Testicular Trauma Research Articles

7394 Testicular Function in Young Adults with Growth Hormone (GH) Deficiency Previously Treated with GH: Comparison with Normal Controls

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (>18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

9277 Testicular Function in Young Adults with Growth Hormone (GH) Deficiency Previously Treated with GH: Comparison with Normal Controls

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (>18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Epidemiology of Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database

BackgroundThe epidemiology of testicular trauma in sports on a national scale has not been well studied. Timely management and treatment after testicular trauma is critical to avoid serious, long-term ramifications of mismanagement. ObjectiveThe aim was to analyze trends in sports-related testicular trauma based on specific sports and patient demographic characteristics over time. MethodsThe National Electronic Injury Surveillance System was queried for emergency department cases between 2012 and 2021 with injuries in the pubic region related to 10 commonly played sports. Variables examined included patient age, race, disposition, and sport using incidence rate, incidence rate ratios, and χ2 analysis. ResultsThere were an estimated 28,844 emergency department cases of sports-related testicular trauma between 2012 and 2021. Young patients, aged between 10 and 14 years and 15 and 19 years, accounted for most cases, and results of χ2 analysis showed a significant difference in incidence based on age group (p < 0.01). Most injuries occurred while athletes played basketball, football, and soccer (73.6%). ConclusionsSports-related testicular trauma injury rates remained steady between 2012 and 2021, which suggests greater efforts are necessary to reduce the incidence of sports-related testicular trauma. Education efforts should focus on 10- to 19-year-olds because they have the highest incidence. Given the high incidence in sports like basketball and soccer compared with football and lacrosse, testicular trauma seems to be a risk for athletes competing both recreationally and competitively.

SURGICAL REPAIR FOLLOWING TRAUMATIC TESTICULAR RUPTURE : OUTCOME OF 3 CASES

Scrotal traumas are relatively uncommon. Most are blunt trauma caused by a direct blow to the scrotum. Early surgical exploration has considerably improved the prognosis of testicular trauma and reduced the rate of orchiectomy. Ultrasound has also improved the management of scrotal trauma. But there is controversy over the accuracy of ultrasound in predicting the presence or absence of testicular rupture. Its important to acknowledge the potential long-term repercussions such as testicular atrophy and infertility. We report three clinical cases, all young and victims of scrotal trauma with unilateral testicular rupture, all three of whom benefited from scrotal exploration with testicular preservation.

Analysis of the quality of life and patient satisfaction with the results of testicular prosthetics

BACKGROUND: Satisfaction with the results is a complex and poorly studied aspect of testicular prosthetics, which currently has no comprehensive consecration in the literature. There are no works that are based on a comprehensive view of the problem, from a subjective analysis of the local physical characteristics of the implant itself and the aesthetic perception of one’s body to assessing the impact of prosthetics on the patient’s sex life and socialization. AIM: The aim of this study is to evaluate the results of testicular prosthetics using an original questionnaire reflecting satisfaction with the physical characteristics of the implant, sexual behavior characteristics and the socio-psychological status of the patient. MATERIALS AND METHODS: Questionnaires of 236 patients were analyzed — 112 adults 1 year after prosthetics and 124 adolescents after reaching 18 years of age with a period after surgery from 1 to 8 years. The survey was carried out using an original questionnaire that included 15 questions reflecting various aspects of the patient’s attitude to the results of prosthetics. RESULTS: Overall satisfaction with prosthetics was more than 90% in both groups, prevailing in patients operated on in adolescence. The greatest satisfaction with prosthetics was noted in patients after testicular torsion and trauma, less satisfaction in patients with cryptorchidism, testicular hypoplasia, and monorchidism. When analyzing the patient’s interest in this procedure depending on the period before prosthetics, it was noted that satisfaction does not tend to decrease over time, up to a 10-year interval between the loss of the gonad and prosthetics. Requirements for the final result of prosthetics tend to increase in more educated patients. The results of the survey demonstrate the greatest demands for prosthetics in patients in the age group of 21–30 years as the most sexually active age category. CONCLUSIONS: Patient satisfaction with modern implant prosthetics is quite high — at least 90%. However, these values are not maximum and leave room for further optimization of this method, which follows from the lack of a maximum assessment of satisfaction with the results of prosthetics — for all criteria the indicators do not exceed 95%.

