Torsion of the Testis and its Appendages

In a survey of 101 cases with an index diagnosis of torsion of the testis or its appendage, there were 86 instances of torsion of the testis and 14 of torsion of the hydatid of Morgagni. In 38 of the patients with testicular torsion there were one or more “warning” attacks of pain and swelling, due to torsion which became spontaneously untwisted. In 19 cases operative fixation was performed because of this warning history, and all the testes were preserved. In the other 19 the testes were not explored until the patient came in with a severe “classical” episode of torsion: seven of these testicles were lost from gangrene or delayed atrophy.In 31 cases torsion resulted in failure to save the testis. Of these, 20 were misdiagnosed and treated initially as epididymo-orchitis, despite there being no evidence of a urinary tract infection. There is no excuse for not exploring any actuely inflammed testicle which is unaccompanied by definite evidence of urinary or urethral infection.     

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.     

Les torsions du cordon spermatique chez l’adulte au CHU Yalgado Ouédraogo de Ouagadougou

Objective

To evaluate the epidemiologic, diagnostic and therapeutic features of testicular torsion in adults aged 15 years and older.

Materials and methods

A retrospective study was conducted from January 2004 to June 2010 in the general surgery emergency unit and urology department of the CHU Yalgado-Ouedraogo of Ouagadougou (Burkina Faso). Medical records of 51 patients who were suspected of torsion of spermatic cord were included in this study.

Results

Torsion of spermatic cord was confirmed in 40 patients (78.4%) after scrotal exploration. The average age was 26 years (range 16–55 years). The average duration from the time of onset of pain to arrival at the emergency department was 24.6 hours, and 84.3% of the patients arrived after 6 hours. Hemi-scrotal tumefaction and ascended testicle were the main clinical findings. Orchidectomy was performed in 22 patients (55%). Post-operative findings were good for all patients, and the average hospital stay was 4.3 days (range 2–7 days).

Conclusion

In our study, a high proportion of patients underwent orchidectomy. We suggest that actions must be taken to educate men about testicular pain and to receive timely treatment in case of any testicular pain.     

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.     

The role of tumor necrosis factor-alpha and interleukin-1 in the mammalian testis and their involvement in testicular torsion and autoimmune orchitis

This review will focus the roles of TNF-alpha, IL-1 alpha, and IL-1 beta in the mammalian testis and in two testicular pathologies, testicular torsion and orchitis. TNF alpha in the testis is produced by round spermatids, pachytene spermatocytes, and testicular macrophages. The type 1 TNF receptor has been found on Sertoli and Leydig cells and numerous studies suggest a paracrine mode of action for TNF alpha in the normal testis. IL-1 alpha has been reported to be produced by Sertoli cells, testicular macrophages, and possibly postmeiotic germ cells. IL-1 receptors have been reported on Sertoli cells, Leydig cells, testicular macrophages, and germ cells suggesting both autocrine and paracrine functions. While these proinflammatory cytokines have important roles in normal testicular homeostasis, an elevation of their expression can lead to testicular dysfunctions. Testicular torsion is a clinical pathology with results in testicular ischemia and surgical intervention is often required for reperfusion. A pivotal role for IL-1beta in the pathology of testicular torsion has been recently described whereby an increase in IL-1beta production after reperfusion of the testis is correlated with the activation of the stress-related kinase, c-jun N-terminal kinase, and ultimately resulting in neutrophil recruitment to the testis and germ cell apoptosis. In autoimmune orchitis, on the other hand, TNF alpha produced by T-lymphocytes and macrophages of the testis has been implicated in the development and progression of the disease. Thus, both proinflammatory cytokines, TNF alpha and IL-1, have significant roles in normal testicular functions as well as in certain testicular pathologies.     

