Micropenis Associated or Not with Cryptorchidism in the Endocrinology Department of Yopougon University Hospital in Ivory Coast: Epidemiological, Clinical, Paraclinical and Therapeutic Aspects

Background: Congenital malformations such as micropenis and cryptorchidism do not have immediate dramatic consequences. However, the diagnosis is often unknown at birth, and therefore late. In Ivory Coast, there are few studies on cryptorchidism and micropenis. We conducted this study to identify the epidemiological, clinical, etiological and therapeutic characteristics of the micropenis associated or not with cryptorchidism at Yopougon University Hospital. Methods: We conducted a retrospective descriptive study in the Department of Endocrinology-Diabetology of the Yopougon University Hospital carried out over 13 years from January 2005 to December 2018. All patients were included regardless of the presence of a micropenis associated or not with cryptorchidism in the clinical or paraclinical examination. Results: A total of 14 micropenis were reported associated in 6 cases with cryptorchidism. It was unilateral cryptorchidism in 4 patients or 66.66% of cases. The average age of affected patients was 21.32 years with extremes ranging from 10 months to 48 years. The reason for consultation was micropenis in 12 out of 14 cases or 85.75%. The associated signs apart from cryptorchidism were obesity in 42.86% of cases, gynecomastia in 35.71% of cases. The aetiology was dominated by idiopathic causes. Treatment with testosterone enanthate was more effective in pre-pubertal children than in adults. Conclusion: The diagnosis of micropenis associated or not with cryptorchidism is late because of the frustrations, taboos and psycho-social states that it causes. However, drug treatment is effective when treatment is started early.

Assessment of germ cell apoptosis in cryptorchid rats

Aim: To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. Methods: Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. Results: Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-dependent increase in the mean apoptotic index. By 60 days after surgery, increased apoptosis in germ cells was also observed in the CDTs. Conclusion: Apoptosis is the predominant mechanism of germ cell death rather than atrophy and necrosis in cryptorchidism.

Trends in the incidence of cryptorchidism and hypospadias of registry-based data in Korea： a comparison between industrialized areas of petrochemical estates and a non-industrialized area

This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients （males） during the first 4 years after a live birth in a population, nationally and regionally （a non-industrialized area （Chuncheon） and petrochemical estates （Yeocheon and Ulsan））, between 2000 and 2005. The data （numerator） for new patients were acquired from the National Health Insurance Review Agency, and the data （denominator） for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon （throughout the study period） and in Ulsan （2001, 2002, 2004 and 2005） than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.

Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abdominal cocoon syndrome(ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.

Effect of prolonged cryptorchidism on germ cell apoptosisand testicular sperm count

Aim: To evaluate the long term effect of experimental cryptorchidism on germ cell apoptotic rate and testicular sperm content in adult rats. Methods: Bilateral cryptorchidism was created in 40 adult male Sprague-Dawley rats by surgically manipulating the testes into the abdominal cavity and closing the internal inguinal ring. The rats were sacrificed and the testes removed 6 hours and 2, 4, 7, 21, 28 and 56 days after cryptorchidism. Germ cell apoptosis was quantified by means of TUNEL assay and apoptosis was confirmed using transmission electron microscopy. Results: The rate of apoptosis peaked at 4 days of cryptorchidism and then progressively declined to a nadir at 14 days of cryptorchidism. At 56 days of cryptorchidism, the germinal epithelium was largely depleted by the apoptotic process and only a few mature sperm were seen within the testis. At this point, a few tubules were seen to be repopulating with primary spermatocytes and the level of germ cell apoptosis began to increase marginally. Testicular sperm count (TSC) began to decline rapidly at day 7 of cryptorchidism. Only a few mature sperm were found in the testes of rats following 56 days of cryptorchidism. Multinucleated giant cells (MGC) were most numerous within the seminiferous tubules at day 4. At day 7, 35 % of MGCs were TUNEL positive. At all subsequent time points, however, MGCs fail to stain positive for apoptosis. This resumption of increased apoptosis coincided with the appearance of a population of primary spermatocytes in some seminiferous tubules. Moreover, there was not a corresponding increase in the number of mature sperm after 56 days of cryptorchidism. Conclusion: The decline in germ cell apoptosis after 4 days of cryptorchidism can be attributed to be the result of an overall depletion of germ cells. It appears that after a prolonged cryptorchidism (56 days), there is a limited resumption of spermatogenesis presumably as a result of a decrease in the maturing germ cells undergoing programmed cell death.

