ESPU Meeting on Wednesday 19, April 2023, 16:10 - 16:35
16:10 - 16:13
S03-1 (OP)
Kolja KVIST 1, Jørgen THORUP 2, Simone HILDORF 2 and Erik CLASSES-LINDE 2
1) Rigshospitalet, Paediatric Surgery, Copenhagen, DENMARK - 2) Rigshospitalet, Pediatric surgery, Copenhagen, DENMARK
PURPOSE
The present study aims to elucidate whether otherwise normal testes of boys undergoing puberty express PLAP, c-Kit, Oct3/4 or D2-40, which is normally associated with GCNIS.
MATERIAL AND METHODS
Biopsies were taken from 43 boys (11.5 to 16.5 years of age), who underwent surgery for torsion of the testis (23) or a history suspicious of intermittent torsion (20), totaling 72 biopsies, as 29 were biopsied on both sides - 6 testes were necrotic.
The biopsies were fixed in Stieve's medium, cut into 2μm sections, and mounted on coated slides. One slide was processed for H-E, the others for PLAP, c-Kit, D2-40 and Oct3/4.
RESULTS
91% of the boys stained positive for both PLAP and c-Kit. None were positive for D2-40 or Oct3/4. None had any GCNIS. Only 4 boys showed no signs of spermatogenesis.
Those positive for PLAP were likewise for c-Kit, and vice versa, except 2; one boy, 13 years, was positive for PLAP, but negative for c-KIT, another, 16 years, was negative for PLAP and positive for c-Kit. 4 boys stained positive for PLAP and c-Kit on the right side, and negative on the left. One boy was negative for c-Kit on the right side, positive on the left, and positive for PLAP bilaterally.
CONCLUSIONS
Positive staining of testicular germ cells for PLAP and c-Kit is a normal finding in boys not having completed puberty, even with complete spermatogenesis.
Rather than indicating pre-malignant transformation, the positivity is indicative of an ongoing maturational process of the germ cells.
16:13 - 16:16
S03-2 (OP)
Eric BORTNICK and Caleb NELSON
Boston Children's Hospital, Urology, Boston, USA
PURPOSE
Pediatricians provide initial assessment and referral of boys with undescended testis (UDT) but receive little training in pediatric genitourinary physical exam (GUPE), and may not be familiar with UDT guidelines for management. We hypothesized that an educational strategy combining asynchronous didactics and simulation-based learning would improve pediatrician confidence, comfort, and skill performing the GUPE and increase knowledge on UDT management.
MATERIAL AND METHODS
We developed a novel manikin that permits realistic simulated GUPE for normal scrotal testicle, palpable UDT, nonpalpable UDT, and retractile testicle. Pediatricians (trainees and attendings) participated in an educational session consisting of an asynchronous video on UDT guidelines and GUPE technique, followed by an in-person simulation session using the manikin. Participants were scored on GUPE technique and immediate deliberate feedback was performed until mastery was achieved. Participants completed a baseline survey and post-intervention survey to assess competence and confidence.
RESULTS
28 trainees and 27 attendings completed the baseline survey, of whom 22 and 21 completed the simulation session. At baseline, only 22% and 11% were very comfortable in GUPE skill and identification of UDT, respectively, and none were very comfortable with UDT guidelines on diagnosis or managment. Participants achieved GUPE mastery in median of two attempts. After training, over 90% were more confident in all areas. 79% felt the hands-on simulation training with the novel manikin was the most useful component of the education. Participant knowledge on management improved significantly on most measures, with no participants opting for imaging prior to referral after completing the education.
CONCLUSIONS
Standardized education for UDT with a novel manikin improved pediatrician confidence, performance, and knowledge. Simulation played an important role in the education. Future studies are ongoing to assess long-term effects.