Assessment of the Characteristics of Traumatic Urogenital Injuries at a Tertiary Care Center: First Report from Somalia

&#x0D; Objective: Urogenital injuries (UGIs) are present in approximately 10% of adult and less than 3% of pediatric trauma patients. To date, no reports have been published regarding urogenital injuries in Somalia, a sub-Saharan African country. We aimed to analyze the data of urogenital trauma patients who presented to the emergency department of the only tertiary care center in Somalia.&#x0D; &#x0D; &#x0D; Materials and Methods: Patients who presented to the emergency department of our institution following trauma between January 2019 and December 2022 and were admitted with the diagnosis of UGI constituted the target population. The collected data included demographic characteristics, type of trauma, involved urogenital organ, admission site, patient management type, and survival. &#x0D; &#x0D; &#x0D; Results: Overall, 2426 trauma patients presented to the emergency department. Among these patients, 116 (4.8%) had UGI. The mean patient age was 28.31±5.2 [1-73]. Most (83.6%, n=97) patients were male. Kidneys were the most commonly injured organs (41.4%, n=48), followed by the urinary bladder (17.2%, n=20) and testis (13.7%, n=16). Nine patients with renal trauma underwent nephrectomy. Among 20 patients with bladder injury, half underwent surgical repair. Ten of 16 patients with testicular trauma underwent orchiectomy due to severe rupture. All 12 patients with penile injuries underwent primary repair. Among 10 (8.6%) patients with urethral injuries, 4 underwent immediate primary repair, 3 underwent endoscopic realignment, while the remaining 3 needed cystostomy and delayed urethroplasty. The mortality rate was 10.3% (n=12). &#x0D; &#x0D; &#x0D; Conclusions: Surgical exploration was commonly performed due to the severity of the traumas and the presence of adjacent organ injuries. This finding arises from the fact that Somalia is a country affected by terrorism and low-density war.&#x0D;

Severe scrotal trauma in polytrauma patients

Testicular or scrotal trauma is rare, but most often occurs after an assault with a firearm. Most patients have only isolated scrotal or testicular trauma.

Enhancing men's awareness of testicular diseases: A feasibility trial and process evaluation

Abstract Background Testicular cancer is the most common cancer in men aged 18 to 44 years. Symptoms of testicular cancer can mimic those of benign diseases like epididymitis and torsion. Men's awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. Athletes involved in field games like hurling are at risk for testicular trauma and diseases. The aim of the enhancing men's awareness of testicular diseases (E-MAT) study was to explore the feasibility of conducting a definitive trial to test the effect of E-MATVR (intervention; virtual reality [VR] game) compared to information delivered electronically E-MATE (control; information in PDF format) on testicular knowledge and self-examination among athletes. Methods In total, 74 participants were recruited from nine Gaelic Athletics Association (GAA) sports clubs in County Cork in Ireland using social media posts and posters. Participants were individually randomised to either E-MATVR or E-MATE. Outcomes were measured at T0 (baseline), T1 (immediately post-test) and T2 (3 months post-test). Results Testicular awareness increased significantly between T0 and T1 (p = 0.01) in both groups. Testicular awareness further increased at T2 for E-MATE participants. All participants in E-MATVR (n = 37, 100%) agreed that the VR headset was easy to use and that they were engaged to learn, while almost all E-MATE participants (n = 33, 89%) agreed with these statements. Most participants in both arms agreed that the time it took to complete the intervention was reasonable (p = 0.036). All participants were either extremely satisfied or somewhat satisfied with their overall experience of participating in the study. Conclusions VR may be effective in enhancing men's awareness of and help-seeking intentions for testicular diseases. A future definite trial is warranted to test the effect of E-MATVR. Key messages • VR may be effective in promoting the wellbeing of hard-to-reach populations, particularly among young men, to help raise awareness and promote testicular self-examination and early help-seeking. • VR may help detect testicular diseases early, reduce treatment costs, and improve overall health outcomes.

