30th ESPU Congress - Lyon, France - 2019

S18: GENITALIA 2

Moderators: Nicolas Kalfa (France), Anna Bujons (Spain)

ESPU Meeting on Friday 26, April 2019, 16:58 - 17:36


16:58 - 17:01
S18-1 (PP)

FERTILITY POTENTIAL IN ADOLESCENTS AFTER BILATERAL ORCHIDOPEXY FOR UNDESCENDED TESTES.

Lucie GRYNBERG 1, Mariette RENAUX-PETEL 1, Diane COMTE 1, Nathalie RIVES 2 and Agnès LIARD-ZMUDA 1
1) Rouen University Hospital, Pediatric Surgery, Rouen, FRANCE - 2) Rouen University Hospital, Reproductive Biology Laboratory, Rouen, FRANCE

PURPOSE

The aim of this study was to evaluate fertility potential in adolescents who had undergone bilateral orchidopexy for undescended testes.

MATERIAL AND METHODS

All 75 patients who underwent bilateral orchidopexy in the years 1999-2004 were invited in 2017 for clinical examination, hormonal analysis, testicular US-scan and semen analysis. Among 40 adolescents who accepted clinical examination, 16 consented to a spermogram.  Sperm parameters have then been compared to those obtained in a population of 26 adolescent cancer patients referred for fertility preservation before chemotherapy or radiotherapy.

RESULTS

Mean age at bilateral orchidopexy was 4.5 years (1.4 – 12.5 years). Among 71 testes which had undergone orchidopexy, 26 (36%) were hypotrophic. Hormonal analysis revealed elevated FSH levels in 5 and decreased inhibin B levels in 3 adolescents. Mean age at spermogram was 16.5 years. Among 16 adolescents who performed spermogram, 2 (12%) had physiological semen parameters, 6 (38%) had hypospermia, 14 (88%) oligozoospermia, 11 (69%) asthenozoospermia and 6 (38 %) teratozoospermia. When compared with the control group, sperm concentration was significantly lower in adolescents with a history of bilateral orchidopexy.

CONCLUSIONS

History of bilateral orchidopexy for undescended testes is associated with decreased fertility potential in adolescents. For these patients, we strongly recommend clinical examination, testicular US-scan and hormonal analysis at 15 years of age. Then a spermogram should be systematically proposed with the aim of preserving later fertility.


17:01 - 17:04
S18-2 (PP)

TESTICULAR ATROPHY FOLLOWING TORSION IN PEDIATRIC PATIENTS. RESULTS OF A LONG-TERM FOLLOW-UP.

Sasa MILIVOJEVIC 1, Ivana DASIC 2, Jelena MILIN LAZOVIC 3, Goran DJURICIC 2 and Zoran RADOJICIC 1
1) University Children's Hospital Belgrade, Pediatric Urology, Belgrade, SERBIA - 2) University Children's Hospital Belgrade, Radiology, Belgrade, SERBIA - 3) Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Medical Statistics and Informatics, Belgrade, SERBIA

PURPOSE

Study assesses torsion outcomes and evaluates the rate of testicular atrophy.

MATERIAL AND METHODS

The study was done over the 2000–2018 period during which 85 patients of average age 12.9±3.1SD were echosonographically followed up after operative detorquation and testicular salvage.The first group includes patients who underwent detorquation within 6 hours after torsion (N=36), the second who underwent detorquation between 6 and 12 hours after torsion (N=24), and the third group who were operated more than 12 hours after torsion (N=24). The follow-up period was 64.4 months ±6.5 SD.

RESULTS

There are 36 (100%) salvaged testicles in the first group, 13 (54.2%) in the second group, and 5 (20.8%) in the third group.The detorquated testicle median size in the first group was 43.0 (40.0-48.0), 11.0 (11.0-14.0) in the second, and 11.0 (11.0-12.0) mm in the third, (p<0.001).The median contralateral testicle size in the first group was 49.5 (45.0-52.5), 56.0 (55.0-64.0) in the second, and 58.0 (57.0-59.0) mm in the third group, (p<0.001).The vascularisation through the detorquated testicle was present in 35 (97.2%) patients in the first, 6 (42.9%) in the second and 1 (20%) patients in the third group, (p<0.001). The structure homogenousness was present in 20 (55.6%) patients in the first, and non-existent in all the patients in the second and third groups, (p<0.001).

CONCLUSIONS

Despite rapid intervention, testicular torsion may still result in testicular atrophy at a higher rate than traditionally thought (if the torsion occurred more than 6 hours the possibility of testicular salvage is very low in the long term). This allows clinicians to more accurately inform patients and families of atrophy risk following detorsion. Further studies with more consistent follow-up are needed.