Activation of extracellular signal-related kinases 1 and 2 in Sertoli cells in experimentally cryptorchid rhesus monkeys

Aim： To assess the spatiotemporal changes in the expression of extracellular signal-regulated kinases 1 and 2 （ERK1/ 2）, c-Jun N-terminal kinases （JNK） and p38 mitogen-activated protein kinases （MAPK） in response to heat stress in the cryptorchid testis, and to investigate a possible relation to Sertoli cell dedifferentiation. Methods： Immunohistochemistry and western blot were used to examine the expression and activation of ERK1/2, p38 and JNK in the cryptorchid testis at various stages after experimental cryptorchidism. Results： The abdominal temperature did not obviously change the total ERK1/2 expression but significantly activated phospho-ERK1/2 in the Sertoli cells of the cryptorchid testis. Heat stress increased total JNK expression in the Sertoli cells of the cryptorchid testis but did not activate phospho-JNK. Neither total p38 nor phospho-p38 was induced by heat stress in the Sertoli cells of the cryptorchid testis. Changes in the spatiotemporal expression of cytokeratin 18 （CK18）, a marker of immature or undifferentiated Sertoli cells, were induced in the cryptorchid testis in a pattern similar to the activation of ERK1/2. Condusion： The activation of ERK1/2 in the testis may be related to dedifferentiation of Sertoli cells under heat stress induced by experimental cryptorchidism.

17beta-estradiol stimulates proliferation of spermatogonia in experimental cryptorchid mice

Aim： To investigate whether estrogen stimulates the proliferation of spermatogonia or induces spermatogenesis in cryptorchid mice. Methods： Mice were surgically rendered cryptorchid, then treated with different doses of 17β- estradiol （E2） s.c. once a day. Mice were killed at sexual maturity （45 days of age）, and histological analysis and inununofluorescence were performed. Serum follicle stimulating hormone （FSH）, estradiol, testosterone and luteinizing hormone （LH） were measured. Results： Low doses of E2 had no notable effect on spermatogonia, but at higher doses, E2 stimulated the proliferation of spermatogonia. Conclusion： E2 has a dose-related mitogenic effect on spermatogonia.

Clinical significance of EGF and EGFR expression changes in cryptorchid boys

AIM: To explore the changes of epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) expressions in cryptorchid children and their clinical significance. METHODS: The level of serum EGF was measured by radioimmunoassay (RIA) and the expression of EGFR by immunohistochemistry. RESULTS: (1) The level of serum EGF was significantly lower in cryptorchid children than in normal subjects at age group of 5-9 years (P

Cryptorchidism in Sheep: A Clinical and Abattoir Survey in the United Kingdom

This paper describes features of a study of different aspects of cryptorchidism in sheep in different parts of England. A total of 83 crytorchid testes (57 unilateral and 13 bilateral) were recognised in 70 animals post-slaughter at three abattoirs in the south west of England between June 2000-January 2004. Abdominal cryptorchids (60) were common than inguinal (23);69% percent of cases were unilateral. External examination for cryptorchidism was carried out on 5134 young male lambs carried out in 2001 at Foot and Mouth Disease disposal sites, and on farms, during the UK outbreak of the disease. A total of 29 cases of cryptorchism [0.56%] were detected;86% of cases were unilateral. In both situations the right testis was more commonly affected than the left.

Transforming growth factor β receptor Ⅱ expression inexperimental cryptorchidism and apoptosisin spermatogenic cells in rats

Objective: To study the transforming growth factor β receptor Ⅱ (TGFβ-R Ⅱ) expression in experimental cryptorchidism and apoptosis in spermatogenic cells in rats. Methods: The apoptosis of spermatogenic cells was detected by means of the terminal deoxynucleotldyl transferase mediated dUTP nick end lableling method (TUNEL) and the TGFβ-R Ⅱ expression was observed with the immunohistochemistry SABC methods. Results: There was a significant increase in the TGFβ-R Ⅱ expression in unilateral undescended testes (UUTs) compared with that in contralateral descended testes (CDTs, P<0.01). However, there was a significant and time-dependent increase in the mean apoptotic index in UUTs than in CDTs. Conclusion: TGFβ-R Ⅱ may play an important role in spermatogenic cell apoptosis.

