Objective:Open retroperitoneal lymph node dissection(RPLND)is the gold-standard surgical approach for the management of metastatic testicular cancer,but robotic RPLND is becoming increasingly popular.There is limited ...Objective:Open retroperitoneal lymph node dissection(RPLND)is the gold-standard surgical approach for the management of metastatic testicular cancer,but robotic RPLND is becoming increasingly popular.There is limited research directly comparing open and robotic RPLND.The objective of this systematic review is to identify all the literature with direct comparisons between the open and robotic techniques for RPLND and to compare the two techniques.The primary outcome was peri-operative outcomes,and the secondary outcomes included oncological outcomes and patient demographics.Methods:This systematic review was prospectively registered and was conducted in accordance with the PRISMA statement.The PubMed,Embase and MEDLINE databases were searched for relevant publication from January 2006 to August 2024.Results:Eight studies,totaling 3995 patients,are included in this systematic review,with 3521 patients who underwent open RPLND and 474 who underwent robotic RPLND.For open RPLND,the mean operative duration,blood loss and length of stay were 267.8 min,475 mL and 7.3 d,respectively.For robotic RPLND,the mean operative duration,blood loss and length of stay were 334.5 min,94.6 mL and 3.7 d,respectively.Teratoma was the most common RPLND specimen pathology from both open and robotic surgeries.For open RPLND,the specimens have 13–23 nodes(26–32 mm),whereas the robotic RPLND specimens have 13–28 nodes(18–20 mm).Conclusion:This systematic review suggests that the benefitsof robotic RPLND may be associated with reduced blood loss,shorter hospitalisation and an overall lower risk of minor and major complications while maintaining oncological safety.展开更多
Testicular torsion is a urological emergency that requires prompt diagnosis and treatment,accounting for 10%-15%of cases of acute scrotum.[1]It occurs most frequently during the perinatal period and adolescence and ca...Testicular torsion is a urological emergency that requires prompt diagnosis and treatment,accounting for 10%-15%of cases of acute scrotum.[1]It occurs most frequently during the perinatal period and adolescence and can occur at any age.[2]The incidence of testicular torsion is 1/4,000 in males under 25 years of age and 1/160 in males over 25 years of age.[3]Unilateral torsion is relatively common,with a higher incidence on the left side.Testicular torsion is typically managed through surgical exploration.Necrotic testes,identified by a black appearance,require orchiectomy.[4]展开更多
Testicular tumor is the most common solid malignancy in males under 40 years of age.This malignancy is known to have a negative impact on male fertility.Therefore,several techniques for sperm retrieval have been propo...Testicular tumor is the most common solid malignancy in males under 40 years of age.This malignancy is known to have a negative impact on male fertility.Therefore,several techniques for sperm retrieval have been proposed,including microdissection testicular sperm extraction(mTESE).The objective of this study was to review the literature on the outcomes of oncological(Onco)-mTESE at the time of radical orchiectomy.We conducted a comprehensive literature search through PubMed,Scopus,and Cochrane Central Controlled Register of Trials.Only studies reporting ex vivo mTESE in patients with testicular tumor were considered.Twelve papers met the inclusion criteria and were included in this review.Tumor size was identified as the sole preoperative factor influencing spermatogenesis.The considered studies demonstrated a satisfactory success rate for Onco-mTESE,associated with a similarly valid percentage of live healthy births through assisted reproductive technology.Currently,no comparison has been made between Onco-mTESE and conventional Onco-TESE,hence further assessment is required.In cases where the tumor completely replaces the cancer-bearing testicle,a contralateral micro-TESE may be a viable alternative.However,the surgeon should evaluate associated risks and benefits preoperatively.In conclusion,Onco-mTESE at the time of radical orchiectomy appears to be a promising therapeutic option for young patients with testicular tumors.Nevertheless,additional studies are necessary to achieve a definitive conclusion.展开更多
Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed a...Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed at the time of sperm retrieval.Onco-micro-TESE addresses the dual objectives of treating both infertility and the testicular tumor simultaneously.The technique is intricate,necessitating a comprehensive understanding of testicular anatomy,physiology,tumor biology,and advanced microsurgical methods.It aims to carefully extract viable spermatozoa while minimizing the risk of tumor dissemination.This review encapsulates the procedural intricacies,evaluates success determinants,including tumor pathology and spermatogenic tissue health,and discusses the implementation of imaging techniques for enhanced surgical precision.Ethical considerations are paramount,as the procedure implicates complex decision-making that weighs the potential oncological risks against the profound desire for fatherhood using the male gametes.The review aims to provide a holistic overview of onco-micro-TESE,detailing methodological advances,clinical outcomes,and the ethical landscape,thus offering an indispensable resource for clinicians navigating this multifaceted clinical scenario.展开更多
A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm ava...A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.展开更多
The aim of this study was to investigate the trend in testicular volume changes after orchiopexy in children with cryptorchidism.The clinical data of 854 children with cryptorchidism who underwent orchiopexy between J...The aim of this study was to investigate the trend in testicular volume changes after orchiopexy in children with cryptorchidism.The clinical data of 854 children with cryptorchidism who underwent orchiopexy between January 2013 and December 2016 in Shenzhen Children’s Hospital(Shenzhen,China)were retrospectively analyzed.The mean(standard deviation)age of the patients was 2.8(2.5)years,and the duration of follow-up ranged from 1 year to 5 years.Ultrasonography was conducted preoperatively and postoperatively.The variables analyzed included age at the time of surgery,type of surgical procedure,laterality,preoperative testicular position,preoperative and postoperative testicular volumes,and the testicular volume ratio of them.The average testicular volumes preoperatively and at 1 year,2 years,3 years,and 5 years postoperatively were 0.27 ml,0.38 ml,0.53 ml,0.87 ml,and 1.00 ml,respectively(P<0.001).The corresponding testicular volume ratios were 0.67,0.76,0.80,0.83,and 0.84(P<0.001).The mean volume of the undescended testes was significantly smaller than the mean normative value(P<0.001,lower than the 10th percentile).The postoperative testicular volumes in children with cryptorchidism were generally lower than those in healthy boys but were still greater than the 10th percentile and exhibited an increasing trend.The older the child is at the time of surgery,the larger the gap in volume between the affected and normal testes.Although testicular volume tends to gradually increase after orchiopexy for cryptorchidism,it could not normalizes.Earlier surgery results in affected testicular volumes closer to those of healthy boys.展开更多