17:04 - 17:09
S18-3 (LO)

★ TESTOSTERONE PRODUCTION BY LEYDIG CELLS STIMULATES PERI-TUMORAL SPERMATOGENESIS IN PRE-PUBERTAL BOYS DESPITE HAVING A QUIESCENT HYPOTHALAMIC-PITUITARY-GONALDAL AXIS

Anne-Sophie BLAIS, Mandy RICKARD, Fadi ZU'BI, Nagam YEHIA and Armando LORENZO
Hospital for Sick Children, Urology, Toronto, CANADA

PURPOSE

Leydig cell tumors (LCT) are hormonally-active testis tumors found in children and are associated with precocious puberty due to testosterone secretion. While high levels of testosterone (induced by gonadotropin secretion during puberty) are known to initiate spermatogenesis, it is yet to be determined if a similar phenomenon is triggered by isolated testosterone production in prepubescent boys. We hypothesized that prepubertal LCT will demonstrate evidence of spermatogenesis on surgical pathology- a finding unique to this population when compared to other testicular lesions in an age matched group. 

MATERIAL AND METHODS

We reviewed patients who underwent an orchiectomy for a testicular tumor from 2003-15. We included patients with LCT and matched them to children with teratomas, excluding other pathologies and pubertal patients, for a total of 31 children for analysis. We focused on presence of spermatogenesis in the pathology specimen. 

RESULTS

Of the 67 patients who underwent an orchiectomy for testicular tumors, 20 had teratomas and 11 LCTs. Age at presentation was 6.3±5.8 years for the teratoma group vs. 8.4±1.6 years for LCTs (p=0.26). Spermatogenesis was detected in 7 (64%) of the LCT group vs 2 (10%) in the teratoma group (p=0.002). While there was no significant difference in the age of the spermatogenesis patients in the LCT (8.3±2.0 years) vs the teratoma group (11.1±2.5 years) (p=0.15), the 2 patients in the teratoma group were approaching age appropriate puberty.

CONCLUSIONS

Leydig cell testicular tumors induce spermatogenesis in prepubertal patients. This reinforces the theory that paracrine testosterone signaling plays a significant role in spermatogenesis. This finding could be further explored for additional fertility preservation opportunities in this population. 


17:09 - 17:12
S18-4 (PP)

PREVALENCE, DOPPLER ULTRASOUND FINDINGS, AND CLINICAL IMPLICATIONS OF THE NUTCRACKER PHENOMENON IN PEDIATRIC VARICOCELES

Jessica HANNICK 1, Anne-Sophie BLAIS 2, Jin Kyu (Justin) KIM 2, Jeffrey TRAUBICI 3, Mitchell SHIFF 2 and Armando LORENZO 2
1) McMaster University, Surgery, Hamilton, CANADA - 2) Hospital for Sick Children, Surgery, Toronto, CANADA - 3) Hospital for Sick Children, Diagnostic Imaging, Toronto, CANADA

PURPOSE

Varicoceles are common in adolescent males, generating concerns regarding etiology and management. Our institution obtains Doppler US of the renal vessels to rule out obstruction due to Nutcracker phenomenon (NcP) as the etiology of varicocele. Our study aimed to evaluate if NcP was associated with testicular characteristic differences or a higher need for initial or recurrent surgery for varicocele repair.

MATERIAL AND METHODS

Between 1/2000 and 3/2017, 182 male patients with clinical varicoceles were evaluated with Doppler ultrasonography. Twenty-two patients were excluded because they had never been evaluated in the urology clinic. Retrospective assessment provided complete data in 137. Presence of NcP was reported in patients with velocity ratios greater than 4.8. Maximum varicose vein diameter, testicular measurements, renal vein velocities at the hilum and impingement point by the superior mesenteric artery, and need for intervention were compared in patients with versus without NcP using Mann-Whitney U testing. Need for intervention was compared between groups using Chi-squared and Fisher's exact tests.

RESULTS

NcP was detected in 77 (56.2%) patients, who experienced a higher velocity ratio (8.33 vs. 2.87; p<0.001) than those without NcP. Overall, 39 (28.5%) patents had a testicular volume discrepancy >20%, without a significant difference based on the presence or absence of NcP (27.3 vs. 30.0%; p=0.36). Patients with and without NcP had similar ages at diagnosis, testicular volumes, volume differences, maximum varicose vein sizes, and follow-up (p greater than or equal to 0.05). Intervention was more likely with testicular volume difference >20% (p=0.014). Having NcP was not associated with a higher incidence of initial (p=0.59) or reoperative surgery (p=0.73).

