Age-Related and Individual Anatomical Variation in Testicular Topography in Human Fetuses

At present, male infertility remains an urgent medical concern. From year to year, despite advances in methods of diagnosis and treatment, medicine encounters an increasing number of infertile couples with male infertility playing a leading role. Prerequisites for fertility disorders very frequently appear in childhood. Urologists consider cryptorchidism a leading cause of male infertility. The aim of our study was to establish the relationship between testicular descent to the scrotum and the age of the fetus. Material and methods. The study was conducted using 195 specimens of male fetuses aged 4–10 months with 81.0–375.0 mm parietalcoccygeal length (PCL) using the methods of macromicroscopic, conventional, and microslide preparation under control of binocular loupes and morphometry. Results. At the beginning of the fetal period of human ontogenesis (fetuses 81.0–135.0 mm PCL), the right and left testicles are mainly located above the corresponding deep inguinal ring and they are less often located in a region of the iliac fossae. An analysis of topographic and anatomical features of the male reproductive glands in 5-month-old fetuses (136.0–185.0 mm PCL) revealed that the testicles were located within the large pelvis, with the lower end of both the right and left testicles located above the entrance to the deep inguinal ring at a distance that equals the length of the pelvic part of the gubernaculum testis—3.2 ± 0.3 mm (right) and 2.8 ± 0.2 mm (left). In 11 fetuses aged 7 months (231.0–270.0 mm PCL), the lower ends of the testicles and their gubernaculum testis are immersed in the corresponding deep inguinal ring. In eight fetuses, the testicles were within the deep inguinal ring. A combination of many factors contributes to the final migration of a testicle through the inguinal canal into the scrotum (fetuses: 270.0 cm–290.0 mm PCL), including muscle contraction of the anterolateral abdominal wall, an increase in intra-abdominal pressure, contractile capacity of the gubernaculum testis of the testicle, the vaginal process of the peritoneum, and the neuro-muscular system. We believe that the gubernaculum testis is a particularly significant factor in testicular descent to the scrotum. The gubernaculum testis is maximally developed prior to migration of a testicle through the inguinal canal (eighth month of antenatal development), as evidenced by the prevalence of smooth muscle cells over connective tissue elements. An analysis of testicular topography in fetuses aged 9 months (311.0–345.0 mm PCL) revealed that testicles were located in the scrotum in nine fetuses, near the superficial inguinal ring in six fetuses, within the inguinal canal in four cases, and in the deep inguinal ring in one case. In fetuses aged 10 months (346.0–375.0 mm PCL), testicles were located in the scrotum in 13 cases and within the inguinal canal in seven cases. According to our research, the fusion of layers of the vaginal process of the peritoneum occurs in fetuses aged 9–10 months, resulting in the disappearance of the communication of its cavity with the peritoneum. A delay in the fusion of the peritoneal vaginal process layers at the end of the fetal period is an anatomic prerequisite for the occurrence of congenital inguinal-scrotal hernias. Conclusions. It has been found that the rate of testicular descent to the scrotum does not always coincide with the corresponding stage of fetal development. An accelerated development of the gubernaculum testis in fetuses aged 5–8 months is a major factor of heterochronic development of a testicle and subsequent testicular descent into the scrotum.     

Total reconstruction of a two-compartment scrotum by tissue expansion

A case report is presented showing the reconstruction of a two-compartment scrotum out of hair-bearing perineal skin following a severe degloving injury of the scrotum and testicles. We feel that this is an appropriate procedure to be used in patients who have lost the testicles and scrotum traumatically, either one or both testicles, or in the situation where both testicles have been spared. Aesthetically, the result in this patient is superior to skin grafting and should be readily reproducible.     

Effect of adrenaline on the post-heat damage to the spermatogenic function in rats

Administration of adrenaline for 5 days did not produce any effect on the mass and histostructure of rat testes. However, adrenaline overtly potentiated an adverse action of high temperature on spermatogenic function of the testicles (immersion of the scrotum into water heated to 41 degrees C for 30 min). That manifested in a further decrease in the testicular mass and an increase in the number of spermatic tubules which had lost two or more generations of germinal cells. It is assumed that the sensitivity of the testes to adrenaline rises under high temperature.     

