Impaired spermatogenesis in testes at risk of torsion

Germ cells positive for PLAP and c-Kit in 11-16 year old normal boys with ongoing spermatogenesis

INTRODUCTION

Positive staining of testicular germ cells for PLAP and c-Kit beyond infancy may be associated with the presence of GCNIS (Germ Cell Neoplasia In Situ). We recently reported our findings of positive staining of normal, infantile germ cells for PLAP, and c-Kit up to 2 years of age, contrary to previous studies. The present study aims to elucidate whether otherwise normal testes of boys undergoing puberty express PLAP, c-Kit, Oct3/4, or D2-40.

MATERIALS AND METHODS

Biopsies were taken from 31 boys (11.5-16.5 years of age, mean and median of 13.5 years), who underwent surgery either for torsion of the testis (15) or a history suspicious of intermittent torsion of the testis (16). 21 were biopsied on both sides, making a total of 52 biopsies. Four testes were necrotic. The biopsies were fixed in Stieve's medium, cut into 2 μm sections, and mounted on coated slides. One slide was processed for H-E, and the others incubated with primary antibody for PLAP, c-Kit, D2-40, and Oct3/4.

RESULTS

87% of the boys stained positive for both PLAP and c-Kit. None were positive for either D2-40 or Oct3/4. None had any histological features characteristic of GCNIS. Only two boys showed no signs of having initiated 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. Three 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.

CONCLUSION

Positive staining of testicular germ cells for PLAP and c-Kit seems to be a normal finding in boys not having completed puberty. Rather than indicating pre-malignant transformation, the positivity is indicative of an ongoing maturational process of the germ cells.

Perspectives in Pediatric Pathology, Chapter 19. Testicular Torsion, Testicular Appendix Torsion, and Other Forms of Testicular Infarction

Among the most frequent specimens at the pediatric surgical pathology bench, orchiectomy performed after testicular torsion deserves significant attention. Multiple implications, including fertility, legal complications, possibility of occult lesion, and others, need to be considered. Furthermore, torsion of testicular and other appendices represents common urological emergencies frequently encountered in surgical pathology. Here we present a review of testicular torsion and infarction, including theories about their pathogenesis and the appropriate handling by the diagnostic pathologist.

Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review

BACKGROUND AND OBJECTIVE

Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism.

METHODS

We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria.

RESULTS

Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare.

CONCLUSIONS

The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.

A fusional anomaly of the epididymis associated with recurrent testicular torsion

A 31-year-old man with recurrent testicular torsion and infertility was found to have a fusional anomaly of the epididymis on scrotal exploration in which only the head of epididymis was attached to the testis, while the body and tail were completely free. He had bilateral orchidopexy, which relieved pain and recurrent torsion. He was then referred for fertility treatment. Literature search has shown that infertility is more associated with congenital anomalies of the epididymis and not with recurrent torsions.

The effects of vasodilatation and chemical sympathectomy on spermatogenesis after unilateral testicular torsion: a flow cytometric DNA analysis

OBJECTIVE

To evaluate the effects of vasodilator therapies and chemical sympathectomy on ipsilateral and contralateral testicular spermatogenetic activity after unilateral testicular torsion using DNA flow cytometry and thus determine whether contralateral testicular damage occurs through a reflexively decreased blood flow.

MATERIALS AND METHODS

The study comprised four groups of 20 rats each (groups 1-4) respectively receiving isotonic saline, verapamil, pentoxifylline and 6-hydroxy dopamine hydrobromide (6-OHD) intraperitoneally. Each group was further divided into two subgroups containing 10 rats which respectively underwent either a sham operation or 720 degrees clockwise torsion applied to the left testis. The testes were harvested after 24 h and the relative proportions of haploid, diploid and tetraploid cells determined by DNA flow cytometry for each testis. The proportion of haploid cells was used as an estimate of spermatogenesis. The mean proportions of haploid cells in the groups were compared using a one-way ANOVA and paired groups were compared using Student's t-test.

RESULTS

The proportions of haploid cells in the ipsilateral testes of rats undergoing torsion were significantly lower than in their contralateral testes and in the ipsilateral testes of the control groups. In group 4 (6-OHD) the proportion of haploid cells in the contralateral testes was significantly higher than those in the other groups after unilateral testicular torsion, but significantly lower than those in groups 1 and 4 after a sham operation. After unilateral testicular torsion the haploid cell proportions of the contralateral tests of groups 1-3 were not significantly different from each other.

CONCLUSIONS

Because the spermatogenetic activity in the contralateral testis is depressed within 24 h of ipsilateral testicular torsion, contralateral testicular damage is an acquired effect: 6-OHD offers some protection and thus the damage seems to result from the involvement of the sympathetic system.