Testicular torsion and its effects on the spermatogenic cycle in the contralateral testis of the rat

The aim of the present study was to evaluate the effects of unilateral testicular torsion on the contralateral testis with respect to the stages of the cycle of the seminiferous epithelium (CSE). Fifty-five male Wistar rats, 60 days old, were used. The animals were divided into 11 groups. Groups 1-5 were subjected to unilateral testicular torsion from 3 to 48 h, followed by detorsion. Groups 6-10 had unilateral orchiectomies after unilateral testicular torsion for 3 to 48 h. Animals constituting group 11 served as the control sham-operated group. All animals were killed after 2 months. The percentage of affected tubules (tubules showing pathological changes) in the contralateral testis was estimated based on the CSE stages. In the torsion/detorsion group, the percentage of affected tubules was significantly greater (58.6%) than in torsion/orchiectomy group (48.0%). Stages VI-XI of the spermatogenic cycle were the most affected when compared with the rest of the stages in each experimental group (P <0.05). These results show that stages VI-XI of the spermatogenic cycle, the stages associated with low antioxidant capacities, are the most sensitive to the effects of testicular torsion on the contralateral testis.     

The protective role of erdosteine on testicular tissue after testicular torsion and detorsion

Testicular torsion and detorsion are important clinical problems for infertile man and oxidative stress may have a role in this clinical situation. The aim of this study was to investigate the protective role of erdosteine, an antioxidant, on unilateral testicular reperfusion injury in rats. The rats were divided into four groups including seven rats in each group: control, torsion, torsion/detorsion and torsion/detorsion+erdosteine. Rats, except the sham operation group, were subjected to left unilateral torsion (720^∘ rotation in the clockwise direction) without including the epididymis. The experiments were finished after sham operation time for control, 120 min torsion for torsion group and 120 min torsion and 240 min detorsion for torsion/detorsion groups. Bilateral orchiectomy was performed for all groups of rats. The ipsilateral and controlateral testis were divided into two pieces to analyse biochemical parameters and to investigate the light microscopic view. Malondialdehyde level of ipsilateral testis was increased in torsion and torsion/detorsion groups in comparison with the other groups (p < 0.05). Erdosteine treatment ameliorated lipid peroxidation after torsion/detorsion in ipsilateral testis (p < 0.05). Also, xanthine oxidase activity of ipsilateral testis was increased in torsion/detorsion group in comparison with the others (p < 0.05). Nitric oxide (NO) level of ipsilateral testis was higher in all experimental groups than sham operated control group (p < 0.05). Also, NO level of torsion group was increased in comparison with detorsion groups (p < 0.05). Erdosteine treatment caused increased glutathione peroxidase activity in comparison with torsion and torsion/detorsion groups and catalase activity in comparison with the other groups in ipsilateral testis (p < 0.05). Superoxide dismutase activity of ipsilateral testis was higher in torsion/detorsion and torsion/detorsion+erdosteine groups than control and torsion groups (p < 0.05). The biochemical parameters were not affected in controlateral testis in all groups. Torsion, torsion/detorsion and torsion/detorsion+erdosteine groups showed ipsilateral testicular damage in the histological examination, but the specimens from torsion/detorsion had a significantly greater histological injury than those from the other groups (p < 0.05). Control rats showed normal seminiferous tubule morphology. Rats in torsion group had slight-to-moderate disruption of the seminiferous epithelium. Rats in torsion/detorsion group displayed moderate-to-severe disruption of the seminiferous epithelium. In all animals from torsion/detorsion+erdosteine group, the testicular tissues were affected with slight-to-moderate degenerative changes of the seminiferous epithelium. Administration of erdosteine resulted in a significantly reduced histological damage associated with torsion of the spermatic cord compared with torsion/detorsion. In all groups, the contralateral testes were histologically normal. In conclusion, the results clearly displayed that erdosteine treatment may have a protective role on testicular torsion/detorsion injury. (Mol Cell Biochem xxx: 193–199, 2005)     

Torsion of the testis: why is the prognosis so poor?

The cases of 83 boys who were admitted to hospital with acute testicular pain or swelling were studied. Twenty seven had torsion of the testis, and 15 (55%) of these lost a testis. The main reason for the poor results was delay by the patient or his parents in seeking medical attention.     