FRI326 Hypophysitis: A Formidable Diagnostic Challenge

Abstract Disclosure: S. Pandey: None. C. Houston: None. Background: Hypophysitis, defined as inflammation of the pituitary gland, may pose a formidable diagnostic challenge due to its protean clinical manifestations and growing spectrum of potential causes. We present a case of a young man with presumed hypophysitis in whom the etiology remains unknown. Case Summary: A previously healthy 20-year-old male with bilateral gynecomastia was referred to the endocrinology clinic. He reported a 1-year history of worsening fatigue, weight gain, intermittent headaches, bilateral breast enlargement, lack of morning erections, polydipsia, and polyuria. His childhood growth and pubertal development were reportedly normal. He denied prior head or testicular trauma, major systemic illnesses, and chronic opiate or glucocorticoid use. His physical exam was remarkable only for scant facial hair and bilateral nontender gynecomastia. His visual fields were normal, and sense of smell was intact. Laboratory evaluation at 8am revealed low total and free testosterone of 32 ng/dL (240-950) and 0.98 ng/dL (5.25-20.7), respectively, with LH of 1.4 mIU/mL (1.0-12.0) and FSH of 1.9 mIU/mL (1.0-12.0). Free T4, prolactin, IGF-1, and serum sodium were all within normal ranges. Serum cortisol was modestly elevated at 22.3 ug/dL (3.7-19.4) with normal ACTH of 49 pg/mL (7.2-63.0). Pituitary MRI showed diffuse thickening and enhancement of the pituitary stalk, compatible with infundibular hypophysitis, without evidence of mass effect upon the native gland or surrounding structures. Additional testing showed normal levels of serum calcium, iron, ferritin, ESR, and antinuclear antibodies. After overnight water deprivation, his serum sodium was elevated at 156 mmol/L (134-144) with low urine osmolality of 121 mOsmol/kg (300-900). He was started on desmopressin and testosterone, and close clinical monitoring was enacted. Conclusion: The diagnosis of hypophysitis poses multiple challenges. Its clinical manifestations can vary widely, including symptoms related to mass effect and/or symptoms of pituitary dysfunction. Diagnosis is often presumptive based on history and exam, biochemical evaluation, and neuroimaging. The spectrum of potential causes is broad and growing, including infiltrative, infectious, neoplastic, immunoglobulin G4-related, immunotherapy-induced, other autoimmune, and paraneoplastic causes. It is often a humbling experience for clinicians to narrow this exhaustive differential. Pituitary biopsy is the gold standard for diagnosis but poses significant risks, so is reserved for cases when the diagnosis remains uncertain or malignancy is suspected. Close clinical monitoring and re-evaluation is an acceptable alternative in select cases. Presentation: Friday, June 16, 2023

