Testis Volume Research Articles

Effect of sikkam (Bischofia javanica Blume) ethanolic extract on the quality and quantity of hyperglycemic rat sperm

Context: Hyperglycemia causes diabetes mellitus (DM), abnormal metabolism, oxidative stress, and chronic complications such as impotence. Hyperglycemia causes testicular atrophy and stromal cell, seminiferous tubular damage, and spermatogenic cells. Bischofia javanica Blume is a plant that is used for the treatment of various chronic conditions and has traditionally by the people of Indonesia as a diabetes medicine. Aims: To determine the effect of B. javanica extract on the increase in the quality and quantity of sperm of hyperglycemic rats. Methods: The treatment groups consisted of; G0: negative control (-), G1: positive control (DM: alloxan induction + standard feed), G2-G4: DM + 300, 600 and 900 mg/kg BW of B. javanica leaves ethanol extract, respectively, and G5: DM + glibenclamide 0.5 mg/kg BW. Rats were dissected, and then the testes were taken to analyze sperm quantity and quality and immunohistochemistry. Results: There was a significant difference (p<0.05) in testes volume, sperm concentration and sperm motility in hyperglycemic rats. The decrease in caspase 3 expression and apoptosis was accompanied by an increase in the dose of the highest B. javanica ethanol extract, and it was seen that testicular histology in groups G4 (900 mg/kg) and G5 (glibenclamide) could improve testicular histology like in the control group (G0). Conclusions: B. javanica can improve the quality and quantity of hyperglycemic rats’ sperm and also reduce apoptosis via caspase 3 in the histology of testis.

Marijuana Is Associated With a Hormonal Imbalance Among Several Habits Related to Male Infertility: A Retrospective Study.

Marijuana is one of the most consumed drugs worldwide. There is increasing evidence of an association between marijuana and male infertility. This study intends to assess the repercussion of marijuana smoking and other habits (sedentary lifestyle, alcohol, and tobacco use) in the testicular function of infertile men seeking andrological evaluation. A retrospective study was performed using medical records data of men aged 18–59 years from 2009 to 2017. Complete semen analyses, sperm functional tests, SHBG, and hormonal levels, testosterone-to-estradiol ratio (T/E2), and testis volume were evaluated. Exclusion criteria included cryptorchidism, infertility caused by genetic or infectious diseases, and cancer. A multiple linear regression analysis was performed to investigate which habit could predict certain parameters using the software SPSS 23.0 (P < 0.05). In a sample of 153 men, semen parameters, testosterone levels, and testis volume were not significantly influenced. Marijuana use had the broader hormonal changes since it influences estradiol (P = 0.000; B = −11.616), prolactin (P = 0.000; B = 3.211), SHBG levels (P = 0.017; B = 7.489), and T/E2 (P = 0.004; B = 14.030). Sedentary lifestyle (P = 0.028; B = 1.279) and tobacco smoking (P = 0.031; B = −2.401) influenced the prolactin levels. Marijuana is associated with hormonal imbalance in this infertile cohort by lowering estradiol levels and inhibiting aromatase function.

Machine learning based prediction models in male reproductive health: Development of a proof-of-concept model for Klinefelter Syndrome in azoospermic patients.

Due to the highly variable clinical phenotype, Klinefelter Syndrome is underdiagnosed. Assessment of supervised machine learning based prediction models for identification of Klinefelter Syndrome among azoospermic patients, and comparison to expert clinical evaluation. Retrospective patient data (karyotype, age, height, weight, testis volume, follicle-stimulating hormone, luteinizing hormone, testosterone, estradiol, prolactin, semen pH and semen volume) collected between January 2005 and June 2019 were retrieved from a patient data bank of a University Centre. Models were trained, validated and benchmarked based on different supervised machine learning algorithms. Models were then tested on an independent, prospectively acquired set of patient data (between July 2019 and July 2020). Benchmarking against physicians was performed in addition. Based on average performance, support vector machines and CatBoost were particularly well-suited models, with 100% sensitivity and >93% specificity on the test dataset. Compared to a group of 18 expert clinicians, the machine learning models had significantly better median sensitivity (100% vs. 87.5%, p=0.0455) and fared comparably with regards to specificity (90% vs. 89.9%, p=0.4795), thereby possibly improving diagnosis rate. A Klinefelter Syndrome Score Calculator based on the prediction models is available on http://klinefelter-score-calculator.uni-muenster.de. Differentiating Klinefelter Syndrome patients from azoospermic patients with normal karyotype (46,XY) is a problem that can be solved with supervised machine learning techniques, improving patient care. Machine learning could improve the diagnostic rate of Klinefelter Syndrome among azoospermic patients, even more for less-experienced physicians.

TESTIS ABNORMALITIES IN A POPULATION OF SOUTH AUSTRALIAN KOALAS (PHASCOLARCTOS CINEREUS).

