Unilateral Undescended Testis Research Articles

Pregnancy outcomes with undescended testis husbands: influenced by wive’s life style and surgical correction before 1 year

Background The most prevalent sexual differentiation disorder in males is undescended testis (UDT), which occurs when the testis is absent from the scrotum or cannot be brought down during a physical examination. Pregnancy outcome may be influenced by the wife’s lifestyle and surgical correction within the past year
 Objectives This study aims to determine pregnancy outcome in Assisted Reproductive Technology (ART) on a wive with a UDT husband assessed by the wive’s life style and surgery correction before 1 year.
 Methods A cross-sectional study was conducted. Data were taken from patients who underwent Assisted Reproductive Technology at AMC Hospital, Yogyakarta. Data collection from 2018 to 2021. Samples in the unilateral and bilateral groups were 20 husbands. Wilcoxon Signed Rank Test helped carry out the analyses.
 Results There was an association between infertility and UDT either unilaterally or bilaterally (p = 0.009). Most UDT husbands had a BMI in the overweight category and the average age was 28 and 29. Other factors such as the wive’s life style and surgery correction before 1 year , including smoking habit, alcohol consumption, addictive drug and hormonal drug, had no significant effect on the success of pregnancy outcome (p > 0.05).
 Conclusions Although pregnancy outcome in unilateral and bilateral UDT patients was not statistically significant, clinically, the pregnancy outcome was better in husbands with unilateral UDT by IUI than in IVF.
 Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 455-462

Risk for testicular germ cell tumors and spermatogenesis failure in post-pubertal undescended testes.

Cryptorchidism is a well-defined risk factor for testicular germ cell tumors, whereas the underlying mechanisms have not been fully elucidated. Surgical procedures to reposition undescended testicles into the scrotum (orchidopexy) in early childhood are recommended both to increase fertility potential and to reduce the risk of developing testicular tumors. However, treatment in the post-pubertal period is controversial. The aim of this study is to review the histopathology of orchiectomy specimens and determination of spermatogenesis in post-pubertal patients with non-treated cryptorchidism. Retrospective chart review was performed to assess the occurrence of TGCTs and determine spermatogenesis in post-pubertal individuals who underwent inguinal orchiectomy for undescended testis between January 2010 and December 2019. Age at the time of surgery, laterality, location of theundescended testis and pathology results were evaluated. All pathology specimens were reviewed by a blinded pathologist. There were 23 patients in the cohort with a mean age of 21years (range 13-46years). All testes were in the inguinal canal. Our results indicated that 1 patient had seminoma. In the histological evaluation of the remaining 22 patients in whom no tumor was detected, normal spermatogenesis was not observed in any patient. Further, seminiferous tubules were not found in 19 patients. Maturation arrest was detected in the remaining 3 patients. Testicular germ cell carcinoma was found in 4% of the patients who underwent post-pubertal orchiectomy. In addition, none of the undescended testes had normal spermatogenetic activity. Thus, orchiectomy should be considered in post-pubertal males with unilateral undescended testis that do not need the endocrinological activity of the testis.

Advocating hormonal treatment to prevent adult in-fertility in patients diagnosed with congenital un-descended testes.

In 2007 the Nordic group came to the following unanimous conclusions: In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long-term adverse effects on spermatogenesis. Thus, surgery is to be preferred. However, defective mini puberty inducing insufficient gonadotropin secretion is one of the most common causes of nonobstructive azoospermia in men suffering from congenital isolated unilateral or bilateral cryptorchidism. The extent of alteration in the unilateral undescended testis correlate with the contralateral descended testis, indicating that unilateral cryptorchidism is a bilateral disease. Idiopathic central hypogonadism explains the phenomenon of defective mini puberty in otherwise healthy cryptorchid boys. We therefore recommend hormonal treatment for cryptorchid boys with defective mini puberty. Gonadotropin releasing hormone agonist (GnRHa) treatment following surgery to correct cryptorchidism restores mini puberty via endocrinological and transcriptional effects and prevents adult infertility in most cases. Several genes are important for central hypogonadotropic hypogonadism in mammals, including many that are transcribed in both the brain and testis. At the molecular level, there is no convincing evidence that heat shock is responsible for the observed pathological testicular changes. Thus, impaired transformation of gonocytes is not the result of temperature stress but rather a hormonal imbalance. Cryptorchidism should therefore be considered a serious andrological problem that cannot be successfully treated by early orchidopexy alone.

