Unilateral Cryptorchid Testes Research Articles

The Inhibin-B Level at Orchidopexy and Follow-up of 280 Boys With Non-syndromic Unilateral Cryptorchid Testes

PurposeAn impaired germ cell number per tubular cross-section (G/T) at orchidopexy indicates a high risk of infertility. A recent study in boys with bilateral cryptorchidism showed a very high predictive value for a low serum inhibin-B level, indicating bilateral impaired G/T. Several other studies have shown a fairly strong correlation between inhibin-B and G/T. We aimed to evaluate if inhibin-B levels at orchidopexy improved at follow-up in boys with unilateral cryptorchidism. MethodsWe included 280 boys with unilateral non-syndromic cryptorchidism at the median age of 1 year (4 months-9 years) who underwent orchidopexy. They were evaluated for serum FSH, LH and inhibin-B levels at surgery and at follow-up (median 16 months later), including multiple of the median (MoM) estimations of inhibin-B due to the age dependency of normal levels. ResultsThe inhibin-B MoM score improved significantly at follow-up. At orchidopexy, 59 (21%) boys had inhibin-B levels below the normal 2.5-percentile indicating impaired G/T bilaterally. At follow-up, 36% of the boys still had low inhibin-B. At orchidopexy, 221 (79%) boys had inhibin-B levels above normal 2.5-percentile and only 5% had low inhibin-B levels at follow-up. The risk of low inhibin-B levels at follow-up was significantly different between the two groups (p < 0.0001). At follow-up, totally, 32 (11%) boys had low inhibin-B levels, hereof only 3 patients with increased FSH. ConclusionsOrchidopexy benefits the fertility potential. About 10% of boys with unilateral non-syndromic cryptorchidism may have a bilateral testicular disease reducing their fertility potential. Insufficient gonadotropin stimulation may possibly be the cause.

Analysis of trends in testicular atrophy index values with age in patients with unilateral palpable cryptorchidism.

Cryptorchidism affects the growth of testicular volume. Testicular volume is associated with reproductive function. The testicular atrophy index evaluates the degree of damage caused by cryptorchidism, but it remains unclear whether changes in testicular atrophy index are related to age. We selected patients who underwent surgery for unilateral palpable cryptorchidism. Testicular volume was measured using ultrasonography. The testicular atrophy indices of the undescended testes were then reviewed, and their correlation with age was analyzed. We studied 228 cases (age range: 6–53 months). Scatter plots were constructed, and Loess curves were fitted, revealing a turning point at 24 months of age. The patients were divided into age groups of 6–24 months and 25–53 months. The testicular volume of the cryptorchid side was smaller than that of the normal side in both groups (both P < 0.001). In the 6–24-month group, the testicular atrophy index was positively correlated with age, testicular volume on the cryptorchid side was not correlated with age, and testicular volume was positively correlated with age on the normal side. In the 25–53-month group, testicular atrophy index and testicular volumes on either side were not correlated with age. A palpable unilateral cryptorchid testis is smaller than the contralateral testis. The testicular atrophy index increases with age between 6 months and 24 months, but not between 25 months and 53 months. Testicular volume increased with age on the normal side between 6 months and 24 months, but not on the cryptorchid side. Trends in testicular atrophy index with age contribute to the decision of operation time.

Removal of equine cryptorchid testes through an enlarged umbilical portal in dorsally recumbent horses after intra-abdominal laparoscopic castration.

