Testicular Location Research Articles

Guideline for the Surgical Diagnosis and Treatment of Nonpalpable Testis Based on Experiences with Laparoscopic Procedure

Purpose: We assessed our laparoscopic experiences for the children with nonpalpable testis to evaluated the advantages of performing laparoscopy and we suggest a surgical management guideline for them. Materials and Methods: We retrospectively reviewed the medical records of a total of 83 children(97 testes) who underwent diagnostic laparoscopy for nonpalpable testes. We analyzed the surgical decisions and outcomes according to the laparoscopic findings. Results: On the laparoscopic examination, 48(49.5%) testes were located in the abdominal cavity. We subsequently performed inguinal orchiopexy (28), laparoscopic orchiopexy(8), Fowler-Stephens orchiopexy(10, one or two stage), or orchiectomy(2). The other 40(41.2%) were suspected to be testicular nubbin, and we managed this by excision of the testicular nubbin by the inguinal(29) or scrotal(10) approach, except for one viable testis in the inguinal canal. When blind-ending vessels were observed, we stopped the procedure under the diagnosis of vanishing testis in 9 cases(9.3%). The testicular survival rates were 92.6%(25/27) for inguinal orchiopexy, 100%(8/8) for laparoscopic orchiopexy and 60%(6/10) for Fowler-Stephen orchiopexy. Conclusions: We preferred laparoscopic orchiopexy for treating intraabdominal testis when the location was 2.5cm from the internal ring. When the testicular location was closer to the internal ring, we recommend inguinal orchiopexy as a viable option. In cases with high riding testis or very short internal spermatic vessels, we recommend Fowler-Stephens orchiopexy. For the suspected testicular nubbin, we preferred trans-scrotal excision when the nubbin was identified in the scrotum. Otherwise, we recommend inguinal exploration.

Advantages of Video-Assisted Approach in Detecting Epididymal Anomalies and Treatment of Nonpalpable Testis

In children with a nonpalpable abdominal testis, preoperative localization is very helpful prior to surgical investigation both to reduce the time required and to plan the correct surgical procedure. It is no doubt that laparoscopy is useful in both diagnosis and management of nonpalpable testis. In this study, 15 patients with 17 nonpalpable testes admitted to our clinic in 2 years period were evaluated retrospectively. Ultrasound study was performed in all patients after detailed physical examination. Testicular location, size, and configuration of epididymis were determined by laparoscopy and compared with ultrasound findings. Laparoscopy, in conjunction with ultrasound, permits not only a better localization and anatomy of the testis but is also superior in planning the best choice of management. We believe that the video-assisted inguinal approach is a feasible method in the treatment of nonpalpable testis when compared to pure open surgery.

STRUCTURAL EVIDENCE AGAINST HORMONAL THERAPY FOR CRYPTORCHID TESTIS: ABNORMAL GUBERNACULAR ATTACHMENT

Various factors are involved in testicular descent, and no single factor is elucidated as the cause of cryptorchidism. We prospectively observed the locations of gubernacular attachments in the cryptorchid testis. From April 1996 to June 2002, 639 boys underwent surgical correction of cryptorchid testis. Those with complete records of testicular locations and gubernacular attachments were analyzed. A total of 639 boys underwent 732 surgical corrections of inguinal testis (425, 58%), high scrotal testis (165, 23%) and impalpable abdominal testis (142, 19%). Impalpable abdominal testes had gubernacular attachment to either the lateral or upper scrotum in 36 cases (25%) or around the inguinal ring in 83 (58%). The gubernaculum was attached to the bottom of the scrotum in 21 inguinal testes (5%), to the lateral or upper scrotum in 132 (31%) or around the inguinal ring in 268 (63%). In cases of high scrotal testis the gubernaculum was attached usually to the bottom of the scrotum (28, 17%), to the lateral or upper scrotum (109, 66%) or around the inguinal ring (26, 16%). The locations of distal gubernacular attachments in the cryptorchid testis were usually abnormal (93%). In these cases the possible testicular descent induced by hormonal therapy may either be insufficient or unable to prevent future ascent. Thus, early surgical correction rather than hormonal therapy is warranted in boys with cryptorchid testis.