Intérêt de l’autoconservation de spermatozoïdes testiculaires en cas d’azoospermie avant castration sur testicule unique

Two male patients were urgently referred for gamete cryopreservation before orchiectomy for cancer in a solitary testis (previous history of orchiectomy for torsion of the contralateral spermatic cord), with azoospermia before any sterilizing treatment. In both cases, testicular sperm extraction was performed at the same time as orchiectomy, allowing the cryopreservation of testicular spermatozoa. Karyotypes were normal and no Y microdeletion or gr/gr deletion was detected. In one case, one year after the end of treatment, a straw was thawed and testicular spermatozoa were successfully used in a cryoTESE ICSI procedure. A twin pregnancy was obtained and a healthy boy and girl were born. Testicular sperm extraction and cryopreservation should be proposed to all patients with cancer in a solitary testis and azoospermia.     

Aspects diagnostiques et thérapeutiques de la torsion du cordon spermatique au CHU Aristide-Le-Dantec de Dakar

Objective

To study the diagnostic and therapeutic features of testicular torsion in our daily practice, and to compare our results with that of the existing literature.

Patients and methods

A retrospective study was conducted from January 2002 to December 2009 on all patients who presented in emergency with suspicion of testicular torsion.

Results

Testicular torsion was confirmed in 58 patients after scrotal exploration. The average age was 20 years (range, 1–44 years), and 48 patients (83%) were more than 15 years old. The average duration from time of onset of pain to arrival at the emergency department was 102 hours; 47 patients (81%) were received after the sixth hour and 19 (33%) were referred from peripheral health facilities. Torsion was supravaginal in 5 patients, all more than 15 years old; orchidectomy was performed in 30 patients (52%).

Conclusion

In our study, we have a high proportion of orchidectomy. To reduce this, it will be important to sensibilize population to go to the hospital when they have cases of testicular pain and edema.     

Traumatismes fermés des bourses: stratégie de prise en charge

Introduction

Blunt scrotal trauma is increasingly frequent, but surgical exploration of these cases of trauma remains controversial. The objectives of this study were to assess the diagnostic value of clinical examination and ultrasound in testicular trauma and to analyse the complications of the various treatments proposed (surgical and medical treatments), in order to more clearly define the place of medical or surgical treatment in this form of trauma in young adults.

Patients and Methods

130 cases of blunt scrotal trauma were managed between 1993 and 2004. In the absence of clinical and ultrasound criteria of severity (haematocele, very large intratesticular haematoma, rupture of the tunica albuginea), medical treatment consisting of rest, anti-inflammatory drugs, and testicular support was instituted. Surgical exploration was performed when serious lesions of the testis were suspected. Scrotal ultrasound was performed in 68 patients and 46 of them underwent scrotal exploration. The sensitivity and specificity of scrotal ultrasound were determined by comparing radiological findings with definitive intraoperative findings. The immediate morbidity and long-term sequelae were analysed.

Results

The mean age of the patients was 24 years (range: 4 to 73 years). The clinical features were dominated by pain (73.8%) and scrotal swelling (89.2%). The sensitivity of testicular ultrasound was 34.7% for testicular rupture, 100% for testicular contusions, 33.3% for intratesticular hematoma and 76.9% for haematocele. Medical and surgical treatments were instituted in 29.2% and 70.7% of cases, respectively. With a mean follow-up of 8 months, chronic pain and testicular atrophy were observed in 18% and 5.5% of cases, respectively.

Conclusion

In the absence of signs of severity, medical treatment with regular surveillance remains justified. However, in the presence of doubtful clinical or ultrasound findings, surgical exploration must be performed as soon as possible     

Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1,335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism.

