34th ESPU Congress in Naples, Italy

S05: TESTIS 2

Moderators: Anil Takvani (India), Tariq Abbas (Qatar)

Parallel Meeting on Wednesday 17, April 2024, 17:00 - 17:50


17:00 - 17:03
S05-1 (OP)

THE ROLE OF NEUTROPHYL-TO-LYMPHOCYTE RATIO AS A PREDICTOR OF ORCHIECTOMY OR TESTICULAR ATROPHY AFTER TESTICULAR TORSION IN CHILDREN. RESULTS OF A MULTICENTRIC STUDY.

Carlos DELGADO-MIGUEL 1, Javier ARREDONDO MONTERO 2, Julio César MORENO ALFONSO 3, María SAN BASILIO 1, Irene HERNÁNDEZ BERMEJO 4, Noela CARRERA 5, Pablo AGUADO RONCERO 6, Ennio FUENTES CEBALLOS 7, Pedro LÓPEZ-PEREIRA 8 and Ricardo DÍEZ GARCÍA 6
1) La Paz Children's Hospital, Pediatric Surgery Department, Madrid, SPAIN - 2) León University Hospital, Pediatric Surgery Department, León, SPAIN - 3) Navarra University Hospital, Pediatric Surgery Department, Pamplona, SPAIN - 4) Rey Juan Carlos University Hospital, Urology Department, Móstoles, SPAIN - 5) Toledo University Hospital, Pediatric Surgery Department, Toledo, SPAIN - 6) Fundación Jiménez Díaz University Hospital, Pediatric Surgery Department, Madrid, SPAIN - 7) Villalba General University Hospital, Pediatric Surgery Department, Villalba, SPAIN - 8) La Paz Children's Hospital, Pediatric Urology Department, Madrid, SPAIN

PURPOSE

Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory biomarker related to ischaemic-inflammatory diseases. Its usefulness in the diagnosis of pediatric testicular torsion (TT) has recently been reported, although its prognostic implication has not been evaluated. Our aim is to analyse the role of NLR in the evolution of TT in children, determining its potential for predicting the risk of adverse outcomes such as orchiectomy or testicular atrophy.

MATERIAL AND METHODS

We performed a retrospective multicentric case-control study in patients with clinical and ultrasound suspicion of TT, in whom surgical testicular examination was performed between 2016-2022 in seven pediatric hospitals. Patients outcomes were analysed according to the intraoperative and postoperative evolution (orchiectomy/ testicular atrophy or not). Demographics, clinical, ultrasound and laboratory features at admission were analyzed. Sensitivity and specificity were determined by the area under the curve (AUC) represented on the receiver operating characteristic (ROC) curves.

RESULTS

A total of 402 patients were included (median age 13.4 years; interquartile range 11.2-15.6 years), in whom 87 orchiectomies (21.6%) were performed and 26 (6.5%) cases of testicular atrophy were observed during follow-up (median follow-up: 10 months). When comparing clinical, ultrasound and laboratory predictors of both events on ROC curves, the NLR was the most sensitive and specific parameter (AUC=0.890), ahead of platelet-to-lymphocyte ratio (AUC=0.825), time since symptoms onset (AUC=0.721), number of twisted sperm cord turns (AUC=0.704) and C-reactive protein (AUC=0.612). The cut-off point of NLR=3.99 presented maximum sensitivity and specificity (86.2% and 84% respectively) for the prediction of orchiectomy or atrophy after a testicular torsion.

CONCLUSIONS

NLR may be considered as the best predictor for the risk of orchiectomy or testicular atrophy following torsion in pediatric patients, helping the identification of high-risk cases. It can be useful both for obtaining more accurate preoperative information on patient prognosis and for closer follow-up of high-risk testicular atrophy patients.