A renal aplasia case mimicking radiologically as unilateral renal agenesis in a child with spina bifida, atresia ani and unilateral undescended testis: a case report

BackgroundAs a result of the failure of embryogenic kidney formation, a condition can occur where not a single kidney appears and this phenomenon is known as unilateral renal agenesis (URA). Both aplastic and dysplastic kidney are different from renal agenesis, atrophy and renal hypoplasia. However, from this case report it can be seen that there are similarities, both radiologically and macroscopically, between cases of unilateral renal aplasia and renal agenesis.Case presentationA 2 year old Javanese boy came to the health facility with complaints of recurrent fever and urinary tract symptoms such as dysuria and straining. Computerized Tomography (CT) scan of the abdomen and urography showed agenesis of the left kidney and a probable spina bifida. Cystourethrography examination was done and showed grade 5 voiding, then retrograde pyelography was performed with the diagnosis of unilateral renal agenesis was made because there was no visible left side collecting system even though there was a duplication in the left ureter. The next examination was carried out by histopathology and immunohistochemistry after resection of the left side of the ureter and the diagnosis increasingly pointed towards renal aplasia after primitive renal structures were found.ConclusionsRenal agenesis and aplastic kidney are difficult to differentiate macroscopically and radiologically. Nevertheless, from this case report, we try to provide some interesting points to differentiate cases of unilateral renal agenesis from Renal Dysplasia which presents as unilateral renal aplasia.

Diagnostic role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study.

Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes. Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group. Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group's echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes. The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.

Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study

PurposeTo evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children.MethodsWe prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus.ResultsNo differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen.ConclusionSingle-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

Background: Undescended testes (UDT) is a condition where one or both testes is absent in the scrotum. The general age recommendation in which the treatment should be performed is before 18 months old due to the infertility risk and malignancy in later life. On the other hand, in post-pubertal UDT, the current guideline recommends orchiectomy; however, this recommendation is weak. Therefore, this study aimed to provide a systematic review of post-pubertal UDT treatment, focusing on the malignancy risk point of view. Methods: A systematic search was performed using PubMed, Wiley Online Library and the Cochrane Library up to 5 March 2023. Any study with either post-pubertal orchiectomy or orchidopexy in patients with UDT and reporting the testicular malignancy was included. The exclusion criteria were studies with lack of information of UDT correction time, no history of correction and the full text wasn’t available. The data collected were the occurrence of testicular malignancy in post-pubertal UDT patients corrected with any method. Quality and bias assessment was assessed with Newcastle-Ottawa scale and Joanna Briggs Institute tools. Results: Seven articles (three case reports and four observational studies) were reviewed with a total of 42 patients who underwent post-pubertal correction of either unilateral or bilateral UDT. The correction age ranged from 13 to 34 years old, with follow-up of 48.7–252 months. Among those who developed malignancies, the most common were seminoma, teratoma and carcinoma in situ of the testes. In addition, this study was able to propose an algorithm for post-pubertal UDT treatment strategy. Conclusions: The scarce resource was the main limitation of this study. Nevertheless, this review showed that post-pubertal UDT management should be tailored individually. Several factors that should be considered include the condition of the contralateral descended testis, UDT location, serum testosterone level, patient’s age, comorbidities, and interest in fertility.

Giant liver cyst in a newborn with pseudoprune-belly syndrome - A case report

Pseudoprune-belly syndrome is a rare anomaly, an incomplete form of Prune-belly syndrome. The etiology is not clear, and though this syndrome may present associated with other malformations, the association with a liver cyst is extremely rare. We report the case of a male newborn who was referred to our hospital with an antenatal ultrasound that suggested a gastric duplication. Clinical examination revealed lax abdominal wall, unilateral undescended testis and a palpable mass on the right upper quadrant with fuzzy boundaries. On laparotomy we found a giant hepatic cyst displacing the bowel to the left. The baby underwent a partial ressection and marsupialization of the cyst as total resection was infeasible. The patient's recovery was uneventful. Although rarely, the Pseudoprune-belly syndrome can present with a liver cyst. Large liver cysts should be partially or totally ressected as soon as possible.

Factors affecting testicular volume after orchiopexy for undescended testes.

