Testicular volumes revisited: A proposal for a simple clinical method that can closely match the volumes obtained by ultrasound and its clinical application

Significant reduction in left testicular volume shown by ultrasonography in infertile patients with left-side grade 2-3 varicocele as compared to less than grade 2: An evidence for indication of varicocelectomy

PURPOSE

Testicular volume (TV) is known to be one of the main parameters for testicular function (TF). This study was conducted to re-evaluate the indications of a varicocelectomy based on a survey of preoperative TV results in left-side varicocele patients considered to reflect the detrimental effects of a varicocele on TF.

METHODS

TV results of infertile patients determined using ultrasonography by a single expert physician were retrospectively evaluated.

RESULTS

Of 590 examined patients, 424 had no varicocele findings (Group A), while 148 had a left-side varicocele (Group B). Group B was subdivided based on varicocele grade into Group B0 (subclinical), B1 (grade 1), B2 (grade 2), and B3 (grade 3). Comparisons of left-side TV showed no significant differences for grade among Group A, B0, and B1, whereas that for Group B2 and B3 was significantly lower as compared with Group A (p < 0.01, 0.02, respectively). The median TV of Group B I (composed of Groups B0 and B1) was 9.8 cm3, while that of Group B II (Groups B2 and B3) was significantly lower at 8.4 cm3 (p < 0.05). In contrast, a comparison of right TV values identified no significant differences among the groups (p = 0.918).

CONCLUSION

A varicocelectomy should be performed for patients with a grade 2 and 3 varicocele for ameliorating testicular function.

Does the contralateral testicular volume decide the need for diagnostic laparoscopy in cases of unilateral impalpable undescended testis?

BACKGROUND

This study aimed the evaluation of the value of the calculated volume of a normal testis to predict the status of its contralateral impalpable side and hence decide the importance of laparoscopic exploration.

METHODS

Patients with unilateral impalpable undescended testis - as confirmed by clinical and sonographic examination- were enrolled in our prospective interventional study between November 2018 and August 2022 at Elshatby University Hospital, Faculty of Medicine, Alexandria University. The volume and three-dimensional diameter of the normal contralateral testis were measured by the pre-operative US using the formula: Volume = L x W x H x π/6, where L is the length, W is the width, H is the height, and was correlated with the intra-operative laparoscopic findings.

RESULTS

Seventy-six patients were included in our study. The age of the studied patients ranged between 6 months and 4 years with a mean of 2.17 ± 1.30 years; most of them were between one and three years old. Forty-six patients (60.5%) have left-sided impalpable testis and 30 patients (39.5%) have right-sided impalpable testis. The calculated volume of the contralateral normal testis was significantly larger in those patients who had both blind ending vas and vessels (0.89 ± 0.16) and in those who had an atrophic testis passing through the deep inguinal ring (DIR) -which was excised through the inguinal region- (0.83 ± 0.20) than in those patients who had their testes intra-abdominal (0.53 ± 0.18) or passing through the DIR to the inguinal region (0.80 ± 0.19). (Kruskal Wallis test; p < 0.001*).

CONCLUSIONS

The calculated sonographic volume of a normal testis can predict the status of its contralateral impalpable side significantly with sensitivity & specificity of 75.0% & 88.89% respectively and a cut-off point of ≤ 0.674; hence, helps in parent counselling preoperatively.

TRIAL REGISTRATION

Name of the registry: Clinicaltrials.gov PRS.

TRIAL REGISTRATION NUMBER

NCT05933811. Date of registration: 10-7-2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov .

Effects of Deslorelin on Testosterone Secretion and Testicular Volume in Male Rhesus Macaques (Macaca mulatta)

Sterility in male NHP has long been achieved through surgical castration or vasectomy. However, these techniques are irreversible, require a surgical procedure, and have potential consequences such as sperm granulomas and long recovery time. Deslorelin is a gonadotropin-releasing hormone agonist that temporarily and reversibly suppresses sex hormone secretion. Our goal in this study was to investigate the effects of deslorelin on testosterone secretion and testicular volume in male rhesus macaques (Macaca mulatta). Male macaques (n = 4) each received two, 4.7-mg deslorelin implants subcutaneously in the interscapular region. Serum testosterone and testicular volume were then monitored at specific time points until 10 mo after treatment. Testosterone suppression was defined as testosterone levels lower than 0.6 ng/mL for a sustained period of at least 30 d. After implantation, mean testicular volume was significantly reduced by day 121. Testosterone suppression was observed in all subjects. However, the time from implantation to testosterone suppression and duration of suppression varied. Two macaques were hormonally suppressed by day 26 after implantation and remained suppressed for at least 6 mo. The other 2 macaques were hormonally suppressed by 2 mo after implantation; of these two, one remained suppressed for 70 days while the other was suppressed for at least 245 days. We conclude that deslorelin can safely suppress testosterone secretion in male rhesus macaques, but individual variation in onset and duration of action should be considered when establishing reimplantation time points and potential return to reproductive activity.

The optimum cut-off value of contralateral testis size in the prediction of monorchidism in children with nonpalpable testis: A systematic review

BACKGROUND

Contralateral Testis Hypertrophy (CTH) is a clinical marker that could be used to guide the choice of the main surgical strategy. In patients with a Non-palpable Testis (NPT), the degree of CTH as measured by testicular length or volume has been shown to be able to predict whether the undescended testis will survive.

OBJECTIVE

The purpose of this study was to establish the proper cut-off for identifying non-viable testes based on the current literature.

DESIGN

We systematically searched several medical databases as well as Google Scholar search engines for references and citations. All the studies that reported CTH as a result of NPT in prepubertal boys were included. Data from the included articles was gathered by two independent reviewers. The checklist developed by the Joanna Briggs Institute (JBI) was used to evaluate the methodological quality of the studies that were included. Due to the incredibly high degree of heterogeneity among the studies, no meta-analysis was done.

RESULTS

The current systematic review included 17 studies that assessed the cut-off point to detect non-viable testis. The size and length of the testes were taken into consideration based on our findings. We found that different studies reported various ideal cut-off values for predicting non-viable testes, which can be brought on by various measuring techniques, evaluation ages, and patient groupings. The difference in testis volume was greater than the difference in its length, which can be attributable to the fact that some studies used an orchidometer to measure the testis's length directly or indirectly.

CONCLUSION

According to the results of our study, it seems that defining a cut point for diagnosis of CTH based on the size of the testis, cannot demonstrate the absence of a non-palpable testis.

Neurobiology of puberty and its disorders

Puberty, which in humans is considered to include both gonadarche and adrenarche, is the period of becoming capable of reproducing sexually and is recognized by maturation of the gonads and development of secondary sex characteristics. Gonadarche referring to growth and maturation of the gonads is fundamental to puberty since it encompasses increased gonadal steroid secretion and initiation of gametogenesis resulting from enhanced pituitary gonadotropin secretion, triggered in turn by robust pulsatile GnRH release from the hypothalamus. This chapter reviews the development of GnRH pulsatility from before birth until the onset of puberty. In humans, GnRH pulse generation is restrained during childhood and juvenile development. This prepubertal hiatus in hypothalamic activity is considered to result from a neurobiological brake imposed upon the GnRH pulse generator resident in the infundibular nucleus. Reactivation of the GnRH pulse generator initiates pubertal development. Current understanding of the genetics and physiology of the brake will be discussed, as will hypotheses proposed to account for timing the resurgence in pulsatile GnRH and initiation of puberty. The chapter ends with a discussion of disorders associated with precocious or delayed puberty with a focus on those with etiologies attributed to aberrant GnRH neuron anatomy or function. A pediatric approach to patients with pubertal disorders is provided and contemporary treatments for both precocious and delayed puberty outlined.

