5th Joint Meeting of ESPU-SPU - Virtual

S14: GENITALIA

Moderators: Marcel Drlik (Czech Republic)

ESPU-SPU Meeting on Saturday 25, September 2021, 10:45 - 11:39


10:45 - 10:48
S14-1 (PP)

★ ALTERED EXPRESSION OF ADAMTS PROTEOLYTIC ENZYMES IN CRYPTORCHID TESTES FOLLOWING CURRATIVE GNRHA TREATMENT

Faruk HADZISELIMOVIC 1, Gilvydas VERKAUSKAS 2, Beata VINCEL 3 and Michael B. STADLER 4
1) Children's Day Care Center Liestal, Liestal, Switzerland, Cryptorchidism Research Institute, Liestal, SWITZERLAND - 2) Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Centre of Children's Surgery, Orthopaedics and Traumatology, Vilnius, LITHUANIA - 3) Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius, LITHUANIA - 4) Swiss Institute of Bioinformatics, Friedrich Miescher Institute for Biomedical Research, Basel, SWITZERLAND

PURPOSE

ADAMTS family members encode extracellular, multidomain proteolytic enzymes, for which known functions include collagen processing, cleavage of matrix proteoglycans, inhibition of angiogenesis and homoeostasis of blood coagulation. Mutant Adamts16 mice display cryptorchidism and sterility. We hypothesize that gonadotropin-regulated ADAMTS genes are involved in testicular development during mini-puberty.

MATERIAL AND METHODS

Testicular biopsies for histological and RNA-Sequencing analysis from bilateral cryptorchid boys were analyzed. RNA samples were processed using a standard RiboMinus Gold/TrueSeq (Illumina) RNA protocol. No Ad spermatogonia identified high infertility risk patients (HIR) who were prospectively randomized for treatment either with surgery in combination with gonadotropin releasing hormone agonist (GnRHa) or surgery only. Four biopsies before and four after six months of GnRHa treatment were compared to three before and three after six months of surgery only. In addition, RNA sequencing
data from our previous study of 8 low infertility risk (Ad positive) cryptorchid patients were included as controls.

RESULTS

All ADAMTS family genes were investigated. Surgery alone did not affect ADAMTS gene expression. Importantly, ADAMTS20 expression, which was decreased in HIR patients in comparison to low infertility risk patients [-1.67 log2; FDR=0.0008], increases after GnRHa treatment [+1.06 log2; FDR=0.001]. ADAMTS4 and ADAMTS18 showed identical expression between HIR and low infertility risk patients and were transcriptionally stimulated by GnRHa. Both genes are implicated in extracellular matrix remodelling and organogenesis.

CONCLUSIONS

We show for the first time that testes from cryptorchid boys with abortive mini-puberty display decreased expression of ADAMTS20 and that the gene's expression is upregulated by hormone treatment. This indicates a novel role for ADAMTS20 in the development of Ad spermatogonia and the establishment of fertility.


10:48 - 10:51
S14-2 (PP)

★ THE POSITIVE PREDICTIVE VALUE OF USING FSH AND INHIBIN-B SERUM LEVELS TO DIAGNOSE GONADOTROPIN INSUFFICIENCY IN BILATERAL CRYPTORCHID BOYS IS HIGH

Simone HILDORF 1, Erik CLASEN-LINDE 2, Magdalena FOSSUM 1, Dina CORTES 3 and Jorgen THORUP 4
1) Rigshospitalet, Pediatric Surgery, Copenhagen, DENMARK - 2) Rigshospitalet, Pathology, Copenhagen, DENMARK - 3) Hvidovre Hospital, Pediatrics, Hvidovre, DENMARK - 4) Rigshospitalet, Paediatric Surgery 4272, Copenhagen, DENMARK

PURPOSE

Despite early surgery a significant part of boys with bilateral cryptorchidism have impaired fertility potential. Insufficient genuine gonadotropin stimulation may be the cause, as maturation of germ cells is impaired in such cases and orchidopexy alone will not cure the endocrinopathy. The aim of study was to investigate whether the boy's hormonal profile could identify patients that might benefit from adjuvant hormonal treatment.

