ESPU-SPU Meeting on Saturday 25, September 2021, 10:45 - 11:39
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
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.
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.
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.
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
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).
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.
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.
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
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.
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).
The neoadjuvant hormonal stimulation has no effect on resting hormonal levels, on penile and testicular size evaluated at time of surgery for undescended testis.
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
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.
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.
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.
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
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.
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|
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.
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
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.
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.
RFFA and ALT result in good erogenous sensitivity but fistulas and strictures are frequent.
Mohamed NEGM 1 and Salah NAGLA 2
1) SOUTH VALLY UNIVERSITY, PEDIATRIC SURGERY, Qena, EGYPT - 2) Tanta University, Urology, Tanta, EGYPT
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.
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%.
peno-dermopexy after penile degloving can correct all types of primary webbed penis with acceptable results