FRI438 A Unique Case Of Secondary Hypogonadism And The Covid Booster Vaccine

Abstract Disclosure: O.Z. Syed: None. M. Shakir: None. K. Sajid: None. A. Sood: None. N. Bansal: None. 38-year-old male with no past medical or surgical history presented for an evaluation of his low testosterone. The patient transports patients in the hospital, he denies any medication use, including steroids, opioids, and antibiotics. He has a biological 8-year-old son and denied any history of viral infection recently and denied any history of testicular trauma, mumps, or radiation therapy. He started having fatigue, chronic mild headache, and generalized weakness after receiving his third dose of covid vaccine in January, however, he denied any diplopia, galactorrhea, hirsutism, or sexual dysfunction. He did not report any side effects with the previous 2 covid vaccines. After a couple of months of persistent symptoms accompanied by 40 pounds of weight loss( half of which he regained in a few months without intervention), he went to his PCP for evaluation. On physical examination, there were no abnormalities seen and as per the patient, there was no change in testicular size either. The patient was found to have mildly elevated prolactin of 17.8 with low free and total testosterone of 134 accompanied by FSH of less than 1.0 and LH of 1.4. The remaining labs include but are not limited to CBC, CMP, TSH, Vitamin D, CK, Sex hormone-binding globulin, and cortisol. The autoimmune panel, Hepatitis, HIV, and tick panels were negative. While he was being worked up he tested himself multiple times for covid and was negative. The patient had an MRI done which did not show any mass or lesions. Furthermore, he also had a Chest x-ray and CT of his abdomen/pelvis along with an Ultrasound of the abdomen, which did not show any concerning findings. The patient was started on testosterone gel at the endocrinology clinic with regular follow-ups to assess for response and side effects.As per the currently available literature, there have been multiple associations made between Covid 19 infection and hypogonadism. There have been reports of low testosterone following covid 19 infections and conversely there have been worse outcomes of covid 19 related to men with lower levels of testosterone. This could possibly be due to ACE 2 expression on testicular cells or due to secondary inflammation and oxidative stress inhbitiing steroidogenesis. However no literature was found linking the covid 19 vaccine to secondary hypogonadim other than a case of pituitary apoplexy. These findings in light of our case warrant further research into possible association between the covid vaccine and hypogonadism. In patients presenting with generalized weakness and similar vague symptoms, we need to consider a history of covid vaccination as it could potentially be a cause of secondary hypogonadism. Furthermore, more detailed and larger-scale studies need to be done concerning the covid booster vaccines and hypogonadism. Presentation: Friday, June 16, 2023

Enhancing men's awareness of testicular diseases (E-MAT) feasibility trial: Protocol for a mixed method process evaluation

Background: Testicular cancer (TC) is the most common malignancy in men under 50 years. Athletes are particularly at risk of testicular trauma and diseases. Experiencing negative testicular symptoms does not necessarily imply that men seek help. Men’s awareness of testicular diseases is often lacking and their intention to seek help for testicular symptoms is sub-optimal. The use of virtual reality (VR) may be effective in promoting men’s awareness of testicular diseases. The Enhancing Men's Awareness of Testicular diseases (E-MAT) feasibility trial aims to test the effect of E-MATVR (intervention; interactive experience using virtual reality [VR]) compared to information delivered Electronically E-MATE (control; same information as E-MATVR delivered as plain text and images) on testicular knowledge, and testicular self-examination among male athletes affiliated with a national sports organisation. The overall aim of this mixed method process evaluation will be to describe (i) the experiences of participants and key stakeholders (e.g., researchers); (ii) the perceived effectiveness of intervention components; (iii) acceptability of the feasibility trial and intervention procedures; (iv) the relationship between implementation, mechanisms, and context; and (v) the barriers and facilitators to support effective conduct of a future definitive trial. Methods: This mixed method process evaluation will use a descriptive realist evaluation. Quantitative data will be gathered using a usability and satisfaction survey, in addition to fidelity checks during intervention delivery. Quantitative data will be analysed using descriptive and inferential statistics. Qualitative data will be gathered from semi-structured interviews and focus groups with participants and key stakeholders to investigate their experiences of E-MATVR and E-MATE, and explore areas for improvement. Thematic analysis of transcripts will be conducted. Conclusions: This process evaluation will provide an in-depth understanding of how the interventions worked within this cohort and lessons for a future definitive trial.

