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
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
The female internal sex organs develop from the paramesonephric （Mullerian） duct. In male embryos, the regression of the Mullerian duct is caused by the anti-Mullerian hormone （AMH）, which plays an important role ...The female internal sex organs develop from the paramesonephric （Mullerian） duct. In male embryos, the regression of the Mullerian duct is caused by the anti-Mullerian hormone （AMH）, which plays an important role in the process of testicular descent. The physiological remnant of the Mullerian duct in males is the appendix testis （AT）. In our previous study, we presented evidence for the decreased incidence of AT in cryptorchidism with intraoperative surgery. In this report, the expression of the anti-Mullerian hormone receptor type 2 （AMHR2）, the specific receptor of AMH, on the AT was investigated in connection with different urological disorders, such as hernia inguinalis, torsion of AT, cysta epididymis, varicocele, hydrocele testis and various forms of undescended testis. The correlation between the age of the patients and the expression of the AMHR2 was also examined. Reverse transcriptase-polymerase chain reaction （RT-PCR） and immunohistochemistry were used to detect the receptor＇s mRNA and protein levels, respectively. We demonstrate that AMHR2 is expressed in the ATs. Additionally, the presence of this receptor was proven at the mRNA and protein levels. The expression pattern of the receptor correlated with neither the examined urological disorders nor the age of the patients; therefore, the function of the AT remains obscure.展开更多
Hedgehog(HH)signaling has been researched for decades and Hedgehog has 3 homologs:Sonic Hedgehog(Shh),Indian Hedgehog(Ihh),and Desert Hedgehog(Dhh).Dhh is the one involved in male gonad and germ cell development.The d...Hedgehog(HH)signaling has been researched for decades and Hedgehog has 3 homologs:Sonic Hedgehog(Shh),Indian Hedgehog(Ihh),and Desert Hedgehog(Dhh).Dhh is the one involved in male gonad and germ cell development.The distribution of molecules in Hedgehog signaling in testis indicated that Hedgehog signaling executes important functions during testis development.The patients with Dhh signaling deficiency develop dysgenesis of gonads and hormone production which demands further exploration of gonad HH signaling.Some results proved the indispensable roles of HH signaling in gonad and germ cell development and the interaction with hormones.This review evaluates HH functions in the testis and how HH affects and is affected by hormones and provides novel insights about HH signaling to the readers.展开更多
Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structur...Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structure that pulls the testis into the scrotum.However,the mechanisms of androgen actions underlying many of the processes associated with gubernaculum development have not been fully elucidated.To identify the androgen-regulated genes,we conducted large-scale gene expression analyses on the gubernaculum harvested from luteinizing hormone/choriogonadotropin receptor knockout(Lhcgr KO)mice,an animal model of inguinoscrotal testis maldescent resulting from androgen deficiency.We found that the expression of secreted protein acidic and rich in cysteine(SPARC)-related modular calcium binding 1(Smoc1)was the most severely suppressed at both the transcript and protein levels,while its expression was the most dramatically induced by testosterone administration in the gubernacula of Lhcgr KO mice.The upregulation of Smoc1 expression by testosterone was curtailed by the addition of an androgen receptor antagonist,flutamide.In addition,in vitro studies demonstrated that SMOC1 modestly but significantly promoted the proliferation of gubernacular cells.In the cultures of myogenic differentiation medium,both testosterone and SMOC1 enhanced the expression of myogenic regulatory factors such as paired box 7(Pax7)and myogenic factor 5(Myf5).After short-interfering RNA-mediated knocking down of Smoc1,the expression of Pax7 and Myf5 diminished,and testosterone alone did not recover,but additional SMOC1 did.These observations indicate that SMOC1 is pivotal in mediating androgen action to regulate gubernaculum development during inguinoscrotal testicular descent.展开更多
To investigate the impact of preoperative serum follicle-stimulating hormone(FSH)levels on the probability of testicular sperm retrieval,we conducted a study of nonobstructive azoospermic(NOA)men with different testic...To investigate the impact of preoperative serum follicle-stimulating hormone(FSH)levels on the probability of testicular sperm retrieval,we conducted a study of nonobstructive azoospermic(NOA)men with different testicular volumes(TVs)who underwent microdissection testicular sperm extraction(micro-TESE).A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital(formerly Shenzhen Zhongshan Urology Hospital,Shenzhen,China)were retrospectively reviewed.The subjects were divided into four groups based on average TV quartiles.Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups.Overall sperm retrieval rate was 57.6%.FSH levels(median[interquartile range])were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was<5 ml(first quartile[Q1:TV<3 ml]:43.32[17.92]IU l^(−1) vs 32.95[18.56]IU l−1,P=0.048;second quartile[Q2:3 ml≤TV<5 ml]:31.31[15.37]IU l^(−1) vs 25.59[18.40]IU l^(−1),P=0.042).Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were<5 ml(adjusted odds ratio[OR]:1.06 per unit increase;95%confidence interval[CI]:1.01–1.11;P=0.011).In men with TVs≥5 ml,larger TVs were associated with lower odds of sperm retrieval(adjusted OR:0.84 per 1 ml increase;95%CI:0.71–0.98;P=0.029).In conclusion,elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs<5 ml.In men with TV≥5 ml,increases in average TVs were associated with lower odds of sperm retrieval.展开更多
Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathog...Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathogenesis.We have recently presented a study on a series of 453 consecutive boys with bilateral nonsyndromic cryptorchidism,in which we conducted hormonal evaluations and assessed germ cell numbers in testicular biopsies.3 In this series,45%of the boys were classified as having gonadotropin insufficiency.3 Identifying these patients at the time of surgery is important.A recent follow-up study of 208 boys with nonsyndromic bilateral cryptorchidism from our department showed that the boys with gonadotropin insufficiency had an impaired fertility potential after surgery compared to boys with an intact hypothalamus–pituitary–gonadal feedback mechanism.4 In a review from 2022,Hadziselimovic5 suggested that infertility in patients diagnosed with cryptorchid testes is a consequence of a hormonal deficiency rather than temperature-induced cellular damage.展开更多
Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and disco...Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and discovered an effect not mentioned in the article.My analysis showed that luteinizing hormone(LH)levels are significantly lower in patients at high infertility risk(HIR),whose testes lack A dark(Ad)spermatogonia and display an abnormal ratio of germ cells per crosssectional tubule(G/T).展开更多
The aim of this investigation was to determine the optimal storage medium for testicular hypothermic transportation and identify the ideal concentration for the application of the protective agent 5-aminolevulinic aci...The aim of this investigation was to determine the optimal storage medium for testicular hypothermic transportation and identify the ideal concentration for the application of the protective agent 5-aminolevulinic acid(5-ALA).Furthermore,this study aimed to explore the underlying mechanism of the protective effects of 5-ALA.First,we collected and stored mouse testicular fragments in different media,including Hank’s balanced salt solution(HBSS;n=5),Dulbecco’s Modified Eagle Medium/Nutrient Mixture F-12(DMEM/F12;n=5),and alpha-minimum essential medium(αMEM;n=5).Storage of testicular tissue in HBSS preserved the integrity of testicular morphology better than that in the DMEM/F12 group(P<0.05)and theαMEM group(P<0.01).Testicular fragments were subsequently placed in HBSS with various concentrations of 5-ALA(0[control],1 mmol l−1,2 mmol l−1,and 5 mmol l−1)to determine the most effective concentration of 5-ALA.The 2 mmol l−15-ALA group(n=3)presented the highest positive rate of spermatogonial stem cells compared with those in the control,1 mmol l−1,and 5 mmol l−15-ALA groups.Finally,the tissue fragments were preserved in HBSS with control(n=3)and 2 mmol l−15-ALA(n=3)under low-temperature conditions.A comparative analysis was performed against fresh testes(n=3)to elucidate the underlying mechanism of 5-ALA.Gene set enrichment analysis(GSEA)for WikiPathways revealed that the p38 mitogen-activated protein kinase(MAPK)signaling pathway was downregulated in the 2 mmol l−15-ALA group compared with that in the control group(normalized enrichment score[NES]=−1.57,false discovery rate[FDR]=0.229,and P=0.019).In conclusion,these data suggest that using 2 mmol l−15-ALA in HBSS effectively protected the viability of spermatogonial stem cells upon hypothermic transportation.展开更多
A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]...A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]） with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome （TDS）： a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism （high positioned scrotal hypotrophic testis） and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.展开更多
The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formu...The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas.A total of 15 patients underwent high-resolution ultrasonography(US)analysis for testicular volume before orchiectomy.Testicular volume was calculated using three common formulas:(1)length(L)×width(W)×height(H)×0.52;(2)the empirical formula of Lambert:L×W×H×0.71;and(3)L×W^(2)×0.52.The actual volume of each removed testis was estimated directly by a water displacement method.Thus,four volume measurements were obtained for each of the 30 testes.The obtained data were analyzed by paired t-test and linear regression analysis.All three US formula measurements significantly underestimated the true testicular volume.The largest mean biases were observed with US formula 1,which underestimated the true volume by 3.3 mL(31%).US formula 2 had a smaller mean difference from the true volume,with an underestimation of only 0.6 mL(6%).Regression analysis showed that formulas 1 and 2 had better R^(2) values than formula 3.However,all three US formulas displayed a strong linear relationship with the true volume(R^(2)=0.872−0.977;P<0.001).Among the commonly used US formulas,the empirical formula of Lambert(L×W×H×0.71)provided better accuracy than the other two formulas evaluated,and better precision than formula 3.Therefore,the formula of Lambert is the optimal choice in clinical practice.展开更多
Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Met...Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.展开更多
Aim: In order to clarify further the mechanisms underlying the effect of capsulotomy on testicular function, the lev-els of testosterone, LH and FSH were observed. Methods: Intratesticular testosterone levels and LH, ...Aim: In order to clarify further the mechanisms underlying the effect of capsulotomy on testicular function, the lev-els of testosterone, LH and FSH were observed. Methods: Intratesticular testosterone levels and LH, FSH levelsin the peripheral blood of normal, sham-operated and capsulotomized rats were detected by RIA. Results: Aftertesticular capsulotomy, there was a progressive reduction in the testosterone level in the testicular venous blood togetherwith a progressive increase in the LH and FSH levels in the peripheral blood from approximately 30 days post-capsuloto-my. Morphological changes were observed at 5-10 days after capsulotomy, i. e., far ahead of the hormonal changes.Conclusion: The seminiferous tubular damage after testicular capsulotomy was not caused by the reduction in testos-terone, and on the contrary, the hormonal change might be secondary to the morphological alterations. The increase inLH level most likely resulted from a negative feedback influence from the lowered testosterone level, while the increasein FSH secretion may be a feedback signal of the damaged seminiferous tubules. (Asian J Androl 2000 Dec; 2: 257-261 )展开更多
Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique we...Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.展开更多
Objective:To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature.Methods:The case records of 13 patients operated for t...Objective:To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature.Methods:The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed.The medical records included age at presentation,medical history,physical examination,operative findings and the results of follow-up.The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration.Results:In six cases the testis was preserved and orchiopexy was performed,while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case.Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h.From six patients treated by orchiopexy,two patients suffered from testicular atrophy at a mean of 24 months.Conclusion:Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage.The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.展开更多
Enterogenous cyst is a rare congenital lesion generally located in the mediastinum or the abdominal cavity. We reported the first case of testicular enterogenous cyst in a 55-year-old white male presented with testicu...Enterogenous cyst is a rare congenital lesion generally located in the mediastinum or the abdominal cavity. We reported the first case of testicular enterogenous cyst in a 55-year-old white male presented with testicular pain and a gradually enlarging left scrotal mass with a 2-week duration. （Asian J Androl 2006 Mar; 8： 243-245）展开更多
During spermatogenesis, developi ng germ cells that lack the cellular ultrastructures of filopodia and lamellipodia gen erally found in migrating cells, such as macrophages and fibroblasts, rely on Sertoli cells to su...During spermatogenesis, developi ng germ cells that lack the cellular ultrastructures of filopodia and lamellipodia gen erally found in migrating cells, such as macrophages and fibroblasts, rely on Sertoli cells to support their transport across the seminiferous epithelium. These in elude the transport of preleptote ne spermatocytes across the blood-testis barrier (BTB), but also the transport of germ cells, in particular developing haploid spermatids, across the seminiferous epithelium, that is to and away from the tubule lumen, depending on the stages of the epithelial cycle. On the other hand, cell junctions at the Sertoli cell-cell and Sertoli-germ cell in terface also un dergo rapid remodeli ng, invo Iving disassembly and reassembly of cell j un ctions, which, in turn, are supported by actin- and microtubule-based cytoskeletal remodeling. Interestingly, the underlying mechanism(s) and the invoIving biomolecule(s) that regulate or support cytoskeletal remodeling remain largely unknown. Herein, we used an in vitro model of primary Sertoli cell cultures that mimicked the Sertoli BTB in vivo overexpressed with the ribosomal protei n S6 (rpS6, the down stream signali ng protein of mammalian target of rapamycin complex 1 [mTORCl]) cloned into the mammalian expression vector pCI-neo, namely, quadruple phosphomimetic and constitutively active mutant of rpS6 (pCI-neo/p-rpS6-MT) versus pCI-neo/rpS6-WT (wild-type) and empty vector (pCI-neo/Ctrl) for studies. These findings provide compelling evidence that the mT0RCl/rpS6 signal pathway exerted its effects to promote Sertoli cell BTB remodeling. This was mediated through changes in the organization of actin- and microtubulebased cytoskeletons, involving changes in the distribution and/or spatial expression of actin- and microtubule-regulatory proteins.展开更多