Referential Values of Testicular Volume Measured by Ultrasonography in Normal Children and Adolescents: Z-Score Establishment

Objective: To establish Z-score regression equation derived from age for testicular volume measured by ultrasonography in normal boys aged 0 to 18 years old. Method: The length (L), width (W), and height (H) of 3,328 testicles from 1,664 Chinese boys were measured by ultrasonography. Lambert's formula: L × W × H × 0.71 was used to calculate testicular volume. Z-score regression equation derived from age was established by regression analysis of predicted values of testicular volume and standard deviations. Result: There was no significant difference between left and right testicular volumes. Testicular volume was positively correlated with age, and logarithmic transformation of testicular volume can show a fine curve fit with age. To establish Z-score regression equation derived from age, the predicted values of testicular volume used cubic regression equations, and the standard deviation used square regression equations. The Z-score regression equation derived from age was calculated by the formula: z = [lg (L × W × H × 0.71) - (-0.3524-0.01759 × x+0.009417 × x2-0.0001840 × x3)]/(0.1059+0.01434 × x-0.0005324 × x2). Conclusion: The current study provided a reference value for testicular volume of boys aged 0 to 18 years old. Z-score regression equation derived from age for testicular volume can be established. Z-score will be of great value for the testicular development assessment and disease diagnosis and follow-up.

Impact of volume calculation formulae on volume estimation accuracy of different shaped objects: an in vitro ultrasound and CT study

BACKGROUND

In image-assisted volume estimation, the volume of the object is calculated with a formula, using linear measurements of the objects. Since the volume estimation accuracy is thought to be influenced by the shape of the object, the volume estimation error would be related to the calculation formula used.

PURPOSE

To evaluate the volume estimation accuracy of selected volume calculation formulae, for different shaped objects.

MATERIAL AND METHODS

Globular (n = 5), elongated (n = 5), and near-spherical shaped plastic objects (n = 5), filled with water were subjected to ultrasound (US) and computed tomography (CT) in February 2018, to obtain the length, width, depth, and estimated volumes (EV). The volume was calculated manually using prolate, ellipsoid, and Lambert formulae. The actual volume (AV), EV, and calculated volumes were compared.

RESULTS

The AV was in the range of 10-445 mL. The reliability of measurements was high as assessed by the intra-class variability (Cronbach's alpha = 0.992). The EV has shown a high correlation to AV (US: ρ = 0.914, P < 0.001; CT: ρ = 0.943, P < 0.001; ellipsoid: ρ = 0.876, P < 0.001; prolate: ρ = 0.891, P < 0.001; Lambert: ρ = 0.876, P < 0.001). Regardless of the shape, the highest and lowest estimation accuracies were reported for prolate (bias = -0.7) and Lambert formulae (bias = +23.3), respectively. By any method, the globular objects were estimated with the highest accuracy: (US [bias = -0.31]; CT [bias = -0.14]; ellipsoid [bias = -1.5]; prolate [bias = -0.7]; Lambert [bias = 32.9]); and elongated objects were estimated with the lowest accuracy: (US [bias = -17.5]; CT [bias = -32.6]; ellipsoid [bias = -18.4]; prolate [bias = -0.3]; Lambert [bias = 11.4]).

CONCLUSION

The shape of the object and the calculation formula used has an impact on the volume estimation accuracy.

Achievable dose reductions with gonadal shielding for children and adults during abdominal/pelvic radiographic examinations: A Monte Carlo simulation

PURPOSE

Recently, medical professionals have reconsidered the practice of routine gonadal shielding for radiographic examinations. The objective of this study was to evaluate the gonadal dose reduction achievable with gonadal shields in the primary beam during abdominal/pelvic radiographic examinations under ideal and non-ideal shielding placement.

METHODS

CT scans of CIRS anthropomorphic phantoms were used to perform voxelized Monte Carlo simulations of the photon transport during abdominal/pelvic radiographic examinations with standard filtration and 0.1 mm Cu + 1 mm Al added filtration to estimate gonadal doses for an adult, 5 yr old, and newborn phantom with and without gonadal shields. The reduction in dose when the shields were not placed at the ideal locations was also evaluated. The ratio of the number of scattered-to-primary photons (SPR) across the anteroposterior (AP) dimension of the phantoms was also reported.