Laparoscopic removal of cryptorchid testes has been routinely reported through enlarged parainguinal incisions in dorsally recumbent horses. Outcomes following removal through an extended umbilical incision have not been previously reported. To describe the surgical technique of removing cryptorchid testes in dorsally recumbent horses through an enlarged umbilical portal after laparoscopic intra-abdominal castration. Retrospective case series. Medical records were reviewed for horses that underwent laparoscopic removal of unilateral or bilateral cryptorchid testes from January 2006 to December 2016. Horses were placed under general anaesthesia, positioned in dorsal recumbency and then tilted into Trendelenburg position. Cryptorchid testes were castrated by ligating loop application and/or electrosurgery. The umbilical portal incision was extended along the linea alba for testes removal. All descended testes were removed by routine closed castration with the scrotal incision left to heal by second intention. Perianaesthetic laboratory values, surgical procedure descriptions, surgery and anaesthesia times, and in-hospital perioperative complications were recorded. A total of 79 horses, aged 1-14years, with unilateral or bilateral cryptorchidism were included: 90 cryptorchid testes were successfully removed through an enlarged umbilical portal incision. Sixty-eight horses were unilaterally cryptorchid and 11 were bilaterally cryptorchid. Two horses had minor post-operative complications related to the extended umbilical portal incision. Retrospective nature of the study, no control population for comparison and no follow-up after hospital discharge. An extended umbilical portal incision is a successful alternative to extending a parainguinal incision for testis removal after laparoscopic castration.

Antioxidant Enzymes Expression of the Impaired Contralateral Testes in Unilaterally Cryptorchid Rats.

In this study, explored the pathologic mechanism of the contralateral testes impairment in unilaterally cryptorchid rats by investigating the gene expression level. Thirty male Sprague-Dawley rats were randomly and evenly divided into two groups: cryptorchid group and control group. Cryptorchidism was induced by surgical relocation. RT-PCR was then applied to examine the mRNA expression level of antioxidant enzymes in descended testes, including glutathione peroxidase (GSH-PX), copper/zinc-superoxide dismutase (Cu/Zn-SOD), and catalase (CAT). The concentration of malondialdehyde (MDA) was determined by spectrophotometry. In addition, germ-cell apoptosis was detected by a terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. Two weeks after the operation, the mRNA expression levels of GSH-PX and Cu/Zn-SOD in the cryptorchid group were significantly downregulated; the expression of MDA, as well as the number of apoptotic germ cells, significantly increased compared to the control group (p < 0.01). The mRNA expression of CAT did not show significant changes (p > 0.05). GSH-PX and SOD were downregulated in the testis contralateral to the undescended testis, leading to the accumulation of reactive oxygen species and germ-cell apoptosis. Our results may provide molecular explanations for the impairment of the descended testis in unilateral cryptorchidism.

Reductions in calcitonin gene-related peptide may be associated with the impairment of the contralateral testis in unilateral cryptorchidism.

The aim of the present study was to investigate the mechanism underlying the impairment of the contralateral testis in unilateral cryptorchidism in experimental rats using a molecular neurophysiological approach. Thirty-six male rats (21 days old) were divided into a cryptorchidism group, a cryptorchidism with division of the genitofemoral nerve (GFN) group and a control group (n=12/group). The distribution of the calcitonin gene-related peptide (CGRP) immunoreactive nerve fibers in the testes was studied using an immunohistochemistry technique. Germ cell apoptosis was detected using the terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling method. The concentration of malondialdehyde (MDA) in the testis tissue was evaluated using a spectrophotometric determination method, and the ultrastructure of Sertoli cells was observed using transmission electron microscopy. It was found that, 100 days after the surgery, the concentration of CGRP in the cryptorchidism group was decreased significantly, whereas the levels of MDA and the number of apoptotic germ cells were increased significantly compared with the control group (P<0.01). Following the division of the GFN, the damaging effects were decreased (P<0.01). The impairment mechanism may therefore be associated with a reduction in the level of CGRP in the contralateral testis. The reflex decrease in CGRP may be caused by germ cell apoptosis, decreased blood flow and oxygen levels, and the increase in reactive oxygen free radicals and lipid peroxidation.

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age.

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood.Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism.Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment.Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH.Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or age of initial treatment exerts no definite effect on testicular volume improvement or hormonal levels at 18 years of age.

An Unusual Case of Cryptorchid Testis Coexisting with Inguinal Hernia in an 84 year Old Man

Background: Inguinal hernia is not an uncommon finding in the elderly but its occurrence in association with a cryptorchid/undescended testis (UDT) in this age group is a rarity. We present the clinical, operative and histopathological characteristics of an elderly man with bilateral indirect inguinal hernia with associated unilateral cryptorchid testis. Presentation: An 84 yr old man presented with a reducible right groin swelling noticed since birth and a 6 month history of a similar swelling in the left groin. He had also noticed absence of the right testis in the scrotum since birth but never sought medical attention. He however recently noticed a dull painful sensation in the right groin which started a week before presentation.