Unilateral congenital scrotal agenesis with ipsilateral cryptorchidism: A case report

BACKGROUND Congenital scrotal agenesis(CSA)is very rare.There are 11 cases of congenital scrotal agenesis or absence reported in the literature,most of which are bilateral and accompanied by cryptorchidism.Only two cases of which are unilateral scrotal agenesis and not accompanied by cryptorchidism.This is the first reported case of unilateral scrotal agenesis with cryptorchidism and scrotoplasty.CASE SUMMARY A 2-year-old boy was admitted to our hospital with left cryptorchidism and ipsilateral CSA.An innovative method was used in the patient where a scrotal skin pedicle from the right part of scrotal skin was transplanted to the left side.At the same time,descent orchiopexy was performed.At the 4-mo follow-up,the left testicle was located in the scrotum and the size and shape were normal.CONCLUSION For unilateral CSA with ipsilateral cryptorchidism,contralateral scrotal pedicle transplantation and descent orchiopexy appear to be a successful surgical option.

Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism

Objective To evaluate semen quality in infertile men with a history of unilateral cryptorchidism Methods Semen samples were obtained from 47 infertile men with a history of unilateral cryptorchidism. Semen analysis and membrane integrity including both eosin Y stain and hyo-osmotic swelling tests were performed using standard procedures. All men were divided into three groups according to their age at surgery of orchidopexy as follows： group A, 2-7 years （n=23）, group B, 8-13 years （n=14） and group C, 14-17years （n=10）. Results There was wide range for sperm count and motility for all the subjects studied. Majority of men had high percentage of abnormal sperm morphology. Among the three groups of men, group A and B had significantly higher sperm count, motility and membrane integrity than that of group C. Group C also had the highest frequency of oligoasthenoteraozoospermia （50%） than group A （17%） and group B （35%）. Conclusion Semen quality of men with a history of unilateral cryptorchidism appears to be related to their age of performing orchidopexy. Surgery at early age of childhood may improve spermatogenesis which results in better semen quality in adulthood.

Congenital bilateral cryptorchidism in an infant conceived after maternal breast cancer treatment: A case report

BACKGROUND The incidence of breast cancer among women of reproductive age is increasing,as well as the desire for children at late childbearing age.Identifying factors that may be associated with fetal malformation and maternal and fetal prognosis has gained importance.We describe a 32-year-old woman with breast cancer who gave birth to a son with congenital bilateral cryptorchidism after treatment,with a literature review performed.CASE SUMMARY A 32-year-old woman with breast cancer who had been treated by surgery and radiotherapy experienced recurrence and underwent a second surgery,adjuvant chemotherapy,and targeted therapy.Her tumor cells were negative for estrogen receptor(ER)α,progesterone receptor(PR),and p53;positive for ERβ,human epidermal growth factor receptor-2(HER2),epidermal growth factor receptor(EGFR),and Ki67.She had pathogenic BRCA gene mutations.She became pregnant within 2 years and delivered a boy with congenital bilateral cryptorchidism.The boy underwent bilateral orchidopexy.As of this writing,the woman and her son are both healthy.CONCLUSION HER2 overexpression,positivity for EGFR,Ki67,and ER,and PR negativity are associated with a poor prognosis in breast cancer.While no link has been established statistically between treatment for breast cancer and cryptorchidism in a subsequent pregnancy,this case suggests the possibility that ERβand gene mutations may be contributing factors.

Consequences of unilateral cryptorchidism on semen and sperm characteristics in West African Dwarf Goats

Objective: To evaluate the influence of unilateral cryptorchidism on semen and sperm characteristics in West African Dwarf (WAD) bucks. Methods: Semen was collected using electroejaculator from five unilaterally cryptorchid (UC) and five normal (non-cryptorchid) WAD bucks and analyzed for gross, microscopic and biochemical characteristics. Results:Gross semen evaluation showed no differences between the groups in semen color, viscosity and pH, whereas the normal bucks yielded semen with significantly higher specific gravity (P=0.0436) and volume (P=0.0388) than the UC group. Following semen microscopic evaluation, the percentage of sperm vitality (live sperm) was not significantly different between both groups. However, UC bucks yielded semen with significantly lower sperm motility (P=0.0387), sperm concentration per mL (P=0.0020) and total sperm count per ejaculate (P=0.0074). The percentage total sperm abnormality was also higher (P<0.0001) in the semen of UC goats. Abnormalities observed included sperm with cytoplasmic droplets, looped tails, coiled tails and tailless heads. Sperm morphometry showed no differences in the sperm head length and head width between the groups. Biochemical semen evaluation did not reveal any differences between the groups in the concentration of seminal plasma total protein, catalase activity and lipid peroxidation level. Conclusions: Unilateral cryptorchidism significantly affected the quantity and quality of semen and spermatozoa in affected WAD bucks. Due to the hereditary attribute of the condition, it is recommended that animals with this condition should not be used in breeding to forestall increasing prevalence of cryptorchidism in goats.