MATERIAL AND METHODS

353 boys had bilateral orchidopexy performed between 0.5 and 7.5 (median: 2) years old. All were evaluated with follicle stimulating hormone (FSH), inhibin-B in serum and number of germ cells per tubule cross-section (G/T) in testicular biopsies. All values of the investigated parameters were compared to age matched normal materials (95% CI boundary).

RESULTS

25 (7%) patients had increased FSH, low G/T and in 9 of the cases also low inhibin-B, indicating hypergonadotropic hypogonadism. 59 (17%) patients between 8 month and 6.5 years old (median: 2 years) had both low G/T (median: 0.3 (range: 0-1.3)) and low inhibin-B (median: 60 pg/ml (range:7-134)) and not the expected gonadotropin feed-back mechanism, but normal FSH (median: 0.6 U/l (range:0.2-1.3)) indicating gonadotropin insufficiency. 3 patients with normal FSH and low inhibin-B had normal G/T.

CONCLUSIONS

Adjuvant hormonal treatment is indicated because of gonadotropin insufficiency in at least 17% of boys with bilateral cryptorchidism and by using FSH and inhibin-B serum values, the positive predictive value of a selection in this respect is high (59/59+3 = 0.95). A possible option for those preferring to avoid testicular biopsies.


10:51 - 10:54
S14-3 (PP)

EDUCATIONAL INTERVENTION PROGRAM REDUCED DELAYED TREATMENT AND IMPROVED THE TORQUED TESTIS SURVIVAL: A PROSPECTIVE QUALITY OF CARE STUDY

Amitai LORBER 1, Hagai LEVINE 2, Daniel GOLD 1, Ezekiel H LANDAU 1, Ofer N GOFRIT 1, Mordechai DUVDEVANI 3 and Guy HIDAS 4
1) Hadassah University Hospital, Department of Urology,, Jerusalem, ISRAEL - 2) Hadassah University Hospital, Braun School of Public Health and Community Medicine, Jerusalem, ISRAEL - 3) Hadassah University Hospital, Deprtment of Urology,, Jerusalem, ISRAEL - 4) Hadassah, hebrow University Hospital, Department of Urology,, Jerusalem, ISRAEL

PURPOSE

Duration of in-hospital management of patients with testicular torsion (TT) is an independent factor predicting testicular survival (Gold et al. urology 2019;133:211-215). Unlike the time from onset of symptoms until seeking medical attention, the time from registration to the emergency department (ED) to the time of detorsion-"Door To Detorsion time" (DTD) is dependent on medical providers and should be minimized. We aimed to examine the impact of TT educational intervention program to reduce DTD time on testicular survival.

MATERIAL AND METHODS

An explanatory intervention was conducted for nursing and medical staff working in the ED. Intervention included frontal lectures followed by knowledge test on TT. Duration of symptoms before arrival to ED and DTD time were prospectively reviewed. Correlation between these parameters and testicular survival rate were examined before and after the intervention using a univariate and multivariate analysis.

RESULTS

113 patients pre-intervention and 32 patients post-intervention were included. Median DTD time was 146 minutes and 112 minutes respectively (p=0.021). Non-viable testicle rate was 59%, and 28 %. Respectively (p = 0.014). The intervention significantly reduced the risk for nonviable testis (OR = 2.68, p=0.077) 

CONCLUSIONS

Dedicated educational intervention program to ED stuff can shorten the length of time that passes from the entrance to the ED until surgery for de-torsion (DTD time).  Since DTD time is an independent factor predicting testicular survival, an institutional effort should be made to decrease its duration. DTD should be considered as a quality of care measure.


10:54 - 10:57
S14-4 (PP)

EFFICACY OF LYCOPENE AND COENZYME-Q10 IN PRESERVING TESTICULAR FUNCTION OF PERIPUBERTAL BOYS UNDERGOING SURGICAL DEROTATION FOR UNILATERAL TESTICULAR TORSION

Elphiston FERNANDES 1 and Kalpit TENDULKAR 2
1) Healthway hospitals, Vision hospital, Goa, India, Urology, Panjim, INDIA - 2) Vision hospital, Radiology, Mapusa, INDIA

PURPOSE

A delay beyond the golden period of 4 hours in derotating a torsioned testicle is associated with long term anatomical and funactional damage even if the testicle survives. While it may not be possible to avoid a delay in reaching the operating table despite of the best efforts, many medications are under trial to reduce the germ cell damage following derotation. Reactive oxygen species (ROS) scavangers is one such group of drugs which protects the germ cells against the ischemia reperfusion injury. We present a comparative study to see the efficacy and long term benefits of Lycopene and Coenzyme-Q10(CoQ10) on preserving testicular function and anatomy