Objective:To assess the effects of azoxystrobin on sperm quality,hormone levels and testicular structure in Swiss albino mice.Methods:48 Swiss albino male mice were divided into 7 groups containing 6 mice in each grou...Objective:To assess the effects of azoxystrobin on sperm quality,hormone levels and testicular structure in Swiss albino mice.Methods:48 Swiss albino male mice were divided into 7 groups containing 6 mice in each group except Group桏in which 12 mice were taken.Group栺served as the control group and treated with vehicle(distil water for 30 and 60 days).Azoxystrobin at three different doses(125,250,500 mg/kg body weight)was orally administered to Group栻,栿and桇for 30 days and Group桋,桍and桏for 60 days.After dose completion,sperm parameters,hormonal profile and testis histology were analysed.Half animals of group桏(500 mg/kg body weight)were left untreated for next 30 days to assess the recovery from reproductive toxicity.Results:At azoxystrobin 125 and 250 mg/kg,sperm viability,count,and motility remained largely unaffected,but a significant decline was observed at azoxystrobin 500 mg/kg after 30 days.After 60 days,all dose levels led to a significant decrease in sperm parameters.Morphological abnormalities in sperm,such as globular heads,bent or coiled tails,and headless or tailless sperm,were noted to be increased in a dose dependent manner.Antioxidant parameters,serum level of reproductive hormones and steroidogenic enzymes followed a similar trend with non-significant changes at low and medium doses but a marked decline at the high dose after both 30 and 60 days of exposure.Histopathology of testis also revealed degenerative changes in seminiferous tubules and Leydig cell.Conclusions:Azoxystrobin exposure at high dose(500 mg/kg)affects sperm quality and disrupts testicular function via potentially impairing antioxidant defences,deregulating steroidogenesis in Swiss albino male mice.展开更多
Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we ...Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we developed a deep learning(DL)model to establish the associations between testicular grayscale ultrasound images and testicular histology.We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia(353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China)to develop a DL model.We obtained testicular histology during conventional testicular sperm extraction.Our DL model was trained based on ultrasound images or fusion data(ultrasound images fused with the corresponding testicular volume)to distinguish spermatozoa presence in pathology(SPP)and spermatozoa absence in pathology(SAP)and to classify maturation arrest(MA)and Sertoli cell-only syndrome(SCOS)in patients with SAP.Areas under the receiver operating characteristic curve(AUCs),accuracy,sensitivity,and specificity were used to analyze model performance.DL based on images achieved an AUC of 0.922(95%confidence interval[CI]:0.908-0.935),a sensitivity of 80.9%,a specificity of 84.6%,and an accuracy of 83.5%in predicting SPP(including normal spermatogenesis and hypospermatogenesis)and SAP(including MA and SCOS).In the identification of SCOS and MA,DL on fusion data yielded better diagnostic performance with an AUC of 0.979(95%CI:0.969-0.989),a sensitivity of 89.7%,a specificity of 97.1%,and an accuracy of 92.1%.Our study provides a noninvasive method to predict testicular histology for patients with azoospermia,which would avoid unnecessary testicular biopsy.展开更多
Polyorchidism is a rare anomaly of the male urogenital tract characterized by the presence of one or more extra testes.Supernumerary testes can often present with coexistent conditions,including cryptorchidism,inguina...Polyorchidism is a rare anomaly of the male urogenital tract characterized by the presence of one or more extra testes.Supernumerary testes can often present with coexistent conditions,including cryptorchidism,inguinal hernia,and torsion.We report a case of a pediatric patient with initial concern for intra-scrotal left testicular torsion on ultrasonography who was ultimately found to have torsion of an intra-abdominal supernumerary testis.He underwent scrotal exploration with bilateral orchiopexy and laparoscopic excision of the torsed gonad.This case highlights a unique presentation of polyorchidism with incongruent descent of an ipsilateral supernumerary testis.展开更多
Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,partic...Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.展开更多
Objective:Testicular germ cell tumors(TGCTs)represent the most common malignancy among young men aged 20–40 years.Transglutaminase 7(TG7),encoded by TGM7,is a poorly characterized enzyme whose function in TGCT remain...Objective:Testicular germ cell tumors(TGCTs)represent the most common malignancy among young men aged 20–40 years.Transglutaminase 7(TG7),encoded by TGM7,is a poorly characterized enzyme whose function in TGCT remains unknown.This study aimed to assess TG7 expression in clinical specimens and investigate its functional role in a testicular germ cell tumor cell line(NT2/D1).Methods:TG7 protein expression was evaluated in clinical testicular tissue samples via immunohistochemistry(IHC)and immunofluorescence(IF).Functional analysis was conducted in the NT2/D1 human testicular cancer cell line usingDicer-substrate small interferingRNAs(DsiRNAs)targeting TG7.Gene knockdown efficiency was confirmed by reverse transcription quantitative PCR(qRT-PCR),and protein suppression was validated by immunofluorescence.Cell viability was assessed using the MTT assay.The expression of inflammation and apoptosis-related genes was quantified via qRT-PCR.Results:TG7 expression was significantly elevated in testicular germ cell tumor tissues,showing approximately a 4.5-fold increase compared to normal testis,with strong localization in tumor nests and stromal compartments.In NT2/D1 cells,TG7 silencing using 20 nM DsiRNA3 led to a dose-dependent reduction in cell viability,with up to 48%inhibition observed at 200 nM(MTT assay,****p<0.0001).qRT-PCR analysis revealed significant upregulation of IL6(3.2-fold),TNFα(2.8-fold),and CASP3(2.5-fold)mRNA levels following TG7 knockdown(p<0.0001),while p53 expression remained unchanged.These findings support TG7’s role in modulating tumor cell survival,inflammation,and apoptosis via p53-independent pathways.Conclusion:Collectively,TG7 is significantly overexpressed in TGCT tissues and supports tumor cell viability in vitro.This study establishes TG7 as a novel biomarker and therapeutic target in testicular cancer,laying the groundwork for future studies on TG7-targeted interventions.展开更多
BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diff...BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diffuse large B-cell lymphoma(DLBCL),which is typically the aggressive subtype,dominates PTL and shows diffuse B-cell infiltration.Venous tumor thrombus,uncommon in lymphomas,is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.CASE SUMMARY A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness.Diagnostic imaging[ultrasonography,computed tomography(CT),and 18F-fluorodeoxyglucose positron emission tomography/CT(18FFDG-PET/CT)]revealed bilateral testicular masses and a gonadal vein tumor thrombus(SUVmax 16.5).Left orchiectomy confirmed DLBCL with CD20,Bcl-2,and MUM1 positivity(Ki-67:approximately 80%).The disease was staged as Ann Arbor stage IVA(International Prognostic Index score 3,high-intermediate risk).The patient received Rituximab,Polatuzumab Vedotin,Cyclophosphamide,Epirubicin,and Prednisolone chemotherapy,completing the first cycle with good tolerability.No adverse events were reported,and follow-up is ongoing to assess long-term outcomes.This case highlights the diagnostic utility of 18F-FDGPET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.CONCLUSION This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus,underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement.A multi-disciplinary team including urologists,hematologists,and radiation oncologists is needed to ensure appropriate therapy.展开更多
Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications fo...Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications for a diagnostic testicular biopsy to the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones. Nowadays, testicular biopsies are mainly performed for sperm harvesting in men with non-obstructive azoospermia, to be used for intracytoplasmic sperm injection. Testicular biopsy is also performed in men with risk factors for testicular malignancy. In a subgroup of infertile men, there is an increased risk for carcinoma in situ of the testis, especially in men with a history of cryptorchidism and testicular malignancy and in men with testicular atrophy. Ultrasonographic abnormalities, such as testicular microlithiasis, inhomogeneous parenchyma and lesions of the testes, further increase the risk of carcinoma in situ （CIS） in these men. For an accurate histological classification, proper tissue handling, fixation, preparation of the specimen and evaluation are needed. A standardized approach to testicular biopsy is recommended. In addition, approaches to the detection of CIS of the testis testicular immunohistochemistry are mandatory. In this mini-review, we describe the current indications for testicular biopsies in the diagnosis and management of male infertility.展开更多
Objective To observe the clinical efficacy of thunder-fire moxibustion on pediatric testicular hydrocele. Methods Thunder-fire moxa was used for suspending moxibus on on Shu？dào（水道 ST 28） and Guānyuán...Objective To observe the clinical efficacy of thunder-fire moxibustion on pediatric testicular hydrocele. Methods Thunder-fire moxa was used for suspending moxibus on on Shu？dào（水道 ST 28） and Guānyuán（关元 CV 4） on both sides for 10 children with tes cular hydrocele,the moxa s ck was kept 2–3 cm above from the skin and the moxibustion was carried out until the skin become red and hot for about 15–20 min. The treatments were carried out once a day and ten mes were considered as a treatment course,and the therapeutic efficacy was subjected to statistics after two treatment courses. Results Eight cases were cured,and eff ec ve in 2 cases; the cured rate was 80% and the effective rate was 100%. Conclusion Thunder-fire moxibustion has rela vely good clinical effi cacy in trea ng tes cular hydrocele in children.展开更多
Introduction: Testicular cancer accounts for 5% of urological tumors, predominantly affecting young men. The aim of our study was to report the diagnostic and evolutionary aspects of testicular cancer cases treated in...Introduction: Testicular cancer accounts for 5% of urological tumors, predominantly affecting young men. The aim of our study was to report the diagnostic and evolutionary aspects of testicular cancer cases treated in our center. Patients and Methods: A retrospective study conducted over a 15-year period involving 12 patients treated for testicular cancer at the University Hospital of Brazzaville. Results: The median age was 31 years (range 11 to 49 years), with a median consultation delay of 10.6 months (range 3 to 27 months). Scrotal mass was the most common reason for consultation. Cancer was bilateral in two patients. Two patients were admitted with metastatic disease. Histopathological examination favored germ cell tumors in 7 cases, two cases of non-Hodgkin’s malignant lymphoma, and one case of epididymo-testicular adenocarcinoma. Adjuvant chemotherapy resulted in complete remission in patients with germ cell tumors. However, neoadjuvant chemotherapy was not effective in patients admitted with advanced-stage disease. Conclusion: Testicular cancer is a rare condition that is curable in the majority of cases, but its management is often complicated in our setting due to delayed diagnosis caused by taboos surrounding genital organ pathologies.展开更多
Aim： To evaluate the relationship between testicular function and testicular volume measured by using Prader orchidometry and ultrasonography （US） to determine the critical testicular volume indicating normal testi...Aim： To evaluate the relationship between testicular function and testicular volume measured by using Prader orchidometry and ultrasonography （US） to determine the critical testicular volume indicating normal testicular function by each method. Methods： Total testicular volume （right plus left testicular volume） was measured in 794 testes in 397 men with infertility （mean age, 35.6 years） using a Prader orchidometer and also by ultrasonography. Ultrasonographic testicular volumes were calculated as length x width x height x 0.71. To evaluate volume-function relationships, patients were divided into 10 groups representing 5-mL increments of total testicular volume by each method from below 10 mL to 50 mL or more. Results： Mean total testicular volume based on Prader orchidometry and US were 36.8 mL and 26.3 mL, respectively. Semen volume, sperm density, total sperm count, total motile sperm count, and serum FSH, LH, and testosterone all correlated significantly with total testicular volume measured by either method. Mean sperm density was in the oligozoospermic range in patients with total testicular volume below 35 mL by orchidometry or below 20 mL by ultrasonography. Mean total sperm count was subnormal in patients with total testicular volume below 30 mL by orchidometry or under 20 mL by ultrasonography. Conclusion： Testicular volume measured by either ultrasonography or Prader orchidometry correlated significantly with testicular function. However, critical total testicular volume indicating normal or nearly normal testicular function was 30 mL to 35 mL using Prader orchidometer and 20 mL using ultrasonography. Prader orchidometry morphometrically and functionally overestimated the testicular volume in comparison to US. （Asian JAndro12008 Mar; 10： 319-324）展开更多