Testis asymmetry, in which the testes in an individual differ in size, has recently been reported in koalas (Phascolarctos cinereus) in the Mount Lofty Ranges population of South Australia. We describe the morphology and histology of both testes from affected individuals in this population (n=56) and the parameters of koalas with normal-sized testes based on age and breeding season (n=56). Morphologic measurements included testis weight, length, width, and volume; histologic parameters included seminiferous tubule diameter, seminiferous epithelial height, and seminiferous tubule (interstitial tissue ratio and presence or absence of spermatozoa). Of the 56 koalas with intraindividual variation in testes size, 47 were classified as asymmetric and nine as microtestes. For koalas with asymmetric testes, all morphologic parameters were significantly decreased in the smaller testes compared with normal-sized testes, but for the histologic parameters, only seminiferous tubule diameter was significantly less. Histopathologic examination of the asymmetric testes showed 38 with normal parenchyma histologically indistinguishable between intraindividual testes, four with degeneration and atrophy, and three with hypoplasia, whereas examination of microtestes showed degeneration and atrophy in seven, hypoplasia in one, and aplasia in one. No association of testis size difference with Chlamydia pecorum infection was found in a subset of animals. For the 56 koalas with normal-sized testes, morphologic parameters were found to increase with age, and juvenile and young adults were found to have smaller seminiferous tubule diameters than adults. No differences were found between testes of koalas in the breeding and nonbreeding season. Overall, these findings indicate that testis asymmetry in koalas from the Mount Lofty Ranges population is common but not associated with decreased function, except where testis malformations such as hypoplasia or aplasia occur or when parenchyma has been disrupted by acquired disease.

Shear Wave Elastography for Assessment of Testicular Stiffness in Patients with Varicocele: A Prospective Comparative Study.

The purpose of this study was to use ultrasonography and shear wave elastography (SWE) to assess stiffness and volume of testes in adult patients with varicocele, to compare the results with those of normal contralateral testes of the same patients and healthy testes of control subjects. In this IRB-approved prospective comparative study, 58 patients with varicocele (116 testes) and 58 control patients (116 testes) were enrolled. A total of 66 testes with varicocele were added to group A, their 50 healthful contralateral testes were added to Group B, and 116 healthy control testes were added to Group C. Analysis of variance (one way ANOVA) test was used to compare groups and Student's t-test was used for their binary comparisons. The correlation between the testicular stiffness and volume was studied using Pearson's correlation test. There was not a significant difference in the mean SWE values between three groups and also, between two-group comparisons (P < 0.05). In the mean testicular volumes, a significant difference was observed between Groups A and C (P = 0.028). Conversely, there was not a significant difference between Groups A and B (P = 0.907) or Groups B and C (P = 0.094). A meaningful correlation between testicular stiffness and volume was not detected for each group. A significant correlation was not determined between SWE values and varicocele, and also between SWE values and testicular volume. We advise that more studies with larger populations of patients are required to verify the effectiveness of SWE in predicting testicular parenchymal damage.

Morphometric and gross anatomy studies of gonads in day-old Arabic chick (Gallus turcicus) lead to gonadal asymmetry

The differentiation of avian gonads occurred since the embryonic stage, resulted in asymmetric morphology. This study aimed to analyse the morphometric and gross anatomy of gonads in Day old Arabic chick. This study utilized 116 Day old Arabic chick. After necropsy, they were divided into 61 male and 55 female. The variables studies were length, width, volume, location, colour, and shape of the gonads. Data analysis used descriptive analysis and independent T test. The results showed a significant difference (P&lt;0.01) between the right and left ovary lengths 1.67±0.08 mm and 3.69±0.05, respectively. A significant difference (P&lt;0.01) between the width ovaries 0.64±0.03 mm (right ovary) and 1.18±0.03 mm (left ovary), respectively. It was found a significant difference (P&lt;0.05) between the length of right and left testis 2.47±0.08 mm and 3.29±0.07mm, and between volume of testis 1.46±0.12 mm3 (right testis) and 2.03±0.13 mm3 (left testis). However, the right and left testes width was not significant (P&gt;0.01). The testes colour was creamy white, sometimes pink, and grey to black, the colour of ovaries was creamy yellow and pink. Morphometric and gonadal morphology of Day old Arabic chick showed gonadal asymmetry, and the left side is larger than the right side.

Parental Separation and Semen Quality in Young Men: A Population-Based Cohort Study.