Cryptorchidism

Cryptorchidism remains a major cause of male infertility and can be associated with germ cell tumors. Recent reports regarding cause, diagnosis, treatment and outcome of this disorder continue to inform our understanding of this common and important problem. The frequency of the problem makes cryptorchidism an area where diagnostic knowledge is particularly important for healthcare professionals. The literature reviewed in this article approach cryptorchidism from multiple aspects. Reports regarding cause include studies of molecular genetics, endocrine chemical disruptors, the association with galactosemia, the association with low birth weight, and for acquired cryptorchidism, the relationship to infant feeding. In regard to treatment, the benefit of surgical repair at 9 months of age and compliance with recommendations is demonstrated. Further reports continue to document the cryptorchidism's negative impact on fertility, the higher risk of future gonadal malignancy and the lack of function of the unrepaired unilateral cryptorchid testis in adulthood. Management considerations such as the benefit of testicular biopsy at orchiopexy are also reviewed. It was concluded from an analysis of data from the Danish national registry that this can be a valid research tool for future evaluation of the outcome after cryptorchidism. Early recognition and surgery, before 1 year of age, remain the most important interventions to reduce the negative impact of both unilateral and bilateral cryptorchidism. Further research is needed to better understand causes of cryptorchidism and the mechanisms by which it exerts its negative effects and to clarify outcome factors to direct the best clinical management of cryptorchidism.

Comparison of Peritoneal Fluid Values after Laparoscopic Cryptorchidectomy using a Vessel‐Sealing Device (Ligasure™) Versus a Ligating Loop and Removal of the Descended Testis

To determine the effect of unilateral laparoscopic cryptorchidectomy and removal of the descended testis on peritoneal fluid values, and to compare effect between 2 methods for cryptorchid testis vessel hemostasis. Randomized clinical study. Stallions (n = 10) with unilateral abdominal cryptorchid testis. During standing laparoscopic cryptorchidectomy, blood vessels within the mesorchium of the cryptorchid testis were either sealed and transected with the LigaSure Atlas™ or 2 ligating loops were placed proximal to the testis and the tissue transected with laparoscopic scissors. The testis was removed through the body wall. After laparoscopic cryptorchidectomy, stallions were anesthetized and the descended testis was removed using a closed technique leaving the scrotal incision open. Abdominocenteses were performed before surgery, and 24, and 72 hours after surgery. Values for peritoneal total nucleated cell count (TNCC), total protein concentration (TP), and red blood cell count (RBCC) were all elevated at 24 and 72 hours when compared with baseline. Median TNCC for LigaSure™ (59,780 cells/μL) was nearly twice that of the ligating loop (32,880 cells/μL) at 24 hours postoperatively. There was no statistically significant difference in TNCC, TP, or RBCC between groups. TNCC, TP, and RBCC increase appreciably from baseline 24 hours after laparoscopic cryptorchidectomy and closed castration but are markedly reduced by 72 hours.

Histological Examination of Solitary Contralateral Descended Testis in Congenital Absence of Testis

Congenital absence of the testis is believed to be secondary to prenatal torsion, differing from the isolated undescended testis. We determined whether congenital absence of the testis is associated with abnormal histology in the solitary contralateral descended testis. A total of 239 boys with a primary diagnosis of unilateral absent testis underwent orchiectomy and testis biopsy. Germ cell counts were compared between solitary contralateral descended testes and contralateral descended testes in a randomly selected, age matched cohort of patients with unilateral undescended testes. Subanalyses evaluating hypertrophic testes and hypertrophic prepubertal testes between the study groups were performed. The solitary contralateral descended testis group exhibited a significantly greater volume (p <0.001) and a significantly greater germ cell count (p = 0.001). In the hypertrophied testes there was a greater gonocyte count (p = 0.02), greater percentage of gonocytes (p = 0.02), greater primary spermatocyte count (p = 0.04) and greater percentage of primary spermatocytes (p = 0.03). No significant differences in adult dark spermatogonia or Leydig cells were detected. Primary spermatocytes did not differ significantly in prepubertal patients. The solitary contralateral descended testis exhibits increased volume, increased germ cell proliferation and dissimilar maturation patterns compared to the contralateral descended testis in unilateral cryptorchidism. These findings support prenatal torsion rather than endocrinopathy as the etiology for the congenitally absent testis. In the postpubertal solitary contralateral descended testis more germ cell maturation is seen and primary spermatocytes account for the increased total germ cell count. Patients with a solitary testis are likely not at additional risk for infertility.