Histiocytic sarcoma of the scrotum in a rat

A 225-day-old male fourth generation rat from a developing recombinant inbred line (Lewis x Brown Norway) had a bilaterally symmetrical enlargement of the scrotum. Palpation indicated the presence of a firm lobulated mass extending from the tip of the scrotum to the abdominal wall. Bilateral nodular masses totally occupied the scrotal sacs, surrounded the testicles, and extended along the spermatic cords into the abdominal cavity. Tumor nodules also were present in the intestinal mesentery, omentum, mesenteric lymph nodes, pancreas, and lung. Histologically, the neoplasm presented a spectrum of characteristics varying from that of a granuloma with giant cells to a diffuse proliferation of spindle-shaped mononuclear cells.     

Ambiguous Genitalia in a Newborn with 45,X/46,X,Idic(Y) Ovotesticular Disorder of Sex Development

ObjectiveTo discuss a case of ovotesticular disorder of sex development (DSD) with ambiguous genitalia, isodicentric Y sex chromosome mosaicism, and unique histopathologic findings.MethodsWe report the clinical, laboratory, imaging, and operative findings, and we highlight the pertinent features of this case. Results of hormonal and genetic testing are reviewed, and histopathologic findings are illustrated.ResultsA term newborn had ambiguous genitalia and was found to have an uncommon 45,X/46,X,idic(Y) karyotype. This infant had a 2-cm phallic structure, a penoscrotal hypospadias, a gonad easily palpable in the right scrotum, and a second gonad palpable high in the left inguinal canal. On ultrasonography, both gonads appeared as normal testicles, and no müllerian structures were identified. Testosterone and dihydrotestosterone levels were normal for a male neonate. After assessment of the patient at 2 months of age because of an incarcerated left inguinal hernia, both gonads were removed and were found to have both testicular and ovarian tissues spread throughout, with a fallopian tube on the left and an incipient juvenile granulosa cell tumor on the right. He was then diagnosed with ovotesticular DSD and continued to be raised as a boy.ConclusionThis male infant had undervirilization and an ovotesticular DSD. He had evidence of both ovarian and testicular tissues, in conjunction with apparent alterations in local müllerian inhibiting substance levels that allowed one fallopian tube to be preserved. The proportion of actively transcribed Y material in the chromosomes of patients with this karyotype may partially explain the variable phenotypes that can occur. (Endocr Pract. 2009;15:732-736)     

Cryptorchidism in Florida panthers: prevalence,features, and influence of genetic restoration

The overall prevalence of cryptorchidism in Florida panthers (Puma concolor coryi) from 1972-2001 was 49% (24/49), with a significant increase over time. The earliest age at which descent of both testicles was known to occur was 2 mo and the latest was 10-13 mo. Delayed testicular descent was documented in 23% (8/35) of juveniles examined. Most retained testicles were in the inguinal canal. There was no apparent difference in reproductive success between cryptorchid and normal panthers, although no bilaterally cryptorchid panthers were known to have sired litters. Cryptorchidism was thought to be a manifestation of inbreeding and was one of several factors that led to the development of a genetic restoration plan whereby eight female puma from Texas were released into the panther population in 1995. None of the progeny resulting from genetic restoration efforts has been cryptorchid. This report provides evidence that cryptorchidism in panthers is genetically rather than environmentally based, and demonstrates the utility of genetic restoration for eliminating certain deleterious traits that result from inbreeding.     

THE REPAIR OF DIFFICULT INGUINAL HERNIAS—Resection of the Spermatic Cord

A method of removing the cord structures from the inguinal canal and preserving the testis and the portion of the spermatic cord distal to the external ring was used in repair of large or recurrent hernias in 14 patients. Only one patient had pronounced testicular atrophy. In one case there was recurrence through the femoral canal. The procedure is simpler and shorter than removal of the testicle as well as the cord.     

