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.     

The acutely painful scrotum in children: review of 113 consecutive cases

A young boy who presents with an acutely painful scrotum can be a diagnostic challenge to his physician. It is important to differentiate the various causes of this symptom and to institute prompt management. Failure to do so could jeopardize the patient''s future fertility. In a review of 113 consecutive cases of a painful scrotum at a children''s hospital, torsion of the testicle was found in 51 patients (45%). Torsion of the appendix testis was found in 40 patients (35%) and acute epididymitis, once considered rare in children, was diagnosed in 17 (15%). The importance of prompt diagnosis of torsion is emphasized. The clinical diagnosis of the acutely painful scrotum is notoriously difficult, and in this series of cases surgical exploration was required in 92%. Only 2 of the 17 cases of epididymitis were associated with a bacterial urinary tract infection.     

Torsion of the testicle: a clinical review of 20 cases

Early diagnosis of testicular torsion is absolutely mandatory for salvage of a viable organ. The classical clinical presentation is a boy in the second decade with sudden onset of testicular pain accompanied by testicular tenderness and swelling as well as scrotal erythema and edema. The management is emergency exploration of the testicle with either orchiopexy or orchidectomy, depending upon the viability of the testis. In this series of 20 cases 90% had exploration with a salvage rate of 72%. Torsion of the testicle is in most cases due to a congenital abnormality; therefore contralateral orchiopexy is always done at the time of the exploration of the scrotum. The critical time interval from onset to exploration of the torsion is approximately 10 hours. In addition to the acute clinical entity, chronic torsion of the testis should be considered in all patients with unexplained orchalgia.     

13 Years' experience with the combined hormonal therapy of cryptorchidism.

PURPOSE: We analyze the results of the combined treatment with luteinizing hormone releasing hormone (LH-RH) and human chorionic gonadotropin (HCG) of a large series of patients with cryptorchidism. MATERIALS AND METHODS: Between 1987 and 1999 and after strict differentiation between cryptorchid, retractile and gliding testes, 2,467 boys with 2,962 cryptorchid-gliding testes were treated with the combined hormonal therapy. LH-RH was administrated as a nasal spray at a dosage of 1.2 microg daily for a period of 4 weeks. HCG was injected intramuscularly, 5 times at 2-day intervals at a dosage adjusted according to the age. RESULTS: In the prospective study 2,476 boys with 2,962 cryptorchid testes were hormonally treated. Of the 2,962 evaluated cases 1,200 (40.52%) have been treated surgically after the hormone therapy. In 1,762 cases, 59.48% of cryptorchid testes were in the scrotum after combined hormone treatment. CONCLUSIONS: Treatment with LH-RH and HCG induced the descent of the testes to a normal scrotal position of boys with cryptorchidism in 59.48% of the evaluated cases. The combined treatment was effective for inducing descent of cryptorchid and gliding testes. According to the evaluated intraoperative findings, the failure of the combined therapy in 40.52% of the cases is due to the fact that the free descent is limited by local factors such as anatomical alterations of the inguinal canal, epididymal abnormalities or ectopic distal attachment of the lig. testis.     

Measurement of scrotum and testis size of unrestrained captive cotton-top tamarins (Saguinus oedipus oedipus)

Reproduction is restricted to a small number of animals within both captive and wild groups of callitrichid monkeys (marmosets and tamarins). Sexual development of nonbreeding group members might differ from that of active breeders. Measurements of physical growth typically involve animal handling. However, capture and restraint of callitrichid monkeys can disrupt natural behaviors and physiology. This study introduces a method for estimating size of external genitalia by measuring frontal scrotum width of unrestrained cotton-top tamarin males. We examined whether scrotum width was a reliable indicator of testis size, and whether the method provided information useful for comparisons of growth and development among individuals. Animals were lured to a standardized position, and maximum width of the scrotum was systematically compared to a card with a series of rectangles graded in 1 mm increments. Card measures were validated with caliper measurements of scrotum width and testicle dimensions. Regressions of testes dimensions measured by caliper on scrotum width measured by card were between 82 and 93%, suggesting that measures of frontal scrotum width provide consistent estimates of relative testis sizes. The period of rapid growth ended by roughly two years of age, after which scrotum size did not differ from that of breeding males.     

B-mode ultrasonography of the bull testicle

The scrotum and testicles from 20 bulls aged 6 mo to 10 yr were obtained from a slaughterhouse and ultrasonically scanned to determine the normal echographic anatomy Ultrasonically, the normal bull testicle was homogeneous and moderately echogenic. The mediastinum testis was a linear structure in the center of the testicle and was slightly more echogenic than the parenchyma. The head and tail of the epididymis were easily identified on all testicles, but the epididymal body and ductus deferens were difficult to identify consistently. Ultrasound scanning of the testicles may prove to be a valuable noninvasive diagnostic technique for evaluating testicular diseases in bulls.     

Cryptorchidie acquise, testicule oscillant et autres formes secondaires de cryptorchidie

Most of cryptorchidisms are due to failure in testicular descent during fetal life, but secondary forms of cryptorchidism exist. They are represented by cryptorchidism associated to general disease, ascended testis, retractile testis and iatrogenic forms. It is important to know and diagnose these forms, because histological lesions are present in any testis which stayed out of scrotum for a prolonged period.     