Chemical sympathectomy by 6-OH dopamine during fetal life results in inguinal testis through altering cremasteric contractility in rats

Background/Purpose: Androgens are proposed to influence testicular descent through modulating sympathetic tone. An experimental study was undertaken to evaluate the effects of prenatal chemical sympathectomy on testicular location associated with the alterations in contractile properties of cremaster muscles in rats. Methods: Time-mated pregnancies were started in 10 rats. Two groups, each receiving saline or 6-hydroxydopamine from day 15 to day 19 of intrauterine life were established. At 2 months of age, localization of testes were evaluated, cremaster muscles were removed, and contractile properties were studied. Twitch and tetanic contractions were recorded isometrically at 37°C. Effects of verapamil, isoprenaline, and L-NNA were investigated. Results were compared through analysis of variance (ANOVA), and P values less than .05 were considered to be significant. Results: Both testes of all male offspring in the control group (n = 19) were in the scrotum. Six offspring among 17 subjected to 6-hydroxydopamine had undescended testes. Treatment with 6-hydroxydopamine had no effect on force-frequency relationship of cremaster muscle strips. Cremaster muscles of rats exposed to 6-hydroxydopamine had lower sensitivity to voltage-sensitive Ca ++ channel blockade by verapamil (3 × 10 4 mol/L; P < .05). These muscles displayed greater contractile response to isoprenaline (10 −5 mol/L; P < .05) but not to nitric oxide synthase inhibition by N ω-nitro- l-arginine. Alterations in contractile properties of the muscles did not differ according to localization of testes among rats subjected to 6-hydroxydopamine. Conclusions: Administration of 6-hydroxydopamine resulted in suprascrotally located testes. This localization has been associated with less exposure at sympathetic tonus. These findings support that sympathetic activity plays an important role in localization of testis.

Evaluation of men with unilateral or bilateral undescended testes: Does age of correction make a difference?

Objective: It is well documented that patients with undescended testes (UDT) have defects in spermatogenesis and abnormal testicular histology. In this investigation, we reviewed seminal fluid findings and hormone levels in men with bilateral and unilateral undescended testes. With this report, we substantially expand an earlier, smaller series, and confirm trends identified in that pilot study. Design: Retrospective review of data from 4 geographically separate (2 U.S., 1 Egyptian, 1 European) sites including clinical and physical findings, FSH, testosterone, and LH levels. In addition to stratifying based on unilateral versus bilateral cryptorchidism, patients were also categorized based on the age of correction. Materials and Methods: Four institutions were involved in collecting data on men presenting to the andrology clinics with a history of cryptorchidism. Once identified, charts were retrospectively reviewed and analyzed according to the patients’ physical examination, endocrine evaluation, and semen analysis. Results: Ninety-two men were identified with a history of undescended testes, 32 of which had bilateral cryptorchidism. Fifteen of 32 men with bilateral UDT were azoospermic as compared to 26/60 with unilateral UDT. In addition, only 2 men with bilateral UDT had sperm counts 20 million/cc or greater as compared to 11 men with unilateral disease. Regarding patients with bilateral UDT, the average age of correction was 8.0 years and 6 did not undergo surgical correction. The average sperm count of patients with oligospermia was 4.3 million/cc. The average age at correction for those with oligospermia was 6.5 years as compared to 9.5 years for those with azoospermia. When the age of correction was limited to 9–13 years, the average sperm count was 7.5 million/cc. Of interest, we noted a bimodal distribution of sperm with sperm present when the age of correction was up to age 3 years, and then a second peak from 9–13 years. No patient with bilateral UDT had sperm in the ejaculate when corrected after 13 years of age. Conclusions: Testicular dysfunction and impaired spermatogenesis is known to be associated with cryptorchidism. Historically, dysfunction has been noted to occur even before one year of age and increases with increasing age of correction, testicular location, and the presence of bilateralism. We have found that even when corrected peripubertally, sperm may be present in the ejaculate of men with bilateral undescended testes. Interestingly, we also found a bimodal distribution of sperm present in the ejaculate of those corrected before 5 years and then again in the men corrected between the ages of 9–13 years. Although men with former bilateral cryptorchidism have significantly compromised fertility, sperm may still be present and paternity is possible either with or without assisted reproductive techniques.

Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: Case report and review of intraabdominal testicular tumors in children

The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants. J Pediatr Surg 37:1236-1238. Copyright 2002, Elsevier Science (USA). All rights reserved.