RESULTS

The simulated dose reduction with ideal shielding placement for the testes and ovaries ranged from 80% to 90% and 55% to 70% respectively. For children, a misalignment of the shield to the gonad of 4 cm reduced the measured dose reduction to the gonads to <10%. For adults, this effect did not occur until the misalignment increased to ~6 cm. Effects of dose reduction with and without the gonadal shields properly placed were similar for standard filtration and added filtration. SPR at the level of the testes was consistently <1 for all phantoms. SPR for ovaries was ~1.5 for the adult and 5-yr old, and ~1 for the newborn phantom.

CONCLUSION

Dose reduction with ideal alignment of the simulated gonadal shield to the gonads in this study was greater for the testes than the ovaries; both reductions were substantial. However, the dose reductions were greatly reduced (to <10%) for both sexes with misalignment of the gonads to the shields by 4 cm for children and 6 cm for adults.

Are FDA-Approved Sunscreen Components Effective in Preventing Solar UV-Induced Skin Cancer?

Solar ultraviolet (SUV) exposure is a major risk factor in the etiology of cutaneous squamous cell carcinoma (cSCC). People commonly use sunscreens to prevent SUV-induced skin damage and cancer. Nonetheless, the prevalence of cSCC continues to increase every year, suggesting that commercially available sunscreens might not be used appropriately or are not completely effective. In the current study, a solar simulated light (SSL)-induced cSCC mouse model was used to investigate the efficacy of eight commonly used FDA-approved sunscreen components against skin carcinogenesis. First, we tested FDA-approved sunscreen components for their ability to block UVA or UVB irradiation by using VITRO-SKIN (a model that mimics human skin properties), and then the efficacy of FDA-approved sunscreen components was investigated in an SSL-induced cSCC mouse model. Our results identified which FDA-approved sunscreen components or combinations are effective in preventing cSCC development. Not surprisingly, the results indicated that sunscreen combinations that block both UVA and UVB significantly suppressed the formation of cutaneous papillomas and cSCC development and decreased the activation of oncoproteins and the expression of COX-2, keratin 17, and EGFR in SSL-exposed SKH-1 (Crl:SKH1-Hr^hr) hairless mouse skin. Notably, several sunscreen components that were individually purported to block both UVA and UVB were ineffective alone. At least one component had toxic effects that led to a high mortality rate in mice exposed to SSL. Our findings provide new insights into the development of the best sunscreen to prevent chronic SUV-induced cSCC development.

Assessment of 2D ultrasound fluid volume estimation accuracy in different shaped objects: an in vitro study

Background

Volume estimation of organs using two-dimensional (2D) ultrasonography is frequently warranted. Considering the influence of estimated volume on patient management, maintenance of its high accuracy is empirical. However, data are scarce regarding the accuracy of estimated volume of non-globular shaped objects of different volumes.

Purpose

To evaluate the volume estimation accuracy of different shaped and sized objects using high-end 2D ultrasound scanners.

Material and Methods

Globular (n=5); non-globular elongated (n=5), and non-globular near-spherical shaped (n=4) hollow plastic objects were scanned to estimate the volumes; actual volumes were compared with estimated volumes. T-test and one-way ANOVA were used to compare means; P<0.05 was considered significant.

Results

The actual volumes of the objects were in the range of 10–445 mL; estimated volumes ranged from 6.4–425 mL ( P=0.067). The estimated volume was lower than the actual volume; such volume underestimation was marked for non-globular elongated objects. Regardless of the scanner, the highest volume estimation error was for non-globular elongated objects (<40%) followed by non-globular near-spherical shaped objects (<23.88%); the lowest was for globular objects (<3.6%). Irrespective of the shape or the volume of the object, volume estimation difference among the scanners was not significant: globular (F=0.430, P=0.66); non-globular elongated (F=3.69, P=0.064); and non-globular near-spherical (F=4.00, P=0.06). A good inter-rater agreement (R=0.99, P<0.001) and a good correlation between actual versus estimated volumes (R=0.98, P<0.001) were noted.

Conclusion

The 2D ultrasonography can be recommended for volume estimation purposes of different shaped and different sized objects, regardless the type of the high-end scanner used.