Experimental manipulation of sexual differentiation in wallaby pouch young treated with exogenous steroids

We have investigated the effects of androgen or oestrogen treatment of female or male tammar wallabies from the day of birth, when the gonads are histologically undifferentiated, to day 25 of pouch life, when the gonads and the Wolffian and Müllerian ducts have differentiated and the testes have migrated through the inguinal canal. Female tammars treated with testosterone propionate (24-50 mg kg-1 day-1) orally for 25 days had enlarged Wolffian and Müllerian ducts. Mammary and pouch development, however, was indistinguishable from that of control females. The treatment had no apparent effect on ovarian development, or on ovarian position in the abdomen. The phallus of males and females was similar in size, and neither experimental treatment had a significant effect on its size at day 25. Male tammars treated with oestradiol benzoate (1.2-2.5 mg kg-1 day-1) orally for 25 days had gross hypertrophy of the urogenital sinus. Testicular morphology was abnormal; many of the germ cells appeared necrotic, the seminiferous tubules were of reduced diameter, and there were few Leydig cells and increased amounts of fibrous tissue between the tubules. The cortex of these gonads contained some areas which had an ovarian appearance, lacking tubules and containing numerous germ cells. The Müllerian ducts of control males had regressed, but this was prevented by oestrogen treatment, suggesting an inhibition of either Müllerian Inhibiting Substance (MIS) production or its action. Normal testicular migration was inhibited in treated males; the testes remained high in the abdomen, similar in position to the ovaries of control females, whilst control males all had testes in the inguinal region. The gubernaculum and processus vaginalis of control males extended into the scrotum, but in treated males they terminated outside it. Oestrogen treatment had no effect on the size of the scrotum and did not induce mammary or pouch development. These experiments show that marsupials, like eutherians, have a dual hormonal control of Wolffian and Müllerian development. By contrast, the initial development of the mammary glands, pouch, gubernaculum and scrotum does not appear to be under hormonal control and is therefore likely to be autonomous and dependent on genotype.     

Resurrection of a Bull by Cloning from Organs Frozen without Cryoprotectant in a ?80°C Freezer for a Decade

Frozen animal tissues without cryoprotectant have been thought to be inappropriate for use as a nuclear donor for somatic cell nuclear transfer (SCNT). We report the cloning of a bull using cells retrieved from testicles that had been taken from a dead animal and frozen without cryoprotectant in a −80°C freezer for 10 years. We obtained live cells from defrosted pieces of the spermatic cords of frozen testicles. The cells proliferated actively in culture and were apparently normal. We transferred 16 SCNT embryos from these cells into 16 synchronized recipient animals. We obtained five pregnancies and four cloned calves developed to term. Our results indicate that complete genome sets are maintained in mammalian organs even after long-term frozen-storage without cryoprotectant, and that live clones can be produced from the recovered cells.     

Zur Ursache des Hodenabstiegs (Descensus testiculorum) bei Säugetieren1

On the cause of the mammalian descent of the testes (Descensus testiculorum) Two explanations have been offered for the descent of the testes in mammals, both of which are frequently cited in the literature. Moore and co-workers argued that the phylogenetic rise of body temperature caused the translocation of the testes. According to Portmann , the descent of the testes was due to the evolution of the scrotum as a signal. However, both the sensibility of the extra-abdominal testes to temperature elevations and the optical effects of the scrotum can be interpreted as a consequence of testicular descent rather than as its cause. The hypothesis presented in this paper suggests a new adaptive explanation for the descent of the testes in mammals and regards its development as an example of evolutionary compromise. Obvious disadvantages such as reduced protection of the extra-abdominal testes, “perforation” of the inguinal abdominal wall, and an increased loss of heat from the body core have to be outbalanced by a strong selective advantage. This advantage is seen in the development of a completely new, fast mode of locomotion - the gallop. The strong flexions and extensions of the vertebral column during gallop should cause intense fluctuations of intra-abdominal pressure. Fluctuations of intra-abdominal pressure severely impede continuous flow of blood in the abdominal veins. Periodically reduced venous drainage resulting in fluctuations of intra-testicular pressure would impair the process of spermiohistogenesis, which is dependent on an absolutely constant pressure within the testis. Thus, it is the displacement of the pressure sensitive testes out of the abdominal cavity that allows for the evolution of a fast mode of locomotion accompanied by strong fluctuations of intraabdominal pressure. In the course of the phylogenetic translocation of the testes increasing specializations of the testicular blood vessels occur. In mammals possessing a scrotum the return flow of venous blood from the extra-abdominal testes to the abdominal cavity is supported by utilizing the energy of the arterial pulse (‘peripheral arterial pump’). A model for the successive stages of the descent of the testes is illustrated in Figures 7–10. The morphological changes related to the phylogenetic descent of the testes, such as the specialization of the testicular blood vessels, the forming of a cremasteric sack in the inguinal region, and the differentiation of the inguinal or perineal integument into a scrotum can all be interpreted as serving one purpose: they aid in maintaining a constant intra-testicular pressure in spite of increasing fluctuations of intra-abdominal pressure and venous blood flow during the evolution of the gallop. Although the blood vessels of the spermatic chord basically serve the same functions, they show markedly different specializations in Marsupials and Eutherians. This indicates that the descent of the testes has occurred independently, at least, in these two groups. The explanation put forward here postulates a causal relationship between the mode of locomotion and the position of the testes. Mammals possessing testes wnich reside permanently within the abdominal cavity (‘Testiconda’) cannot gallop, whereas mammals with the ability to gallop must have (periodical or permanent) extraabdominal testes (‘Testiphaena’).     