A Rotterdam controversy: the aetiology of the cryptorchid hypothalamo‐pituitary‐testicular axis

Dear Sir, In their contribution, Pierik et al. (2008) found in 43 cryptorchid infants studied, testosterone and free-androgens deficiency indicating a disturbance of testicular function that was already evident early after birth. Twenty years earlier one of the co-authors in this paper analysed 48 cryptorchid infants and came to different conclusion that “during the first year of life boys with cryptorchidism have no functional insufficiency of hypothalamus-pituitary-testis axis (HPG) or disorders in testosterone biosynthesis” (De Muinck Keizer-Schrama et al., 1988). Surprisingly, no annotation regarding this controversy was made in their paper. We would question what has changed in the past 20 years that led them to this observation of Leydig cell dysfunction. Is the ethnic heterogeneity of cryptorchid boys responsible for the observation of the hypothalamo-pituitary-testicular axis insufficiency found in Turkish population? Or, could severity or bilaterality of cryptorchidism, which was not known for the majority of cases studied, be an explanation for the lower LH and FSH levels? During last 35 years it has been histology that contributed most in helping us to understand the aetiology of cryptorchidism. In 1975 we described pronounced Leydig cell atrophy starting in early infancy as the evidence to support the endocrinopathy as an etiologic factor of cryptorchidism (Hadziselimovic et al., 1975). Development of Ad spermatogonia from gonocytes, which takes place during first months of life, has been shown to be testosterone dependent and is disturbed in the majority of cryptorchid boys (Hadziselimovic et al., 2005; Zivkovic et al., 2007). Analysis of the contralateral descended testis in unilateral cryptorchidism demonstrated that cryptorchidism is a bilateral disease (Hadziselimovic et al., 2005; Zivkovic et al., 2007; Huff et al., 2001). Therefore, an examination of histology at the time of orchidopexy could help authors to better understand hypogonadotropic hypogonadism and explain the different ethnical observations.

Activation of NF-κB Associated With Germ Cell Apoptosis in Testes of Experimentally Induced Cryptorchid Rat Model

To evaluate the behavior of NF-kappaB in the cryptorchid testes, we investigated the testes of an experimentally induced cryptorchid rat model. Cryptorchid testes exhibit degenerative changes in the germinal epithelium with germ cell apoptosis, which results in future infertility. However, the mechanisms of apoptosis in the germ cells are multifactorial and have not been completely elucidated. NF-kappaB is a transcription factor considered to play an important role in the apoptosis of various cells. The cryptorchid rat model was generated by the administration of an antiandrogenic agent during the fetal period. The unilateral cryptorchid testes and contralateral descended testes were removed at 7-10 weeks after birth, and histopathologic examination and Western blot analysis were performed. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) staining, and the expression of NF-kappaB and IkappaB proteins was investigated using immunohistochemistry. In the present model, spermatogenesis was arrested at the spermatid differentiation stage, and elongated spermatids or spermatozoa were not detected. Apoptosis was noted predominantly in the primary spermatocytes, and Sertoli cells and Leydig cells did not undergo apoptosis. On immunohistochemistry, NF-kappaB signals were increased and focused on the nucleus of the germ cells in the cryptorchid testes, consistent with TUNEL-positive cells. On Western blot analysis, the NF-kappaB and IkappaB proteins were detected more intensely in the cryptorchid testes. The activation of NF-kappaB was associated with germ cell apoptosis in experimentally induced cryptorchid testes, suggesting that NF-kappaB has certain roles in germ cell apoptosis. The results of the present study may guide toward new therapeutic possibilities for the impairment of spermatogenesis in patients with cryptorchidism.