17:03 - 17:06
S05-2 (OP)

LOW GRADE INJURY FOLLOWING TESTICULAR TORSION: A MULTICENTER STUDY CONFIRMING A DISTURBING POSSIBILITY

Emine Burcu CIGSAR KUZU 1, Sibel TIRYAKI 2, Neslihan GUNEY 3, Kamer POLATDEMIR 4, Yasemin CAKIR 5, Ahsen KARAGOZLU AKGUL 6, Muhammed Hasan TOPER 7, Güngör KARAGÜZEL 8, Murat UÇAR 9, Cumhur Ibrahim BASSORGUN 10, Seyhmus Kerem OZEL 11, Seyma ÖZKANLI 12, Gül ŞALCI 13, Sevdegül AYDIN MUNGAN 14, Mehmet Ugur YILMAZ 15, Berna AYTAÇ VURUŞKAN 16, Ismail YAGMUR 17, Emine Zeynep TARINI 18, Meltem KABA 19, Canan TANIK 20, Furkan Adem CANBAZ , Özge HURDOĞAN , İdil Rana USER , Diclehan ORHAN , Ahmet ATICI , Didar GÜRSOY , Emin Aydın YAĞMURLU , Duygu ENNELI , Şeref Selçuk KILIÇ  and Şeyda ERDOĞAN 
1) Tepecik Training and Research Hospital, Pediatric Surgery, Izmir, TURKEY - 2) Ege University Medical Faculty, Department of Pediatric Surgery Division of Pediatric Urology, Izmir, TURKEY - 3) Tepecik Tranining and Research Hospital, Pathology, Izmir, TURKEY - 4) Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Pediatric Surgery, Izmir, TURKEY - 5) Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Pathology, Izmir, TURKEY - 6) Marmara University Medical Faculty, Dept. Pediatic Surgery Div. Pediatric Urology, Istanbul, TURKEY - 7) Marmara University Medical Faculty, Pathology, Istanbul, TURKEY - 8) Akdeniz University Medical Faculty, Pediatric Surgery Div. Pediatric Urology, Antalya, TURKEY - 9) Akdeniz University Medical Faculty, Urology, div Pediatric Urology, Antalya, TURKEY - 10) Akdeniz University Medical Faculty, Pathology, Antalya, TURKEY - 11) İstanbul Medeniyet University, Dept. Pediatric Surgery Div. Pediatric Urology, Istanbul, TURKEY - 12) İstanbul Medeniyet University, Pathology, Istanbul, TURKEY - 13) Karadeniz Technical University Medical Faculty, Pediatric Surgery, Trabzon, TURKEY - 14) Karadeniz Technical University Medical Faculty, Pathology, Trabzon, TURKEY - 15) Bursa Uludağ University Medical Faculty, Pediatric Surgery Div. Pediatric Urology, Bursa, TURKEY - 16) Bursa Uludağ University Medical Faculty, Pathology, Bursa, TURKEY - 17) Harran University Medical Faculty, Urology Div. Pediatric Urology, Şanlıurfa, TURKEY - 18) Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Pathology, Şanlıurfa, TURKEY - 19) Hamidiye Etfal Training and Research Hospital, Pediatric Surgery, Istanbul, TURKEY - 20) Hamidiye Etfal Training and Research Hospital, Pathology, Istanbul, TURKEY - ) İstanbul Medical Faculty, Pediatric Surgery Div. Pediatric Urology, Istanbul, TURKEY - ) İstanbul Medical Faculty, Pathology, Istanbul, TURKEY - ) Hacettepe Univesity Medical Faculty, Pediatric Surgery, Ankara, TURKEY - ) Hacettepe Univesity Medical Faculty, Pathology, Ankara, TURKEY - ) Mustafa Kemal University Medical Faculty, Pediatric Surgery, Hatay, TURKEY - ) Mustafa Kemal University Medical Faculty, Pathology, Hatay, TURKEY - ) Ankara Univesity Medical Faculty, Pediatric Surgery Div. Pediatric Urology, Ankara, TURKEY - ) Ankara Univesity Medical Faculty, Pathology, Ankara, TURKEY - ) Çukurova University Medical Faculty, Pediatric Surgery, Adana, TURKEY - ) Çukurova University Medical Faculty, Pathology, Adana, TURKEY

PURPOSE

There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion in cases where the testis appears nonviable. The main issue is lack of objective criteria defining testicular viability. The objective of this study was to examine the grade of injury in orchiectomy specimens obtained from cases of testicular torsion (TT), and its association with clinical findings.

