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Cryptorchid-Induced Changes in Spermatogenesis and Fertility
Published in Tom O. Abney, Brooks A. Keel, The Cryptorchid Testis, 2020
If true cryptorchidism has been established through several examinations and lack of response to gonadotropin treatment, then orchidopexy is generally considered to be the correct therapeutic approach. In very young males (2 years of age or less) this procedure would be preferred over orchiectomy. Numerous studies32,33,36 have suggested that orchidopexy at an early age may prevent some or most of the thermal-induced damage to the germinal epithelium. In this regard, several investigators45,46 have reported similar results using an experimental animal model. These investigators demonstrated that in the surgically induced cryptorchid immature rat, spermatogenesis can be restored following orchidopexy. In contrast, spermatogenesis in the mature rat does not recover after orchidopexy.47 Thus, age plays an important role in the subsequent recovery of the testes and development of spermatogenic capacity.
Oncology
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Treatment of early stage disease is started with external beam irradiation and lymph node dissection, followed by radical prostatectomy (surgical removal of the prostate gland). Disseminated carcinoma treatment involves hormonal manipulation to decrease the effect of androgens on cancer cell growth. This involves use of estrogens, antiandrogens, other hormonally active agents, and LH-RH antagonists, as well as surgical excision of the testes (orchiectomy, orchidectomy, orchectomy). Chemotherapy is used as an adjuvant and when response to hormone therapy fails.
Familial Testicular Germ Cell Tumor
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Representing approximately 1.5% of male malignancies, testicular cancer often affects children of 2–4 years in age, adults between ages 25 and 35 years, and elderly of the mid-60s–70s. Being the most common testicular cancer, GCT is responsible for 95% and 77% of testicular neoplasms in adults and children, respectively. While a majority TGCT arises sporadically without family history, about 1.4% of newly diagnosed male patients demonstrate familial segregation, with their sons and siblings showing four- to sixfold and eight- to tenfold increases in TGCT risk, respectively. Compared with sporadic TGCT, familial TGCT often involve two members, who are on average 2.5 years younger and have a higher percentage of bilateral disease. In the absence of a highly penetrant susceptibility locus, familial TGCT appears to be attributable to the combined effects of multiple low-penetrance alleles (e.g., Y chromosome gr/gr deletion, and mutations in KITLG, PDE11A, SPRY4, and BAK1 genes) that underlie the familial phenotype [65]. If diagnosed early, >90% of TGCT cases are curable using a combination of surgery, radiotherapy, and chemotherapy. Testosterone replacement therapy is helpful for patients with potential androgen insufficiency after bilateral or partial orchiectomy.
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
Published in International Journal of Transgender Health, 2022
E. Coleman, A. E. Radix, W. P. Bouman, G. R. Brown, A. L. C. de Vries, M. B. Deutsch, R. Ettner, L. Fraser, M. Goodman, J. Green, A. B. Hancock, T. W. Johnson, D. H. Karasic, G. A. Knudson, S. F. Leibowitz, H. F. L. Meyer-Bahlburg, S. J. Monstrey, J. Motmans, L. Nahata, T. O. Nieder, S. L. Reisner, C. Richards, L. S. Schechter, V. Tangpricha, A. C. Tishelman, M. A. A. Van Trotsenburg, S. Winter, K. Ducheny, N. J. Adams, T. M. Adrián, L. R. Allen, D. Azul, H. Bagga, K. Başar, D. S. Bathory, J. J. Belinky, D. R. Berg, J. U. Berli, R. O. Bluebond-Langner, M.-B. Bouman, M. L. Bowers, P. J. Brassard, J. Byrne, L. Capitán, C. J. Cargill, J. M. Carswell, S. C. Chang, G. Chelvakumar, T. Corneil, K. B. Dalke, G. De Cuypere, E. de Vries, M. Den Heijer, A. H. Devor, C. Dhejne, A. D’Marco, E. K. Edmiston, L. Edwards-Leeper, R. Ehrbar, D. Ehrensaft, J. Eisfeld, E. Elaut, L. Erickson-Schroth, J. L. Feldman, A. D. Fisher, M. M. Garcia, L. Gijs, S. E. Green, B. P. Hall, T. L. D. Hardy, M. S. Irwig, L. A. Jacobs, A. C. Janssen, K. Johnson, D. T. Klink, B. P. C. Kreukels, L. E. Kuper, E. J. Kvach, M. A. Malouf, R. Massey, T. Mazur, C. McLachlan, S. D. Morrison, S. W. Mosser, P. M. Neira, U. Nygren, J. M. Oates, J. Obedin-Maliver, G. Pagkalos, J. Patton, N. Phanuphak, K. Rachlin, T. Reed, G. N. Rider, J. Ristori, S. Robbins-Cherry, S. A. Roberts, K. A. Rodriguez-Wallberg, S. M. Rosenthal, K. Sabir, J. D. Safer, A. I. Scheim, L. J. Seal, T. J. Sehoole, K. Spencer, C. St. Amand, T. D. Steensma, J. F. Strang, G. B. Taylor, K. Tilleman, G. G. T’Sjoen, L. N. Vala, N. M. Van Mello, J. F. Veale, J. A. Vencill, B. Vincent, L. M. Wesp, M. A. West, J. Arcelus