PURPOSE: An attempt to make a rational strategy for treatment of cryptorchidism. MATERIALS AND METHODS: 1,335 cryptorchid boys with biopsy at surgery (1,638 specimens). We studied: frequency of no germ cells in biopsies from 698 patients <12 years at surgery; fertility potential of 140 patients who were now adults, and apperance of testicular neoplasia in all biopsies. RESULTS: Lack of germ cells appeared from 18 months. The frequency increased with increasing age. It appeared in 30% (61/202) bilateral, and 18% (88/496) unilateral cases. In men who had undergone bilateral or unilateral orchiopexy, respectively, there was normal sperm count in 19% (14/75) and 83% (54/65), and infertility was suspected in 56% (42/75) and 8% (5/65) (FE, p < 0.00005, p < 0.00005), respectively. The lowest, the mean, and the highest age-matched spermatogonia count per tubule at orchiopexy was associated with sperm count (Spearman test, p < 0.0001, p < 0.005, p < 0.05). Isolated, this was demonstrated for the 75 formerly bilateral (Spearman, p < 0.0001, p < 0.0001, p < 0.0001), but not the 65 formerly unilateral cases (Spearman, p = 1.0). No germ cells at orchiopexy was associated with suspected infertility. Risk was 78-100% in bilateral (dependent on one or both testes affected), and 33% in unilateral cryptorchidism. There was one invasive germ cell tumor, six cases of carcinoma in situ testis, and one Sertoli cell tumor. Three neoplasms were diagnosed in intra-abdominal testes, four in boys with abnormal external genitalia, and two in boys with known abnormal karyotype. Risk of neoplasia was 5% (7/150) in patients with intra-abdominal testis, abnormal external genitalia or diagnosed abnormal karyotype, versus 0% (0/1,185) in patients without these characteristics (FE, p < 0.00005). CONCLUSION: We recommend surgery for cryptorchidism before 15-18 months of age because: (a) lack of germ cells is very rare before, and (b) lack of germ cells is associated with subsequent risk of infertility. At primary surgery for cryptorchidism, we recommend examination for testicular neoplasia in cases of intra-abdominal testis, abnormal external genitalia or known abnormal karyotype.     

Intratesticular Epidermoid Cyst Masquerading as Testicular Torsion

Epidermoid cysts are benign tumors that comprise approximately 1% of all testicular masses. They usually present as painless masses that can be identified on scrotal ultrasound as well-demarcated intratesticular lesions with mixed echogenicity. This case report describes a rare presentation of an extremely large intratesticular epidermoid cyst with clinical and radiologic findings more consistent with testicular torsion. The sizeable cyst obliterated the surrounding testicular parenchyma, causing it to appear on scrotal Doppler ultrasound as a testicle devoid of blood flow. This obliteration also resulted in failure to identify a testicular mass on physical examination or imaging. The current literature contains previous reports of extratesticular epidermoid cysts presenting as torsion; however, this is the first report of an intratesticular epidermoid cyst presenting in this manner. Though smaller cysts may be managed effectively with testicular-sparing surgery, optimal management of a cyst this size requires orchiectomy.Key words: Epidermoid cyst, Testicular torsion, Acute testicular pain, Intratesticular, Doppler ultrasoundIntratesticular epidermoid cysts are relatively rare benign testicular masses that comprise approximately 1% of all testicular tumors.^1–6 An epidermoid cyst typically presents as a painless testicular mass and consequently often mimics the presentation of a malignant testicular neoplasm. This case review details the case of a patient with an unusual presentation of an intratesticular epidermoid cyst—one of acute testicular torsion. To our knowledge, this is the first case of its kind to be reported in the literature.     

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.     