Testicular prosthesis in a Quarterhorse stallion: a case report

A testicular prosthesis was surgically removed from the scrotum of a Quarterhorse stallion presented for evaluation of a large, firm, unilateral scrotal mass. The prosthesis was constructed from methyl methacrylate moulded around a roll of fiberglass casting tape. The prosthesis had been surgically implanted in the scrotum approximately 4 yr prior to presentation in order to give the appearance of 2 testicles in the scrotum for showing and breeding purposes. The horse had been used to successfully breed mares prior to presentation and produced 4.046 x 10(9) progressively motile, morphologically normal spermatozoa in an ejaculate collected 4 mo after surgery to remove the prosthesis. Ethical issues raised by this case are discussed.     

High Incidence of Scrotal Hernias in a Closed Colony of FVB Mice

Although inguinal hernias are rarely reported to occur in mice, a high incidence of scrotal hernias was observed in a closed breeding colony of FVB/N mice. Unilateral or bilateral hernias occurred in more than 20% of the male mice in the colony that were available for necropsy over 3 inbred and 1 outcross generations; no female mice were affected. Organs commonly present within the hernial sac included the cecum and seminal vesicles. Hernias did not adversely affect the fertility or lifespan of the affected male mice. Although the condition was heritable, no clear pattern of transmission was evident.During development, the testes descend from the abdominal cavity through the inguinal canal and into the scrotum, guided by the processus vaginalis. In primates and carnivores, the processus vaginalis is largely or entirely obliterated during late gestation.¹³ When correct closure fails to occur, a hernial sac may travel through the deep inguinal ring to create an inguinal hernia.¹⁶ Protrusion of a hernial sac containing abdominal organs into the scrotum results in scrotal hernia, a severe and potentially dangerous form of inguinal hernia. In rodents, the inguinal canal is very short and the processus vaginalis remains patent throughout life, allowing the testes to pass freely between the scrotum and abdomen.¹³ Despite this potential pathway for herniation of abdominal organs, scrotal hernias have rarely been reported to occur in laboratory mice.Spontaneous inguinal hernias have rarely been reported in either male or female mice. Inguinal hernias occur in intact but not castrated male mice treated with estrogenic compounds and in intact female mice treated with testosterone or bearing testicular grafts.^1,2,10 Both male and female C57BL/6 mice that fail to express fibulin 3 develop multiple large hernias, including inguinal hernias.¹⁴ In these mice, herniation occurs at the myopectineal orifice, through the external inguinal ring. Female mice transgenic for insulin-like factor 3 develop inguinal hernias with 100% penetrance.¹¹ A recent report described a high incidence of lateral femoral hernias in an inbred colony of FVB/NHsd mice; the condition predominantly affected female mice.¹⁵ This phenomenon was attributed to genetic drift in a closed colony. We now report on another situation in which many hernias were noted in inbred FVB/N mice. In the present case, scrotal hernias occurred in a high proportion of FVB/N mice maintained in a closed breeding colony.     