A simulation study assessing the accuracy and reliability of orchidometer estimation of testicular volume

CONTEXT

Measuring testicular volume (TV) by orchidometer is the standard method of male pubertal staging. A paucity of evidence exists as to its inter- and intra-observer reliability and the impact of clinicians' gender, training and experience on accuracy.

OBJECTIVE

Prosthetic testicular models were engineered to investigate accuracy and reliability of TV estimation.

DESIGN

Simulation study.

SETTING

Conducted over three-day 2015 British Society for Paediatric Endocrinology and Diabetes (BSPED) meeting.

PARTICIPANTS

Two hundred fifteen meeting delegates (161F, 54M): 50% consultants, 30% trainees, 9% clinical nurse specialists, 11% other professionals.

INTERVENTION

Three child-sized mannequins displayed latex scrotum containing prosthetic testicles of 3, 4, 5, 10 and 20 mL. Demographic data, paediatric endocrinology experience, TV examination training, examination technique and TV estimations were collected. Delegates were asked to repeat their measurements later during the meeting. Scrotum order was changed daily.

MAIN OUTCOME MEASURES

Accuracy by variance from the simulated TV. Inter- and intra-observer variability.

RESULTS

One thousand two hundred eighty four individual estimations were obtained. Eighty-five participants repeated measurements. Delegates measured TV accurately on 33.4% (±2.6) of occasions: overestimations 37% (±2.3), underestimations 28% (±1.8) (Fleiss' Kappa score 0.04). The accuracy of assessing a 4 mL testis was 36%-39%. Observers underestimated the volume when paired with a 3 mL testis and overestimated when paired with a 5 mL testis demonstrating a tendency impose biological symmetry. Intra-observer reliability was lacking; individuals giving different estimations for the same size testicle on 61% (±4.2) of occasions, 20% (±3.5) of estimations were more than 1 size outside the previous measurement. On only 39% (±4.2) of occasions did individuals agree with their previous estimation (irrespective of whether or not it was initially accurate). Training did not impact on results but experience did improve accuracy.

CONCLUSIONS

Overall TV estimation accuracy was poor. Considerable variation exists between and within subjects. Seniority slightly improved measurement estimation.

Paternity in 5α-Reductase-2 Deficiency: Report of Two Brothers with Spontaneous or Assisted Fertility and Literature Review

Fertility remains a challenge for men with 5α-reductase-2 deficiency. Such a diagnosis was made in 2 adult brothers who are compound heterozygous for the 5α-reductase type 2 gene (SRD5A2; c.308G>C; c.689A>C). They were born with ambiguous genitalia and the male sex was assigned. Both brothers underwent reconstructive genital surgery during pediatric age and had spontaneous virilization at puberty. The older brother experienced natural conception, while the younger had a son by assisted reproductive technology. Other family members were demonstrated to be compound heterozygous or heterozygous for the same genetic variants. The older brother is the third man with 5α-reductase-2 deficiency and spontaneous paternity. The little series of men with 5α-reductase-2 deficiency and documented spontaneous or assisted paternity is reviewed. In conclusion, the possibility of fatherhood is a main indication for male sex assignment in patients with 5α-reductase-2 deficiency.

Comparison between testicular volumes as measured with prader orchidometer and ultrasonography in Healthy Nigerian Newborns

BACKGROUND

We compared the testicular volume (TV) measured with Prader orchidometer (PO) to the volume measured with ultrasonography in male neonates and their relationships with some selected neonatal characteristics.

SUBJECTS AND METHODS

A cross-sectional study of all term male neonates who had clinical examination of their external genitalia performed and TV was measured using PO and ultrasonography. Information about the gestational age, birth weight, and birth length was also recorded to determine their relationships with TV measured.

RESULTS

The mean TV measured with PO was 1.06 (standard deviation [SD] ± 0.24) ml for both sides. With ultrasonography, the mean left TV was 0.273 (SD ± 0.081) ml and the mean right TV was 0.272 (SD ± 0.079) ml. There were significant correlations between TV using both methods with the birth weight and length.

CONCLUSION

TV measured with the two methods was comparable and correlates well with their birth weight and birth length.