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

Rethinking Prophylaxis: Evaluating Surgical Site Infection Rates in Pediatric Orchidopexy without Prophylactic Antibiotics

Introduction: Undescended testes (UDT) is the most common congenital anomaly of the urogenital system in male newborns. Testicular descent into scrotum is necessary for normal spermatogenesis. The scrotal temperature is 2-7 degrees below body temperature. UDT are prone to impaired spermatogenesis, Surgical site infection (SSI) is a leading cause of postoperative morbidity and mortality. It is the third most common cause of hospital acquired infections. However injudicious use of antibiotics is responsible for increased costs, unwanted drug side effects like Clostridium difficile infection as well as the emergence of resistant strains and multidrug resistant infections. Objective: To determine the frequency of surgical site infection in pediatric patients undergoing orchidopexy without the administration of prophylactic antibiotics. Study Design: Descriptive Study Setting: Department of pediatrics, Lady Reading Hospital Peshawar. Duration of Study: From 08-July-2020 to 08-January-2021. Materials and Methods: In overall 126 respondents of undescended testis were selected in a consecutive manner OPD and subjected to orchidopexy. Follow up was done to detect the presence or absence or SSI. Results: The average age of the sample was 12.9+6.8 months. Mean weight of the included children was 12.8 4.9 kg and mean height was 73.1+ 13.5 cm. 50.8% Presented with right side undescended testis and 57.1% were in ASA class Mean operative time for orchidopexy was 44.4 10.3 minutes. SSI was recorded in 31 (24.6%) of children. Conclusion: Surgical site infection (SSI) is a significant concern in pediatric patients undergoing orchidopexy for unilateral undescended testis. Additional investigation is required to determine the factors that contribute to surgical site infections (SSI) in children and create successful measures for prevention. The use of prophylactic antibiotics should be carefully considered, considering the potential risks and benefits. Addressing SSI in this population is crucial for improving patient outcomes and reducing the burden of complications. Keywords: Orchidopexy, pediatrics, surgical site infection

PD06-11 LOSS OF WNT4 IN THE GUBERNACULUM CAUSES UNILATERAL CRYPTORCHIDISM AND FERTILITY DEFECTS DUE TO IMBALANCE OF MALE AND FEMALE GENES

You have accessJournal of UrologyCME1 Apr 2023PD06-11 LOSS OF WNT4 IN THE GUBERNACULUM CAUSES UNILATERAL CRYPTORCHIDISM AND FERTILITY DEFECTS DUE TO IMBALANCE OF MALE AND FEMALE GENES Abhishek Seth, Hunter Flores, Ahmed Chahdi, and Carolina Jorgez Abhishek SethAbhishek Seth More articles by this author , Hunter FloresHunter Flores More articles by this author , Ahmed ChahdiAhmed Chahdi More articles by this author , and Carolina JorgezCarolina Jorgez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Undescended testis (UDT) is the most common urological birth defect affecting 6% of male births. Despite surgical correction, some men with unilateral UDT may experience infertility with the contralateral descended testis (CDT) showing no A-dark spermatogonia. We hypothesized that WNT4 plays a significant role in gonadal development since mutations in WNT4 are associated with ambiguous genitalia, and overexpression of WNT4 in mice deficient in E2F1 leads to infertility. METHODS: A Wnt4 gubernaculum-specific knock-out mouse was created and phenotyped by crossing RARß2-cre mice to Wnt4-flox mice. Fertility was determined by 6-month paired mating of a wild type (WT) female to a Wnt4f/f;cre+ (Wnt4-cKO) male. RESULTS: All Wnt4-cKO mice presented with a smaller left unilateral UDT, and an equal number of mice had inguinal vs. abdominal UDT. The abdominal UDT had a Sertoli cell-only phenotype. The inguinal UDT had a combination of normal and abnormal seminiferous tubules (ST), including maturation arrest. Half of the mice with inguinal UDT had no sperm in the left epididymis, and the ones with sperm had 33% fewer sperm with a 96% decrease in motility compared to those of WT mice. The left gubernaculum of Wnt4-cKO was longer and thinner with increased collagen and reduced muscle content compared to the right CDT. The fertility of the Wnt4-cKO male was significantly reduced as they produced 23 litters and 88 pups within the same time that 8 WT mice produced 48 litter and 395 pups. Wnt4-cKO mice with abdominal UDT had an increase in serum FSH and LH. Wnt4-cKO UDT and CDT had an increase in ER-a in Leydig cells. Wnt4-cKO CDT and inguinal UDT had an increase in the number of SOX9-positive cells in which SOX9 expression was high in both the cytoplasm and nucleus. Wnt4-cKO testes revealed an up-regulation of genes essential for female gonadal development and function, such as Rspo1, Wnt4,and Foxl2 in both CDT and UDT. Several WNT4 variants were identified in boys with UDT that could potentially cause or contribute to their condition. CONCLUSIONS: Conditional loss of Wnt4 in the gubernaculum leads to aberrant testicular decent and development unilaterally. Although these mice have one normal descended testis, the existence of fertility defects and molecular alterations in the CDT supports our hypothesis that unilateral UDT is a bilateral defect. Our results indicate that the androgen-estrogen imbalance affects both testes and suggest that estrogen impacts the ability of SOX9 to translocate into the nucleus to activate the male developmental pathway. Source of Funding: NIH grant 1R01HD100985 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e160 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Seth More articles by this author Hunter Flores More articles by this author Ahmed Chahdi More articles by this author Carolina Jorgez More articles by this author Expand All Advertisement PDF downloadLoading ...