Cremasteric reflex and retraction of a testis

Purpose: A clinical study has been planned to define the clinical characteristics of cremasteric reflex (CR) for deciding on the possibility of a prolonged suprascrotal stay of a testis through this reflex. Methods: Five hundred boys from 3 days to 16 years of age were divided into 6 groups according to their ages and were evaluated for the presence of the CR. After evoking CR, the presence or absence of changes in testicular location and the most elevated position of the testis were recorded. Testicular position difference (TPD), the duration of the stay of testis in the most elevated position (DEP), and the interval for reevoking the CR (IRCR) were determined. The number of consecutive responses after repetitive evokings were recorded as reproducibility (R). Mean TPD, DEP, IRCR, and R values for both sides were calculated and compared among groups. The boys with a positive reflex were classified further according to their TPD, DEP, IRCR, and R values. Three groups were established according to the aforementioned criteria by dividing the values into 3 equal parts. The association of each of the parameters to other parameters were compared. Results: Bilateral positive CR was encountered in 42.7% of newborns, 36.3% of the boys between 1 month and 1 year old, 38.1% of the boys between 2 years and 4 years old, 75.2% of the boys between 5 years and 8 years old, 70.3% of the boys between 9 years and 12 years old, and 72.1% of the boys between 13 and 16 years old. The highest percentage of the contralateral activations during ipsilateral evokings were encountered in boys who were between 5 and 8 years of age. The highest mean TPD and mean R, the longest mean DEP, and mean IRCR were encountered in boys between 5 and 8 years of age. Boys with the highest TPD did not have shortest IRCR and highest R values. Similarly, boys with the longest DEP or shortest IRCR and highest R values did not have the association of other parameters that would suggest a hypersensitivity. Conclusions: The rate of presence and the characteristics of a positive CR vary largely. However, suprascrotal location of a testis for extended periods through the activation of this reflex does not seem to be likely. Instead of a hyperactive reflex, the clinical condition, so called the retractile testis, might have resulted through alterations within the cremaster muscle itself. J Pediatr Surg 36:863-867. Copyright © 2001 by W.B. Saunders Company.

Laparoscopic orchidopexy: a review of a large clinical series.

To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures. The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one-stage and staged Fowler-Stephens (F-S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery. From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra-abdominal in 46, iliac in 14, in the internal ring in 22, 'peeping' in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one-stage F-S in 20 and a two-stage F-S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5-12 years); the mean (range) follow-up was 5 (1-36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow-up available). Four patients (4%) had testicular atrophy from failed F-S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow-up, was 96% (90 of 94). Of the 20 one-stage F-S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F-S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy. The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra-abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.

Fertility after Unilateral Cryptorchidism

Objective: To further evaluate whether fertility is decreased among a cohort of men with previous unilateral cryptorchidism as compared with a control group of men. Subjects and Methods: Formerly unilateral cryptorchid men who had undergone orchiopexy between the years of 1955 and 1975 at the Children’s Hospital of Pittsburgh and a control group of men who were matched for age of an unrelated surgery at the same institution were evaluated by review of medical records and by completion of a questionnaire. 359 previously cryptorchid men were identified as having attempted paternity. Of these men, 320 had information concerning preoperative testicular location and 163 for preoperative testicular size. 106 of these men had levels of testosterone, inhibin B, FSH, and LH measured, while 95 of the men had semen analyses. Results: Among men who had attempted paternity, there was no statistical difference in success of paternity between the previously unilateral group (89.7%) and the control group (93.7%). There was no difference in the mean time to conception (7.1 ± 0.7 months for the unilateral group vs. 6.9 ± 2.3 for the control group). Within the unilateral group in regard to success at paternity, no difference was found compared with the age of orchiopexy, preoperative testicular location, or preoperative testicular size. Inhibin B levels were lower among the unilateral group. FSH, LH, testosterone, sperm density, motility and morphology were not different, but considerable variation was noted within the cryptorchid group. Conclusions: In this continued evaluation of a cohort of previously cryptorchid men who had undergone unilateral orchiopexy, paternity does not appear to be significantly compromised after unilateral cryptorchidism. Unilateral cryptorchidism appears to be one of several factors contributing to infertility, similar to those found in the general population. No correlation was found between success at paternity and the age of orchiopexy, preoperative testicular size or preoperative testicular location. Inhibin B levels were lower while FSH, LH, T and sperm parameters did not differ.