Late postoperative results in males treated for testicular torsion during childhood

Successful preservation of a testis that has undergone torsion is directly related to the duration and degree of torsion. From 1979 to 1991, 75 cases of testicular torsion were treated. Eleven orchiectomies were performed; operative detorsion was done in the other 64 cases, with concurrent orchiopexy of both testicles. Twenty-five patients were reexamined 1 to 12 years after the surgery. Age of torsion, duration of symptoms, and operative findings were reevaluated. Testicular volume was determined using Prader's orchidometer, a pachymeter, and ultrasonography. In four postpubertal patients, semen analysis was performed. According to clinical data, results of testicular atrophy correlated with duration of symptoms and operative findings. In all cases of surgical detorsion in which torsion lasted more than 24 hours and viability of the testis was questionable, subsequent atrophy was the rule.

Physiopathology of spermatogenic arrest

OBJECTIVE

To review the world literature on the etiology, physiopathology, and treatment of spermatogenesis arrest.

STUDY SELECTION

All the pertinent literature on spermatogenic arrest has been selected. Most studies related to this topic have been identified through Medline and through published literature.

PATIENTS

Spermatogenic arrest has been diagnosed by testicular biopsy in men of reproductive age who had either severe oligospermia (partial arrest) or azoospermia (complete arrest), normal testicular volume, and depending on the etiology normal, high, or low levels of gonadotropins.

INTERVENTIONS

The effects of heat, radiotherapy, and chemotherapy have been reported. Depending on the etiology of spermatogenic arrest, different hormonal treatments have been tested.

MAIN OUTCOME MEASURE

Level of interruption of germ cell differentiation in testicular biopsy have been determined. Improvement of the sperm count or appearance of mature sperm after an hormonal treatment have been observed.

RESULTS

Spermatogenic arrest can occur at spermatogonial level in case of gonadotropin insufficiency or after germ cell damage due to chemotherapy or radiotherapy. The arrest is most frequently observed at primary spermatocyte level. Reversible arrest at that level can be due to heat, infections, hormonal and nutritional factors. Irreversible arrest at primary spermatocyte or spermatid level have a genetic origin due to chromosomes anomalies either in somatic cells or in germ cells.

CONCLUSIONS

Spermatogenic arrest is usually due to genetic factors resulting in irreversible azoospermia. However some cases may be consecutive to hormonal, thermic, or toxic factors and may be reversible either spontaneously or after a specific treatment.

Testicular torsion: a follow-up study

Thirty-five patients were examined 6-11 years after operation for torsion of the testis. Loss of testicular tissue was significantly associated with long preoperative duration of symptoms and with low postoperative sperm counts. The sex hormones were normal in the majority of patients but there were significantly higher levels of both FSH and LH in the group of patients with symptoms exceeding 8 hours. There was also a higher prevalence of abnormal semen quality in the same group. Furthermore, FSH and LH levels correlated significantly to the duration of symptoms and correlated inversely to the sperm count and concentration. Measurement of carnitine levels in seminal plasma, as a sign of vas deferens obstruction or dysfunction of epididymis, and of autoantibodies against spermatozoa revealed no significant findings.

Ipsilateral and contralateral testicular blood flows during unilateral testicular torsion by 133Xe clearance technique

Testicular blood flows during unilateral testicular torsion were measured by Xenon-133 clearance technique. Xenon-133 was injected via the left carotid artery into the heart. Measurements were performed in control and left-sided testicular torsion groups, each consisting of ten rats. Left and right testicular blood flows, which were 29.157 +/- 2.272 ml/100 g/min and 29.773 +/- 2.934 ml/100 g/min in the controls, were 11.983 +/- 3.655 ml/100 g/min and 16.098 +/- 3.757 ml/100 g/min in the experimental group and differed significantly. The decrease in contralateral testicular blood flow may play an important role in the contralateral testicular damage encountered following unilateral testicular torsion.

Recurrent subacute torsion: prospective study of effects on testicular morphology and function

A prospective study was done on 43 consecutive patients with a diagnosis of recurrent subacute testicular torsion. All patients underwent full examination, hormonal assays and seminal fluid analysis before scrotal exploration, bilateral testicular biopsy and fixation. Seminal fluid analysis and hormonal assays were repeated 3 months postoperatively. Of the patients 36 were cured of recurrent pain, 35 of whom had a horizontally lying testis. No hormonal abnormalities were found preoperatively or postoperatively. Three patients had abnormal seminal fluid analysis. Testicular biopsies, including Johnsen scores, were abnormal in these 3 patients and normal in the other 33. It is concluded that patients with recurrent subacute torsion can be identified accurately and treated satisfactorily. There is little evidence that these patients suffer testicular damage as a result of this subacute torsion or that any pre-existing cellular abnormality exists to explain the oligospermia that frequently is seen in patients who have acute testicular torsion.

Contralateral testicular blood flow during unilateral testicular torsion

Changes in contralateral testicular blood flow during unilateral testicular torsion were evaluated using an electromagnetic flowmeter in 13 adult male New Zealand White rabbits. There was an immediate and then a progressive decrease during torsion and a gradual increase following detorsion. A decrease in testicular blood flow over a critical period of time may be associated with contralateral testicular damage following unilateral testicular torsion.