms of cryptorchidism. Conclusions The combination of specific INSL3 SNVs rather than the existence of each one of them alone may offer a new insight into the involvement of allelic variants in phenotypic variability and severity.

Yield of modern genetic evaluation for patients with proximal hypospadias and descended gonads

Although the pediatric urologic community has embraced a multidisciplinary genetic and endocrine evaluation for newborns with ambiguous genitalia, this approach has been reserved for the most severe cases of undervirilized 46,XY individuals despite growing evidence that genetic differences are found even in patients whose only genitourinary anomaly appears to be proximal hypospadias. Identifying these genetic differences is vital for counseling patients as they move through puberty to parenthood as well as parents on future pregnancies. The primary objective was to evaluate genetic diagnosis in patients with proximal hypospadias. The authors hypothesized the more sensitive genetic evaluation available in the modern era will reveal a high rate of patients with proximal hypospadias and descended testicles who are found to have a genetic difference, supporting a thorough genetic evaluation in these patients. A retrospective review was performed of all patients who underwent surgical correction for proximal hypospadias at a single institution from January 1, 2010, to December 31, 2016. Those with midshaft hypospadias were excludedas were patients whose primary surgery was performed at an outside institution. Patient characteristics, including demographics, clinical presentation, genetic evaluation, and referral to a multidisciplinary difference of sex development (DSD) clinic, were collected. The chi-squared test and t-test were used for analysis. There were 112 patients with proximal hypospadias who met the inclusion criteria. Of these, 91 had bilaterally descended testicles, whereas 21 had one or more undescended testicles. Thirty-three percent of patients with isolated proximal hypospadias received genetic testing of some kind, with 24% seen in the multidisciplinary DSD clinic. Four patients had an associated genetic syndrome identified, and 5 had a genetic difference of unknown clinical significance. Overall, 10% of patients with proximal hypospadias and descended testicles had an identifiable genetic difference vs 33% with associated cryptorchidism. Of these, one patient with proximal hypospadias and descended testicles had a genetic difference of known clinical significance that was likely to have been missed in the absence of an evaluation by a geneticist. There was a high rate of identifiable genetic differences in patients whose only genitourinary abnormality was proximal hypospadias, especially with the 1% risk of a likely missed diagnosis. These findings support the discussion of a genetic evaluation for all patients with proximal hypospadias, regardless of the testicular location.

The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis

In this study, we investigated post-orchiopexy testicular growth of undescended testes (UDTs) at different primary locations and determined the risk factors for testicular atrophy (TA). We conducted a retrospective chart review of boys who had undergone orchiopexy for UDTs during January 2001–December 2013. Patient profile, age at operation, primary UDT location, and testicular volume were noted. TA was defined as ≥50% loss of volume after orchiopexy. The primary endpoints were testicular growth and TA after orchiopexy. The secondary endpoint was risk factors for TA. In total, 182 boys had undergone regular ultrasonography; the median follow-up period was 34 months. Among 230 UDTs, 18 (7.8%) atrophic testicles were identified within a median interval of 13 months after orchiopexy. TA rates were 3.3% (1/30), 6.9% (12/173), and 18.5% (5/27) in primary suprascrotal, canalicular, and above-inguinal UDTs, respectively. The survival probability of UDT was 91%, 92% and 100% when orchiopexy was performed in age ≤1 year, 1 < age ≤2 years, and 100% in age >2 years, respectively. Multivariate analysis revealed that inguinal and above-inguinal UDTs (hazard ratio [HR] 11.76, 95% confidence interval [CI] 1.55–89.33, p = 0.017) and genetic or endocrine disorders (HR 3.19, 95% CI 1.19–8.56, p = 0.021) were the risk factors for TA, but not age at operation, premature birth, and laterality. Thus, TA incidence was higher when patients had high primary testicular locations. Early orchiopexy before two years of age may be associated with higher TA risk, while most testicles have promising growth after orchiopexy.

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

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

Nonligation and ligation of hernial sac technique during orchiopexy for palpable undescended testis in children: A comparative study

Purpose: We prospectively evaluated the surgical outcomes of non ligation of hernial sac technique in children with a palpable undescended testis compared with the traditional hernial sac ligation technique during orchiopexy.&#x0D; Material and Methods: A total of 34 orchiopexies (30 children with age ranged from 6 months to 5 years) were included and randomly assigned to the non ligation of hernial sac technique orchiopexy group (Group-A, 15 children, 16 testes) and the traditional hernial sac ligation orchiopexy group (Group-B, 15 children, 18 testes). Operation time and surgical complications were compared between the two groups. Complications, testicular location and development of inguinal hernia were assessed at the follow-up evaluation for 6 months postoperatively.&#x0D; Results: The operation time was significantly shorter in Group-A (34.13±10.3 minutes) than Group-B (73.73±28.97 minutes) (&lt;p001). Postoperative complications were found in two cases (wound infection and testicular re-ascent) in Group-B. Wound infection was managed by conservative care and redo surgery was done for testicular re-ascent after 6 months of operation. None of the patients developed post operative inguinal hernia.&#x0D; Conclusion: We conclude that non ligation of hernial sac technique is a simple procedure that is associated with a shorter operation time than the conventional hernial sac ligation technique during open orchiopexy for palpable undescended testis.&#x0D; Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (2): 35-40