Unilateral Orchiectomy and Its Impact on Male Fertility: A Retrospective Study of Testicular Trauma Patients

Background: Testicular injury has been shown to occur in less than 1% of trauma. Objective: To evaluate the fertility of patients underwent unilateral orchiectomy and live with unilateral testis. Materials and method: In this retrospective study, 86 male trauma patients that admitted to Alsadi hospital and Hatroom Urology Center between January 2015 to December 2018 were studied. All patients underwent unilateral orchiectomy. Married patients were included in this study. Information was collected from the medical records of the patients. The following parameters were included: patient age (years), injury type (blunt vs penetrating), mechanism of injury, conceive and period of conceive after orchiectomy. SPSS program, version 22, was used to analyze the data. The data were tabulated and statistical analysis was done by estimating rates, means and standard deviations, Fisher test was used and p-value &lt; 0.05 was considered as statistically significant. Results: The total study patients were 86. Their age at orchiectomy ranged between 20 – 35 and the mean age was 27 ± 4.3 years. Blunt trauma accounted for (79.1%), while penetrating trauma accounted for (20.9%). The causes were vehicle accident (25.6%), gunshot wounds (20.9%), pedestrian collision (18.6%), sport trauma (15.1%), work site (10.5%), and motor collision (9.3%). Most of unilateral orchiectomy men succeeded to conceive (73.3) while (26.7%) failed to conceive (p &gt; 0.05). After 1 year (27.9%) occurred conceive then after 2 years (23.2%) occurred conceive and after 3 years (22.2%), (p &lt; 0.05). Conclusion: The total study patients who underwent orchiectomy were 86. Blunt trauma was predominant. The causes of the testicular trauma were vehicle accident, gunshot wounds, pedestrian collision, sport trauma, and motor collision. We found the most of unilateral orchiectomy men succeeded to conceive. Further studies are in need. Keywords: Unilateral orchiectomy, male fertility, testicular trauma, Aden, Yemen

A Case Report: Ruptured Testicular Seminoma in a Female with Ambiguous Genitalia, Dr. Sulman Alamin Medical Center, Elhassaheisa, Gezira State, Sudan; 2023

Background: Ambiguous genitalia represent a sequel of sexual development disorders where the external genitalia don’t have a typical resemblance to that of male or female. Methods: This was a female case of ambiguous genitalia, her age was twenty-eight years, ultrasound examination revealed atrophied uterus and bilateral undescended testes. She complained of gradual size increase of her left testicle in the last 6 months. Due to sudden trauma, she developed severe pain and swelling in her left groin. On examination: patient looked unwell, in pain, afebrile, locally there was swelling about 10 cm in size with shiny and red looking, it was very tender, otherwise it was unremarkable. So, this was considered as a case of left testicular trauma that need urgent left groin exploration. The patient was counselled and consented about possible orchidectomy. Intra-operative note: under spinal anesthesia patient was put on supine position, skin painted by yamidin, left inguinal incision was made and hematoma was evacuated, the left testicle was found to be hugely enlarged and ruptured. The spermatic cord was clamped and orchidectomy was done. No intra operative complications. Result: Histological examination of the testicular specimen confirmed that it was a germ cell tumor [Seminoma]. Patient was recommended to for: (1) Chemotherapy at the Oncology Department, (2) Laparoscopic search for her right undescended testis to confirm whether it is a testis or an ovary, (3) Buccal biopsy for sex determination and (4) Surgery, for the right side, if needed. Conclusion and recommendation: Neglected cases of undescended testis may have a serious outcome. Screening for ambiguous genitalia, and early exploration and management was highly recommended.

A 12-Years Old Boy with Penetrating Scrotal Trauma grade III at Bhayangkara Hospital, Kupang, East Nusa Tenggara, Indonesia

A 12-year-old boy was referred to the Emergency Room (ER) after experiencing penetrating trauma to his right scrotum caused by the iron of the bicycle seat. There were no urinary complains and the vital signs were good. Scrotal exploration was performed to repair the testicular trauma.