La descente testiculaire

Gonadal development is intimately linked to that of the mesonephros. The primordial testes differentiate in the dorsal region of the embryonic abdomen, behind the coelomic cavity. To reach their final location within the scrotum, the testes descend into the pelvis, pass through the abdominal wall by the inguinal canal, and attach to the base of the scrotal pouch. Testicular migration therefore comprises three stages, each requiring its own mecanism (s). The genital ducts (epididymis, vas deferens) and ligament which attaches the testis to the scrotal wall (gubernaculum testis) certainly play an essential role in these migratory events. The first phase is quite passive, associated with the growth of the abdominal cavity. In the second phase, the gubernaculum enlarges and shortens, pulling the testis through the inguinal canal. Finally, the gubernaculum, as a short, fibrous ligament, attaches the testis to the scrotal wall.     

Torsion du cordon spermatique sur testicule non descendu (A propos de deux cas et revue de la littérature)

Torsion of an ectopic testis is an exceptional disease and mostly occurs in young adults. Its etiopathogenesis has not been elucidated. The authors report two cases. The clinical presentation consisted of sudden onset of abdominal pain without fever, associated with a palpable inguinal mass and a homolateral empty scrotum. Abdominal ultrasound showed a mass with a heterogeneous echogenicity. Emergency surgical exploration revealed a necrotic inguinal ectopic testis. Orchidectomy was performed and pathological examination did not reveal any signs of malignancy. The management of torsion of an undescended testis revealed by a mass with homolateral empty scrotum consists of urgent surgical exploration. Medical imaging appears to have a limited role. An inguinal incision allows diagnosis, detorsion, reduction and fixation in the homolateral scrotum.     

UNDESCENDED TESTICLE COMPLICATING ACUTE APPENDICITIS

1. Symptoms referable to compression of the spermatic cord and incarceration of right testicle, obscure the underlying pathologic changes occurring in the vermiform appendix.2. Testicular underdevelopment and resulting subnormal cerebration.3. Operative technique:(a) Pre-operative diagnosis: Incarceration of right testicle and possible perforative appendicitis.(b) Descent of right incarcerated testicle. Bassini closure.(c) Exploratory laparotomy: Intramuscular gridiron incision.4. Operative findings:(a) Strangulation and incarceration of undescended right testicle and spermatic cord in inguinal canal.(b) Copious pus, free in peritoneal cavity. An adherent, sloughing, perforative, retrocecal appendix identified, left undisturbed and free drainage established.5. Progress:(a) Eventful recovery from acute suppurative appendicitis following drainage of appendical focus.(b) Marked development following the operative descent of an incarcerated testicle in a backward boy, age twelve, who had a bilateral cryptorchism.     

Basic morphological data of external genitals in 177 healthy Central European men

Five basic measurements were made of the penis, the scrotum and the testicles of 177 healthy Bohemian (Czechoslovakian) men, 18–20 years of age. The average length of the penis was 72.18 mm. The average circumference of the penis was 95.65 mm. The length of the right testicle was 47.37 mm, the length of the left was 45.17 mm. In 16.2% of those examined slight deformations of the urethral opening and mild malformations of the prepuce and the frenum were found. These defects did not disturb function. The method of measurement used has been described.     

Malignant fibrous histiocytoma of the glans penis: a case report

BACKGROUND: Malignant fibrous histiocytoma has been regarded as the most common sarcoma of older adults. However, recent opinion regards pleomorphic malignant fibrous histiocytoma as an undifferentiated high grade pleomorphic sarcoma not otherwise classifiable utilizing current techniques available in surgical pathology. Notwithstanding controversy regarding its nomenclature, malignant fibrous histiocytoma involving the penis is exceedingly rare, with only 4 cases previously described, to our knowledge. CASE: An uncircumcised 73-year-old male presented with a painless, granular, partially necrotic lesion beneath the penile foreskin. There was no history of sexually transmitted disease, constitutional symptoms or dysuria. Examination of penile shaft, testicles, spermatic cord and inguinal lymph nodes were unremarkable. Biopsy revealed a markedly pleomorphic sarcoma. Subsequent, partial penectomy revealed the same lesion with an adjacent area of squamous cell carcinoma in situ. CONCLUSION: Malignant fibrous histiocytoma remains a diagnosis of exclusion. The investigation requires extensive tumor sampling in search of areas of differentiation and a complete battery of immunohistochemical markers. Therapeutically important entities in the differential diagnosis that must be ruled out include other poorly differentiated sarcomas, sarcomatoid squamous cell carcinoma and desmoplastic melanoma.     