Appraisal of testicular volumes: volumes matching ultrasound values referenced to stages of genital development

Background

Testicular volumes obtained with orchidometers or external linear measurements in the scrotum (centimeter ruler or calipers) grossly over-estimate ultrasound volumes, have much variability and may not be accurate or reproducible. The reference of the values obtained by orchidometers or US, to age or Tanner stages is not useful to determine the normal values for stages of puberty, because overlapping of ages and values. Pubertal development is determined by two events, genital and pubic hair development, that should be analyzed independently because one could be out of step with the other. The ultrasound (US) measurement of testicular volumes is the gold standard but is somewhat inconvenient, because it requires another procedure and, mainly, is costly.

The solution of the problems would be to determine testicular volumes matching US values, from the width of the testis obtained in the scrotum with a centimeter ruler, by formulas recently described, and to reference them to the stages of genital development.

Methods

The width and length of the testes in the scrotum with a centimeter ruler were obtained in 159 study subjects, in different stages of genital development and adults, for a total of 318 testicular determinations, from the age of 3 to 34 years. The width obtained in the scrotum was corrected by subtracting the values of the double scrotal skin (ss). The formulas were then applied and the testicular volumes matching US values were calculated. The volumes and the range of ages for different stages of genital development were determined. Penile measurements were obtained in 145 subjects and pubic and other hair recorded.

Paired and unpaired 2 tail student t-test was used to compare the means of the different groups expressed as means and SD and, in addition the Wilcoxon rank sum test and Bootstrap methods for the testicular volume groups. A p value of 0.05 or less was considered significant.

The Institutional Review Board (IRB) of Nationwide Children’s Hospital determined that this study did not require IRB approval.

Results

With a simple measurement of the width of the testis in the scrotum, with a centimeter ruler, testicular volumes matching US values were calculated and normative values for each stage of genital development were determined.

Conclusion

This information should solve present problems.

Electronic supplementary material

The online version of this article (doi:10.1186/s13633-017-0046-x) contains supplementary material, which is available to authorized users.

Scrotal testis size in unilateral non-palpable cryptorchidism, what it can and cannot tell: Study of a Middle Eastern population

BACKGROUND

Predicting the fate of a unilateral non-palpable testis based on its scrotal counterpart has been recommended by some, yet disputed by others, and the question remains open.

OBJECTIVE

To investigate the accuracy of contralateral testis hypertrophy in predicting the absence of a unilateral non-palpable testis in a Middle Eastern population.

STUDY DESIGN

This retrospective study included all patients referred to the present institution with unilateral non-palpable testis between June 2010 and August 2014, who had undergone laparoscopy. The scrotal testis was examined by sonography for size and volume, and diagnostic laparoscopy was utilized to determine the state of the cryptorchid testis.

RESULTS

Of the 135 referred patients, 64 were aged ≤8 years, 29 were 9-18 years, and 42 were >18 years old. Diagnostic laparoscopy revealed 63 intra-abdominal testes, 20 small intra-inguinal testes, 32 vanished testes, and 20 nubbins or aplasia (Summary fig.). Scrotal testis volume was only a modest predictor for absence of the contralateral gonad in adult patients in whom a 22 ml cut-off yielded 64.3% sensitivity and 92.9% specificity. For those aged <18 years, overall accuracy was poor and dropped below 60%. Relative enlargement of contralateral testis in decreasing order of size was observed in patients with primary monorchism, followed by those with secondarily atrophic or nubbin testis, and then those with normal sized inguinal or abdominal testis.

DISCUSSION

Unlike some previous series, which based their conclusions upon open exploration and mostly studied pre-pubertal subjects, the present results exclusively from laparoscopic exploration suggested that contralateral testis volume is a poor and inconsistent predictor of monorchism in children, and marginally predictive for young adults with unilateral non-palpable testis. This study comprised a reasonably large overall sample size compared with preceding reports; however, the number of patients within in each age group was limited. Greater numbers could allow for statistical comparison stratified by age group, for which this study was not powered.

CONCLUSION

Contralateral testis volume predicts, with modest accuracy, monorchism in adults with unilateral non-palpable testis. In younger patients, the overall predictive accuracy of scrotal testis size is poor and not consistently dependable.