Intrascrotal Incision: An Alternative Technique for the Management of Inguinoscrotal Pathologies, Experience from 76 Cases

Abstract Introduction The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies. Materials and Methods A total of 76 male patients, between 2 and 16 years, underwent surgical treatment through a mid raphe intrascrotal incision, for a wide range of inguinoscrotal diseases, including torsion of the spermatic cord, torsion of the testicular appendages, non-communicating hydrocele, communicating hydrocele, ectopic testis, retractile testicles, palpable undescended testis, testicular trauma and testicular prosthesis placement. Results All the patients had an uneventful postoperative recovery, with none mentioned complication, and none of them required convention to the traditional inguinal method. The follow-up examination ranged from 6 months to 3 years, with no surgical complication highlighted. Conclusions We recommend that the intrascrotal incision through the mid raphe may be considered as an alternative technique to inguinoscrotal pathologies, instead of other approaches. The ability to treat a variety of pathologies regarding both two hemi-scrotums and the inguinal region at the same time, the provision of adequate surgical site, while succeeding much less dissection and disruption of tissue, the excellent cosmetic result, the greater comfort for the ‘day-case’ child, the ability to use the scrotal septum in order to fix the testis in the scrotum and the avoidance of an extra incision are the main advantages of the intrascrotal incision.

Clinicopathological Study of Testicular Lesions in a Tertiary Care Centre of Dakshina Kannada, India

Introduction: Testicular biopsies are performed for both diagnostic and therapeutic purposes. Diagnostic testicular biopsies are usually performed as a part of a male infertility work-up. Therapeutic testicular excision biopsies are performed for a wide range of disorders, including neoplastic lesions, inflammatory lesions, cryptorchidism, testicular trauma, and as a part of prophylactic treatment of carcinoma prostate. Aim: To evaluate the indications for orchidectomy and diagnostic testicular biopsies and to understand the histopathological spectrum of testicular lesions and concordance with clinical diagnosis. Materials and Methods: This was a retrospective study conducted in the Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India. The study period is from July 2017 to June 2020. Data was collected and analysed in August 2020. All testis’ biopsies, including excision and diagnostic biopsies, are included in the study. Histopathological findings and the clinical diagnosis were evaluated for concordance. Data were tabulated and statistically evaluated for age distribution, laterality, and frequency using Microsoft Excel 2021. Percentages for the variables and concordance rate were calculated. Results: A total of 139 cases (mean age 54.5 years) were included in the study. Prophylactic orchidectomy for carcinoma prostate (64/139=46.04%) was the most common clinical indication. Non neoplastic lesions account for 48.20% (67/139). Frequent non neoplastic lesions are testicular torsion (23/139=16.55%) and abscess (12/139=8.63%), followed by cryptorchidism (9/139=6.47%). Left-sided lesions are more frequent than right-sided lesions. Histopathology confirmed two cases of suspected male infertility and Androgen Insensitivity Syndrome (AIS). Neoplastic lesion accounts to 6.47% (9/139). Frequent neoplasm in the study was seminoma (3/139=2.16%), followed by lymphoma (2/139=1.44%). Other neoplasms included in the study were mixed germ cell tumours, post-pubertal teratoma, and spermatocytic tumour. Testicular tuberculosis accounts to 1.44% (2/139) in the present population. Conclusion: Non neoplastic lesions were common compared to testicular neoplasms. Testicular torsion, followed by abscess, was the most common indication for orchidectomy. Testicular Tuberculosis can mimic a neoplasm on clinical and radiological work-up. Hence, careful evaluation has to be performed in young suspected cases of tuberculosis.