PurposeParental separation may be a stressful life event with the potential to influence hormonal regulation of offspring reproductive health and thereby affect semen quality in young men. We aimed to study the association between parental separation in pregnancy or in childhood and semen quality in young men and to study whether the timing of parental separation in childhood was important.Patients and MethodsWe conducted a follow-up study of 1058 young men born 1998–2000 from the Fetal Programming of Semen Quality (FEPOS) cohort nested within the Danish National Birth Cohort. Data on parental separation were obtained longitudinal by self-report. Parental separation in pregnancy was dichotomized, and parental separation in childhood was both dichotomized and categorized according to the timing of parental separation (from birth, from early childhood (0–5 years), and from late childhood (6–10 years)). Semen volume, concentration, total sperm count, motility, morphology, and testes volume were analysed using multivariable negative binomial regression models.ResultsParental separation in pregnancy was not associated with semen quality. The association between parental separation in childhood and semen quality differed with the timing of parental separation. Parental separation from birth was associated with higher semen volume of 25%, 95% CI (−5; 64); higher total sperm count of 62%, 95% CI (−6; 179); and higher proportion of morphologically normal spermatozoa of 59%, 95% CI (20; 111). Parental separation in early childhood was associated with lower semen volume of −14%, 95% CI (−24; −3); lower concentration of −15%, 95% CI (−28; 1); lower total sperm count of −17%, 95% CI (−32; 2) and lower testes volume of −11%, 95% CI (−18; −3).ConclusionThe timing of parental separation was important, and parental separation from birth was associated with higher semen quality, and parental separation in early childhood was associated with lower semen quality.

Diurnal rhythms in testicular blood flow, testicular morphometry and reproductive hormones in Shiba goats.

Testicular blood flow (TBF) is crucial for testicular function. The pattern of TBF in Shiba goats indicates seasonal variations. This study aimed to investigate the effect of diurnal variations on TBF, testis volume (TV), testicular echogenicity, and reproductive hormones in goats over a 24-h period. In three trials that went for three consecutive days each, 12 bucks were scanned using Triplex ultrasonography to assess the TV, pixel intensity of testicular echotexture (PIX), and Doppler indices of TBF (resistive index: RI and pulsatility index: PI) in four-time points a day (at 6.00, 12.00, 18.00, and 00.00h). Concomitantly, the changes in circulating FSH, LH, inhibin, testosterone (T), estradiol (E2), cortisol, and melatonin were assessed. Results revealed diurnal alterations in the calculated RI of TBF and the PIX of testicular parenchyma (P <0.05). Lower RI values of the TBF were observed at 6.00h compared to other time points. There were significant diurnal alterations in the levels of FSH (P <0.05), LH (P <0.05), T (P <0.0001), E2 (P <0.0001), cortisol (P <0.0001), and melatonin (P <0.0001). FSH attained a higher concentration at 18.00h compared to 12.00h. Concentrations of LH were significantly higher at 06.00h compared to those at 18.00h. Concentrations of T were significantly higher at 6.00 compared to other time points. E2 showed higher concentrations at 6.00h and 00.00h compared to 12.00h and 18.00h. On the contrary, concentrations of cortisol were significantly higher at 12.00h and 18.00h compared to 06.00h and 00.00h. The highest concentrations of melatonin were observed at 00.00h compared to other time points, while the lowest concentrations were at 12.00h. Diurnal rhythm induces significant changes in TBF, testicular PIX, and circulating FSH, LH, T, E2, cortisol, and melatonin over the 24-hday. The outcomes of the study are reflected in the advisability of monitoring the TBF at a fixed time a day to avoid the circadian rhythm effect.

Reproductive parameters of male crab-eating foxes (Cerdocyon thous) subjected to pharmacological semen collection by urethral catheterization

The crab-eating fox inhabits all Brazilian biomes, but little is known about its in situ reproduction. The objective of this study was to assess the pharmacological semen collection by urethral catheterization in crab-eating foxes. In addition, we compare seminal and reproductive biometric parameters between juveniles and adults, as well as between the breeding season (June to September) and the non-breeding season (October to May). For this study, free-living crab-eating foxes (individuals n = 8; adult = 6 and juvenile = 2; capture events N = 10) were captured in the Pantanal using Tomahawk traps. Biometric parameters, such as testis volume, differed between juveniles and adults, but there was no difference when comparing adults across seasons. All eight attempts to collect semen from adults were successful, but attempts to collect from juveniles were unsuccessful. The average semen volume (±SD) was 39.13 ± 21.98 µL, with motility averaging 40 ± 29.01 % and vigor of 2.57 ± 0.79. The sperm concentration was 277.57 ± 298.74 × 106 sperm/mL, and the percentage of morphologically normal sperm was 50.1 ± 14.7 on average. Significant increases were observed in sperm motility, concentration, and the proportion of sperm with normal morphology during the breeding season. It is the first time that pharmacological collection has been performed on the species and the first time that semen has been collected from free-living C. thous. The results suggest that male crab-eating foxes exhibit temporal variation in seminal quality, providing additional evidence that this species is a seasonal breeder.

Therapeutic Effects of Edaravone on Azoospermia: Free Radical Scavenging and Autophagy Modulation in Testicular Tissue of Mice.