MATERIAL AND METHODS

This multicenter retrospective study involved double blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings.

RESULTS

A total of 228 patient charts and speciments from 14 centers were reviewed. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p<0.001); however, range was wide in both groups (as long as 96 hours for grade one and as short as 7 hours for higher grades). There was no significant difference in any other variables including age (median 14 for both, p=0.531), symptoms (pain:19/20 vs 189/202, p=0.801; swelling: 13/19 vs 168/197, p=0.094), absence of blood flow in Doppler US (15/19 vs 164/197, p=0.635) or degree of torsion (median 720° for both, p=0.172).

CONCLUSIONS

This study revealed necessity for better criteria to define viability of testis following testicular torsion. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high grade injury.


17:06 - 17:11
Discussion
 

17:11 - 17:14
S05-3 (OP)

THE PATHOGENESIS OF ASCENDING TESTES IS RELATED TO GONADOTROPIN INSUFFICIENCY

Jorgen THORUP 1, Simone HILDORF 2, Andrea HILDORF 3, Tina OLSEN 4 and Dina CORTES 5
1) Rigshospitalet, Paediatric Surgery 4272, Copenhagen, DENMARK - 2) Rigshospitalet, Pediatric Surgery, Copenhagen, DENMARK - 3) Rigshospitalet, Copenhagen, DENMARK - 4) Rigshospitalet, Department of Pathology, Copenhagen, DENMARK - 5) Hvidovre Hospital, Department of Pediatrics, Hvidovre, DENMARK

PURPOSE

Males with an intact hypothalamic-pituitary-gonadal axis react on an impaired germ cell status with an increased serum level of Follicle Stimulating Hormone (FSH). Boys with a low number of germ cells in the testes and no rise of the FSH serum level probably have hypogonadotropic hypogonadism. The aim of the study is to relate the function of the hypothalamic-pituitary-gonadal axis to the patho-anatomic findings of cryptorchid testes.

MATERIAL AND METHODS

We included 453 boys <5-years old with bilateral non-syndromic cryptorchidism. The position of the testes at orchidopexy, the germ cell number per tubular cross section (G/T) in testicular biopsies and serum FSH at surgery were evaluated.

RESULTS

We found 187 boys responding to impaired G/T with FSH higher than 2 SD of normal values (group A) and 202 boys with hypogonadotropic hypogonadism (normal FSH and G/T under the lower range of normal G/T (group B). Sixty-four boys had normal FSH and G/T. In group A 24% had ascending testes and in group B 35% had ascending testes (p<0.02). The number of boys with normal G/T in age groups 0-<1, 1-<2, 2<3, 3-<4 and 4-<5 years was decreasing by age (52%,16%,18%,28%,13% respectively (p<0.001)). In contrast the percentage of boys with ascending testes was increasing by age (3%,26%,46%,35%,39% respectively (p<0.001)). Congenital cryptorchid testes had slightly lower median G/T (0.436) than ascending testes (0.500).

DISCUSSION

Ascending testes are associated with hypogonadotropic hypogonadism. Interpreting testes in distal suprascrotal position as late referral ascending testes with unknown history and not as congenital, the difference between group A and B increases (p<0.0001).


17:14 - 17:17
S05-4 (OP)

TESTICULAR LOCATION SCORE IN THE RETRACTILE TESTIS

Jae Min CHUNG and Sang Don LEE
Pusan National University Children's Hospital, Urology, Yangsan, REPUBLIC OF KOREA

PURPOSE

A small percentage of retractile testis (RT) can ascend and become undescended testicles that need the surgery. The testicular location score for the RT was created and applied clinically to compare the difference between the group that underwent surgery and the group that only followed up.

MATERIAL AND METHODS

We evaluated 191 consecutive boys who visited our clinic due to RT. The testicular location score was given according to the position of the testis at the time of supine position(0-2), standing position(0-1), re-supine position(0-2), and making contraction-induced state of cremasteric reflex (0-2). The range of the total sum was 0-7. We compared and analyzed these scores by dividing them into two groups: the orchiopexy group and the follow-up group.