ODP401 A new FGFR1 mutation causing Idiopathic Hypogonadotropic Hypogonadism and Polydactyly

Abstract Introduction Congenital idiopathic hypogonadotropic hypogonadism (IHH) is a heterogeneous condition with unknown genetic basis in approximately 30% of patients. We describe a case with normosmic IHH and an unreported FGFR1 mutation. Case Report A 23-year-old hispanic man, with a history of polydactyly presented to our clinic for evaluation of delayed puberty. He had no facial hair and minimal pubic and axillary hair. He reported fatigue, low libido and scant ejaculation. He denied anosmia, eating disorders, learning disability, urological malformations, obesity, galactorrhea, testicular trauma, mumps, or use of androgenic steroids. Family history was significant for polydactyly in his mother. Physical exam findings showed normal vitals, height 185 cm, BMI 24 kg/m2, eunuchoid body habitus, bilateral gynecomastia, no facial hair, scant axillary and pubic hair, prepubertal 2 ml testicles within the scrotum and a micro-penis. Serum total testosterone was 7 ng/dl (250-1100 ng/dl), free testosterone 0.9 pg/ml (9.3-26.5 pg/ml), FSH 2.2 mIU/ml (1.6-8. 0 mIU/ml), LH 0.8 mIU/ml (1.5-9.3 mIU/ml), Prolactin 4.1 ng/ml (4-15.2 ng/ml), TSH 1.68 mIU/ml (0.4-5.5 mIU/ml), free t4 1.2 ng/dl (0.8-1.7 ng/dl), growth hormone 0.3 ng/ml (0. 0-10 ng/ml), IGF-1 175 ng/ml (155-432 ng/ml), ACTH 14.6 pg/ml (7.2-63 pg/ml), cortisol (not am) 3. 0 ug/dl (6.2-19.4 ug/dl). Pituitary MRI revealed no focal sellar/suprasellar lesions with normal enhancement of the pituitary gland . DXA scan showed a low bone density for his age with Z-scores below -2. 0 in all regions. Chromosome analysis revealed a normal male 46, XY karyotype. Genetic testing of both patient and mother, using Invitae test kit, revealed an heterozygous mutation in FGFR1 gene, exon 9, variant c.1231C&amp;gt;A (p. Gln411Lys), not described in medical literature. A diagnosis of normosmic idiopathic hypogonadotropic hypogonadism (nIHH) was made. Testosterone cypionate IM 100 mg once weekly was initiated and after 6 months he experienced improvement in energy, libido, muscle mass, facial and body hair, and virilization of his voice. Conclusions The heterogeneity in phenotypic presentation of IHH makes its diagnosis a challenge. Furthermore, the genetic basis for these multiple phenotypes are still not fully described. We report a new FGFR1 mutation causing hypogonadism. Reference: Ferreira Gontijo, L., Latronico, A. Approach to the Patient With Hypogonadotropic Hypogonadism. JES, Vol. 98, Issue 5, 1 May 2013, P. 1781–1788. Presentation: No date and time listed

ODP113 Presentation of two similar Klinefelter Syndrome cases with different clinical outcomes