Aim: To demonstrate the effect of capsulotomy on the fertility of male rats. Methods: Testicular capsulotomywas carded out in immature (21 days) and adult (60 days) male rats. The fertility of them was assessed by coh...Aim: To demonstrate the effect of capsulotomy on the fertility of male rats. Methods: Testicular capsulotomywas carded out in immature (21 days) and adult (60 days) male rats. The fertility of them was assessed by cohabita-tion with proestrus females overnight and 20 days later, the females were examined for impregnation. Morphologicalchanges at the site of the capsulotomy were observed under light microscope. Results: In rats capsulotomized atDay 60, the fertility was gradually depressed and all the rats completely lost their fertility 2 months post-operation. Atthat time, a partial regeneration of the capsule at the site of capsulotomy was observed. Immature rats capsulotomized atDay 21 were found to possess normal fertility at maturity. The capsulotomy site was almost completely recovered 60days post-operation. Conclusion: In male rats, testicular capsulotomy at the age of Day 60 will damage fertility.However, when capsulotomy is performed at Day 21, fertility is preserve.(Asian J Androl 2001 Mar; 3: 21-25)展开更多
The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer,torsion,atrophic testis,or trauma.However,data suggest that patients find the offer of a testicular p...The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer,torsion,atrophic testis,or trauma.However,data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective.Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement.The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure.The most common postoperative patient concerns are minor and involve implant positioning,size,and weight.Herein,we provide an up-to-date review of modern preoperative evaluation,patient selection,expectation management,surgical technique,and expected outcomes for testicular prostheses.展开更多
Objective:Testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patien...Objective:Testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed.Data obtained included demographic data,history,physical examination results,ultrasound findings including size,color Doppler flow,and echotexture,torsion degrees,and surgical procedure.In addition,the histopathological findings of patients who underwent orchiectomy were reviewed.Results:A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018.The mean age at presentation was 20.4±7.0 years.The average time from the onset of pain until the presentation was 36.0±55.1 h.Out of the 71 ultrasound scans reviewed,45.1%showed homogenous echotexture and 54.9%showed heterogeneous echotexture of the affected testis.On scrotal exploration,the mean degree of torsion was 475.7±301.8 degrees;66.2%of the patients had a viable testis;and bilateral orchidopexy was done.The remaining 33.8%had a non-viable testis.Homogenous echotexture was after an average of 13.5 h of scrotal pain,while heterogeneous echotexture presented after 53.7 h of scrotal pain.There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography(p<0.01).The relationship between echotexture changes and testicular viability was statistically significant as well(p<0.001).Conclusion:A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability.However,we still advocate for surgical exploration as the gold standard in diagnosis and management.展开更多
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The female internal sex organs develop from the paramesonephric （Mullerian） duct. In male embryos, the regression of the Mullerian duct is caused by the anti-Mullerian hormone （AMH）, which plays an important role in the process of testicular descent. The physiological remnant of the Mullerian duct in males is the appendix testis （AT）. In our previous study, we presented evidence for the decreased incidence of AT in cryptorchidism with intraoperative surgery. In this report, the expression of the anti-Mullerian hormone receptor type 2 （AMHR2）, the specific receptor of AMH, on the AT was investigated in connection with different urological disorders, such as hernia inguinalis, torsion of AT, cysta epididymis, varicocele, hydrocele testis and various forms of undescended testis. The correlation between the age of the patients and the expression of the AMHR2 was also examined. Reverse transcriptase-polymerase chain reaction （RT-PCR） and immunohistochemistry were used to detect the receptor＇s mRNA and protein levels, respectively. We demonstrate that AMHR2 is expressed in the ATs. Additionally, the presence of this receptor was proven at the mRNA and protein levels. The expression pattern of the receptor correlated with neither the examined urological disorders nor the age of the patients; therefore, the function of the AT remains obscure.