RESULTS

The mean age was 33.8 ± 26.5 months (6-111 months) at the first visit and 44.8 ± 26.4 months (12-123 months) at the last visit. The mean follow-up period was 10.5±6.6 months (3-37 months). The laterality was 29 right, 20 left, and 142 both. The total score of 333 RT was 1.4 ± 1.7 on the first visit and 1.3 ± 1.7 on the last visit. The total score of 51 RT (15.3%) in the orchiopexy group was 2.3 ± 2.0 at the first visit and 3.3 ± 1.9 at the last visit. The total score of 282 RT (84.7%) in the follow-up group was 1.2 ± 1.6 on the first visit and 1.0 ± 1.4 on the last visit. The total score of the orchiopexy group was significantly higher than the follow-up group on the first and last visit (p=0.001).

CONCLUSIONS

The testicular location score for the RT was valuable and effective, and it was very helpful in the surgical decision. Active use is required for confirmation and follow-up of testicular location in clinical practice.


17:17 - 17:21
S05-5 (LOP)

CURATIVE GNRHA TREATMENT FOLLOWING SURGICAL CORRECTION OF CRYPTORCHIDISM STIMULATES TESTICULAR EXPRESSION OF GENES INVOLVED IN RETROTRANSPOSON SILENCING

Faruk HADZISELIMOVIC 1, Gilvydas VERKAUSKAS 2 and Michael B. STADLER 3
1) Cryptorchidism Research Institute, Children's Day Care Center, Liestal, SWITZERLAND - 2) Vilnius University, Faculty of Medicine, Vilnius, LITHUANIA - 3) Friedrich Miescher Institute for Biomedical Research, Swiss Institute of Bioinformatics, Basel, SWITZERLAND

PURPOSE

Spermatogonia contain processing bodies (P-bodies) that harbour P-elements specifically associated with Piwi-interacting RNAs to silence transposable DNA elements. MORC genes are important for the transcription of piRNA precursors and for de novo DNA methylation of a retrotransposon affecting genome structure and gene silencing. The derepression of retrotransposons results in infertility. Here, we examined the expression of key retrotransposon silencing genes in testicular samples from patients diagnosed with cryptorchidism.

MATERIAL AND METHODS

Testicular biopsies from bilateral cryptorchid boys for histological and transcriptome analyses using the Illumina system. Lacking Ad spermatogonia in high infertility risk (HIR) patients results in adult infertility. HIR patients were randomized for treatment either with surgery and GnRHa or surgery only.

RESULTS

In samples from the HIR group four PIWIL genes, MORC1 (-0.24 log2/0.002 FDR) and MORC4 (-0.57 log2/0.008 FDR) show decreased signals when compared to samples from the low infertility risk (LIR) group. Curative GnRHa treatment stimulates PIWIL3 and TEX19 expression, which may contribute to the silencing of retrotransposons.

CONCLUSIONS

Our observations support the notion that downregulation of PIWIL and MORC genes may be associated with the derepression of retrotransposons that is thought to cause infertility. Normal mini puberty and LH/testosterone secretion is essential for the development of the endogenous defence system mediated by transposons. We propose that GnRHa treatment - but not early orchidopexy alone - stimulates PIWIL and MORC genes and thereby restores the adult fertility of HIR patients.


17:21 - 17:31
Discussion
 

17:31 - 17:34
S05-6 (OP)

HIGHER PREVALENCE OF BENIGN TUMORS IN MEN WITH TESTICULAR TUMORS AND HISTORY OF TREATED CRYPTORCHIDISM

Rachel DAVIS, Alexander M. HIRSCH, Victoria MAXON, Ahmad HAFFAR, Christian MORRILL, Mahir MARUF, Joseph CHEAIB, Phillip PIERORAZIO and Heather DI CARLO
Johns Hopkins University, Brady Urological Institute, Baltimore, USA

PURPOSE

To identify if surgically treated cryptorchidism correlated with testicular tumor pathology at presentation.