PATERNITY AND HORMONE LEVELS AFTER UNILATERAL CRYPTORCHIDISM: ASSOCIATION WITH PRETREATMENT TESTICULAR LOCATION

We determined differences in paternity and levels of the hormones inhibin B, follicle- stimulating hormone, luteinizing hormone, testosterone and free testosterone based on the preoperative location of the undescended testis in men with previous unilateral cryptorchidism. Testicular location was determined by a review of the medical records and paternity or attempted paternity using a detailed questionnaire administered to 320 men with previous unilateral cryptorchidism. In 103 cases we performed semen analysis and measured the levels of the hormones inhibin B, luteinizing hormone, follicle-stimulating hormone, testosterone and free testosterone. Paternity, sperm count and hormonal parameters were compared with cryptorchid testicular location using analysis of variance and chi-square analysis. Logistic regression was done to analyze pretreatment testicular location as a risk factor for infertility. Paternity, duration of attempted conception in men who achieved paternity, sperm count and hormone levels did not differ based on pretreatment abdominal, internal ring, inguinal canal, external ring, upper scrotum or ectopic testicular location. The overall paternity rate was 90% with the lowest rate of 83.3% in the abdominal group. More than 12 months were required to achieve conception in 28.9% of the study group overall and in 39.4% of the abdominal group. Varicocele and a partner with fertility problems were risk factors for infertility, while abdominal testicular location caused borderline significant risk. Preoperative testicular location in men with previous unilateral cryptorchidism is not a major determinant of fertility according to paternity, sperm count or hormone levels.

PATERNITY AND HORMONE LEVELS AFTER UNILATERAL CRYPTORCHIDISM: ASSOCIATION WITH PRETREATMENT TESTICULAR LOCATION

We determined differences in paternity and levels of the hormones inhibin B, follicle- stimulating hormone, luteinizing hormone, testosterone and free testosterone based on the preoperative location of the undescended testis in men with previous unilateral cryptorchidism.Testicular location was determined by a review of the medical records and paternity or attempted paternity using a detailed questionnaire administered to 320 men with previous unilateral cryptorchidism. In 103 cases we performed semen analysis and measured the levels of the hormones inhibin B, luteinizing hormone, follicle-stimulating hormone, testosterone and free testosterone. Paternity, sperm count and hormonal parameters were compared with cryptorchid testicular location using analysis of variance and chi-square analysis. Logistic regression was done to analyze pretreatment testicular location as a risk factor for infertility.Paternity, duration of attempted conception in men who achieved paternity, sperm count and hormone levels did not differ based on pretreatment abdominal, internal ring, inguinal canal, external ring, upper scrotum or ectopic testicular location. The overall paternity rate was 90% with the lowest rate of 83.3% in the abdominal group. More than 12 months were required to achieve conception in 28.9% of the study group overall and in 39.4% of the abdominal group. Varicocele and a partner with fertility problems were risk factors for infertility, while abdominal testicular location caused borderline significant risk.Preoperative testicular location in men with previous unilateral cryptorchidism is not a major determinant of fertility according to paternity, sperm count or hormone levels.

Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood

To determine the clinical, physical, sperm and hormonal status during adulthood in cryptorchid patients operated on during childhood, and to assess these variables according to the age at surgery and preoperative testicular position. A letter was sent to all 890 patients > 18 years old who underwent surgery for cryptorchidism during childhood; 274 responded and were assessed using a sexual history, physical examination, pituitary axis study and sperm analysis. Data were complete for 251 patients (mean age 21 years, range 18-30); 196 had unilateral (25 anorchic) and 55 had bilateral cryptorchidism. Clinical, surgical and anatomopathological records at surgery during childhood were also reviewed. The mean (SD) age at orchidopexy was 6.4 (3.3) years and the mean age at assessment 21.1 (2.7) years. Semen samples generally showed abnormalities; 10 patients (4%) with bilateral and 57 (23%) with unilateral cryptorchidism had semen values within the normal range. There was no correlation between the sperm count and age at surgery for unilateral or bilateral cases (Spearman test). There was a significant correlation (r = - 0.41) between the sperm count and level of follicle-stimulating hormone (FSH). There were no significant differences in the sperm count for patients with different testicular locations (ANOVA) or in those treated or untreated with human chorionic gonadotrophin (Student's t-test). The only significant relationship (P < 0.001) was between the sperm count and unilateral or bilateral cryptorchidism. The sperm quality of adults operated on for cryptorchidism during childhood is independent of the age at surgery or testicular location, but is influenced by whether the cryptorchidism was unilateral or bilateral. FSH levels were negatively correlated with sperm density.

Emerging trends in the management of the impalpable testis.