Essential role of neutrophils in germ cell-specific apoptosis following ischemia/reperfusion injury of the mouse testis

This study investigates the role of neutrophils in ischemia-induced aspermatogenesis in the mouse. Previous studies in the rat have demonstrated that ischemia-inducing testicular torsion followed by torsion repair and reperfusion resulted in germ cell-specific apoptosis. This was correlated with an increase in neutrophil adhesion to subtunical venules, an increase in reactive oxygen species, and increased expression of several apoptosis-associated molecules. In the present investigation, wild-type C57BL/6 mice were subjected to various degrees and duration of testicular torsion. A torsion of 720 degrees for 2 h caused disruption of the seminiferous epithelium and significantly reduced testis weight and daily sperm production. An immunohistochemical method specific for apoptotic nuclei indicated that these effects were due to germ cell-specific apoptosis. An increase in myeloperoxidase (MPO) activity and an increase in the number of neutrophils adhering to testicular subtunical venules after torsion repair/reperfusion demonstrated an increase in neutrophil recruitment to the testis. In contrast, E-selectin knockout mice and wild-type mice rendered neutropenic showed a significant decrease in neutrophil recruitment as evidenced by MPO activity and microscopic examination of subtunical venules. Importantly, germ cell-specific apoptosis was also reduced. Thus, germ cell-specific apoptosis is observed after ischemia/reperfusion of the murine testis, and this apoptosis is directly linked to the recruitment of neutrophils to subtunical venules. Endothelial cell adhesion molecules, particularly E-selectin, play an important role in mediating this pathology.     

Spermatic cord torsion, reactive oxygen and nitrogen species and ischemia-reperfusion injury

Mammalian testes are highly sensitive to oxidative free radical damage. Acute scrotum is a clinical syndrome mainly caused by torsion of the spermatic cord that constitutes a surgical emergence affecting newborns, children and adolescents. This syndrome often leads to infertility of the ipsilateral (torted) and contralateral (not torted) testis, an outcome that makes surgical intervention mandatory. There is a controversy involving the effects of ischemia and reperfusion on ipsilateral and contralateral testes after unilateral torsion and detorsion of the spermatic cord. Conflicting reports have led to two distinct and opposite recommendations regarding surgical intervention: detortion and preservation of the ipsilateral testis, or ipsilateral orchiectomy to preserve contralateral fertility. Early detortion surgery in humans preserves fertility, but after prolonged torsion periods followed by preservation of the ipsilateral fertility of both testis is jeopardized. Lowered contralateral blood flow after unilateral testicular torsion is associated with reactive oxygen species (ROS) overgeneration and therefore with the corresponding tissue damage. Reperfusion time appears to be determinant of contralateral testes damage due to the consequent oxidative insult that accompanies the rise in ROS following ischemia-reperfusion. Nevertheless, more investigations on the molecular mechanisms and the antioxidant status in testis are necessary to ascertain the contribution of ROS to the tissue damage produced by spermatic cord torsion in experimental animals and humans.     

Fluctuations in rat testicular interstitial oxygen tensions are linked to testicular vasomotion: persistence after repair of torsion

Testicular microvascular blood flow is known to exhibit vasomotion, which has been shown to be significantly altered in the short term following the repair of testicular torsion. This loss of vasomotion may ultimately be responsible for the loss of spermatogenesis observed after testicular torsion in rats. In the present study, testicular vasomotion and interstitial oxygen tensions were simultaneously measured prior to, during, and at various time points after repair of testicular torsion in the rat. Testicular torsion was induced by a 720 degrees rotation of the testis for 1 h. Laser-Doppler flowmetry and an oxygen electrode were used to simultaneously measure vasomotion and interstitial oxygen tensions (PO(2)), respectively. Pretorsion control testes had a mean blood flow of 16.3 +/- 1.3 perfusion units (PU) and displayed vasomotion with a cycle frequency of 12 +/- 0.2 cycles per minute and a mean amplitude of 4.2 +/- 0.3 PU. Mean testicular interstitial PO(2) was 12.5 +/- 2.6 mm Hg, which displayed a cyclical variation of 11.9 +/- 0.4 cycles per minute with a mean amplitude of 2.8 +/- 0.8 mm Hg. During the torsion period, both mean blood flow and interstitial PO(2) decreased to approximately zero. Upon detorsion, mean microvascular blood flow and mean interstitial PO(2) values returned to values that were not significantly different from pretorsion values within 30 min; however, vasomotion and PO(2) cycling did not return, even after 24 h. It was 7 days after the repair of torsion before a regular pattern of vasomotion and PO(2) cycling returned. These results demonstrate for the first time a correlation between testicular vasomotion and interstitial PO(2) cycling, and this correlation persists after the repair of testicular torsion.     