Influence of Unilateral Cryptorchidism on Libido, Haematology and Serum Reproductive Hormones, Total Protein, Lipid Profile and Oxidative Stress in West African Dwarf Goats

The failure of testicular descent (cryptorchidism) is known to cause abnormal testicular development and function. Unilateral cryptorchidism is prevalent in West African Dwarf (WAD) goats particularly in some areas where affected bucks are presumed to have better libido and reproductive efficiency by farmers. Androgens produced by the testes can influence libido and other hormonal and metabolic processes in the body. The study investigated the influence of natural unilateral cryptorchidism on serum reproductive hormones, total protein, lipid profile, oxidative stress, and haematology and libido in WAD bucks. Ten WAD bucks (aged 12 - 14 months) comprising 5 bucks with normal descended testes (N group) and 5 unilaterally-cryptorchid bucks (UC group) were studied. Blood and sera were collected and evaluated for haematology, serum total proteins and lipids (cholesterol, triglycerides and lipoproteins) concentrations, serum oxidative stress (catalase and lipid peroxidation activity), and serum levels of reproductive hormones (testosterone, FSH and LH). Libido testing of bucks was also performed by randomly isolating and confining each individual male with a doe on standing heat and recording the number of mountings made by the male within a period of 5 minutes as the libido score. The evaluated haematological indices and serum levels of proteins, lipids, oxidative stress indicators and reproductive hormones were not significantly different between the N and UC groups (p > 0.05). Although a higher mean libido score was recorded in N bucks compared to the UC group, this difference was not significant. Whereas no negative effects were observed in the evaluated physiologic indices in UC bucks, these findings do not support the presumption by farmers that UC bucks have better libido than bucks with fully descended testes. Therefore, these animals should not be selected for breeding to avoid increasing the prevalence of unilateral cryptorchidism due to its genetic attribute.

Bilateral Impalpable Testes: A Special Entity of Cryptorchidism

Background: Cryptorchidism is one of the most common genitourinary disorders in young boys. About 1% - 2% of boys at age of 1 year have an undescended testis (UDT);this disorder is unilateral in about 90% of individuals and bilateral in about 10%. However, bilateral impalpable testes represent a special category that should be differentiated from anorchidism as well as male pseudohermaphroditism. We investigated whether bilateral impalpable testes with its inherent hormonal and genetic factors has different outcomes in terms of success of orchiopexies compared to unilateral impalpable testes. Methods: We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6 month outcomes, in patients diagnosed with bilateral impalpable undescended testes between 2006 and 2010. Findings were reported after a minimum of 6 months from the last surgical intervention. Results: Nine patients underwent laparoscopy for bilateral impalpable testes, 7 of whom had testes in the region of the internal inguinal ring. The success rate after laparoscopic exploration and open orchiopexy was 60% while the success rate with unilateral impalpable testes was 63.3% in the same study. Conclusion: Although laparoscopy is extremely useful in both the diagnosis and treatment of patients with bilateral impalpable testes, laparoscopy should be preceded by careful cytogenetic and hormonal workup for this particular group of patients. We found that the success rates of laparoscopic management of bilateral and unilateral impalpable testes were similar, as shown by testicular size clinically sassed during serial postoperative outpatient visits.

Male Infertility as a Circumstance of Discovery of Adult Cryptorchidism: A Retrospective Analysis from the Region of Thies