CONCLUSIONS

NcP is common in males with adolescent varicocele but was not correlated with an increased frequency of initial or reoperative surgery. NcP may have few clinical ramifications as an isolated finding in this patient population, calling into question the need to assess for its presence.


17:12 - 17:15
S18-5 (PP)

RELATIONSHIP BETWEEN ANOGENITAL DISTANCE AND TESTICULAR POSITION IN EGYPTIAN MALE INFANTS WITH CRYPTORCHIDISM WITH AND WITHOUT HYPOSPADIAS

Shymaa ELRIFAEY 1, Salah NAGLA 2, Hend ABDELNABI 3, Ayman HAGRASS 2, Waleed DAWOOD 4 and Ahmed ARAFA 1
1) Tanta University, PEDIATRICS, Tanta, EGYPT - 2) Tanta University, Urology, Tanta, EGYPT - 3) Tanta University, Tanta, EGYPT - 4) ALEXANDRIA UNIVERSITY, Urology, Alexandria, EGYPT

PURPOSE

The aim of this study was to evaluate the relations between anogenital distance (AGD) and testicular position in males with cryptorchidism with and without hypospadias in comparison to normative data

MATERIAL AND METHODS

This study included 300 male infants aging 1-24 months, divided to 150 cryptorchidism patients with and without hypospadias and 150 controls with matched age and normal genitalia in the period from March 2017 to October 2018. AGD (the distance from the posterior aspect of the scrotum to the anal verge) and stretched penile length measured using calipers and wooden spatula respectively. Testicular position in the undescended group was graded as high scrotal, inguinal and non-palpable by clinical examination

RESULTS

Group I: > 1-6 months age, the mean of AGD for patients with cryptorchidism was significantly shorter than controls (31.10 ± 2.19, 33.27 ± 3.33 respectively) (p0.024*). Group II: >6-12 months age, the mean of AGD for patients with cryptorchidism was significantly shorter than controls (35.82 ± 4.18, 37.95 ± 5.37 respectively) (p0.001*). Group III: >12-18 months age, the mean of AGD for patients with cryptorchidism was significantly shorter than controls (39.88 ± 1.16, 41.33 ± 1.45 respectively) (p0.003*). Group IV: >18-24 months age, the mean of AGD for patients with cryptorchidism was significantly shorter than controls (40.10 ± 1.86, 44.12 ± 1.68 respectively) (p0.001*). There was significant difference between the patients group of cryptorchidism with hypospadias and those without hypospadias and controls (P = 0.001*). No significant difference was found between controls and patients group of cryptorchidism without hypospadias (P = 0.951). AGD was significantly shorter in patients with upper scrotal positions than inguinal and non-palpable testis

CONCLUSIONS

Shorter AGD is associated with a higher incidence of cryptorchidism and hypospadias relative to normative data in male. Shorter AGD is related to higher position of undescended testis


17:15 - 17:18
S18-6 (PP)

TESTICULAR ATROPHY AFTER ORCHIDOPEXY IN CHILDREN

Ines BEN CHOUCHENE, Yosra BEN AHMED, Faouzi NOUIRA, Hajer AHMED, Elhem LATROUS, Awatef CHAREIG, Riadh JUINI and Said JLIDI
Children's Hospital of Tunis, Pediaric surgery service B, Tunis, TUNISIA

PURPOSE

Estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy

MATERIAL AND METHODS

We retrospectively reviewed all patients who have had orchiopexy during a period of 5 years. The following variables were captured: age , preoperative testicular position and size, type of procedure, surgical approach , intra-operative and post-operative complications, results (focusing on risk factors for atrophic testes). Follow-up of all patients until the resolution of their testicular problem

RESULTS

There were 806 attempted orchidopexies involving low type (n =555 ), ectopic type (n = 2), and high type testes (n = 249). There were a total of 61(9,3%) made atrophic testes, and 27 (41%) were FOUND atrophic.
The average age at surgery patients whose evolution was glazed by testicular atrophy was 4.6 years against 4.9 years for patients without this complication.
Testicular atrophy was significantly more common in laparoscopic procedures (28%) than in inguinal orchiopexy (7.5%) (p <10-3) and was occurred significantly more often in the case of a testicle in the deep inguinal orifice (19.7% vs. 5.6%, p <10-3) and intra-abdominal testis (28, 6% vs 8.1%, p = 0.002)

The most significant risk factors associated to the testes made atrophic were high testicle, testicular hypotrophy preoperatively, epididymal abnormalities(23.1% vs 2.8%, p <10-3) and vessels problems

CONCLUSIONS

In this series, the incidence of postoperative testicular atrophy was 31% in the common type (low) and 68.8% in the high type.
This complication and the risk factors for its occurrence must be clearly clarified to the parents in preoperative


17:18 - 17:36
Discussion