Testicular microlithiasis （TM） is one of the symptoms of testicular dysgenesis syndrome （TDS）. TM is particularly interesting as an informative marker of testicular germ cell tumors （TGCTs）. KIT ligand gene （KI...Testicular microlithiasis （TM） is one of the symptoms of testicular dysgenesis syndrome （TDS）. TM is particularly interesting as an informative marker of testicular germ cell tumors （TGCTs）. KIT ligand gene （KITLG）, BCL2 antagonist/killer 1 （BAK1）, and sprouty RTK signaling antagonist 4 （SPRY4） genes are associated with a high risk of TGCTs, whereas bone morphogenetic protein 7 gene （BMP7）, transforming growth factor beta receptor 3 gene （TGFBR3）, and homeobox D cluster genes （HOXD） are related to TDS. Using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） analysis, we investigated allele and genotype frequencies for KITLG （rs995030, rs1508595）, SPRY4 （rs4624820, rs6897876）, BAK1 （rs210138）, BMP7 （rs388286）, TGFBR3 （rs12082710）, and HOXD （rs17198432） in 142 TGCT patients, 137 TM patients, and 153 fertile men （control group）. We found significant differences in the KITLG GG_rs995030 genotype in TM （P= 0.01） and TGCT patients （P = 0.0005） compared with the control. We also revealed strong associations between KITLGrs1508595 and TM （G allele, P = 0.003; GG genotype, P= 0.01） and between KITLG_rs1508595 and TGCTs （G allele, P-- 0.0001; GG genotype, P = 0.0007）. Moreover, there was a significant difference in BMP7_rs388286 between the TGCT group and the control （T allele, P = 0.00004; TT genotype, P = 0.00006） and between the TM group and the control （T allele, P= 0.04）. HOXDalso demonstrated a strong association with TGCTs （rs17198432 A allele, P = 0.0001; AA genotype, P = 0.001）. Furthermore, significant differences were found between the TGCT group and the control in the BAK1_rs210138 G allele （P= 0.03） and the GG genotype （P= 0.01）. KITLG and BMP7genes, associated with the development of TGCTs, may also be related to TM. In summary, the KITLG GG_rs995030, GG_rs1508595, BMP7 TT_rs388286, HOXD AA_rs17198432, and BAK1 GG_rs210138 genotypes were associated with a high risk of TGCT development.展开更多
Aim： To evaluate the outcome of repetitive micro-surgical testicular sperm extraction （mTESE） attempts in non-obstructive azoospermia （NOA） cases, in relation to patients＇ initial testicular histology results. M...Aim： To evaluate the outcome of repetitive micro-surgical testicular sperm extraction （mTESE） attempts in non-obstructive azoospermia （NOA） cases, in relation to patients＇ initial testicular histology results. Methods： A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection （ICSI） attempts were reviewed. Results： Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 （64%） （Sp^＋）, and failed in the remaining 24 （36%） （Sp^-）. Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp^＋ but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two （n = 24）, three （n = 4） and four （n = 1） times. The second attempt yielded mature sperm in 3/5 patients from the Sp group and 16/19 patients from the Sp^＋ group. At the third and fourth trials, 4/4 and 1/1 of the original Sp^＋ patients were Sp^＋ again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome （16%）, maturation arrest （22%）, hypospermatogenesis （21%） and focal spermatogenesis （41%）. Overall, in repetitive mTESE, 24/29 （82%） of the attempts were finally Sp^＋. Conclusion： Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.展开更多
Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unc...Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unclear whether changes in testicular atrophy index are related to age.We selected patients who underwent surgery for unilateral palpable cryptorchidism.Testicular volume was measured using ultrasonography.The testicular atrophy indices of the undescended testes were then reviewed,and their correlation with age was analyzed.We studied 228 cases(age range:6–53 months).Scatter plots were constructed,and Loess curves were fitted,revealing a turning point at 24 months of age.The patients were divided into age groups of 6–24 months and 25–53 months.The testicular volume of the cryptorchid side was smaller than that of the normal side in both groups(both P<0.001).In the 6–24-month group,the testicular atrophy index was positively correlated with age,testicular volume on the cryptorchid side was not correlated with age,and testicular volume was positively correlated with age on the normal side.In the 25–53-month group,testicular atrophy index and testicular volumes on either side were not correlated with age.A palpable unilateral cryptorchid testis is smaller than the contralateral testis.The testicular atrophy index increases with age between 6 months and 24 months,but not between 25 months and 53 months.Testicular volume increased with age on the normal side between 6 months and 24 months,but not on the cryptorchid side.Trends in testicular atrophy index with age contribute to the decision of operation time.展开更多
We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia(iNOA).We studied 193 patients with nonobstructive azoospermia who underwe...We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia(iNOA).We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction.The Chi-square test and Mann–Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons.A logistic regression analysis was conducted to identify predictors of retrieval failure.Area under the receiver operating characteristic curve for each variable was evaluated,and the net clinical benefit was calculated using a clinical decision curve.Patients with iNOA had a lower sperm retrieval rate than those with known causes.Moreover,testicular volume was an independent factor affecting sperm extraction outcomes(odds ratio=0.79,P<0.05).The testicular volume cut-off value was 6.5 ml(area under the curve:0.694).The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed.The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution.There was also a significant association between a uniform tubule distribution and testicular volume.In conclusion,a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.展开更多
文摘Objective:Open retroperitoneal lymph node dissection(RPLND)is the gold-standard surgical approach for the management of metastatic testicular cancer,but robotic RPLND is becoming increasingly popular.There is limited research directly comparing open and robotic RPLND.The objective of this systematic review is to identify all the literature with direct comparisons between the open and robotic techniques for RPLND and to compare the two techniques.The primary outcome was peri-operative outcomes,and the secondary outcomes included oncological outcomes and patient demographics.Methods:This systematic review was prospectively registered and was conducted in accordance with the PRISMA statement.The PubMed,Embase and MEDLINE databases were searched for relevant publication from January 2006 to August 2024.Results:Eight studies,totaling 3995 patients,are included in this systematic review,with 3521 patients who underwent open RPLND and 474 who underwent robotic RPLND.For open RPLND,the mean operative duration,blood loss and length of stay were 267.8 min,475 mL and 7.3 d,respectively.For robotic RPLND,the mean operative duration,blood loss and length of stay were 334.5 min,94.6 mL and 3.7 d,respectively.Teratoma was the most common RPLND specimen pathology from both open and robotic surgeries.For open RPLND,the specimens have 13–23 nodes(26–32 mm),whereas the robotic RPLND specimens have 13–28 nodes(18–20 mm).Conclusion:This systematic review suggests that the benefitsof robotic RPLND may be associated with reduced blood loss,shorter hospitalisation and an overall lower risk of minor and major complications while maintaining oncological safety.