Introduction: The aim of this work is to study the clinical aspects and the impact of cryptorchidism on male infertility in the region of Thies. Patients and methods: This is a retrospective study involving 28 patients followed up at the Saint Jean de Dieu, Barthimée and Tivaouane hospitals of the region of Thies between January 2007 and December 2016. Results: Among the 223 patients followed up for the undescended testicle, 13% (n = 28) were adults or at least 15 years old. 71% (n = 20) were married. Fourteen patients were followed up for primary infertility lasting for a period of time averaging 7 years. The mean age of the patients was 28 years (range: 17 years and 45 years). Cryptorchidism was unilateral in 82% (n = 23) and bilateral in 18% (n = 5). The mean delay of consultation varied from 1 to 13 years. The main reason for consultation was couple infertility (50%). The semen analysis was requested in all our patients. The levels of FSH, LH and testosterone were measured by immunoassay for the patients with azoospermia (n = 9). We noticed 2 cases of hypotestosteronemia and 3 cases of increased FSH serum level. Computed Tomography scans (CT) were performed in 28.5% of patients (n = 8) and ectopic testicles were found very high in the inguinal area in 5 cases. The open inguinal approach was used. In perioperative period, the testicle was found, high in the inguinal region in 5 patients (17.8% of the cases) and low in inguinal region in 19 patients (67.8%). In 4 cases the testicle was in abdominal position. The testicle was atrophied in 53.5% of the patients (n = 15) and 8 patients presented testicular hypotrophy. An orchidectomy was performed in 1 patient in whom it was impossible to lower the atrophied testicle. The postoperative period was uneventful and simple. The mean follow-up duration after the operation was 36 months (12 - 60 months).

Prenatal [Ultrasound] Diagnosis of Cryptorchid Testicles

The role of ultrasonography as a routine investigative test for diagnosing testicular pathologies (in-utero and postnatally) cannot be overemphasized. Undescended (cryptorchid) testis according to literature is prone to neoplastic transformation. Determination of fetal gender in-utero by ultrasound allows for sex determination albeit;its full ethical implication should be considered. 3D ultrasonography is affordable, ubiquitous, reproducible and ensures rapid evaluation of a wide array of testicular pathologies, early (coincidental) diagnosis is important to avoid complications (such as torsion, bleeding or malignant-mass-formation) thus;sonar imaging features as an indispensable tool. The case aims to document and highlight accidental detection (at 31 weeks gestational age) and expunge on the accuracy of ultrasonography in diagnosing cryptorchidism. There is sparse (Nigerian) literature on Undescended Fetal Testis (UDFT). This report used antenatal imaging as a clear descriptive evidence of faulty testicular descent with detailed examination of the fetal genitalia. Ultrasound examination during the 3rd semester allows for accurate cryptorchid diagnosis (prenataly).

Prevalence and Clinical Anatomic Characteristics of Cryptorchidism in Schools in the City of Conakry

Objective: To report the prevalence, anatomic and clinical characteristics of cryptorchidism in schools in the city of Conakry. Material and Methods: We carried out a 6-month cross-sectional study which took place in 32 public and private general education establishments in the city of Conakry. Each student boy was interviewed and examined;some information was collected from parents over the phone. Results: The prevalence of cryptorchidism was 3.6%. It was higher among children of mothers who were not in school, and among those who attended public institutions. The average age of students with cryptorchidism was 9.84 ± 2.33 years, with extremes of 4 and 17 years. 85% of these pupils were born in a care structure (CHU, municipal hospital, health center). Cryptorchidism sat on the right in 64 cases (37.4%), on the left in 44 cases (25.7%), it was bilateral in 63 cases (36.9%). The testicle was palpable at the inguinal level in 77 cases or 45% of the cases. Conclusion: Many school children have cryptorchidism at advanced ages, thus exposing them to the risk of complications (infertility and malignant degeneration of the testicle). Raising awareness among the various players could reverse this trend.

针式抓钳水分离辅助腹腔镜睾丸固定术的初步经验

目的探讨针式抓钳水分离辅助腹腔镜睾丸固定术治疗隐睾症的安全性和有效性。方法2020年9月~2022年9月我科行针式抓钳水分离辅助腹腔镜睾丸固定术治疗21例25侧隐睾,应用针式抓钳可注水功能,在后腹膜间隙注入生理盐水充分分离后腹膜与输精管、精索血管,建立液体隔层保护输精管及精索血管,并在针式抓钳辅助下桥状离断后腹膜,按照整体性及无损性原则,彻底松解输精管及精索血管,完成睾丸引降固定。结果术中证实腹股沟型隐睾15例,腹内型隐睾6例;17例为单侧隐睾,4例为双侧隐睾。25侧睾丸在腹腔镜监视下成功固定在阴囊肉膜外间隙。手术时间35~75 min,(45.1±14.3)min,无手术并发症。21例随访12~24个月,睾丸均位于阴囊内,无回缩、萎缩,无切口感染、切口疝或腹股沟疝的发生。结论针式抓钳水分离辅助腹腔镜睾丸固定术可有效保护输精管和精索血管,操作简便、安全、有效。