MATERIAL AND METHODS

An institutional database of patients treated for testicular cancer between 2003-2020 was reviewed. Inclusion criteria included orchiectomy patients. Exclusion criteria included unknown cryptorchidism history or pathology or laterality of orchiectomy. Data collection included demographics, surgical history, and tumor marker status.

RESULTS

A total of 435 patients were included. Thirty-three of these patients had a history of UDT. There was no statistical difference in age at orchiectomy, laterality of orchiectomy, or lymphovascular invasion with regard to UDT history. There was a statistical difference in tumor pathology after orchiectomy, p = 0.03. On secondary analysis, benign pathology was significantly more common in patients with a history of UDT (15.2%) than without (4.7%), p = 0.01.

Mixed GCT was also found at a significantly lower rate in patients with a history of UDT (18.2%) compared to those with no history of UDT (37.3%), p = 0.03. There were no statistically significant differences in other pathology. 

CONCLUSIONS

Previous studies have shown that there is a greater rate of seminoma in patients with testicular cancer in an undescended testis. This study shows that in patients with a history of UDT compared to those without a history of UDT, there is a greater percentage of patients with benign testicular masses after orchiectomy. Guideline based practices including monthly self-examination and testis-sparing surgery for appropriate patients may reduce rates of radical orchiectomy for benign tumors.


17:34 - 17:37
S05-7 (OP)

SURGICAL MANAGEMENT AND OUTCOMES OF TESTICULAR STROMAL TUMOURS IN CHILDREN: 15 YEAR EXPERIENCE

Kristina DZHUMA 1, Ciaran HUTCHINSON 2, Imran MUSHTAQ 3, Naima SMEULDERS 3, Alexander CHO 3, Abraham CHERIAN 3 and Navroop JOHAL 3
1) Great Ormond Street Hospital, Paediatric urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital NHS Foundation Trust, Department of Histopathology, London, UNITED KINGDOM - 3) Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Urology, London, UNITED KINGDOM

PURPOSE

Testicular stromal tumours are extremely rare and 10% show malignant behaviour in adults. There is paucity of long-term outcome data in children. We report our experience in management and outcomes of testicular stromal tumours in prepubertal boys.

MATERIAL AND METHODS

With ethical approval retrospective cohort study of patients presenting with Leydig cell(LC), Sertoli cell(SC), juvenile granulosa cell(JGS) and undifferentiated testicular stromal(UST) tumours managed at a single tertiary centre from 2007 to 2023. Clinical, biochemical, radiological, surgical and follow-up data was analysed.

RESULTS

A total of 15 patients comprising JGS(n=8), LC(n=5), SC and UST(n=1) were included. Age was <10years in all, with JGS exclusively diagnosed in infants <6 months.The common presentation was painless testicular swelling in 10(67%), pain - 3(20%), precocious puberty - 2(13%). One patient had bilateral JGS and one diagnosed with Alport syndrome. Inhibin B was checked in one JGS patient preoperatively and was elevated; all other tumour markers (B-HCG, AFP, LDH) were within normal range for all patients. Ultrasound showed 10(67%) lesions presented as well-defined lesions and 5(33%) as diffuse. 6(40%) lesions were heterogeneous, including 3 cystic and 1 with calcifications. 11 had radical inguinal orchidectomy and 4 had testis-sparing surgery(TSS) with an on-table US in 2/4. Local pathological stage I was assigned in all cases. No relapses at median follow-up of 54 months(range 7-184). In 4 TSS patients the residual testis has shown good growth on the US. Precocious puberty symptoms resolved in both patients.

CONCLUSIONS

Testicular stromal tumours in prepubertal boys are benign with excellent long-term outcome. Our data shows an evolution to TSS and it should be performed when technically feasible using on-table US to delineate margins.


17:37 - 17:40
S05-8 [WITHDRAWN] THE PROGNOSIS OF PARTIAL ORCHIECTOMY IN PREPUBERTAL BOYS
 
17:40 - 17:50
Discussion