MATERIAL AND METHODS

A total of 14 boys between 13-17yrs, had unilateral testicular torsion lasting between 4-24hrs , underwent unilateral derotation with bilateral orchidopexy.They were divided into 2group of 7pts each
Group1 (G1)-All pts were simply followwed.up at 3 and 12 months with clinical examination and scrotal USG and Doppler . At 24 months an additional semen. Analysis was done.

Group2(G2)The follow up protocol was the same, but these pts were started on Tab lycopene20mgs and Tab CoQ10 50mgs once a day, immediately after surgery for 6months

RESULTS

In G1, at 3months, 2pts had poor flow and decreased volume.at 2yrs a total of 4pts had reduction in volume and blood flow. At 2yrs the semen analysis showed an average sperm count and active motility.of 10.4million/ml and 35.7% respectively
In G2 At 2yrs, all pts had normal volume and blood flow.The sperm count and motility was 50million/ml and 60.5%respectively

CONCLUSIONS

Testicular torsion lasting between 4 to 24hours, causes germ cell damage even though the testicle may have survived after derotation. The use of ROS scavangers like Lycopene and CoQ10 has shown to preserve the testicular anatomy and function.


10:57 - 11:00
S14-5 (PP)

THE EFFECT OF NEOADJUVANT HORMONAL TREATMENT IN CRYPTORCHID BOYS

Vojtěch FIALA 1, Zuzana VALOVÁ 1, Marcel DRLÍK 1, Josef SEDLÁČEK 1, Zdeněk DÍTĚ 1, Radim KOČVARA 1 and Marta KALOUSOVÁ 2
1) General University Hospital and 1st Faculty of Medicine, Charles University, Urology, Prague, CZECH REPUBLIC - 2) General University Hospital and 1st Faculty of Medicine, Charles University, Institute of Medical Biochemistry and Laboratory Diagnostics, Prague, CZECH REPUBLIC

PURPOSE

Neoadjuvant treatment with gonadorelin(GNRH), administered to improve spermatogonia maturation in cryptorchidism, has been proposed by studies with testicular biopsy. We aimed on early anatomical and hormonal effect of the neoadjuvant stimulation in infant cryptorchid boys randomly compared with the group without stimulation.

MATERIAL AND METHODS

Full term unilateral non-syndromic cryptorchid boys were examined (hormonal levels, physical, ultrasound examination) at age of 2.5 - 3.5 months. At 6 months of age those with persistent palpable undescended testis were randomized to groups with (GNRH) and without (control) intranasal gonadorelin treatment (4 weeks, 3 times daily). Orchidopexy was performed before 12 months of age together with repeated examination. Serum levels of LH, FSH, testosterone, Inhibin B, AMH, penile size and testicular size of both groups were evaluated at age of three months and on the date of surgery.

RESULTS

Criteria fulfilled 36 boys (21 in GNRH, 15 in control group). Within the study period, penile size significantly increased in both GNRH and control groups (by 4.6mm and 3,7mm, resp.), without significant difference between the groups (p=0.62). Between both groups, the growth difference of the descended testis was insignificant (p=0.30), as well as of the undescended testis (p=0.14)
In both groups, significant decrease in hormonal levels was observed between minipuberty and time of surgery. There were no differences in individual hormonal findings between the groups (p= 0.62/LH; p= 1.0/FSH; p= 0.55/Testosterone; p= 0.43/Inhibin B; p= 0.96/AMH).

CONCLUSIONS

The neoadjuvant hormonal stimulation has no effect on resting hormonal levels, on penile and testicular size evaluated at time of surgery for undescended testis.


11:00 - 11:15
Discussion
 

11:15 - 11:18
S14-6 (PP)

AGONY OF CHOICE: CAUDAL BLOCK VS. ILIOINGUINAL BLOCK IN UNILATERAL ORCHIDOPEXY

Franziska VAUTH 1, Bernhard KOLLER 2, Aybike HOFMANN 1 and Wolfgang ROESCH 1
1) Clinic St. Hedwig, Department of Paediatric Urology, University Medical Center Regensburg, Regensburg, GERMANY - 2) Clinic St. Hedwig, Department of Anaesthesia, Regensburg, GERMANY

PURPOSE

The aim of this prospective study was to compare two types of regional anaesthesia regarding intra- and postoperative effectiveness and all over benefit for the patient.