基金supported by the National Natural Science Foundation of China(82371709).
文摘Testicular torsion is a urological emergency that requires prompt diagnosis and treatment,accounting for 10%-15%of cases of acute scrotum.[1]It occurs most frequently during the perinatal period and adolescence and can occur at any age.[2]The incidence of testicular torsion is 1/4,000 in males under 25 years of age and 1/160 in males over 25 years of age.[3]Unilateral torsion is relatively common,with a higher incidence on the left side.Testicular torsion is typically managed through surgical exploration.Necrotic testes,identified by a black appearance,require orchiectomy.[4]
文摘Testicular tumor is the most common solid malignancy in males under 40 years of age.This malignancy is known to have a negative impact on male fertility.Therefore,several techniques for sperm retrieval have been proposed,including microdissection testicular sperm extraction(mTESE).The objective of this study was to review the literature on the outcomes of oncological(Onco)-mTESE at the time of radical orchiectomy.We conducted a comprehensive literature search through PubMed,Scopus,and Cochrane Central Controlled Register of Trials.Only studies reporting ex vivo mTESE in patients with testicular tumor were considered.Twelve papers met the inclusion criteria and were included in this review.Tumor size was identified as the sole preoperative factor influencing spermatogenesis.The considered studies demonstrated a satisfactory success rate for Onco-mTESE,associated with a similarly valid percentage of live healthy births through assisted reproductive technology.Currently,no comparison has been made between Onco-mTESE and conventional Onco-TESE,hence further assessment is required.In cases where the tumor completely replaces the cancer-bearing testicle,a contralateral micro-TESE may be a viable alternative.However,the surgeon should evaluate associated risks and benefits preoperatively.In conclusion,Onco-mTESE at the time of radical orchiectomy appears to be a promising therapeutic option for young patients with testicular tumors.Nevertheless,additional studies are necessary to achieve a definitive conclusion.
基金supported by the National Natural Science Foundation of China(No.82371633)Peking University Clinical Scientist Training Program and the Fundamental Research Funds for the Central University(BMU2023PYJ H012).
文摘Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed at the time of sperm retrieval.Onco-micro-TESE addresses the dual objectives of treating both infertility and the testicular tumor simultaneously.The technique is intricate,necessitating a comprehensive understanding of testicular anatomy,physiology,tumor biology,and advanced microsurgical methods.It aims to carefully extract viable spermatozoa while minimizing the risk of tumor dissemination.This review encapsulates the procedural intricacies,evaluates success determinants,including tumor pathology and spermatogenic tissue health,and discusses the implementation of imaging techniques for enhanced surgical precision.Ethical considerations are paramount,as the procedure implicates complex decision-making that weighs the potential oncological risks against the profound desire for fatherhood using the male gametes.The review aims to provide a holistic overview of onco-micro-TESE,detailing methodological advances,clinical outcomes,and the ethical landscape,thus offering an indispensable resource for clinicians navigating this multifaceted clinical scenario.
基金VMR is funded by the AUA and Urology Care Foundation(Research Scholars Award)as well as an NIH NRSA training grant(5T32DK060442-20)HT is funded by the AUA and Urology Care Foundation(Research Scholars Award),SUFU(Chemodenervation Grant),and the Office of Faculty Development at Harvard Medical School.
文摘A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain.Examination showed a non-tender left testis that was significantly larger than the right.Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma.Tumor markers were unremarkable.A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord.Due to a suspicion of chronic torsion vs.malignancy,a left radical orchiectomy was performed.Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia,a rare entity.
基金This study was funded by the Guangdong High-level Hospital Construction Fund and Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties(SZXK035).
文摘The aim of this study was to investigate the trend in testicular volume changes after orchiopexy in children with cryptorchidism.The clinical data of 854 children with cryptorchidism who underwent orchiopexy between January 2013 and December 2016 in Shenzhen Children’s Hospital(Shenzhen,China)were retrospectively analyzed.The mean(standard deviation)age of the patients was 2.8(2.5)years,and the duration of follow-up ranged from 1 year to 5 years.Ultrasonography was conducted preoperatively and postoperatively.The variables analyzed included age at the time of surgery,type of surgical procedure,laterality,preoperative testicular position,preoperative and postoperative testicular volumes,and the testicular volume ratio of them.The average testicular volumes preoperatively and at 1 year,2 years,3 years,and 5 years postoperatively were 0.27 ml,0.38 ml,0.53 ml,0.87 ml,and 1.00 ml,respectively(P<0.001).The corresponding testicular volume ratios were 0.67,0.76,0.80,0.83,and 0.84(P<0.001).The mean volume of the undescended testes was significantly smaller than the mean normative value(P<0.001,lower than the 10th percentile).The postoperative testicular volumes in children with cryptorchidism were generally lower than those in healthy boys but were still greater than the 10th percentile and exhibited an increasing trend.The older the child is at the time of surgery,the larger the gap in volume between the affected and normal testes.Although testicular volume tends to gradually increase after orchiopexy for cryptorchidism,it could not normalizes.Earlier surgery results in affected testicular volumes closer to those of healthy boys.