Background:Chemotherapeutic agents such as cyclophosphamide and busulfan have been shown to have a negative impact on the spermatogenesis process. Based on this fact, the objective of this study was to investigate the effects of edaravone on spermatogenesis in busulfan-induced mice.Methods:Forty adult male mice were equally divided into the four groups: 1) control, 2) edaravone, 3) busulfan, and 4) busulfan + edaravone. Then, the sperm parameters, histopathological examinations, and serum levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were also assessed. Caspase-3, Beclin-1, and ATG-7 mRNA levels were also determined using real-time PCR.Results:Our results revealed that treatment of mice with edaravone in busulfan-induced azoospermia significantly improves sperm parameters, including total count, morphology, and viability (p<0.05). Furthermore, edaravone administration led to a significant increase in serum testosterone (p<0.0001) and FSH (p<0.001) levels, as well as testis weight (p<0.05) and volume (p<0.01). Edaravone also prevented a decrease in the number of testicular cells including spermatogonia (p<0.0001), primary spermatocytes (p<0.001), round spermatids (p<0.0001), Sertoli (p<0.01), and Leydig cells (p<0.0001) in busulfan-treated mice. Additionally, in busulfan-induced azoospermia, edaravone significantly reduced the percentage of sperm with immature chromatin (p<0.0001). Following treatment with edaravone, a decrease in reactive oxygen species (ROS) and an increase in glutathione (GSH) production were noted compared to busulfan-treated mice. Furthermore, caspase-3 (p<0.05), Beclin-1, and ATG-7 (p<0.001) genes expression decreased significantly in treatment groups compared to busulfan-induced azoospermia.Conclusion:According to our findings, edaravone can improve spermatogenesis in busulfan-induced azoospermia through free radical scavenging and autophagy modulation in testicular tissue.

Algorithms for Predicting the Probability of Azoospermia from Follicle Stimulating Hormone: Design and Multi-Institutional External Validation.

PurposeTo predict the probability of azoospermia without a semen analysis in men presenting with infertility by developing an azoospermia prediction model.Materials and MethodsTwo predictive algorithms were generated, one with follicle stimulating hormone (FSH) as the only input and another logistic regression (LR) model with additional clinical inputs of age, luteinizing hormone, total testosterone, and bilateral testis volume. Men presenting between 01/2016 and 03/2020 with semen analyses, testicular ochiodemetry, and serum gonadotropin measurements collected within 120 days were included. An azoospermia prediction model was developed with multi-institutional two-fold external validation from tertiary urologic infertility clinics in Chicago, Miami, and Milan.ResultsTotal 3,497 participants were included (n=Miami 946, Milan 1,955, Chicago 596). Incidence of azoospermia in Miami, Milan, and Chicago was 13.8%, 23.8%, and 32.0%, respectively. Predictive algorithms were generated with Miami data. On Milan external validation, the LR and quadratic FSH models both demonstrated good discrimination with areas under the receiver-operating-characteristic (ROC) curve (AUC) of 0.79 and 0.78, respectively. Data from Chicago performed with AUCs of 0.71 for the FSH only model and 0.72 for LR. Correlation between the quadratic FSH model and LR model was 0.95 with Milan and 0.92 with Chicago data.ConclusionsWe present and validate algorithms to predict the probability of azoospermia. The ability to predict the probability of azoospermia without a semen analysis is useful when there are logistical hurdles in obtaining a semen analysis or for reevaluation prior to surgical sperm extraction.

Filgrastim (r-met-hu G-CSF) enhances the efficiency of spermatogenesis in prepubertal Bos indicus bulls.

This study aimed to test the effects of the drug r-met-hu-G-CSF (filgrastim) on spermatogenic efficiency in prepubertal Brahman bulls. Twelve intact, healthy prepubertal bulls were administered 0, 1 (LD=low dose) or 4 (HD=high dose) µg/Kg r-met-hu-G-CSF (daily for 4days), and haematological analysis was performed. Bulls were castrated (D0 or D60). BW (body weight) and SC (scrotal circumference) were recorded. Testis weight and volume were taken at castration with samples for testis histology and stereology: germ cell types, spermatids count and DSP (daily sperm production per gram)/g of testicular parenchyma. Testicular weight, volume, BW, SC and gonadosomatic index (GSI) were NS (LD-HD; p>.05). At D0 (age 11months), the most advanced germ cell types (maGCt) ranged from intermediate spermatogonia to pachytene spermatocytes. After 2months, control animals had round spermatids as maGCt, LD animals 75% round spermatids and 25% elongated spermatids, and HD animals round spermatids. Spermatids/testis were higher in LD (1.23±0.2 millions) than in controls (0.65±0.1 millions, p<.05). Spermatogenic efficiency (DSP/g) was higher in LD (5.4±0.4 million) than in controls (3.2±0.2 million, p<.01). In conclusion, r-met-hu-G-CSF raises spermatogenic efficiency in prepubertal Brahman bulls.

Spermatogenesis in a vulnerable South American cervid, dwarf red brocket (Mazama rufina).