MATERIAL AND METHODS

From October 2016 to February 2018 72 boys undergoing unilateral orchidopexy were included. 38 boys got caudal block (CB) and 34 ilioinguinalis block (IB). Requirements were ASA classification I/II, no contraindications against regional anaesthesia and age less than 48 month. Boys undergoing bilateral orchidopexy, re-orchidopexy and ASA-classification more/equal to III were excluded.
Intraoperatively additional analgesia was applied when the heart frequency was 10% above initial value. Postoperatively the boys were evaluated via KUSS-pain score of Büttner. Additional analgesia was applied at a pain score more or equal to 4.
We compared the following parameter: intraoperative, early-postoperative and postoperative need of additional analgesia. All boys were monitored up to 24 h after surgery.

RESULTS

The use of CB could significantly reduce necessity of additional intraoperative (p = 0) and early-postoperative (p=0,005) analgesia compared to IIB. Whereas IB was superior regarding the need of additional analgesia (p = 0,036) on the ward.

CONCLUSIONS

Regional anaesthesia in children is a well-established procedure to minimize intra- and postoperative pain. In terms of blocking intra- and early-postoperative pain CB is more beneficial and should be the first choice. But in case of older children or contraindications for CB, the IB is a good alternative and should be performed routinely.


11:18 - 11:21
S14-7 (PP)

★ CONCEALED INDEX OF CONCEALED PENIS OF PREPUBERTAL CHILDREN

Jae Min CHUNG 1, Kobiljon ERGASHEV 2 and Sang Don LEE 1
1) Pusan National University School of Medicine, Urology, Yangsan-Si, REPUBLIC OF KOREA - 2) Pusan Naional University School of Medicine, Urology, Yangsan-Si, REPUBLIC OF KOREA

PURPOSE

To make an objective severity index of concealed penis (CP), we compared the penile parameters of a CP with a normal penis (NP).

MATERIAL AND METHODS

In this retrospective study, 534 boys with ages ranging from 12 months to 10 years who visited our hospital between June 2017 and January 2020 were included. Among these boys, 100 patients had a CP and 434 boys had a normal penis without CP. The stretched penile length (SPL), penile circumference (PC) and penile length above baseline skin level (BPL) were measured using a ruler (cm), and testicular volume was measured using orchidometer (ml). SPL was the distance from under pubic symphysis to the tip of the glans. BPL was the distance from the baseline penile skin level to the tip of the glans. We defined the concealed index with SPL (CIs) as BPL/SPL, and the concealed index with circumference (CIc) as BPL/PC.

RESULTS

There was no difference between CP and NP in age, height, weight, BMI, penile circumference and testis volume. However, CP had significant smaller SPL, BPL, CIs, and CIc than NP (Table). Cutoff values of CIs and CIc were 0.53 and 0.59 (sensitivity 51.9 and 88.3%, specificity 94.8 and 80.6%). After repair of CP, SPL, BPL, and CI were higher than preoperative findings.

NP (434) CP (100) p value
Age (months) 48.4±30.3 54.7±42.3 0.516
SPL (cm) 4.2±0.6 3.2±0.6 0.000
Circumference (cm) 4.1±0.5 4.3±0.6 0.153
BPL (cm) 3.0±0.6 1.6±0.6 0.000
BPL/SPL 0.7±0.1 0.5±0.2 0.000
BPL/Circumference 0.7±0.1 0.4±0.1 0.000
SPL/Circumference 1.0±0.1 0.8±0.1 0.000

CONCLUSIONS

The CIs and CIc are a useful and objective parameter for checking the severity of CP. We newly introduce the cutoff value of CIs (0.53) and CIc (0.59) for diagnosis and indication of repair of CP.