基金supported in part by the National Natural Science Foundation of China(Nos.32270555 and 32072954).
文摘Hedgehog(HH)signaling has been researched for decades and Hedgehog has 3 homologs:Sonic Hedgehog(Shh),Indian Hedgehog(Ihh),and Desert Hedgehog(Dhh).Dhh is the one involved in male gonad and germ cell development.The distribution of molecules in Hedgehog signaling in testis indicated that Hedgehog signaling executes important functions during testis development.The patients with Dhh signaling deficiency develop dysgenesis of gonads and hormone production which demands further exploration of gonad HH signaling.Some results proved the indispensable roles of HH signaling in gonad and germ cell development and the interaction with hormones.This review evaluates HH functions in the testis and how HH affects and is affected by hormones and provides novel insights about HH signaling to the readers.
基金supported in part by the Department of OB/GYN research funds(University of Louisville,Louisville,KY,USA)Jilin Province Health Technology Capability Enhancement funds(No.2022JC055).
文摘Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structure that pulls the testis into the scrotum.However,the mechanisms of androgen actions underlying many of the processes associated with gubernaculum development have not been fully elucidated.To identify the androgen-regulated genes,we conducted large-scale gene expression analyses on the gubernaculum harvested from luteinizing hormone/choriogonadotropin receptor knockout(Lhcgr KO)mice,an animal model of inguinoscrotal testis maldescent resulting from androgen deficiency.We found that the expression of secreted protein acidic and rich in cysteine(SPARC)-related modular calcium binding 1(Smoc1)was the most severely suppressed at both the transcript and protein levels,while its expression was the most dramatically induced by testosterone administration in the gubernacula of Lhcgr KO mice.The upregulation of Smoc1 expression by testosterone was curtailed by the addition of an androgen receptor antagonist,flutamide.In addition,in vitro studies demonstrated that SMOC1 modestly but significantly promoted the proliferation of gubernacular cells.In the cultures of myogenic differentiation medium,both testosterone and SMOC1 enhanced the expression of myogenic regulatory factors such as paired box 7(Pax7)and myogenic factor 5(Myf5).After short-interfering RNA-mediated knocking down of Smoc1,the expression of Pax7 and Myf5 diminished,and testosterone alone did not recover,but additional SMOC1 did.These observations indicate that SMOC1 is pivotal in mediating androgen action to regulate gubernaculum development during inguinoscrotal testicular descent.
基金supported by the Shenzhen Fundamental Research Program(No.JCYJ20210324121807021).
文摘To investigate the impact of preoperative serum follicle-stimulating hormone(FSH)levels on the probability of testicular sperm retrieval,we conducted a study of nonobstructive azoospermic(NOA)men with different testicular volumes(TVs)who underwent microdissection testicular sperm extraction(micro-TESE).A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital(formerly Shenzhen Zhongshan Urology Hospital,Shenzhen,China)were retrospectively reviewed.The subjects were divided into four groups based on average TV quartiles.Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups.Overall sperm retrieval rate was 57.6%.FSH levels(median[interquartile range])were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was<5 ml(first quartile[Q1:TV<3 ml]:43.32[17.92]IU l^(−1) vs 32.95[18.56]IU l−1,P=0.048;second quartile[Q2:3 ml≤TV<5 ml]:31.31[15.37]IU l^(−1) vs 25.59[18.40]IU l^(−1),P=0.042).Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were<5 ml(adjusted odds ratio[OR]:1.06 per unit increase;95%confidence interval[CI]:1.01–1.11;P=0.011).In men with TVs≥5 ml,larger TVs were associated with lower odds of sperm retrieval(adjusted OR:0.84 per 1 ml increase;95%CI:0.71–0.98;P=0.029).In conclusion,elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs<5 ml.In men with TV≥5 ml,increases in average TVs were associated with lower odds of sperm retrieval.