The management of the impalpable undescended testis is controversial. The study examines emerging trends in the management of this problem. Two groups of boys were treated consecutively and recorded prospectively from 1974 to 1984 and from 1990 to 1998 inclusive. A consistent policy of using the preperitoneal approach for impalpable testis was adopted during both time intervals but during the second study period examination under anaesthesia and diagnostic laparoscopy were introduced to ascertain testicular presence and location. Some 919 boys were treated for cryptorchidism during the study period. Ninety boys in the first group (23 per cent) underwent preperitoneal explorations for impalpable testes. Anorchia was present in 18 and orchidectomy was performed in two boys. Thirty boys in the later group (5 per cent) were diagnosed as having impalpable testes. Fifteen boys underwent successful preperitoneal orchidopexy, anorchia was present in 11 and four underwent orchidectomy, carried out for high intra-abdominal testes. Examination under anaesthesia and subsequent laparoscopic assessment for all impalpable testes has reduced the need for preperitoneal exploration for the impalpable undescended testis. In this large series, division of the testicular vessels in order to secure scrotal placement of the testis was required in one instance only.

Effect of Age at Operation, Location of Testis and Preoperative Hormonal Treatment on Testicular Growth after Cryptorchidism

Purpose We evaluated the effect of patient age, primary location of the gonad and preoperative human chorionic gonadotropin administration on future testicular growth in patients treated for cryptorchidism. Materials and Methods Testicular volume was measured in 75 adults treated for cryptorchidism when they were 10 months to 13 years old. Results The mean volume of the cryptorchid testes plus or minus standard deviation, whether unilateral or bilateral, was 11 +/− 6 ml. compared to 20 +/− 7 ml. for the spontaneously descended testes in patients with unilateral cryptorchidism. The results showed no significant correlation between patient age at treatment or original testicular location and final testicular volume, although the 22 testes of 18 patients undergoing surgery after age 5 years were somewhat smaller (9 +/− 5 ml.) than the 66 testes of 55 younger patients (12 +/− 6 ml.). However, 26 patients who had received human chorionic gonadotropin treatment had a significantly smaller testis (9 +/− 5 ml.) than did 57 treated with surgery alone (12 +/− 6 ml., p <0.05). Conclusions Early orchiopexy at age younger than 2 years is not necessarily essential. Adult testicular volume is slightly greater in patients with cryptorchidism if treated at ages up to 5 years. Preoperative location of the testis in otherwise healthy boys exerts no definite effect on final testicular volume. Preoperative human chorionic gonadotropin administration may have an adverse effect on future testicular growth.

Late Presentation of Cryptorchidism: The Etiology of Testicular Re-Ascent

Purpose We reviewed the records of 21 boys who had 23 previously documented descended testes that reascended and who underwent orchiopexy during a 2-year period. Materials and Methods We retrospectively reviewed a 2-year experience in 103 boys (115 undescended testes) who underwent orchiopexy in 1988 and 1989. Results In our 2-year experience 21 of the 103 boys with undescended testes had multiple recorded confirmations of testicular descent in the past. Of the boys 40% had previously been examined in the office or with general anesthesia by a pediatric urologist or pediatric surgeon for another reason, and 40% had a nurse or physician parent. Surgery was performed at ages 5 to 14 years, an average of 2 years after the initial presentation with reascent. Human chorionic gonadotropin was unsuccessful in causing testicular descent. There was no correlation with a patent processus vaginalis and no association with adhesions. The testis was located in the superficial inguinal pouch in the majority of patients, and the gubernacular attachment was in an abnormal location in all and ectopic in half of the cases. Conclusions Our observations confirm that the etiology of this condition is a missed diagnosis at a younger age. The testis is undescended but almost completely descended. With somatic growth the distance between the terminal portion of the gubernaculum of the apparently descended testis and the scrotum increases, making the diagnosis more obvious. The potential for this condition makes it mandatory that intrascrotal testicular location be confirmed by periodic physical examination through puberty.

Consequence of cryptorchidism: Relationship to etiology and treatment

Increased risk of infertility and testicular tumors after cryptorchidism is the basis for treatment. Over the past few decades the recommended age of therapy has become younger and younger, so that currently therapy is recommended before 2 years of age and as early as 6 months. Evidence indicates that treatment before 10 years of age reduces the incidence of testicular tumors among men who formerly had unilateral cryptorchidism to that of men without a history of cryptorchidism. However, the effect of the age of treatment among the bilateral group is unknown. Infertility after bilateral cryptorchidism is about six times greater than that of the general population, affecting about half of patients; it appears to be only two times greater among the unilateral group, affecting about 10% of patients. To date no effect of age of therapy has been demonstrated, although current studies have not been able to consider the underlying cause of the cryptorchidism. Data are not yet available to determine whether pretreatment testicular location or size is related to subsequent fertility. The current recommendation for treatment within the first 2 years of life is based on the progressive degeneration of germ cells within the persistently cryptorchid testis after the first year of life. This recommendation should stand, even though some testes may be irretrievably damaged before such early therapy, and others may suffer minimal or no detrimental effect after delayed treatment. Future information may identify specific causes of cryptorchidism and, hence, determination of which patients will benefit from early therapy.