MP43-11 EIGHT-YEAR FERTILITY PRESERVATION PROGRAM AT ATRIUM HEALTH WAKE FOREST BAPTIST FOCUSING ON SPERMATOGONIAL STEM CELL AND ROUND SPERMATID TECHNOLOGIES.

You have accessJournal of UrologyCME1 Apr 2023MP43-11 EIGHT-YEAR FERTILITY PRESERVATION PROGRAM AT ATRIUM HEALTH WAKE FOREST BAPTIST FOCUSING ON SPERMATOGONIAL STEM CELL AND ROUND SPERMATID TECHNOLOGIES. Adam Cohen, Janmejay Hingu, Nima Pourhabibi Zarandi, Guillermo Galdon, Omar Abdelaal, Banafsheh Nickmehr, Kimberly Stogner-Underwood, Stanley Kogan, Steve Hodges, Stuart Howards, Thomas McLean, Anthony Atala, and Hooman Sadri-Ardekani Adam CohenAdam Cohen More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Nima Pourhabibi ZarandiNima Pourhabibi Zarandi More articles by this author , Guillermo GaldonGuillermo Galdon More articles by this author , Omar AbdelaalOmar Abdelaal More articles by this author , Banafsheh NickmehrBanafsheh Nickmehr More articles by this author , Kimberly Stogner-UnderwoodKimberly Stogner-Underwood More articles by this author , Stanley KoganStanley Kogan More articles by this author , Steve HodgesSteve Hodges More articles by this author , Stuart HowardsStuart Howards More articles by this author , Thomas McLeanThomas McLean More articles by this author , Anthony AtalaAnthony Atala More articles by this author , and Hooman Sadri-ArdekaniHooman Sadri-Ardekani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male infertility has been associated with many disease processes, including chemotherapy and radiotherapy for cancer, undescended testis (UDT), and genetic conditions such as Klinefelter Syndrome (KS). Preservation of human spermatogonial stem cells (SSC) may be a suitable option for young male patients at risk of losing fertility. With optimal cryopreservation, cell viability can be retained to reestablish spermatogenesis in the future through in vitro germ cell differentiation or round spermatid injection. METHODS: Urology and hematology-oncology patients at Atrium Health Wake Forest Baptist with malignancy, UDT, or KS were approached for consent and assent (if ≥seven years old) for the fertility preservation program. If participation was accepted, patients were given the option to undergo a fertility-preserving testicular biopsy, preferably during general anesthesia for other procedures such as Port-a-Cath placement, orchidopexy, or lymph node biopsy. They were also allowed to enroll as a registry participant (non-biopsy control). Histological and microbiological analyses were performed on biopsies before being cryopreserved. Further data were obtained retrospectively via chart review. RESULTS: Over eight years of banking, a total of 202 patients were approached for the study, with 125 (61.8%) undergoing a biopsy, 39 (19.3%) enrolling as non-biopsy control, and 38 (18.8%) declining participation. The mean age at which biopsy was performed across all diagnoses was 8.39 years (range 0.61 to 37.39). Of the 125 biopsy patients, 73% opted to donate a portion (up to 20%) of the tissue for basic research with no direct benefit to the donor. Of the biopsied patients, 76 (60.8%) were performed for cancer, 38 (30.4%) for unilateral or bilateral UDT, and 11 (8.8%) for KS. Based on PRM1 immunofluorescence, 48.3% of specimens had round spermatids. Short-term complications for testicular biopsy, primarily pain and swelling, were typically mild to moderate. CONCLUSIONS: A multidisciplinary approach can accommodate patients at risk for reduced future fertility due to various pathologies. The preservation of testicular tissue at present can aid in future fertility restoration through techniques such as in vitro SSC differentiation or round cell spermatid injection (ROSI). Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e605 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Cohen More articles by this author Janmejay Hingu More articles by this author Nima Pourhabibi Zarandi More articles by this author Guillermo Galdon More articles by this author Omar Abdelaal More articles by this author Banafsheh Nickmehr More articles by this author Kimberly Stogner-Underwood More articles by this author Stanley Kogan More articles by this author Steve Hodges More articles by this author Stuart Howards More articles by this author Thomas McLean More articles by this author Anthony Atala More articles by this author Hooman Sadri-Ardekani More articles by this author Expand All Advertisement PDF downloadLoading ...