Penile Length and Testicular Volume in Newborns

OBJECTIVES

To measure Penile length (PL) and Testicular volume (TV) in newborn boys for assessing genital abnormalities.

METHODS

In a tertiary care setting, measurements of PL and TV were recorded from 480 babies born on alternate days except the weekend, at 24 to 72 h of life by one investigator with the same set of instruments. The penis was stretched to the point of increased resistance and the distance from the tip of the glans penis to the pubic ramus was measured as the stretched PL. Testicular volume was measured by a Prader orchidometer. Improvised beads made of plasticine were used for recording volumes <1 ml.

RESULTS

In the study cohort, 365 (76.04 %) were term babies. The mean PL was 34 ± 4.7 mm for the whole cohort while the corresponding value for mean TV was 0.6 ± 0.2 ml. The gestation age-wise percentile charts of PL and TV have been generated. There was modest positive correlation between PL and TV. Positive correlation was also observed between PL and TV and birth weight, body length, and head, chest and arm circumference. Both PL and TV showed statistically significant increase with gestational age. By the index data, the cut-off for suspecting abnormal penile length should be <24.5 or >45.5 mm for term babies.

CONCLUSIONS

The normative values generated can serve as reference standard in the diagnosis of penile length abnormalities in Indian babies and in clarifying issues of ambiguous genitalia and maldevelopment of male external genitalia.

Measurement of Testicular Volume in healthy Nigerian newborns AT IBADAN, NIGERIA using THE PRADER Orchidometer

BACKGROUND

Determining the normal testicular volume in the newborn at birth is essential in the assessment of the degree of virilization of the external genitalia since abnormal development of the genitalia is closely related to the testicular volume in the male newborns.

OBJECTIVES

To establish a standard testicular volume (TV) for male newborn Nigerians using the Prader Orchidometer and determine the relationship between the testicular volume in the newborn and the age of the newborns at birth, the birth weight, the maternal age at delivery and the maternal parity.

METHODS

Prospective cross-sectional study of all term male neonates within 72 hours of birth from April 2013 to March 2014 in the three largest obstetric centres (University College Hospital, Adeoyo Maternity Hospital and Our Lady of Apostles Catholic Hospital) in Ibadan, Nigeria. They underwent clinical examination of the external genitalia and the testicular volumes were measured using the Prader orchidometer.

RESULTS

A total of 867 male neonates were recruited into the study with a mean age of 2.89±6.21 days. The testicular volume ranged from 1 - 3 ml on both sides with a mean right testicular volume of 1.14±0.38 ml. There was a significant correlation between gestational age as well as birth weight and the testicular volume (r = 0.146, p = 0.03).

CONCLUSION

This study has determined a normative value for testicular volume measured by Prader Orchidometer in newborns in a typical African population which could be used as a reference when evaluating neonates with patients with testicular abnormalities.

Metformin Treatment Does Not Affect Testicular Size in Offspring Born to Mothers with Gestational Diabetes

OBJECTIVES

Studies in rodents suggest that metformin treatment during pregnancy may have harmful effects on testicular development in offspring. Our aim was to determine whether metformin treatment of gestational diabetes mellitus (GDM) affects testicular size in male offspring.

METHODS

We compared the testicular size in prepubertal boys born to mothers who participated in a randomized controlled trial (RCT) comparing metformin with insulin in the treatment of GDM. Twenty-five (42.4% of invited) and 27 (52.9% of invited) boys whose mothers had been treated with metformin or insulin, respectively, participated in the study. Testicular size was measured by a ruler, an orchidometer, and by ultrasonography at the age of 33 to 85 months.

RESULTS

The mean age of the boys was 60 months at the time of examination, and did not differ between the metformin and insulin group (p = 0.88). There was no difference in testicular size between the boys in the two groups (p always ≥ 0.40), and there were no significant differences in height, weight, BMI, BMI z-score, or waist-to-hip ratio (WHR) between the boys in the groups.

CONCLUSIONS

Prepubertal testicular size did not differ between offspring born to metformin-treated mothers and those born to insulin-treated mothers.