Is the prohibition of hormonal treatment for cryptorchidism, as suggested by the Nordic consensus group, justifiable?

Recently, the Nordic consensus on the treatment of undescended testis prohibited the use of hormones because of possible long-term adverse effects on spermatogenesis (1). This conclusion was based on articles published by groups from Finland and Denmark analyzing testicular histology and apoptosis of the germ cells (1). Even if human chorionic gonadotropin (HCG) treatment induces increased apoptosis of the germ cells, it is still irrelevant for subsequent fertility outcome. The follow-up spermiogram performed in these patients showed no significant difference in fertility outcome between the treated and untreated groups. The second reason was the observation of decreased numbers of germ cells in cryptorchid boys aged 1–3 years who were previously unsuccessfully treated with HCG in comparison to the untreated group (1). These results, although statistically significant, are again irrelevant for the fertility outcome because the germ cell count in both groups was below 0.2 germ cells per tubular cross-section. If the germ cell count is <0.2, the majority of patients will develop infertility irrespective of whether they had only surgery or hormonal pretreatment in addition to orchidopexy. Abnormal contralateral testis is ideal for evaluating the effect of hormonal treatment because there is no effect from abnormal position and increased temperature to interfere with the results. In contrast to the concerns raised by the Nordic consensus group, the results of our recent study showed that hormonal treatment for undescended testis improved the histopathology of the contralateral testis without harming the germ cells (2). Furthermore, neoadjuvant gonadotropin relasing hormone (GNRH) treatment was found to improve the fertility index in prepubertal cryptorchidism (3). Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life (3). We entirely agree with the Nordic consensus group that infertility is the primary concern for the treatment of boys with unilateral or bilateral undescended testes. This especially because analysis of contralateral descended testis in unilateral cryptorchidism demonstrated that cryptorchidism is a bilateral disease, and infertility in cryptorchidism is endocrinopathy of mini-puberty (4,5). It is important to realize that male fertility potential depends on the presence of Ad spermatogonia (5–7). Development of Ad spermatogonia from gonocytes, which takes place during first months of life, was shown to be testosterone dependent (8). However, early and seemingly successful orchidopexy does not improve fertility in a substantial number of cryptorchid males because it does not address the underlying pathophysiology of cryptorchidism, namely, the impaired transformation of gonocytes into Ad spermatogonia (6,7). Furthermore, successfully surgically treated patients at risk for infertility after 6 months of luteinizing hormonerelasing hormone analogue (LH-RHa) treatment had a lasting increase in the number of germ cells in their cryptorchid testis (9). The efficacy of the LH-RHa treatment was the best in boys younger than 7 years (9,10). Treatment with LH-RHa normalized sperm concentration in 86% of unilateral cryptorchid males, who were in the high-risk group for developing infertility (Fig. 1). All males in the untreated group (surgery only) were severely oligospermic, with 20% being azoospermic (10). This profoundly changes our current concept of cryptorchidism treatment. For the first time, it is possible to demonstrate that infertility caused by cryptorchidism, which is believed to be a congenital malformation, can be successfully corrected if adequately treated. During the last 35 years, histological studies have contributed the most to our understanding of the aetiology of cryptorchidism. Only the comparison of histology and hormonal levels exemplify hypogonadotropic hypogonadism in the majority of cryptorchid boys. Why the Nordic consensus group did not take the histopathologic findings into consideration remains unclear. Nonetheless, their recommendation as to when a testicular biopsy should be obtained is passe. A testicular biopsy is the only sure way of identifying those cryptorchid boys who need to be treated hormonally with LH-RHa following successful surgery;

Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis

To determine the optimal timing for orchiopexy, we evaluated the histological parameters of the cryptorchid testis. We prospectively performed testicular biopsy in a total of 65 consecutive children with palpable unilateral inguinal cryptorchid testes. For controls, we used testicular histological slides from 15 age-matched children with testicular tumor. To investigate the fertility potential, we analyzed the parameters including mean tubular diameter (MTD), mean tubular fertility index (MTFI), germ cell count/tubule (GCC), Sertoli cell index (SCI) and interstitial fibrosis index (IFI). The MTFI and GCC in children < or =1 years of age were significantly higher than those of other older age groups. The MTFI, GCC and IFI were significantly better in patients < or =2 years of age when compared to those of > 2 years. Compared to the controls, the MTFI and GCC in the patients were significantly worse in those aged > 2 years at surgical repair. In the < or =2-year age group, the MTFI and GCC of the cryptorchid testis showed a decreasing tendency with age, which were contrasting with the ascending curves in the control and the curves crossed at 1-2 years of age in each parameter. To protect fertility potential, we recommend, orchiopexy should be performed within the first year of life, and no later than 2 years of age in patients with palpable inguinal cryptorchid testes.

Testicular Superoxide Dismutase Activity, Heat Shock Protein 70 Concentration and Blood Plasma Inhibin-.ALPHA. Concentration of Dogs with a Sertoli Cell Tumor in a Unilateral Cryptorchid Testis

The proportions of Sertoli cell tumor (SCT), seminoma and Leydig cell tumor in 50 dogs with unilateral testicular tumors were 52%, 36% and 12%, respectively. The rate of occurrence of SCT in the cryptorchid testis was very high (71%). The testicular superoxide dismutase (SOD) activity, testicular heat shock protein (HSP) 70 concentration and peripheral blood plasma inhibin (INH)-alpha concentration of 10 dogs with a unilateral cryptorchid testis and no testicular tumors, 10 dogs with SCT in a unilateral cryptorchid testis and 10 normal dogs, all aged 5-15 years, were measured in order to identify high risk factors for the occurrence of SCT in the canine cryptorchid testis. The mean SOD activity in cryptorchid testes and SCTs was significantly lower and higher, respectively, than in normal testes (both P<0.01). The mean HSP 70 concentration in both cryptorchid testes and SCTs was significantly higher than in normal testes (both P<0.01). The mean plasma INH-alpha concentration of the cryptorchid and SCT dogs was significantly lower and higher, respectively, than in normal dogs (P<0.05 and 0.01, respectively). The low SOD activity in the cryptorchid testis, low blood plasma INH-alpha concentration of the cryptorchid dogs and high HSP 70 concentration in the SCTs may be related to the occurrence of SCT and tumor cell proliferation in canine cryptorchid testes.

Effects of hormonal treatment on the contralateral descended testis in unilateral cryptorchidism

Objective One of the therapeutic options in the treatment of cryptorchidism is hormonal therapy with luteinizing hormone releasing hormone (LHRH) and/or human chorionic gonadotropin (HCG); concerns have, however, been raised regarding its safety. The purpose of this study was to demonstrate that hormonal therapy improves the abnormal histology of the contralateral descended testis without harming the germ cells. Method Patients with unilateral cryptorchidism were randomized into two groups: those treated with orchiopexy alone and those treated with LHRH long acting analog and HCG. Biopsies taken from contralateral descended testes were analyzed and compared with controls. Results The number of germ cells per tubule in contralateral testes of patients treated with orchiopexy alone is significantly lower than the number of germ cells in testes of patients with spontaneously descended testes ( P < 0.0001). Hormonal therapy did not have any adverse effect upon the histology of the contralateral testis, but in fact improved it. Seven weeks of hormonal therapy induced a rise in the number of germ cells per tubule ( P < 0.05). It was also beneficial for the number of adult dark spermatogonia per tubule and the number of primary spermatocytes, although these differences did not reach statistical significance. Conclusion The contralateral testis in patients with unilateral cryptorchidism is abnormal. Hormonal therapy improves the histopathology of the contralateral testis without harming the germ cells.