The current set of recommendations is directed at professionals working with individuals who identify as eunuchs (Johnson & Wassersug, 2016; Vale et al., 2010) requesting medically necessary gender-affirming medical and/or surgical treatments (GAMSTs). Although not a specific diagnostic category in the ICD or DSM, eunuch is a useful construct as it speaks to the specifics of eunuch experience while also connecting it to the experience of gender incongruence more broadly. Eunuch individuals will present themselves clinically in various ways. They wish for a body that is compatible with their eunuch identity—a body that does not have fully functional male genitalia. Some other eunuch individuals feel acute discomfort with their male genitals and need to have them removed to feel comfortable in their bodies (Johnson et al., 2007; Roberts et al., 2008). Others are indifferent to having male external genitalia as long as they are only physically present and do not function to produce androgens and male secondary sexual features (Brett et al., 2007). Hormonal means may be used to suppress the production of androgens, although orchiectomy provides a permanent solution for those not wishing genital functioning (Wibowo et al., 2016). Some eunuch individuals desire lower testosterone levels achieved with orchiectomy, but many will elect some form of hormone replacement to prevent adverse effects associated with hypogonadism. Most who elect hormone therapy choose either a full or partial replacement dose of testosterone. A smaller number elect estrogen.
A retrospective multicentric analysis on testicular torsion: is there still something to learn?
Published in Scandinavian Journal of Urology, 2021
Nicolò Leone, Alessandro Morlacco, Carolina D’Elia, Antonio Amodeo, Daniele Vecchio, Daniele Tiscione, Guglielmo Zeccolini, Giordana Ferraioli, Luca Andrea Frazza, Laura Bettin, Anna Congregalli, Francesca Migliozzi, Giovanni Liguori, Carlo Trombetta, Fabrizio Dal Moro, Massimo Iafrate
As reported by Williamson in the Bristol area, the annual incidence of this urologic emergency is about one case in 4000 males at risk and 1:160 boys will have developed a torsion by the age of 25 [1]; more recently, Lee et al. [2] reported an incidence of 2.9 per 100,000 males younger than 25 years. As is widely known, fast diagnosis and treatment are mandatory, with the aim to prevent ischemic necrosis. Unfortunately, some cases of irreversible ischemic damage can still occur and leads to orchiectomy, in turn affecting fertility and quality of life of the patients. The overall survival rate of the testis is largely dependent on the correct diagnosis, ranging from 23% in a 1957 study [1] to 75.7% in the 2000s [2]; a prompt recognition and treatment of this condition is crucial. In this study we analysed the diagnostic and the therapeutic results of patients undergoing surgical exploration for acute scrotum in a collaborative multicentric study, with the aim of understanding the results of surgical treatment as well as identifying possible predictors of outcome.
Aggressive Non-Hodgkin lymphomas: risk factors and treatment of central nervous system recurrence
Published in Expert Review of Hematology, 2019
Elisa Santambrogio, Maura Nicolosi, Francesco Vassallo, Alessia Castellino, Mattia Novo, Annalisa Chiappella, Umberto Vitolo
Primary testicular lymphoma (PTL) usually presents as limited stage disease, with typical unilateral testicular mass and bilateral testicular involvement in 10% of cases only. Multiple extranodal dissemination is possible (i.e. pleura, skin, soft tissue, and Waldeyer’s ring), associated with an aggressive clinical behavior. The risk of CNS progression in PTL is particularly high with up to one-third of patients who may present a CNS relapse, within 1–2 years of diagnosis in old series. Therefore, in addition to standard tests, diagnostic lumbar puncture with cytological and flow cytometry on CSF are now recommended as staging procedure [38]. Rituximab-chemotherapy with anthracycline-containing regimens improved the outcome in all patients [57]. Orchiectomy remains mandatory both for diagnosis and treatment; in addition to radiotherapy on contralateral testis. The latter significantly reduces the testicular relapse in retrospective and prospective studies [51]. CNS prophylactic strategies to reduce risk of relapse should be added to standard systemic treatment in PTL [38].