11:21 - 11:24
S14-8 (PP)

PHALLOPLASTY IN BIOLOGICAL MEN WITH PENILE INSUFFICIENCY

Céline SINATTI 1, Dylan WOLFF 1, Marlon BUNCAMPER 2, Wesley VERLA 1, Karel CLAES 2, Nicolaas LUMEN 1, Marjan WATERLOOS 1, Stanislas MONSTREY 2, Piet HOEBEKE 1 and Anne-Françoise SPINOIT 1
1) University Hospital Ghent, Urology, Ghent, BELGIUM - 2) University Hospital Ghent, Plastic Surgery, Ghent, BELGIUM

PURPOSE

Phalloplasty for penile insufficiency in biological men differs from phalloplasty in trans-men by incorporating native penile tissue. Different techniques have been suggested but are based on small series. The objective of this study is to describe techniques used in a tertiary referral center with over 30 years of phalloplasty experience and to report surgical and functional outcomes.

MATERIAL AND METHODS

Data of biological men undergoing phalloplasty between 2004-2018 were retrospectively collected. Patients with more than 1 year of follow-up were considered for inclusion. Phalloplasty was performed with a radial free forearm (RFFA) or a pedicled anterolateral thigh (ALT) flap. The tube-within-tube technique was used when urethroplasty was required. Descriptive statistics were used. Complications occuring within 30 days postoperative were categorized according to Clavien-Dindo. Functional outcome was assessed by review of electronic patient files.

RESULTS

30 patients, median (IQR) age of 21 (18-30) year, were included. In 16 patients RFFA was used. 19 patients needed urethroplasty. Median (IQR) follow-up was 33 (14-80) months. Within 30 days postoperative, 3 patients (10%) developed partial flap necrosis (Clavien-Dindo III). One patient (3.3%) had graft failure requiring redo phalloplasty (Clavien-Dindo III). Two patients (6.6%) developed an infected hematoma needing drainage (Clavien-Dindo III). One phalloplasty (3.3%) was complicated with hematuria and clot retention requiring bladder irrigation (Clavien-Dindo II). Long-term complications involved fistulas and strictures. Ten patients (33%) developed fistulas, of whom 6 (20%) needed urethroplasty. Seven patients (23%) had (an) urethral stricture(s), all needing urethroplasty or urethrotomy. All patients but one (97%) had erogenous sensitivity in the neo-phallus. All patients with urethroplasty reported normal, antegrade ejaculation. Sixteen (84%) voided through the urethra.

CONCLUSIONS

RFFA and ALT result in good erogenous sensitivity but fistulas and strictures are frequent.


11:24 - 11:27
S14-9 (PP)

IS PENO-DERMOPEXY AFTER PENILE DEGLOVING SUFFICIENT TO CORRECT A CONGENITAL WEBBED PENIS?

Mohamed NEGM 1 and Salah NAGLA 2
1) SOUTH VALLY UNIVERSITY, PEDIATRIC SURGERY, Qena, EGYPT - 2) Tanta University, Urology, Tanta, EGYPT

PURPOSE

There is no standard operation for correction of all types of webbed penis. We aimed to evaluate the peno-dermopexy after penile degloving in correction of all grades of the primary webbed penis.

MATERIAL AND METHODS

This prospective study conducted on 107 patients from July 2016 to June 2019 at our departments. The patients were presented mainly for circumcision. We included all grades of primary non-circumcised webbed penis. The primary outcome was the absence of any degree of post-operative penile web. Under general anesthesia, all cases had complete penile degloving. Then the dartos attachment at the peno-scrotal junction was released. Thereafter, peno-dermopexy was accomplished using Vicryl 6/0 between the tunica on both sides lateral to the urethra to the nearby penile skin at the new penoscrotal junction without transfixing the penile skin. We did circumcision at the end of the procedure. Patients discharged at the same day. Follow-up visits were scheduled at one week, 2 weeks, 2 months and 6 months thereafter.

RESULTS

The median age was 9 (6-40 months), the median operative time was 40(30-65 minutes) and the median follow-up was 17 (6-36 months). We had 6 (5.6%) cases with self-limited post-operative penile edema, 2 (1.9%) wound infections and 3 (2.8%) cases had self-limited scrotal hematoma. At the 6 months follow-up, we had 3 cases with persistent grade (1) web; 2 were grade 3 and one was grade 2 pre-operatively with success rate 97.2%.

CONCLUSIONS

peno-dermopexy after penile degloving can correct all types of primary webbed penis with acceptable results


11:27 - 11:39
Discussion