The brocket deer (Genus Mazama) is a highly diverse cervid group distributed from Mexico to Argentina, with a downward population trend. However, literature on the basic reproductive biology of the genus is scarce. This work aimed to study biometric, histological and stereological aspects of the testes of Dwarf Red Brocket (Mazama rufina). Testes from free-ranging adult brockets (n=3) were retrieved from necropsies. Testes were histologically processed. From histological images, several stereological parameters were estimated, and seminiferous epithelium cycle morphology was described. Testes volumes were between 8.2 and 18.4ml and weights from 8.3 to 19.4g. Gonadosomatic index (% paired-testes weight to body weight) went from 0.17 to 0.64. The tubular cross-sectional diameter was 179.8±2.8µm. Estimated volume densities for parenchyma and interstitium were 78.8% and 21.2% respectively. There were (in millions/ml) 96.0±13.1germ cells and 37.7±6.0somatic cells. Specific cell densities were (all expressed in millions/ml) as follows: spermatogonia 13.1±4.2; primary spermatocytes 43.1±5.0; round spermatids 36.8±8.0 (lower density near the caudal pole, p<0.01); sustentacular (Sertoli) cells 16.8±4.1 and interstitial endocrine (Leydig) cells 17.4±3.4. Sertoli cell index (germ cells per Sertoli cell) was 6.72. Eight stages of the cycle were described, and frequencies estimated, resembling those of goats. M.rufina adult testis anatomy is similar to that of other cervids and domestic ruminants, with an apparently lower spermatogenic efficiency. This work is a first approximation to the physiology of the testis of M.rufina. Basic knowledge of the reproductive physiology of vulnerable species may allow biotechnological approaches for the restitution of animal populations.

Effects of Annual Rainfall on Reproduction of Pleurodema tucumanum (Anura: Leptodactylidae) on the Western Border of the Great American Chaco

The objective of this study was to describe and compare the reproductive cycle of Pleurodema tucumanum in dry and rainy years in a portion of the Chaco Serrano in western Argentina. We captured 141 males and 93 females during their months of activity between 2011 and 2015. Adults were sexed and their body size and weight were determined. We weighed fat bodies and calculated testis volume in males and fecundity in females. Fecundity was based on the number of mature oocytes present in the ovary, the ovarian complement. Like many species of the family Leptodactylidae, this species presents sexual dimorphism, with females being larger than males. The reproductive variables showed no significant differences between dry and rainy years. Linear regression analyses between abiotic factors (maximum temperature, minimum temperature, and accumulated rainfall) and reproductive variables showed significant positive relationships. Both in dry and rainy years, we recorded the presence of atretic follicles and developing and maturing oviducts. In rainy years, mature oocytes were observed from November through April, and from October to March in dry years (local summer). Only in dry years were significant variations observed in fat body weight during the reproductive season. Annual cycles of rainy periods do not affect the reproductive activity of this species, which appears to be a strategy for its permanence in this Chacoan region.

The effects of gallic acid and metformin on male reproductive dysfunction in diabetic mice induced by methylglyoxal: An experimental study.

Background Diabetes mellitus is a disease that has reached a dangerous point. Today, nearly 500 million men and women around the world live with diabetes. Gallic acid (Gal) affects diabetes.ObjectiveTo evaluate the effects of Gal and metformin (met) on the levels of glucose, insulin, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), sperm count, antioxidant status, and histological changes in the testes of diabetic mice induced by methylglyoxal (MGO).Materials and Methods In this experimental study, 50 male adult NMRI mice, weighting 25-30 gr, aged 3-4 months were randomly divided into five equal groups (n = 10/each). (i) Control (vehicle, normal saline), (ii) MGO (600 mg/kg/d) orally for 28 days, (iii) Gal (50 mg/kg/d), (iv) MGO+Gal, and (v) MGO+met (200 mg/kg/d). Gal and met were administered orally for 21 consecutive days after the induction of diabetes. Blood samples were taken at 24 hr after the latest doses of treatment. Histological assessment of the testis was done, and the epididymis sperm count was obtained. Antioxidant indices, glucose, insulin, LH, FSH, and testosterone levels were measured.ResultsIn the MGO group compared to the control group, insulin, glucose (p = 0.001), LH (p = 0.04) and malondialdehyde (p = 0.001) were increased. However, the level of testosterone (p = 0.001), seminiferous tubule diameters, epithelial height, sperm count, superoxide dismutase activity (p = 0.02), and testis volume (p = 0.01) were decreased. The results indicated that Gal and met ameliorated the MGO effects.ConclusionThese findings suggested that the animals receiving MGO became diabetic. According to the results, Gal and met can effectively prevent MGO-induced diabetes. The effect of Gal was equivalent and sometimes better than metformin.