基金The research was conducted without any financial support from external funding agency.
文摘Objective:To assess the effects of azoxystrobin on sperm quality,hormone levels and testicular structure in Swiss albino mice.Methods:48 Swiss albino male mice were divided into 7 groups containing 6 mice in each group except Group桏in which 12 mice were taken.Group栺served as the control group and treated with vehicle(distil water for 30 and 60 days).Azoxystrobin at three different doses(125,250,500 mg/kg body weight)was orally administered to Group栻,栿and桇for 30 days and Group桋,桍and桏for 60 days.After dose completion,sperm parameters,hormonal profile and testis histology were analysed.Half animals of group桏(500 mg/kg body weight)were left untreated for next 30 days to assess the recovery from reproductive toxicity.Results:At azoxystrobin 125 and 250 mg/kg,sperm viability,count,and motility remained largely unaffected,but a significant decline was observed at azoxystrobin 500 mg/kg after 30 days.After 60 days,all dose levels led to a significant decrease in sperm parameters.Morphological abnormalities in sperm,such as globular heads,bent or coiled tails,and headless or tailless sperm,were noted to be increased in a dose dependent manner.Antioxidant parameters,serum level of reproductive hormones and steroidogenic enzymes followed a similar trend with non-significant changes at low and medium doses but a marked decline at the high dose after both 30 and 60 days of exposure.Histopathology of testis also revealed degenerative changes in seminiferous tubules and Leydig cell.Conclusions:Azoxystrobin exposure at high dose(500 mg/kg)affects sperm quality and disrupts testicular function via potentially impairing antioxidant defences,deregulating steroidogenesis in Swiss albino male mice.
基金supported by the Key Research and Development Program of Guangzhou Science and Technology Projects(No.2023B03J1260).
文摘Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we developed a deep learning(DL)model to establish the associations between testicular grayscale ultrasound images and testicular histology.We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia(353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China)to develop a DL model.We obtained testicular histology during conventional testicular sperm extraction.Our DL model was trained based on ultrasound images or fusion data(ultrasound images fused with the corresponding testicular volume)to distinguish spermatozoa presence in pathology(SPP)and spermatozoa absence in pathology(SAP)and to classify maturation arrest(MA)and Sertoli cell-only syndrome(SCOS)in patients with SAP.Areas under the receiver operating characteristic curve(AUCs),accuracy,sensitivity,and specificity were used to analyze model performance.DL based on images achieved an AUC of 0.922(95%confidence interval[CI]:0.908-0.935),a sensitivity of 80.9%,a specificity of 84.6%,and an accuracy of 83.5%in predicting SPP(including normal spermatogenesis and hypospermatogenesis)and SAP(including MA and SCOS).In the identification of SCOS and MA,DL on fusion data yielded better diagnostic performance with an AUC of 0.979(95%CI:0.969-0.989),a sensitivity of 89.7%,a specificity of 97.1%,and an accuracy of 92.1%.Our study provides a noninvasive method to predict testicular histology for patients with azoospermia,which would avoid unnecessary testicular biopsy.
文摘Polyorchidism is a rare anomaly of the male urogenital tract characterized by the presence of one or more extra testes.Supernumerary testes can often present with coexistent conditions,including cryptorchidism,inguinal hernia,and torsion.We report a case of a pediatric patient with initial concern for intra-scrotal left testicular torsion on ultrasonography who was ultimately found to have torsion of an intra-abdominal supernumerary testis.He underwent scrotal exploration with bilateral orchiopexy and laparoscopic excision of the torsed gonad.This case highlights a unique presentation of polyorchidism with incongruent descent of an ipsilateral supernumerary testis.
文摘Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.
文摘Objective:Testicular germ cell tumors(TGCTs)represent the most common malignancy among young men aged 20–40 years.Transglutaminase 7(TG7),encoded by TGM7,is a poorly characterized enzyme whose function in TGCT remains unknown.This study aimed to assess TG7 expression in clinical specimens and investigate its functional role in a testicular germ cell tumor cell line(NT2/D1).Methods:TG7 protein expression was evaluated in clinical testicular tissue samples via immunohistochemistry(IHC)and immunofluorescence(IF).Functional analysis was conducted in the NT2/D1 human testicular cancer cell line usingDicer-substrate small interferingRNAs(DsiRNAs)targeting TG7.Gene knockdown efficiency was confirmed by reverse transcription quantitative PCR(qRT-PCR),and protein suppression was validated by immunofluorescence.Cell viability was assessed using the MTT assay.The expression of inflammation and apoptosis-related genes was quantified via qRT-PCR.Results:TG7 expression was significantly elevated in testicular germ cell tumor tissues,showing approximately a 4.5-fold increase compared to normal testis,with strong localization in tumor nests and stromal compartments.In NT2/D1 cells,TG7 silencing using 20 nM DsiRNA3 led to a dose-dependent reduction in cell viability,with up to 48%inhibition observed at 200 nM(MTT assay,****p<0.0001).qRT-PCR analysis revealed significant upregulation of IL6(3.2-fold),TNFα(2.8-fold),and CASP3(2.5-fold)mRNA levels following TG7 knockdown(p<0.0001),while p53 expression remained unchanged.These findings support TG7’s role in modulating tumor cell survival,inflammation,and apoptosis via p53-independent pathways.Conclusion:Collectively,TG7 is significantly overexpressed in TGCT tissues and supports tumor cell viability in vitro.This study establishes TG7 as a novel biomarker and therapeutic target in testicular cancer,laying the groundwork for future studies on TG7-targeted interventions.