Interleukin-6 secretion from rat Leydig cells in culture.

Recent evidence indicates that interleukin-6 (IL-6) acts on Sertoli cells to modulate secretory function. IL-6 is also detected in medium bathing tissue or cells from the seminiferous tubule, suggesting a testicular regulatory role. Because other cytokines found to be active in testicular function have more than one site of production, we examined whether Leydig cells may serve as an alternate source of IL-6. Purified Leydig cells were cultured with or without modulatory substances, and the medium was subjected to the 7TD1 bioassay for IL-6. Northern analysis using an IL-6 cDNA probe was performed on companion cell preparations. Incubation with either hCG or IL-1 beta increased the levels of bioactive IL-6 released into the medium and IL-6 mRNA detected in the cells in a dose-related manner. When used together, these agents had an additive stimulatory influence on both the release of IL-6 bioactivity and the amount of IL-6 mRNA. Our results demonstrate that IL-6 is secreted from enriched preparations of Leydig cells and that its release is under the control of at least two modulators of testicular function. Identification of interstitial cells as a site of IL-6 production coupled with reports of IL-6 release and action in seminiferous tubular cell preparations suggest that IL-6 may serve a role in signal integration or communication from one testicular location to another.

Management of the impalpable testis: Long-term results of the preperitoneal approach

During a 12-year period 396 operations for undescended testes were carried out by one surgeon. In 90 boys the testis was impalpable, and exploration was performed using a muscle-splitting preperitoneal approach. Testicular volume and location were prospectively recorded at 3 months and 1 year, 94% were intrascrotal at 1 year and 84% were judged to have grown. At late follow-up 6 to 16 years (mean, 11 years) after ochidopexy, 81% of testes were in the scrotum and 57% were of normal volume. The value and advantages of this operative approach and its place in the management strategy of the impalpable testis are discussed.

Long-Term Effects of Prepubertal Testicular Vessel Ligation on Testicular Function in the Rat

To determine the effects of unilateral testicular vein and artery ligation in the immature rat on the function and final location of the testis at adulthood, 10-day-old male rats underwent either a sham opearation or unilateral ligation of these vessels of the still undescended testis. Testicular location, blood flow, size and histology as well as ventral prostate weights were measured 50 days later at adulthood. At age 60 days, it was determined that all testes were descended into the scrotum, and there were no differences in testis and ventral prostate weights, intratesticular sperm counts and mean seminiferous tubular area between the control and sham operated animals. However, there was an 18% reduction in testicular blood flow (ml. per 100gm. per minute ± standard error of mean) in the operated animals when compared to the sham (20.43 ± 1.10 versus 16.69 ± 0.74, p <0.02).These data indicate that although there is a slight but significant reduction in testicular blood flow at adulthood when the testicular artery and vein are ligated early in life, this diminution is not sufficient to alter the ultimate location, testicular weight and spermatogenic function of the testis. This would suggest that after ligation of the main testicular vessels to the immature testis, the collateral blood supply is able to compensate with time to allow normal growth and development of the testis. These experimental observations provide additional support for the 2-staged approach to the high undescended testis whereby the testicular vessels are initially ligated and a subsequent procedure is performed to place the undescended testis into the scrotum.

Diagnostic ultrasonography for evaluation of cryptorchidism in horses

Summary The location and size of 11 retained testes were accurately determined ultrasonographically. There was 100% correlation between the location of the testis determined by ultrasound vs that determined by surgery. Testicular size determined presurgically in all cases closely approximated the actual size obtained by gross measurement of the excised testis. The cryptorchid testicular echotexture was less dense than that of the normal descended testicles, but was easily identified. Ultrasonographic evaluations were completed by use of an ultrasound base unit with attached 5-MHz transrectal transducer. Rectal scans were started at the pelvic brim and continued in a to-and-fro pattern between the midline and the lateral abdominal wall. When the testis was located, the image was froze to allow measurement. All testicular locations were ascertained ultrasonographically either by rectal or external inguinal scans.