MP31-03 MICRODISSECTION TESTICULAR SPERM EXTRACTION VS MULTIPLE NEEDLE-PASS PERCUTANEOUS TESTICULAR SPERM ASPIRATION IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA: A RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-03 MICRODISSECTION TESTICULAR SPERM EXTRACTION VS MULTIPLE NEEDLE-PASS PERCUTANEOUS TESTICULAR SPERM ASPIRATION IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA: A RANDOMIZED CLINICAL TRIAL Christian Fuglesang S. Jensen, Dana A. Ohl, Mikkel Fode, Niels Jørgensen, Aleksander Giwercman, Angel Elenkov, Anna Klajnbard, Claus Y. Andersen, Lise Aksglaede, Marie Louise Grøndahl, Mette C. Bekker, and Jens Sønksen Christian Fuglesang S. JensenChristian Fuglesang S. Jensen More articles by this author , Dana A. OhlDana A. Ohl More articles by this author , Mikkel FodeMikkel Fode More articles by this author , Niels JørgensenNiels Jørgensen More articles by this author , Aleksander GiwercmanAleksander Giwercman More articles by this author , Angel ElenkovAngel Elenkov More articles by this author , Anna KlajnbardAnna Klajnbard More articles by this author , Claus Y. AndersenClaus Y. Andersen More articles by this author , Lise AksglaedeLise Aksglaede More articles by this author , Marie Louise GrøndahlMarie Louise Grøndahl More articles by this author , Mette C. BekkerMette C. Bekker More articles by this author , and Jens SønksenJens Sønksen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-obstructive azoospermia (NOA) is a severe infertility diagnosis. No level-1 evidence supports a specific surgical sperm retrieval procedure. Microdissection testicular sperm extraction (mTESE) has gained popularity due to reports on relatively high sperm retrieval rates (SRR) ranging 30–70%. However, mTESE is an invasive, demanding and costly procedure. We previously reported SRR for a modified needle aspiration (TESA) applied in NOA men (Jensen et al. 2016). Modified TESA is done with an 18-gauge needle performing multiple passes (50-100) while applying a vacuum. The SRR from this procedure was 30%. When performing salvage mTESE after an unsuccessful modified TESA, the SRR was only 11%. Therefore, we hypothesized that modified TESA is an effective alternative to mTESE. Accordingly, we conducted the first randomized clinical trial on surgical sperm retrieval in NOA men comparing modified TESA with mTESE. METHODS: Ethical approval was obtained, and a prospective randomized clinical trial was conducted between 04/2017–10/2020. Inclusion criteria were azoospermia according to WHO, testis volume ≤15ml and no indication of obstructive causes of azoospermia. Exclusion criteria were previous surgical sperm retrieval or testicular biopsy, anejaculation, retrograde ejaculation, Klinefelter’s Syndrome, XX male, AZFa/b microdeletion and CFTR mutation. The calculated population size was 100 (using 25% SRR for TESA and 52% for mTESE, power 80% and alpha 0.05) and with an expected drop-out rate of 10%, 110 men with NOA needed to be included. Men were randomized to mTESE or modified TESA. Patients with a failed TESA proceeded directly to mTESE while in the operating room. The primary outcome was successful sperm retrieval. SRRs were compared using Chi-square test. Statistical significance was set at p<0.05. RESULTS: 110 men were included, 10 withdrew before randomization and 100 underwent surgery. Median age was 33 years (range 22–54). Spermatozoa were retrieved in 11/51 (22%) men randomized for TESA and 21/49 (43%) men undergoing mTESE (p=0.02). SSR from salvage mTESE was 4/38 (11%). Thus, the combined SRR for men randomized to TESA was 15/51 (29%) which did not reach statistical significance compared to mTESE (p=0.16). CONCLUSIONS: In direct comparison SRR was higher in mTESE compared to modified TESA. Although not powered for such comparison, the study may indicate that combining salvage mTESE with the modified TESA is a viable alternative reducing invasiveness and cost for a proportion of patients. Source of Funding: European Reasearch Council, ReproUnion © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e555-e556 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Fuglesang S. Jensen More articles by this author Dana A. Ohl More articles by this author Mikkel Fode More articles by this author Niels Jørgensen More articles by this author Aleksander Giwercman More articles by this author Angel Elenkov More articles by this author Anna Klajnbard More articles by this author Claus Y. Andersen More articles by this author Lise Aksglaede More articles by this author Marie Louise Grøndahl More articles by this author Mette C. Bekker More articles by this author Jens Sønksen More articles by this author Expand All Advertisement Loading ...

MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyPediatric Urology V (MP55)1 Sep 2021MP55-09 ALBUGINEOTOMY WITH TUNICA VAGINALIS FLAP COVERAGE IN ACUTE TESTICULAR TORSION: A PROSPECTIVE RANDOMIZED STUDY Rafael Ribeiro Zanotti, Luis Gustavo Morato de Toledo, André Costa Matos, Marcos Broglio, Sergio Paolillo, and Jorge Ricardo Gois e Cunha Rafael Ribeiro ZanottiRafael Ribeiro Zanotti More articles by this author , Luis Gustavo Morato de ToledoLuis Gustavo Morato de Toledo More articles by this author , André Costa MatosAndré Costa Matos More articles by this author , Marcos BroglioMarcos Broglio More articles by this author , Sergio PaolilloSergio Paolillo More articles by this author , and Jorge Ricardo Gois e CunhaJorge Ricardo Gois e Cunha More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002085.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular torsion is the most potential harmful cause of acute scrotal pain. To date, the most significant efforts in terms of testicular rescue rates have been based on early detorsion. Compartment syndrome has been increasingly recognized as important in enhancing the ischemic insult of several organs limited by their natural sheaths, such as the testis. Therefore we evaluate the impact of albugineotomy with reconstruction using a vaginal tunica flap in testicular salvage rate and late viability. METHODS: This study was conducted after institutional approval by local Research Ethics Committee. We randomized testicles that appeared to be ischemic even after detorsion and heating (which traditionally would be treated by orchiectomy), in one group for albugineotomy with tunica vaginalis flap coverage and another group for orchiectomy. Testicles with signs of good perfusion were not randomized, and so treated by orchidopexy. The follow-up was maintained for further analysis of testicular viability. Time from pain to surgery was not a variable that would determine the technique. Doppler sonography was performed at 6 postoperative months to assess the symmetry of blood flow and the volume in relation to the contralateral testis. Viable testes were defined as those with detectable flow and more than 50% of contralateral testis volume. RESULTS: From December 2018 to August 2020, a total of 28 patients were treated. Ten patients were randomized to albugineotomy and 7 to orchiectomy. Eleven patients were not randomized because the affected testicle had good perfusion aspect, so they underwent orchidopexy. The median time between the onset of pain and surgery was 48 hours (4 to 140 hours). This late presentation was mainly caused by the transfer of patients from other centers. Upon arriving at our service, the patient was immediately referred to treatment in the operating room. In the group with good reperfusion after detorsion and heating; and therefore, not randomized, only 22% of the testicles did not suffer atrophy after 6 months. Of those who underwent the technique under study, 25% did not atrophy. CONCLUSIONS: The application of albugineotomy with tunica vaginalis flap resulted in decrease of orchiectomy rates and avoids long-term testicular atrophy in a significant percentage of gonads (25%) that would otherwise be considered for orchiectomy, without causing major complications. We can conclude that albugineotomy allows to increase the intraoperative and long-term testicular preservation rate. Only 22% of testicles considered viable in the intraoperative, non-randomized, did not present atrophy after 6 months. The use of albugineotomy for these patients with late presentation but good perfusion aspect has not yet been studied. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e961-e962 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Ribeiro Zanotti More articles by this author Luis Gustavo Morato de Toledo More articles by this author André Costa Matos More articles by this author Marcos Broglio More articles by this author Sergio Paolillo More articles by this author Jorge Ricardo Gois e Cunha More articles by this author Expand All Advertisement Loading ...

Riboflavin recovery of spermatogenic dysfunction via a dual inhibition of oxidative changes and regulation of the PINK1-mediated pathway in arsenic-injured rat model.

Arsenic trioxide (As2O3) poisoning and associated potential lesions are of a global concern. Inversely, riboflavin (vitamin B2, VB2) as a component of flavoproteins could play a vital role in the spermatogenic enzymatic reactions. Thus, this research aimed to explore potential beneficial roles of VB2 during As2O3-injured-toxicity. Rats were randomly allocated into 4 groups (n=8/group) and challenged as follows (for 30 days continuously): Group 1 received normal saline; Group 2 was treated with 3 mg As2O3/L; Group 3 received 40 mg VB2/L; Group 4 received 3 mg As2O3/L + 40 mg VB2/L. Both As2O3 and VB2 were dissolved in deionized water. Malondialdehyde (MDA), Glutathione Peroxidase (GSH-Px), Superoxide dismutase (SOD), and Catalase (CAT) were assessed for the oxidative profile, while TAS (Total Antioxidative Status) levels were evaluated for the antioxidant system, in both serum and testicular tissue. P<0.05 was considered statistically significant. The results show that As2O3 significantly decreased the body weight, testicular weight and testis volume, semen quality and testicular cell count (p<0.05). Furthermore, MDA content in the testicular tissue of the As2O3 group rats was significantly higher in comparison to the vehicle group (p<0.05). Likewise, TAS and the activities of GSH-Px, CAT and SOD were reduced (p<0.05) when compared to the control. As(2)O(3) induced testicular damage and seminiferous tubular atrophy. Monodansylcadaverine assays mirrored the histopathology observations. Meanwhile, As2O3 upregulated the expression of mitophagy-related genes including PINK1, Parkin, USP8, LC3-I, Fis1 and Mfn2. The p38 gene, responsible to stress stimuli, was also upregulated by As2O3 administration. Meanwhile, exposure to VB2 led to a significant decrease of the expression levels of mitophagy related genes. Our study revealed that VB2 supplementation protected testicular structures against As2O3-induced injury via a dual inhibition of oxidative changes and a regulation of the PINK1-mediated pathway.

Effects of crocin and metformin on methylglyoxal-induced reproductive system dysfunction in diabetic male mice.