文摘BACKGROUND Primary testicular lymphoma(PTL)is a rare,aggressive malignancy,representing a small fraction of testicular tumors and non-Hodgkin lymphomas,yet it is the most common testicular malignancy in older men.Diffuse large B-cell lymphoma(DLBCL),which is typically the aggressive subtype,dominates PTL and shows diffuse B-cell infiltration.Venous tumor thrombus,uncommon in lymphomas,is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.CASE SUMMARY A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness.Diagnostic imaging[ultrasonography,computed tomography(CT),and 18F-fluorodeoxyglucose positron emission tomography/CT(18FFDG-PET/CT)]revealed bilateral testicular masses and a gonadal vein tumor thrombus(SUVmax 16.5).Left orchiectomy confirmed DLBCL with CD20,Bcl-2,and MUM1 positivity(Ki-67:approximately 80%).The disease was staged as Ann Arbor stage IVA(International Prognostic Index score 3,high-intermediate risk).The patient received Rituximab,Polatuzumab Vedotin,Cyclophosphamide,Epirubicin,and Prednisolone chemotherapy,completing the first cycle with good tolerability.No adverse events were reported,and follow-up is ongoing to assess long-term outcomes.This case highlights the diagnostic utility of 18F-FDGPET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.CONCLUSION This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus,underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement.A multi-disciplinary team including urologists,hematologists,and radiation oncologists is needed to ensure appropriate therapy.
文摘Testicular biopsy was considered the cornerstone of male infertility diagnosis for many years in men with unexplained infertility and azoospermia. Recent guidelines for male infertility have limited the indications for a diagnostic testicular biopsy to the confirmation of obstructive azoospermia in men with normal size testes and normal reproductive hormones. Nowadays, testicular biopsies are mainly performed for sperm harvesting in men with non-obstructive azoospermia, to be used for intracytoplasmic sperm injection. Testicular biopsy is also performed in men with risk factors for testicular malignancy. In a subgroup of infertile men, there is an increased risk for carcinoma in situ of the testis, especially in men with a history of cryptorchidism and testicular malignancy and in men with testicular atrophy. Ultrasonographic abnormalities, such as testicular microlithiasis, inhomogeneous parenchyma and lesions of the testes, further increase the risk of carcinoma in situ （CIS） in these men. For an accurate histological classification, proper tissue handling, fixation, preparation of the specimen and evaluation are needed. A standardized approach to testicular biopsy is recommended. In addition, approaches to the detection of CIS of the testis testicular immunohistochemistry are mandatory. In this mini-review, we describe the current indications for testicular biopsies in the diagnosis and management of male infertility.
文摘Objective To observe the clinical efficacy of thunder-fire moxibustion on pediatric testicular hydrocele. Methods Thunder-fire moxa was used for suspending moxibus on on Shu？dào（水道 ST 28） and Guānyuán（关元 CV 4） on both sides for 10 children with tes cular hydrocele,the moxa s ck was kept 2–3 cm above from the skin and the moxibustion was carried out until the skin become red and hot for about 15–20 min. The treatments were carried out once a day and ten mes were considered as a treatment course,and the therapeutic efficacy was subjected to statistics after two treatment courses. Results Eight cases were cured,and eff ec ve in 2 cases; the cured rate was 80% and the effective rate was 100%. Conclusion Thunder-fire moxibustion has rela vely good clinical effi cacy in trea ng tes cular hydrocele in children.
文摘Introduction: Testicular cancer accounts for 5% of urological tumors, predominantly affecting young men. The aim of our study was to report the diagnostic and evolutionary aspects of testicular cancer cases treated in our center. Patients and Methods: A retrospective study conducted over a 15-year period involving 12 patients treated for testicular cancer at the University Hospital of Brazzaville. Results: The median age was 31 years (range 11 to 49 years), with a median consultation delay of 10.6 months (range 3 to 27 months). Scrotal mass was the most common reason for consultation. Cancer was bilateral in two patients. Two patients were admitted with metastatic disease. Histopathological examination favored germ cell tumors in 7 cases, two cases of non-Hodgkin’s malignant lymphoma, and one case of epididymo-testicular adenocarcinoma. Adjuvant chemotherapy resulted in complete remission in patients with germ cell tumors. However, neoadjuvant chemotherapy was not effective in patients admitted with advanced-stage disease. Conclusion: Testicular cancer is a rare condition that is curable in the majority of cases, but its management is often complicated in our setting due to delayed diagnosis caused by taboos surrounding genital organ pathologies.