文摘Dear Editor,We are much obliged that Hadziselimovic1 has used our data2 to highlight the substantial proportion of boys with cryptorchidism where gonadotropin insufficiency is an important factor related to the pathogenesis.We have recently presented a study on a series of 453 consecutive boys with bilateral nonsyndromic cryptorchidism,in which we conducted hormonal evaluations and assessed germ cell numbers in testicular biopsies.3 In this series,45%of the boys were classified as having gonadotropin insufficiency.3 Identifying these patients at the time of surgery is important.A recent follow-up study of 208 boys with nonsyndromic bilateral cryptorchidism from our department showed that the boys with gonadotropin insufficiency had an impaired fertility potential after surgery compared to boys with an intact hypothalamus–pituitary–gonadal feedback mechanism.4 In a review from 2022,Hadziselimovic5 suggested that infertility in patients diagnosed with cryptorchid testes is a consequence of a hormonal deficiency rather than temperature-induced cellular damage.
文摘Dear Editor,I would like to congratulate Mamsen et al.i on their extensive and scientifically valuable work.I analyzed their raw data presented in Table 1 of the original article from a different perspective and discovered an effect not mentioned in the article.My analysis showed that luteinizing hormone(LH)levels are significantly lower in patients at high infertility risk(HIR),whose testes lack A dark(Ad)spermatogonia and display an abnormal ratio of germ cells per crosssectional tubule(G/T).
基金funded by the National Natural Science Foundation of China(No.81971759 and No.82171604)the Guangdong Basic and Applied Basic Research Foundation(2023B1515020108)+3 种基金the Science and Technology Program of Guangzhou(202206010089)the Excellent Talents Training Project of The Sixth Affiliated Hospital of Sun Yat-sen University(R20210217202601970)the Postdoctoral Fellowship Program of CPSF(GZC20233216)the Basic and Applied Basic Research Foundation of Guangdong Province(2021A1515111195).
文摘The aim of this investigation was to determine the optimal storage medium for testicular hypothermic transportation and identify the ideal concentration for the application of the protective agent 5-aminolevulinic acid(5-ALA).Furthermore,this study aimed to explore the underlying mechanism of the protective effects of 5-ALA.First,we collected and stored mouse testicular fragments in different media,including Hank’s balanced salt solution(HBSS;n=5),Dulbecco’s Modified Eagle Medium/Nutrient Mixture F-12(DMEM/F12;n=5),and alpha-minimum essential medium(αMEM;n=5).Storage of testicular tissue in HBSS preserved the integrity of testicular morphology better than that in the DMEM/F12 group(P<0.05)and theαMEM group(P<0.01).Testicular fragments were subsequently placed in HBSS with various concentrations of 5-ALA(0[control],1 mmol l−1,2 mmol l−1,and 5 mmol l−1)to determine the most effective concentration of 5-ALA.The 2 mmol l−15-ALA group(n=3)presented the highest positive rate of spermatogonial stem cells compared with those in the control,1 mmol l−1,and 5 mmol l−15-ALA groups.Finally,the tissue fragments were preserved in HBSS with control(n=3)and 2 mmol l−15-ALA(n=3)under low-temperature conditions.A comparative analysis was performed against fresh testes(n=3)to elucidate the underlying mechanism of 5-ALA.Gene set enrichment analysis(GSEA)for WikiPathways revealed that the p38 mitogen-activated protein kinase(MAPK)signaling pathway was downregulated in the 2 mmol l−15-ALA group compared with that in the control group(normalized enrichment score[NES]=−1.57,false discovery rate[FDR]=0.229,and P=0.019).In conclusion,these data suggest that using 2 mmol l−15-ALA in HBSS effectively protected the viability of spermatogonial stem cells upon hypothermic transportation.
文摘A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ （CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]） with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome （TDS）： a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism （high positioned scrotal hypotrophic testis） and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.