Testicular organogenesis in the fetal calf: interstitial endocrine (Leydig) cell development

The development of the interstitial endocrine (Leydig) cells of the fetal testis in the calf is described and correlated with a swelling reaction of the gubernaculum and normal, prenatal descent of the testis. An hydroxysteroid dehydrogenase (HSD) procedure is used to determine the onset of functional activity for the interstitial endocrine cells (IEC). The NADH control procedure was strongly positive for the IECs at all ages investigated, indicating that these cells utilize the pyridine nucleotide as a coenzyme for oxireduction conversions. The 3 alpha- and 3 beta-HSD reactions were strongly positive and lightly positive, respectively, demonstrating that these cells contain the HSDs commonly utilized in the early steroidogenesis. TEM revealed structural evidence of this differentiating steroidogenic capability within IECs. During the period of the swelling reaction there is a functional IEC population, but there is no evidence presented by this study for a causal relationship of the gubernacular swelling reaction and subsequent normal descent of the testis into the scrotum.     

Evaluation of the safety and efficacy of testicular biopsies in llamas

Evaluation of the reproductive function of Lama glama is generally considered to be a challenging task due to the difficulty of obtaining representative semen samples. One method that has been proposed for evaluation of testicular function in these animals is histologic examination of testicular needle biopsies. This study was undertaken to examine the safety and efficacy of using needle biopsies to assess testicular function in this species. One randomly selected testicle from each of 16 sexually mature llamas was biopsied with a 14-gauge self-firing biopsy instrument. The llamas were evaluated over a 6-week period with thermography for temperature changes of the scrotum. At the end of the 6-week trial, the llamas were castrated and sections of each testis were fixed in Bouin's solution for histologic examination. Immediately prior to castration, an additional biopsy was taken from each testis to compare the tissue obtained via biopsy with sections from the corresponding testis obtained after castration. A qualitative grading scale was used to compare the seminiferous tubules from each testis. No difference was found between the biopsied and the nonbiopsied testes (P = 0.69). The percentage of normal tubules between the biopsied and the nonbiopsied sides also did not differ (P = 0.70). Furthermore, the percentage of normal seminiferous tubules did not differ between the needle biopsy samples and the corresponding tissue samples obtained at castration (P = 0.48). The number of round seminiferous tubules counted in each biopsy section ranged from 3 to 67. There was no significant difference in the thermographic images of the scrotum between the biopsied and the nonbiopsied testes. This study supports testicular biopsies as a safe and useful procedure in the evaluation of testicular function.     

Cryptorchidie de l’enfant: syndrome ou symptôme?

Cryptorchidism is a frequent disease of children whose management remains controversial. Clinical diagnosis of cryptorchidism must assess the permanent location of the testis outside scrotum and must look for associated malformations. Endocrine investigation should include an evaluation of basal plasma testosterone and after an HCG stimulation test. Development of cryptorchidism is due to anatomical, histological and endocrine abnormalities. Medical treatment should be realised as early as possible. If testis descent does not occur, orchidopexy must be performed. Long-term effects of cryptorchidism are defined by infertility and testis cancer.     

Anomalies de position des testicules dans l’enfance: conséquences à l’âge adulte

Non descended testes in the low scrotum is a common anomaly at birth, with about 4% of the newborn males affected. Only one quarter of these newborn babies will still have non descended testes when one year old. However, the testes that will descend within the first year of life seem no more to be considered as normally descended testes. Moreover, the retractile testis, which represents a secondary anomaly of testicular position occuring after the babies are older than one year, is no more to be regarded as a physiological variant of the normally descended testis, since several reports indicate histological and clinical modifications in such cases. The testicular non descent can be associated with two consequences in adult life. Firstly, an history of non descended testis is the only known risk factor for the testicular cancer. Secondly, such an history is a risk factor for the male fertility because of spermatogenesis alterations, as indicated by qualitative and quantitative histological analyses of the testicular tissue, and by depressed spermatozoa output and quality (motility, normal forms); moreover, testicular volumes are reduced, and the time to pregnancy as well as the rate of infertility are increased. Time is arrived for a reappraisal of the consequences in adult life of the abnormal testicular location (either congenital or acquired) during childhood.     

Cryptorchidie et température testiculaire

The testis migrates to a scrotal location before birth. This physiological descent is associated with a reduction in the temperature of the testicular environment since the temperature of the scrotal cavity is lower than that of the body one. This leads to the etablishment of a themperature gradient between the testis and the body which already exists in prepubertal boys. In cases of testicular maldescent (cryptorchidism), the temperature of the testis in its cryptorchid location is much higher than that of the normally descended contrlateral testis. However, there are no data obtained from human studies to establish wether the increased temperature of a cryptorchid testis is responsible for the spermatogenic perturbations typically observed. Nor do we know wether the relocation of a cryptorchid testis to the scrotum permits re-establishment of a normal testicular temperature. Adult men with a history of cryptorchidism constitute about 10% of infertile men, and among these previously cryptorchid infertile men 45% have an abnormally elevated scrotal temperature. This abnormal increase in scrotal temperature is a negative risk factor for fertility: these men have smaller testicular volumes, a more severely impaired spermatogenesis and a higher prevalence of primary infertility than previously cryptorchid infertile than previously cryptorchid infertile men with normal scrotal temperature. However, data provided until now do not allow to know whether elevated temperature is due to the decreased testicular size (hypotrophy) or is a consequence of cryptorchidism per se.     