文摘Aim： To evaluate the relationship between testicular function and testicular volume measured by using Prader orchidometry and ultrasonography （US） to determine the critical testicular volume indicating normal testicular function by each method. Methods： Total testicular volume （right plus left testicular volume） was measured in 794 testes in 397 men with infertility （mean age, 35.6 years） using a Prader orchidometer and also by ultrasonography. Ultrasonographic testicular volumes were calculated as length x width x height x 0.71. To evaluate volume-function relationships, patients were divided into 10 groups representing 5-mL increments of total testicular volume by each method from below 10 mL to 50 mL or more. Results： Mean total testicular volume based on Prader orchidometry and US were 36.8 mL and 26.3 mL, respectively. Semen volume, sperm density, total sperm count, total motile sperm count, and serum FSH, LH, and testosterone all correlated significantly with total testicular volume measured by either method. Mean sperm density was in the oligozoospermic range in patients with total testicular volume below 35 mL by orchidometry or below 20 mL by ultrasonography. Mean total sperm count was subnormal in patients with total testicular volume below 30 mL by orchidometry or under 20 mL by ultrasonography. Conclusion： Testicular volume measured by either ultrasonography or Prader orchidometry correlated significantly with testicular function. However, critical total testicular volume indicating normal or nearly normal testicular function was 30 mL to 35 mL using Prader orchidometer and 20 mL using ultrasonography. Prader orchidometry morphometrically and functionally overestimated the testicular volume in comparison to US. （Asian JAndro12008 Mar; 10： 319-324）
文摘Testicular microlithiasis （TM） is one of the symptoms of testicular dysgenesis syndrome （TDS）. TM is particularly interesting as an informative marker of testicular germ cell tumors （TGCTs）. KIT ligand gene （KITLG）, BCL2 antagonist/killer 1 （BAK1）, and sprouty RTK signaling antagonist 4 （SPRY4） genes are associated with a high risk of TGCTs, whereas bone morphogenetic protein 7 gene （BMP7）, transforming growth factor beta receptor 3 gene （TGFBR3）, and homeobox D cluster genes （HOXD） are related to TDS. Using polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） analysis, we investigated allele and genotype frequencies for KITLG （rs995030, rs1508595）, SPRY4 （rs4624820, rs6897876）, BAK1 （rs210138）, BMP7 （rs388286）, TGFBR3 （rs12082710）, and HOXD （rs17198432） in 142 TGCT patients, 137 TM patients, and 153 fertile men （control group）. We found significant differences in the KITLG GG_rs995030 genotype in TM （P= 0.01） and TGCT patients （P = 0.0005） compared with the control. We also revealed strong associations between KITLGrs1508595 and TM （G allele, P = 0.003; GG genotype, P= 0.01） and between KITLG_rs1508595 and TGCTs （G allele, P-- 0.0001; GG genotype, P = 0.0007）. Moreover, there was a significant difference in BMP7_rs388286 between the TGCT group and the control （T allele, P = 0.00004; TT genotype, P = 0.00006） and between the TM group and the control （T allele, P= 0.04）. HOXDalso demonstrated a strong association with TGCTs （rs17198432 A allele, P = 0.0001; AA genotype, P = 0.001）. Furthermore, significant differences were found between the TGCT group and the control in the BAK1_rs210138 G allele （P= 0.03） and the GG genotype （P= 0.01）. KITLG and BMP7genes, associated with the development of TGCTs, may also be related to TM. In summary, the KITLG GG_rs995030, GG_rs1508595, BMP7 TT_rs388286, HOXD AA_rs17198432, and BAK1 GG_rs210138 genotypes were associated with a high risk of TGCT development.
文摘Aim： To evaluate the outcome of repetitive micro-surgical testicular sperm extraction （mTESE） attempts in non-obstructive azoospermia （NOA） cases, in relation to patients＇ initial testicular histology results. Methods： A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection （ICSI） attempts were reviewed. Results： Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 （64%） （Sp^＋）, and failed in the remaining 24 （36%） （Sp^-）. Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp^＋ but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two （n = 24）, three （n = 4） and four （n = 1） times. The second attempt yielded mature sperm in 3/5 patients from the Sp group and 16/19 patients from the Sp^＋ group. At the third and fourth trials, 4/4 and 1/1 of the original Sp^＋ patients were Sp^＋ again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome （16%）, maturation arrest （22%）, hypospermatogenesis （21%） and focal spermatogenesis （41%）. Overall, in repetitive mTESE, 24/29 （82%） of the attempts were finally Sp^＋. Conclusion： Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.
基金funded by the Medical Science and Technology Research Project of Henan Province provided by the Health Commission of Henan Province(No.LHGJ20190383).
文摘Cryptorchidism affects the growth of testicular volume.Testicular volume is associated with reproductive function.The testicular atrophy index evaluates the degree of damage caused by cryptorchidism,but it remains unclear whether changes in testicular atrophy index are related to age.We selected patients who underwent surgery for unilateral palpable cryptorchidism.Testicular volume was measured using ultrasonography.The testicular atrophy indices of the undescended testes were then reviewed,and their correlation with age was analyzed.We studied 228 cases(age range:6–53 months).Scatter plots were constructed,and Loess curves were fitted,revealing a turning point at 24 months of age.The patients were divided into age groups of 6–24 months and 25–53 months.The testicular volume of the cryptorchid side was smaller than that of the normal side in both groups(both P<0.001).In the 6–24-month group,the testicular atrophy index was positively correlated with age,testicular volume on the cryptorchid side was not correlated with age,and testicular volume was positively correlated with age on the normal side.In the 25–53-month group,testicular atrophy index and testicular volumes on either side were not correlated with age.A palpable unilateral cryptorchid testis is smaller than the contralateral testis.The testicular atrophy index increases with age between 6 months and 24 months,but not between 25 months and 53 months.Testicular volume increased with age on the normal side between 6 months and 24 months,but not on the cryptorchid side.Trends in testicular atrophy index with age contribute to the decision of operation time.
文摘We investigated the prognostic importance of noninvasive factors in predicting sperm retrieval failure in idiopathic nonobstructive azoospermia(iNOA).We studied 193 patients with nonobstructive azoospermia who underwent microsurgical testicular sperm extraction.The Chi-square test and Mann–Whitney U tests for clinical parameters and seminiferous tubule distribution were used for between-group comparisons.A logistic regression analysis was conducted to identify predictors of retrieval failure.Area under the receiver operating characteristic curve for each variable was evaluated,and the net clinical benefit was calculated using a clinical decision curve.Patients with iNOA had a lower sperm retrieval rate than those with known causes.Moreover,testicular volume was an independent factor affecting sperm extraction outcomes(odds ratio=0.79,P<0.05).The testicular volume cut-off value was 6.5 ml(area under the curve:0.694).The patients with iNOA were categorized into two groups on the basis of the distribution of seminiferous tubules observed.The sperm retrieval rate and testicular volume were significantly different between the groups with a uniform or heterogeneous tubule distribution.There was also a significant association between a uniform tubule distribution and testicular volume.In conclusion,a testicular volume of more than 6.5 ml effectively predicts microsurgical testicular sperm extraction failure due to a uniform tubule distribution in patients with iNOA.