基金We are grateful to Ms Shu-Fang Huang,a statistical specialist at our institute,for her valuable assistance in statistical analysis and review of the statistical section.
文摘The aim of this study was to determine the correlation of ultrasonographic estimates of testicular volume with true testicular volume and to compare the accuracy and precision of the three most commonly utilized formulas.A total of 15 patients underwent high-resolution ultrasonography(US)analysis for testicular volume before orchiectomy.Testicular volume was calculated using three common formulas:(1)length(L)×width(W)×height(H)×0.52;(2)the empirical formula of Lambert:L×W×H×0.71;and(3)L×W^(2)×0.52.The actual volume of each removed testis was estimated directly by a water displacement method.Thus,four volume measurements were obtained for each of the 30 testes.The obtained data were analyzed by paired t-test and linear regression analysis.All three US formula measurements significantly underestimated the true testicular volume.The largest mean biases were observed with US formula 1,which underestimated the true volume by 3.3 mL(31%).US formula 2 had a smaller mean difference from the true volume,with an underestimation of only 0.6 mL(6%).Regression analysis showed that formulas 1 and 2 had better R^(2) values than formula 3.However,all three US formulas displayed a strong linear relationship with the true volume(R^(2)=0.872−0.977;P<0.001).Among the commonly used US formulas,the empirical formula of Lambert(L×W×H×0.71)provided better accuracy than the other two formulas evaluated,and better precision than formula 3.Therefore,the formula of Lambert is the optimal choice in clinical practice.
文摘Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.Aim: In SD rats, histological changes in the testis were observed after bilateral capsulotomy (of the tunica albug-inea) in order to investigate the physiological role of the testicular capsule on sperm transport. Methods: Bilaterallongitudinal capsulotomy was devised to disrupt the capsular contractile function. With this technique, only the tunicavaginalis and tunica albuginea were slit open, leaving the tunica vasculosa intact to embrace the underlying testicularparenchyma. After capsulotomy, the structural changes in the seminiferous tubules, the transitional distal seminiferoussegment, and the rete testis were observed. Results: In the capsulotomized testis, there was sperm retention at thetransitional seminiferous segment and progressive degenerative changes in seminiferous tubules. Conclusion: Theresults clearly indicated that an intact testicular capsule was required for normal sperm transport from the seminiferoustubules into the rete testis. This is the first attempt to study the physiological role of the testicular capsule in intact ani-mals.
文摘Aim: In order to clarify further the mechanisms underlying the effect of capsulotomy on testicular function, the lev-els of testosterone, LH and FSH were observed. Methods: Intratesticular testosterone levels and LH, FSH levelsin the peripheral blood of normal, sham-operated and capsulotomized rats were detected by RIA. Results: Aftertesticular capsulotomy, there was a progressive reduction in the testosterone level in the testicular venous blood togetherwith a progressive increase in the LH and FSH levels in the peripheral blood from approximately 30 days post-capsuloto-my. Morphological changes were observed at 5-10 days after capsulotomy, i. e., far ahead of the hormonal changes.Conclusion: The seminiferous tubular damage after testicular capsulotomy was not caused by the reduction in testos-terone, and on the contrary, the hormonal change might be secondary to the morphological alterations. The increase inLH level most likely resulted from a negative feedback influence from the lowered testosterone level, while the increasein FSH secretion may be a feedback signal of the damaged seminiferous tubules. (Asian J Androl 2000 Dec; 2: 257-261 )
文摘Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.
文摘Objective:To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature.Methods:The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed.The medical records included age at presentation,medical history,physical examination,operative findings and the results of follow-up.The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration.Results:In six cases the testis was preserved and orchiopexy was performed,while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case.Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h.From six patients treated by orchiopexy,two patients suffered from testicular atrophy at a mean of 24 months.Conclusion:Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage.The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.
文摘Enterogenous cyst is a rare congenital lesion generally located in the mediastinum or the abdominal cavity. We reported the first case of testicular enterogenous cyst in a 55-year-old white male presented with testicular pain and a gradually enlarging left scrotal mass with a 2-week duration. （Asian J Androl 2006 Mar; 8： 243-245）
基金grants from the National Institutes of Health (R01 HD056034 to CYC)the Natural Science Foundation of China (NSFC)(No. 81601264 to LXLand No. 81730042 to RSG).