Résultats hémodynamiques et cliniques de la dissection, assistée par lunettes chirurgicales, des veines spermatiques au niveau de l’orifice inguinal interne

Inversion of venous flow is well visualized by colour duplex ultrasound and is the basic haemodynamic feature of varicocele. We tried to assess the value of dissection of branches of the spermatic vein in the internal inguinal ring using an operating microscope with a magnification of 4.5x. 16 patients were operated according to the ultrasound classification proposed by Hirsh et al. [8]. Varicocele was grade III in 2 cases, grade IV in 11 cases and grade V in 3 cases and was situated on the left in 13 patients and on the right in 3 patients. The diagnosis was based on clinical examination and colour duplex ultrasound. The operating time was 25–35 min. The incision was 1.5 to 2 cm long. No short-term complications or long-term hydrocele were observed. No reno-spermatic flow was observed on colour duplex ultrasound after six months. The mean testicular volume was 22 ml before surgery and did not change after the operation. This surgical technique is less invasive than the conventional retroperitoneal or laparoscopic procedures, and the incision is smaller than with the percutaneous technique. It is less radical than conventional microsurgery, but the operating time is shorter, and the surgical wound is smaller, sparing the artery and lymphatic vessels. In conclusion, this operation can be considered to be a good option in the surgical treatment of varicocele in view of its low complication rate, the absence of hydrocele, a minimally invasive procedure and the good haemodynamic results.     

Ambiguous external genitalia due to defect of 5-α-reductase in seven Iraqi patients: Prevalence of a novel mutation

We report on seven Iraqi patients with 46,XY karyotype and ambiguous genitalia characterized by perineo-scrotal hypospadias, bifid scrotum, clitoris like phallus, palpable testes in inguinal canal and pseudovagina. Patients were raised five as females and two as males. They are all unrelated with the exception of two couples of brothers. The diagnosis of 5-α-reductase-2 deficiency syndrome was first hypothesized on clinical grounds and then confirmed by molecular analysis. Direct sequencing analysis of the SRD5A2 gene revealed in five patients a novel homozygous frame-shift mutation (c.453delC) and in two related patients a previous reported missense mutation. The presence of the same mutation in unrelated patients of the same population suggests a possible founder effect. This report brings the 5-α-reductase-2 deficiency syndrome to the attention of clinical geneticists and child surgeons and discusses the appropriate clinical and surgical strategies for treating these patients.     

The long-term effect of mesh bioprosthesis in inguinal hernia repair on testicular nitric oxide metabolism and apoptosis in rat testis

Polypropylene mesh is the most widely used material in inguinal hernia repair. Although polypropylene mesh is known as an inert material, it is experimentally proven that mesh generates a chronic inflammatory tissue reaction. The aim of the present study was to investigate the long-term effects of polypropylene mesh material used in inguinal hernia operations on testicular function, testicular nitric oxide (NO) metabolism and germ cell-specific apoptosis in rats. The study comprised 40 male rats that were randomly allocated into two groups. In group 1, the left spermatic cord was elevated and a 0.5 x 1 cm polypropylene mesh was placed behind the left inguinal spermatic cord and group 2 consisted of the sham-operated controls. Blood samples were taken at 6 months preoperatively and postoperatively after to assess luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels for hormonal evaluation. Testicular NO was evaluated by the Griess method, apoptosis by a TUNEL method and inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS) expressions by immunohistochemical staining. Mild (+) eNOS expression was observed in all specimens. Mild (+) iNOS expression was only detected in ipsilateral testis of the mesh-implanted study group. Apoptotic cells were not detected in any samples. We are of the opinion that long-term polypropylene mesh implantation has no effect on testicular hormonal function and only a limited effect on nitric oxide levels and this effect is not sufficient to cause apoptosis in testis that could lead to infertility. It seems that mesh implantation is a reliable method in inguinal hernia repair; however, further work is required by more sensitive methods to fully elucidate the potential testicular damage.