Abstract Case 1 74-year-old Caucasian male with dysphagia, s/p laryngeal carcinoma, partial laryngectomy and past radiotherapy, was referred for breast enlargement with some increase over the last few years. He denied tenderness or breast discharge, but reported bilateral testicular atrophy, which he attributed to agent orange red exposure. Although married for 53 years, he did not have biological children. He had decreased libido, and denied testicular trauma, urinary symptoms, or history of infections, opiate, steroids abuse, or OTC herbal supplements. Pituitary MRI for head injury was normal. Physical exam-HT= 180.3 cm; 172 cm arm span, bilateral testicular atrophy. Laboratory findings: [PO4= 3.2mg/dL (2.5-4.9); Calcium=9.2 mg/dl(8.5-10.1);Magnesium =2.1 mg/dl(1.7-2.4); Vit D,25 OH=52.9 ng/mL (30–100); PTH =54.9 pg/ml (18.4-80.1),;FSH =41.7 mIU/mL(0 .7-10.8); LH=27.5 mIU/mL (1.2-10.6);Prolactin=4.5 ng/mL(2.5 -7.4); total Testosterone 81 ng/dL (250–1100); free testosterone 4.5pg/mL (30. 0-135. 0); Sex HBG 63 nmol/L (10–57); Estradiol &amp;lt;11.80 pg/mL(&amp;lt;11-39.8); Tumor marker BHCG &amp;lt;2mIU/mL (&amp;lt;5 mIU/ml; Cortisol, am=15.5 ug/dl (5.3-22.5);PSA=.260 ng/mL (0. 0- 4. 0)]. Karyotype analysis=47, XXY [15]/46, XX[5]. With supernumerary X chromosome, consistent with KS. DXA= osteopenia in AP spine and severe osteoporosis in other areas: femur neck left T-Score of -3.1. Right femur neck T-Score=-3. 0, total left femur T-Score= -2.9, right total femur T-Score of -2.9, left forearm radius 33% T-Score=-2.8. Mammogram: mild bilateral gynecomastia, L&amp;gt;R, Testosterone supplementation and intravenous zoledronic acid therapy were started. Case 2 74-year-old Caucasian male referred for low energy, generalized weakness, decreased libido and gynecomastia, long thin arms/legs and "difficulty building muscle". He was taking OTC "testosterone enhancers" herbals only. He reported no biological children. Physical exam: height 187.3 cm, with sparse body hair, absent facial hair, gynecomastia, small testes. Laboratory: [total testosterone=40 ng/dl; free testosterone=5.2 pg/ml; SHBG=40 nmol/L;LH=16.1 mIU/ml; FSH=31.8 mIU/ml; Prolactin=4.3 ng/ml; BHCG &amp;lt;3 mIU/ml; Estradiol=33.60 pg/m] Karyotype: mosaic KS 47, XXY[16]/46,XY[4] with additional X chromosome in 16/20 metaphase cells. DXA =normal bone density. Clinical symptoms and testosterone levels improved after starting testosterone supplementation. Discussion Hypogonadism is an important cause of male osteoporosis. Testosterone is known to regulate male bone metabolism both indirectly by aromatization to estrogens and directly through the androgen receptor on osteoblasts, promoting periosteal bone formation during puberty and reducing bone resorption during adult life. Early onset testosterone deficiency, as in KS, is an important risk factor for osteoporosis, although it is seen in only 40% of patients. Aromatization of testosterone into estradiol from adiposity, may also contribute to normal BMD in some patients. Therefore, it is important to recognize that osteoporosis is not always present in all Klinefelter's patients, even without testosterone therapy and that various phenotypes may account for discrepant conditions, as in these cases. Presentation: No date and time listed

The effect of testicular trauma on male infertility

We aim to evaluate the effect of testicular trauma on male reproductive outcomes. The electronic medical record was retrospectively searched using diagnosis codes for testicular trauma and procedure codes for testicular trauma repairs, at Los Angeles County and Parkland Hospitals, for males aged 18–55 years. Charts were reviewed for trauma details, reproductive hormones, and semen analyses. Men were contacted by phone for a fertility and sexual performance survey. Fifty-six patients were identified as having testicular trauma. Twelve were reached by telephone, of which 33.3% had blunt and 66.7% had penetrating traumas. The mean duration since trauma was 41 months. One quarter reported new-onset erectile dysfunction post-trauma, 16.7% endorsed new-onset dysuria, 8.3% endorsed long-term testicular pain. Only two males (16.7%) attempted paternity post-trauma, both with primary infertility. One patient (8.3%) was attempting paternity post-trauma and experiencing primary infertility for 42 months. Two patients (16.7%) had undergone semen analysis testing, both patient-reported as ‘normal’. None of the 12 patients we reached were under the care of a urologist. Both short and long-term urologic follow-up is crucial for testicular trauma patients. Despite some experiencing lasting consequences, none of these men were under the care of a urologist.