文摘During spermatogenesis, developi ng germ cells that lack the cellular ultrastructures of filopodia and lamellipodia gen erally found in migrating cells, such as macrophages and fibroblasts, rely on Sertoli cells to support their transport across the seminiferous epithelium. These in elude the transport of preleptote ne spermatocytes across the blood-testis barrier (BTB), but also the transport of germ cells, in particular developing haploid spermatids, across the seminiferous epithelium, that is to and away from the tubule lumen, depending on the stages of the epithelial cycle. On the other hand, cell junctions at the Sertoli cell-cell and Sertoli-germ cell in terface also un dergo rapid remodeli ng, invo Iving disassembly and reassembly of cell j un ctions, which, in turn, are supported by actin- and microtubule-based cytoskeletal remodeling. Interestingly, the underlying mechanism(s) and the invoIving biomolecule(s) that regulate or support cytoskeletal remodeling remain largely unknown. Herein, we used an in vitro model of primary Sertoli cell cultures that mimicked the Sertoli BTB in vivo overexpressed with the ribosomal protei n S6 (rpS6, the down stream signali ng protein of mammalian target of rapamycin complex 1 [mTORCl]) cloned into the mammalian expression vector pCI-neo, namely, quadruple phosphomimetic and constitutively active mutant of rpS6 (pCI-neo/p-rpS6-MT) versus pCI-neo/rpS6-WT (wild-type) and empty vector (pCI-neo/Ctrl) for studies. These findings provide compelling evidence that the mT0RCl/rpS6 signal pathway exerted its effects to promote Sertoli cell BTB remodeling. This was mediated through changes in the organization of actin- and microtubulebased cytoskeletons, involving changes in the distribution and/or spatial expression of actin- and microtubule-regulatory proteins.
文摘Aim: To demonstrate the effect of capsulotomy on the fertility of male rats. Methods: Testicular capsulotomywas carded out in immature (21 days) and adult (60 days) male rats. The fertility of them was assessed by cohabita-tion with proestrus females overnight and 20 days later, the females were examined for impregnation. Morphologicalchanges at the site of the capsulotomy were observed under light microscope. Results: In rats capsulotomized atDay 60, the fertility was gradually depressed and all the rats completely lost their fertility 2 months post-operation. Atthat time, a partial regeneration of the capsule at the site of capsulotomy was observed. Immature rats capsulotomized atDay 21 were found to possess normal fertility at maturity. The capsulotomy site was almost completely recovered 60days post-operation. Conclusion: In male rats, testicular capsulotomy at the age of Day 60 will damage fertility.However, when capsulotomy is performed at Day 21, fertility is preserve.(Asian J Androl 2001 Mar; 3: 21-25)
基金Figure 1,2,3,Table 2,and testicular implant market data were provided by Coloplast Corporation(Minneapolis,MN,USA)with written permission.
文摘The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer,torsion,atrophic testis,or trauma.However,data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective.Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement.The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure.The most common postoperative patient concerns are minor and involve implant positioning,size,and weight.Herein,we provide an up-to-date review of modern preoperative evaluation,patient selection,expectation management,surgical technique,and expected outcomes for testicular prostheses.
文摘Objective:Testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed.Data obtained included demographic data,history,physical examination results,ultrasound findings including size,color Doppler flow,and echotexture,torsion degrees,and surgical procedure.In addition,the histopathological findings of patients who underwent orchiectomy were reviewed.Results:A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018.The mean age at presentation was 20.4±7.0 years.The average time from the onset of pain until the presentation was 36.0±55.1 h.Out of the 71 ultrasound scans reviewed,45.1%showed homogenous echotexture and 54.9%showed heterogeneous echotexture of the affected testis.On scrotal exploration,the mean degree of torsion was 475.7±301.8 degrees;66.2%of the patients had a viable testis;and bilateral orchidopexy was done.The remaining 33.8%had a non-viable testis.Homogenous echotexture was after an average of 13.5 h of scrotal pain,while heterogeneous echotexture presented after 53.7 h of scrotal pain.There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography(p<0.01).The relationship between echotexture changes and testicular viability was statistically significant as well(p<0.001).Conclusion:A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability.However,we still advocate for surgical exploration as the gold standard in diagnosis and management.