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.     

Glycosylation pattern in the appendix testis in children with cryptorchidism

In humans, at about week 6, sex cords develop within the forming testes. Testes normally descend to the scrotum; cryptorchidism occurs when one or two testes do not descend to scrotum and in some case are accompanied by the appendix testis. The appendix testis is a small sessile or polypoid structure located at the antero superior pole of the testis, adjacent to the head of the epididymis. Glycans can be involved in development of the appendix testis and cryptorchidism. In this work, lectin histochemistry was used to evaluate glycans expression in appendix testis in children with cryptorchidism. Our results showed that lectin from Lens culinaris, Ulex europaeus I., Canavalia ensiformis, Artocarpus integrifolia, Glycine max, and Griffonia simplicifolia recognizes epithelial and estromal cells. Not interaction was observed with lectin from Amaranthus leucocarpus, while lectin from Dolichus biflorus lectin only recognizes epithelial cells. Our results suggest that O-glycans linked in some glycoproteins represent important elements in appendix testis development.     

Müllerian inhibiting substance production and testicular migration and descent in the pouch young of a marsupial

The ontogeny of Müllerian inhibiting substance (MIS) production by the developing testis of an Australian marsupial, the tammar wallaby (Macropus eugenii), was determined during pouch life using an organ-culture bioassay of mouse fetal urogenital ridge. This information was related to the morphological events during testicular migration and descent. MIS biological activity was found in testes (but not ovaries or liver) of pouch young from 2 to 85 days of age. MIS production had commenced by day 2, which is within a day of the first gross morphological signs of testicular differentiation. Müllerian duct regression occurred between 10 and 30 days, which partly coincided with testicular migration to the inguinal region and enlargement of the gubernacular bulb (15 to 30 days). These observations are consistent with the hypothesis that MIS may be involved in testicular transabdominal migration. The epididymis commenced development and growth only after the testis had descended through the inguinal ring. This provides no support for the suggestion that the epididymis is involved in testicular descent into the scrotum. The basic sequence of events in post-testicular sexual differentiation in the wallaby is sufficiently similar to that seen in eutherian mammals to make it an excellent experimental model for future studies of testicular differentiation, migration and descent.     

Abnormalities of testicular descent

Testicular descent occurs in two stages. The transabdominal phase (8–15 weeks) is controlled by enlargement of the caudal genito-inguinal ligament (gubernaculum) and regression of the cranial ligament. Insulin-like 3 from the Leydig cell appears to be the prime stimulator of gubernacular growth, augmented by Müllerian inhibiting substance/anti-Müllerian hormone. Testosterone causes regression of the cranial ligament. The inguinoscrotal phase (25–35 weeks) requires the migration of the gubernaculum from the groin to the scrotum; this migration is guided by the genito-femoral nerve releasing calcitonin gene-related peptide under the influence of androgen. The neonatal gonocyte transforms into a type A spermatogonium at 3–12 months of age, a step that is now known to be crucial for subsequent fertility, as the stem cells for spermatogenesis are created in this structure. This step is blocked in undescended testis and, hence, orchidopexy is currently recommended at 6–12 months of age. Congenital cryptorchidism is caused by the failure of gubernacular migration to the scrotum (1%–2%) but we now recognise that another 1%–2% of boys have acquired cryptorchidism, secondary to the failure of spermatic cord elongation with growth of the boy. These latter cases come to operation at 5–10 years of age. Surgery remains the mainstay of treatment, as hormonal therapy has not been proven to be effective, presumably because testicular descent is a complex anatomical mechanism.     

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’).     

Growth and reproductive development in the male tree shrew (Tupaia belangeri) from birth to sexual maturity

The growth and reproductive development of the male tree shrew were studied from birth to sexual maturity. An infantile phase from birth to Day 30 was characterized by the rapid involution of the testis and adrenal gland from a fetal condition followed by a nadir in testosterone levels and slow growth and differentiation of the testis and accessory sex organs. The initiation of puberty occurred collaterally with the emergence of the young from the nest and was marked by a sharp rise in testosterone levels from Days 30 to 35 to maximum levels at Days 40-55. Peak testosterone levels were temporally correlated with the onset of maximum growth and differentiation of the testis and accessory sex organs, descent of the testis, development of the scrotum, and a pronounced peak in the weight-velocity curve. The rapid growth of males at puberty contributed to a moderate degree of sexual dimorphism in this species. Puberty was attained at about Day 90 with the completion of spermatogenesis and the functional differentiation of the accessory sex organs. The postnatal development of the tree shrew conforms with the general primate pattern. The precise endocrine correlates established during puberty make Tupaia belangeri a useful small animal model for the study of puberty in primates.