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Overview of Cryptorchidism with Emphasis on the Human
Published in Tom O. Abney, Brooks A. Keel, The Cryptorchid Testis, 2020
David R. Roth, Larry I. Lipshultz
Other authors have suggested that orchiopexy before age 2 will offer the best opportunity for preservation of testicular function.29 Gaudio documented changes in testicular histology as early as 2 years of age and observed ultrastructural abnormalities in the Sertoli cell in patients of this age as well.30 Hadziselimovic found that 22% of 2-year-olds with unilateral cryptorchidism had already lost all germ cells in the ipsilateral testis.22 Those testes with germ cells present showed inhibition of development. Significantly, the contralateral gonad showed a definite decrease in the germ cell population when compared to uninvolved control gonads.
O
Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Orchiopexy [Greek: orchios, testis + pexis, fixation] Operation to mobilize the undescended testis. Performed by Charles Bell Robert Keetly (1848–1909) of West London Hospital in 1894. He implanted the testis in the thigh and this method was adopted and perfected by Franz C. Torek (1861–1938) of America in 1908. Another method was devised by Arthur Dean Bevan (1861–1943) of America in 1899. Implanting through the septum of the scrotum was described by C. Walther, a French surgeon, in 1906. Louis Ombredanne (b 1871), a French pediatric surgeon perfected the Walther procedure and used it on 1000 patients. His method was popularized in England by Philip Turner (b 1873) of Guy’s Hospital in the 1920s.
History and Physical Examination: Male Infertility
Published in Nicolás Garrido, Rocio Rivera, A Practical Guide to Sperm Analysis, 2017
Jared L. Moss, Mary Kate Keeter, Robert E. Brannigan
Special attention should be paid to whether the patient's testicles descended properly as a child. The presence or history of an undescended testicle has been linked to reduced fertility, with approximately 10% of infertile men having a history of cryptorchidism and subsequent orchiopexy.8,9 Infertility is two times more common in men with a history of unilateral cryptorchidism and six times more common in men with a history of bilateral cryptorchidism.10,11 The reduction in fertility potential has been attributed to a limited number of germ cells as well as defective prepubertal germ cell maturation associated with the abnormal position of the testicle.12 Additional data indicate little fertility potential for testicles that are not descended properly in the scrotum prior to puberty.13 The AUA recommends that orchiopexy be considered in patients who have not had descent of the testicle by 6 months of age because the deleterious effects on the testicle worsen with time.14 It should be noted that although scrotal relocation of the testis may reduce the likelihood of infertility, it will not prevent it entirely.9,14
Testicular developmental impairment caused by flutamide-induced and DEHP-induced cryptorchid rat models is mediated by excessive apoptosis and deficient autophagy
Published in Toxicology Mechanisms and Methods, 2018
Yi Wei, Yu Zhou, Xiang-Liang Tang, Bin Liu, Lian-Ju Shen, Chun-lan Long, Tao Lin, Da-wei He, Sheng-de Wu, Guang-hui Wei
Cryptorchidism is a common condition of childhood, and it is estimated to affect 1–4% of full-term and up to 30% of preterm male neonates (Berkowitz et al. 1993; Hutson et al. 1997; Chung and Brock 2011). The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and associated inguinal hernia (Sampaio and Favorito 1998; Kolon et al. 2014). The surgical therapy for the cryptorchidism is orchiopexy. However, the sperm concentration and total sperm count of patients underwent orchidopexy were also reported reduced (Kollin et al. 2012). While means the effective therapy and prevention of cryptorchidism is still poorly understood and underlying mechanisms of testicular impairment caused by cryptorchidism need further study.
Identification of two AMH gene variants in two unrelated patients with persistent Müllerian duct syndrome: one novel variant
Published in Gynecological Endocrinology, 2021
Sezer Acar, Özlem Nalbantoğlu, Semra Gürsoy, Beyhan Özkaya, Özge Köprülü, Gülçin Arslan, Filiz Hazan, Behzat Özkan
A 2-year-and-2-month old male was referred to our clinic for further evaluation upon detection of müllerian structures in laparoscopic examination performed by a pediatric surgeon while investigating for cryptorchidism. He was born at term with a weight of 2900 grams and his parents were first-degree cousins. Past medical history of his family was unremarkable. On physical examination, body weight was 12.1 kg (–0.95 SDS), height was 87.4 cm (–0.98 SDS). He was externally normal male and had a single opening at the end of the urethra and his stretched penis length was 4.1 cm. The testicles could not be palpated in the scrotum or inguinal canal. Serum levels of gonadotropin/total testosterone were in normal range according to age-appropriate references and congenital adrenal hyperplasia was excluded. Serum level of AMH measured by ECLIA was undetectable (< 0.01 ng/mL, N: 33.4-342.5). His karyotype was 46, XY. Post-hCG (1500 U/m2, three times every other day), serum total testosterone level was measured as 567 ng/dL, suggesting an adequate testosterone response. While the right testes was detected at the proximal of the inguinal canal by USG, the left testicle or uterus could not be visualized. Pelvic MRI (suboptimal) revealed bilateral abdominal testes but no uterus or müllerian remnants. In laparoscopic exploration, the right testis was found at the proximal of the inguinal canal, and the left testis was found in the normal location of the ovarian tissue (pseudo-ovarian position) in the pelvis and in addition, müllerian derivatives (hypoplastic uterus and tuba uterina) were also observed. At the same laparoscopic session, müllerian residues were removed. Staged bilateral orchiopexy was performed. Pathological evaluation of the excised structures confirmed the presence müllerian remnants
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
Three hundred and sixty-eight cases were retrospectively collected from January 2010 to June 2019. The preoperative features are reported in Table 1. Median age of the patients was 17 years (IQR 14– 23); only 14 patients (3.8%) had undergone previous scrotal surgery. Seventy-three percent of patients reported high level of pain (NPRS > 6). The time between symptom onset and ER access time was within 3 h in majority of patients, however, 17.4% of subject presented after more than 12 h from the onset of pain. The surgical treatment was performed within 6 h from symptom onset in 40.8%, while 30.4% of patients were treated after more than 12 h. In the patients who underwent US, the US data were concordant with the surgical findings in 254 cases (82.7%%). Table 2 lists the intra- and postoperative results. Surgical treatment consisted of orchiopexy (with preoperative manual detorsion) in 147 subjects (39.9%), operative detorsion + orchiopexy in 178 (48.4%) and orchiectomy for necrotic testicle in 43 (11.7%). Concurrent orchiopexy of the contralateral gonad was carried out in 89 patients (24%), while deferred treatment for torsion of the contralateral gonad occurred in 22 subjects (6%). When analysing specific subgroups, the need for orchiectomy was only 2.8% in patients presenting to ER 3 h after the onset of the pain, while it reached 22.4% in patients presenting after more than 10 h. In patients with NPRS = 0 at urological evaluation (N = 68) 17 (25%) received manual preoperative detorsion and fixation, 45 (66%) operative detorsion and fixation and 6 (8.8%) orchiectomies. The number of these patients that received Doppler US were 67.6% and, among them, 29/46 (63%) had US signs of ischemia, concordance between US and surgery was 51.1%. Remarkably, time from symptoms to treatment in this subgroup was 0–6 h in 46%, 6–10 h in 16% and more than 10 h in 38%.