Intérêt de l’abaissement du testicule non descendu chez l’adulte. Etude à propos de 259 patients

Introduction

Undescended testis is a frequent congenital disease, more often diagnosed and treated during childhood. However, due to ignorance or negligence, this disease can be seen even after puberty, when it raises a therapeutic problem: is orchidopexy still useful? This study was designed to evaluate the outcome of orchidopexy at adulthood in terms of improvement of fertility and prevention of malignant degeneration.

Material and methods

Retrospective study performed over a 23-year period (1983–2005). We have found 259 patients with undescended testis diagnosed and treated after the age of 18 years.

Results

The mean age of patients was 24 years (range: 18–63). In the majority of cases, undescended testis was diagnosed at a systemic medical examination in 199 patients (77% of cases), and in a context of infertility in 33 patients, testicular malignancy in 8 patients, testicular torsion in 2 patients and, in 17 cases, undescended testis had been known since birth but was neglected by the parents. Undescended testis was unilateral in 209 cases and bilateral in 50 cases. Out of 37 couples, only 4 gave birth to children (10.8% paternity rate). Sperm analysis was abnormal in all infertile patients. All patients were treated by orchidopexy, except for 36 patients in whom orchidectomy was performed due to testicular atrophy (27 cases), malignancy (8 cases) or necrosis (1 case). Biopsy of the intrascrotal testis was performed in 3 patients with unilateral cryptorchidism. Histological examination was normal in two cases and abnormal in one case. The long-term outcome was characterized by:

1. Testicular atrophy in 6 patients (2.7% of cases).
2. Progression to malignancy in 3 patients (1.3% of cases).
3. Improvement of sperm parameters in 16 of 33 infertile patients (48.5%); 4 patients fathered children after treatment.

Conclusion

Orchidopexy at adulthood can lead to improvement of infertility. It can also decrease the incidence of malignancy and facilitate clinical examination looking for possible malignancy. However, the best treatment remains preventive, based on early diagnosis and orchidopexy.     

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.     

Erythropoietin may reduce the risk of germ cell loss in boys with cryptorchidism.

PURPOSE: In boys with cryptorchidism older than 2 years a testicular biopsy at time of orchiopexy shows lack of germ cells in 10-40% of the cases. The number of spermatogonia per tubule is prognostic for subsequent fertility potential. A biopsy without germ cells is associated with 33-100% risk of infertility. In order to increase the number of germ cells, and thereby the fertility potential, additional hormonal therapy has been attempted before surgery. In a study, small doses of the gonadotropin-releasing hormone analogue buserelin before orchiopexy caused higher values. Others have found that hormonal treatment with human chorionic gonadotropin or gonadotropin releasing hormone analogue may harm the germ cells in cryptorchidism. The aim of the study is to demonstrate that additional hormonal therapy with erythropoietin has a positive effect on the number of germ cells. MATERIALS AND METHODS: Erythropoietin (Eprex) 100 IU/kg were administered subcutaneously weekly for 3 months prior to surgery in two cryptorchid boys, 6 months old and 1 year 9 months old, respectively, with renal function impairment. RESULTS: The number of spermatogonia per tubular cross-section in testicular biopsies was unusually high in both erythropoietin- treated cryptorchid cases compared to the control material of biopsies from the undescended testes of 698 cryptorchid patients and compared to the normal values. CONCLUSION: There are several hypothetic mechanisms that can explain the elevated number of spermatogonia seen in our erythropoietin treated cryptorchid patients. Erythropoietin may have a positive effect on germ cell proliferation in cryptorchidism.