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

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

Loss of WNT4 in the gubernaculum causes unilateral cryptorchidism and fertility defects.

Undescended testis (UDT) affects 6% of male births. Despite surgical correction, some men with unilateral UDT may experience infertility with the contralateral descended testis (CDT) showing no A-dark spermatogonia. To improve our understanding of the etiology of infertility in UDT, we generated a novel murine model of left unilateral UDT. Gubernaculum-specific Wnt4 knockout (KO) mice (Wnt4-cKO) were generated using retinoic acid receptor β2-cre mice and were found to have a smaller left-unilateral UDT. Wnt4-cKO mice with abdominal UDT had an increase in serum follicle-stimulating hormone and luteinizing hormone and an absence of germ cells in the undescended testicle. Wnt4-cKO mice with inguinal UDT had normal hormonal profiles, and 50% of these mice had no sperm in the left epididymis. Wnt4-cKO mice had fertility defects and produced 52% fewer litters and 78% fewer pups than control mice. Wnt4-cKO testes demonstrated increased expression of estrogen receptor α and SOX9, upregulation of female gonadal genes, and a decrease in male gonadal genes in both CDT and UDT. Several WNT4 variants were identified in boys with UDT. The presence of UDT and fertility defects in Wnt4-cKO mice highlights the crucial role of WNT4 in testicular development.

Contralateral testicular hypertrophy is associated with a higher incidence of absent testis in children with non-palpable testis

The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020. We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org). A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p=0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17mm (16-19.2)) as compared to patients with a viable testis (median length 15mm (14-17), p=0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p<0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p=0.007]. Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.

The safety of neoadjuvant hormonal treatment in infants with cryptorchidism

The standard treatment for boys with non-syndromic cryptorchidism is an early orchidopexy. It is unclear if surgical intervention alone is enough for future fertility. Recent studies show benefit of neoadjuvant or adjuvant hormonal treatment with gonadorelin (GnRH) for spermatogonia maturation based on testicular biopsy. The aim of this prospective study was to assess the safety of this treatment in infants with undescended testis at the recommended timing of early gonadorelin administration and timing of orchidopexy. Unilateral cryptorchid full term boys were initially examined (including hormonal, physical and ultrasound examination) at the age of 2.5-3.5 months. At 6 months of age, cryptorchidism was confirmed. Those with non-syndromic cryptorchidism and palpable or sonographically detected testis were randomly assigned into two groups: with and without intranasal gonadorelin treatment. Inclusion criteria were met by 36 boys (21 in GNRH and 15 in the control groups). The following orchidopexy was performed before 12 months of age with repeated examination at time of surgery. Penile size and testicular volume (using ultrasound) and basal serum levels of LH, FSH, testosterone, Inhibin B and AMH were recorded at age of 3.0 (mean) months and 11.0 (mean) months (date of surgery). The stimulation hormonal levels were checked during GnRH administration. Between minipuberty (mean 3 months) and time of orchidopexy (mean 11 months of age) the penile size increased significantly and similarly in both groups. There was no significant difference in the change of the volume of descended testis between the groups nor of the volume of undescended testis. In addition, we did not find any significant difference in the change (drop) of hormonal levels of LH, FSH, Testosterone, Inhibin B and AMH (Table 1a) CONCLUSION: The neoadjuvant gonadorelin stimulation in infants with unilateral undescended testis has not shown any specific effect on the development of penile size, testicular volume and hormonal levels at time of orchidopexy in comparison with boys without stimulation, and in the mid-term, this treatment can be considered safe. Further follow-up is necessary to evaluate the long-term effect of this early treatment.

Clinical Presentation, Diagnostic Approach, Laparoscopic Evaluation and Treatment of Impalpable Testis.