16:16 - 16:19
S03-3 (OP)
Jorgen THORUP 1, Simone HILDORF 1, Andrea HILDORF 1, Erik CLASEN-LINDE 2 and Dina CORTES 3
1) Rigshospitalet, Pediatric Surgery, Copenhagen, DENMARK - 2) Rigshospitalet, Department of Pathology, Copenhagen, DENMARK - 3) Hvidovre Hospital, Department of Pediatrics, Hvidovre, DENMARK
PURPOSE
In Journal of Pediatric Urology it is recently published that low-dose LHRH treatment after bilateral orchidopexy in childhood is safe and has only advantages. Therefore, the results of the study with follow-up in adult age enabled the authors to recommend low-dose LHRH therapy in all bilateral cryptorchid boys. However, it is evidence based that around one third of adult men with previous prepubertal bilateral orchidopexy for cryptorchidism has hypergonadotropic hypogonadism with increased follicle stimulating hormone (FSH) as an intact pituitary gland feed-back response. These infertile men had sperm-count <2million/ml (median:0.025). The aim of our study was to identify such males in childhood.
MATERIAL AND METHODS
A cohort of 450 boys had bilateral orchidopexy performed between 0.4 and 10 (median: 3.7) years old. All were evaluated with FSH in serum and total number of germ cells (G/T) and Ad-Spermatogonia (AdS/T) per tubule cross-section in testicular biopsies. All values of the investigated parameters were compared to age matched normal materials.
RESULTS
97 (22%) patients had increased FSH, low G/T indicating hypergonadotropic hypogonadism. 303 (67%) patients had low G/T (median: 0.432 (range:0-1.7)) (20% of these with no AdS/T) and not the expected gonadotropin feed-back mechanism, but normal FSH (median: 0.6 U/l (range:0.05-1.8)) indicating gonadotropin insufficiency. 11 patients with high FSH had normal G/T.
CONCLUSIONS
Adjuvant hormonal treatment is indicated because of gonadotropin insufficiency in 2/3 of boys with bilateral cryptorchidism. But more than 20% have a genuine intact pituitary gland feed-back response and does probably not benefit from the treatment. They may be identified with a FSH blood sample.
16:19 - 16:22
S03-4 (OP)
Vojtěch FIALA 1, Radim KOČVARA 1, Marcel DRLÍK 1, Josef SEDLÁČEK 1, Zdeněk DÍTĚ 1, Petra NOVÁKOVÁ 1, Marta KALOUSOVÁ 2, Viktor SOUKUP 1 and Tomas ZIMA 1
1) General University Hospital and 1st Faculty of Medicine of Charles University in Prague, Urology, Prague, CZECH REPUBLIC - 2) General University Hospital and 1st. Faculty of Medicine of Charles University in Prague, Institute of Medical Biochemistry and Laboratory Diagnostics, Prague, CZECH REPUBLIC
PURPOSE
Neoadjuvant hormonal treatment in patient with unilateral undescended testis (UUT) is a matter of controversy. The aim of this study is to show the hormonal status of patients with UUT in comparison with controls at minipuberty, and to compare the development in UUT patients with and without hormonal pretreatment up to surgery.
MATERIAL AND METHODS
Patients with UUT (palpable or visible on ultrasound) who completed the initial study protocol: hormonal (LH, FSH, Testosterone, Inhibin B, AMH) and physical examination at mean 2.9 months (2.5-3.5) were assigned to surgery at 6 months and divided into group 1 with and group 0 without Kryptocur® neoadjuvant treatment. The final examination was completed at surgery, at mean 11.2 months (10-14), no biopsy was performed.
RESULTS
Criteria fulfilled 32 patients in group 1, 30 in group 0 and 31 controls. At time of minipuberty, the UUT groups (0;1) in between were comparable in hormonal levels, and in physical findings: mean penile lenght 45.9 vs. 45.8mm and total testicular volume 1.1 vs 1.0ml; no difference was found between UUT patients and controls. At time of surgery, hormonal levels between the two UUT groups (0;1) were comparable: LH (p=0.44), (p=0.53), Testosteron (p=0.38), Inhibin B (p=0.58) and AMH (p=0.08).
CONCLUSIONS
The hormonal status of patients with UUT did not differ from healthy controls at time of minipuberty. At time of surgery, the hormonal and physical findings were comparable between the two UUT groups irrespective of neoadjuvant treatment. Follow-up until puberty is required to discover any difference.