ObjectiveThis study investigated the effect of crocin in methylglyoxal (MGO)-induced diabetic male mice.MethodsSeventy 1-month-old male NMRI mice weighing 20–25 g were divided into seven groups (n=10): sham, MGO (600 mg/kg/day), MGO+crocin (15, 30, and 60 mg/kg/day), MGO+metformin (150 mg/kg/day), and crocin (60 mg/kg/day). MGO was administered orally for 30 days. Starting on day 14, after confirming hyperglycemia, metformin and crocin were administered orally. On day 31, plasma and tissue samples were prepared for experimental assessments.ResultsBlood glucose and insulin levels in the MGO group were higher than those in the sham group (p<0.001), and decreased in response to metformin (p<0.001) and crocin treatment (not at all doses). Testis width and volume decreased in the MGO mice and improved in the crocin-treated mice (p<0.05), but not in the metformin group. Superoxide dismutase levels decreased in diabetic mice (p<0.05) and malondialdehyde levels increased (p<0.001). Crocin and metformin improved malondialdehyde and superoxide dismutase. Testosterone (p<0.001) and sperm count (p<0.05) decreased in the diabetic mice, and treatment with metformin and crocin recovered these variables. Luteinizing hormone levels increased in diabetic mice (p<0.001) and crocin treatment (but not metformin) attenuated this increase. Seminiferous diameter and height decreased in the diabetic mice and increased in the treatment groups. Vacuoles and ruptures were seen in diabetic testicular tissue, and crocin improved testicular morphology (p<0.01).ConclusionMGO increased oxidative stress, reduced sex hormones, and induced histological problems in male reproductive organs. Crocin and metformin improved the reproductive damage caused by MGO-induced diabetes.

P–002 Prediction model for salvage microdissection testicular sperm extraction in patients with failed conventional testicular sperm extraction

Abstract Study question Is there any intra-surgical parameter able to predict the outcome of salvage microdissection testicular sperm extraction (mTESE) in patients with previous failed TESE? Summary answer Among all the variables under consideration, only the seminiferous tubules (ST) caliber pattern found at high magnification was able to significantly predict the mTESE outcome... What is known already Several studies have demonstrated that no clinical or hormonal parameters are able to predict the outcome of a salvage mTESE performed in patients with previous sperm retrieval failure (SRF). It has been previously demonstrated that a prediction model with the combination of two intra-surgical parameters such as the STs caliber, defined as dilated tubule (DT), slightly dilated tubules (SDT) and not dilated tubules (NDT), and testis histology had an excellent discrimination ability (AUC 0.93) to distinguish between cases with and without the outcome, but such prediction model has not been tested in patients undergoing salvage mTESE. Study design, size, duration A prediction model was built on a dataset of 63 patients, 29–50 years old, undergoing unilateral (15 ) or bilateral (48) salvage mTESE after failed TESE from 2015 through 2019, with a resulting N = 111 testes under consideration. Two models were compared, one with STs and histology as covariates, the other with STs alone: the second model was chosen due to better discrimination... Participants/materials, setting, methods we assessed internal validity with a bootstrapping procedure for a realistic estimate of the performance of the prediction model in similar future patients with NOA undergoing salvage mTESE. We repeated the entire modeling process in 259 samples drawn with replacement from the original sample, and determined the performances (AUC, sensitivity, specificity) of the selected prediction model. Calibration (correspondence between the predicted and observed probabilities) was visually assessed by inspecting the calibration belt... Main results and the role of chance Sperm retrieval was successful in 24 out of 63 patients (38%): age, testis volume and hormonal parameters did not vary among patients with successful sperm retrieval (SSR) or SRF. The prevalent histological pattern was Sertoli cell only syndrome (69.6%), while hypospermatogenesis, maturation arrest and hyalinosis were found in 4.5%, 23% and 1.8% of cases. The STs pattern was heterogeneous, with DTs being found only in 23.4% of testes. Sperm were found in 69% of DTs, 29% of SDTs, and 5% of NDTs. The prediction model correctly classified 82.88% of patients and explained the 26.5% variability of the outcome. The STs pattern significantly predicted the mTESE outcome with a sensitivity of 62% and a specificity of 90.2%, PPV 69.2%, NPV 87%. Both SDT (OR 0.105, 95% CI 0.034–0.317, p &amp;lt; 0.0001) and NDT (OR 0.024, 95% CI 0.004–0.128, p &amp;lt; 0.0001) were negatively associated with the chance of retrieving sperm, the resulting prediction equation being Log (SSR)= 0.81 – 2.2 SDT – 3.7 NDT. The model had a clearly useful discrimination (AUC 0.813). The optimism corrected AUC was 0.7977, and the model was well calibrated (p = 1.00) with both the 80% and 95% calibration belts encompassing the bisector over the whole range of the predicted probabilities Limitations, reasons for caution The STs caliber pattern was subjectively evaluated at high magnification (24–36x) by comparing the individual ST appearance with the surrounding ones, however such evaluation was performed by the same experienced urologist with more than 1000 mTESE procedures performed to date. Wider implications of the findings: No clinical data but the STs appearance at high magnification could discriminate between patients with and without chances of SSR. These results reinforce the evidence supporting the superiority of mTESE compared to conventional TESE in retrieving sperm, particularly in lower prognosis patients with NOA such as those with previous SR. Trial registration number Not applicable