To find out the clinical presentation, utility of ultrasound for diagnosis, laparoscopic findings and treatment for clinically impalpable testis. Cross-sectional study. Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University Karachi, from September 2019 to April 2020. Patients with clinically impalpable testis were included. Ultrasound of inguinal region was done to locate testis. Presence of testis and its position was confirmed at laparoscopy and surgical procedure done according to the findings. Data was stratified according to the age and Chi-square test and Student t-test were applied to find out statistical significance among different variables in children below and above five years of age. A p <0.05 was taken as significant. Ninety-one patients with 113 testes were included. The median age of the children was 48 months. Sixty-nine (75.8%) patients had unilateral undescended testis and 22 (24.2%) bilateral undescended testes. Fifty-three (58.2%) patients were less than five years of age. On ultrasound, testis was found near deep ring in 23 (25.3%) patients. At laparoscopy, 74 (81.3%) testes were found within the abdominal cavity. In 7 (7.7%) patients, only nubbin of tissue was identified and removed. The first stage of Fowler Stephen procedure was done in the majority of the patients. There was statistically no significant difference following stratification in relation to laterality and position of undescended testis (p = 0.556 and p = 0.846, respectively). However, mean size of the testis was found statistically significant (p = 0.032). Most of the patients were above five years of age. Ultrasound helped in identifying low-lying intra-abdominal testis in more than 80% of patients. Laparoscopy was helpful in further defining the position of the testis and selection of surgical procedure. Undescended testis, Cryptorchidism, Laparoscopy, Orchiopexy.

Effectiveness of Hormonal Therapy for unilateral and bilateral Undescended testis

Effectiveness of Hormonal Therapy for unilateral and bilateral Undescended testis

Clinico-demographic Characteristics, Associated Anomalies and Treatment Profiles of Children presented with Undescended Testis at Medical University of Bangladesh

Background: The most common paediatric disorder among boy is undescended testis (UDT) which is usually identified during birth and these patients require proper treatment at the appropriate time due to increased risk of torsion, infertility, testicular cancer and associated inguinal hernia(&gt;90%) as well as for cosmetic purposes.&#x0D; Objective: The purpose of this study was to determine side, palpability, age at presentation, associated anomalies and treatment plan in our institution.&#x0D; Methodology: This retrospective study was carried out in the department of Paediatric Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2017 to June 2019.&#x0D; Results: In this study 1.08% (213 children had UDT out of total paediatric outdoor 19803 patients) boys had UDT. They were aged from 7 months to 15 years (mean 5.61±3.81 years) at presentation. Only 16 (7.5%) patients presented within the 1 years of age in this study. 51.8% of patients presented at the age of &gt;1yrs-5yrs. &gt; 5yrs-10yrs of age was 33.5% cases and 13.6% of patients presented as late as 10yrs to 15 yrs. Unilateral UDT was found in 184 (86.4%) patients and bilateral was in 29(13.6%) patients. Right- sided unilateral UDT was in 112(52.6%) patients, left -sided unilateral UDT was in 72 (33.8%) patients. Palpable testis was found in 178(83.6%) patients and non-palpable found in 35(16.4%) patients. Associated anomalies of UDT were seen in 64(30%) patients. Hypospaedias was in 19(08%) patients and intersex disorders were in 15 (07%) patients. Orchidopexy was done in 192(90.1%) cases and orchidectomy was done only in 4(1.9%) cases. No testis was found in17 (08%) cases.&#x0D; Conclusion: UDT is one of the commonest disorders of paediatric age group. Very important issue is the early diagnosis and treatment of this anomaly. To treat the UDT in proper time help to optimize testicular function, earlier diagnosis of testicular malignancy, give cosmetic benefits and to prevent complications such as a clinical hernia or torsion.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 173-176

Proportion of Testicular Absence and Position of Testis in Unilateral Nonpalpable Undescended Testis in a Tertiary Teaching Hospital in South India

Introduction: Undescended testis is a common surgical problem in children which needs to be treated by one and a half year of age. When testis is non palpable, it could be either absent, and when present intra-abdominal or inguinal. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with nonpalpable undescended testis from January 2016 to June 2021. Results: Mean age of intervention was 43.7 months (range 7 to 153 months). Incidence of absent testis was 30.97%. in 156 children who had ipsilateral undescended testis, 92 had intra-abdominal testis and 43 had inguinal testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy were suggestive of absent ipsilateral testis (p &lt;0.001). Testis is absent in 11.3% only when ipsilateral hemi scrotum is under developed. Conclusion: Proportion of absent testis is 30.97% in children with unilateral undescended testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy are predictive of ipsilateral testicular absence. Keywords: Undescended testis, atrophic testis, Contralateral hypertrophy.