MAGNETIC RESONANCE ANGIOGRAPHY FOR THE NONPALPABLE TESTIS: A COST AND CANCER RISK ANALYSIS

For the unilateral nonpalpable testis standard management is open surgical or laparoscopic exploration. An ideal imaging technique would reliably identify testicular nubbins and safely allow children to forgo surgical exploration without compromising future health or fertility. Our goal was to perform a cost and risk analysis of magnetic resonance angiography (MRA) for unilateral nonpalpable cryptorchid testes. A search of the English medical literature revealed 3 studies addressing the usefulness of MRA for the nonpalpable testicle. We performed a meta-analysis and applied the results to a hypothetical set of patients using historical testicular localization data. Analysis was then performed using 3 different management protocols-MRA with removal of testicular nubbin tissue, MRA with observation of testicular nubbin tissue and diagnostic laparoscopy. A cancer risk and cost analysis was then performed. MRA with observation of testicular nubbin tissue results in 29% of patients avoiding surgery without any increased cost of care. Among the 29% of boys with testicular nubbins left in situ and observed the highest estimated risk was 1 in 300 of cancer developing, and 1 in 5,300 of dying of cancer. A protocol using MRA with observation of inguinal nubbins results in nearly a third of boys avoiding surgical intervention at a similar cost to standard care without any significant increased risk of development of testis cancer.

Expression of Hsp70-2 in unilateral cryptorchid testis of rhesus monkey during germ cell apoptosis.

We investigated the possible role of Hsp70-2 in germ cell apoptosis induced by heat stress in monkey unilateral cryptorchid testis. The study focused on in situ analysis of the testicular cell DNA fragmentation and on the possible relationship between Hsp70-2 expression and germ cell apoptosis. The TUNEL result showed that most of the germ cells were labeled in the cryptorchid testis on d 5 after induction of cryptorchidism; that with most of the apoptotic germ cells depleted, only a few germ cells were labeled on d 10; and that almost no apoptotic signal was observed in the cryptorchid testis on d 15 and thereafter. This indicates that the increasing germ cell degeneration in cryptorchid testis may take the form of apoptosis. Using in situ hybridization, immunohistochemistry, and Northern blot, we examined the changes of Hsp70-2 expression in the monkey cryptorchid testis. The level of Hsp70-2 mRNA decreased slightly, while the expression of HSP70-2 protein was almost unchanged at the early stage of germ cell apoptosis in the cryptorchid testis on d 5 and dropped dramatically along with the loss of apoptotic germ cells in the cryptorchid testis on d 10 after operation. It is therefore suggested that Hsp70-2 might not take part in inhibiting the apoptosis of germ cells at the early stage during operation-induced cryptorchid testis, and that Hsp70-2 gene does not belong to the immediate early related gene responsible for germ cell apoptosis induced by heat stress.

Expression of HSP70-2 gene during germ cell apoptosis in rat unilateral cryptorchid testes.

To investigate the role of Hsp70-2 gene in germ cell apoptosis induced by heat stress, its expression changes were examined in rat normal and unilateral cryptorchid testes by using in situ hybridization, immunohistochemistry, and northern blot analysis techniques. The results showed that the expression level of Hsp70-2 gene declined slightly at the early stage of germ cell apoptosis, and dropped dramatically when most of the germ cells were undergoing apoptosis on day 7.5 after the induction of cryptorchidism. This report suggests for the first time that Hsp70-2 gene might not inhibit the apoptosis of germ cells at the early stage in cryptorchid testes. Hsp70-2 gene does not belong to the immediate early related genes that are responsible for germ cell apoptosis induced by heat stress.

Apoptosis In Experimental Unilateral Abdominal Cryptorchid Testis In Rat

It has been reported that cryptorchidism caused disruption of spermatogenesis that become extensive with time (1). The process of spermatogenesis undergoes spontaneous degeneration in rats, the spermatids degenerate, the primary spermatocytes have been reported to degenerate more commonly (2). Apoptosis has been considered the route for removing sensitive germ cells after short-term experimental cryptorchidism (3). The abdominal heat stress causes cell loss by apoptotic pathway (4). The cellular damage of the experimentally induced cryptorchid adult rat is regulated by local testicular factors in pachytene spermatocyte (5). In this preliminary diagnostic study, we examined the role of the effect of the body temperature on the seminiferous tubule cells in surgically induced unilateral cryptorchid testis at various time periods in rats. This study is to document the extent of the cellular damage at various specified time periods of abdominal retention of the testis.