Evaluation of Human Chorionic Gonadotropin (HCG) Therapeutic Results in Patients With Unilateral cryptorchidism (Undescended Testis)

Background: Cryptorchidism or undescended testis is an evolutionary defect where one or both testes fail to descend into the scrotum. HCG causes the testes to fail, possibly due to weight gain, an increase in testicular vasculature, and stimulating the testosterone and di-hydro-testosterone. The present study has been conducted to evaluate the therapeutic effects of HCG on patients with unilateral cryptorchidism. Methods: In a prospective descriptive study, 211 patients of 8 months to 7 years old with unilateral cryptorchidism whose parents refused surgery received HCG therapy. The patients were followed up 1 month, 3months, and 12 months after the first injection. They were examined in terms of the location of testes, possible relapses, sides of undescended testes, treatment complications, and HCG therapeutic results. Results: Four weeks after the first injection, 160 patients (75.12%) out of 211 cases had the descent of testes into the inguinal canal and the scrotum. 69.5% of non-palpable abdominal testes descended into the inguinal canal, 69.7% of patients with inguinal testes, 78% of patients with supra inguinal testes and 100% of patients with retractile testis experienced the descent of testes into the scrotum. Conclusion: The therapeutic response to HCG was successful in more than 50% of the cases in all the groups. Therefore, the need for performing surgical procedures on children with unilateral cryptorchidism would be decreased and they can be treated by a cost-effective and less invasive method. Moreover, at least one-year follow-up of the patients is required to ensure outcomes of the treatment.

Clinically Differentiated Abnormalities of the Architecture and Expression of Myosin Isoforms of the Human Cremaster Muscle in Cryptorchidism and Retractile Testis

<b><i>Aim:</i></b> To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). <b><i>Background:</i></b> The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. <b><i>Subjects and Methods:</i></b> Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. <b><i>Results and Conclusions:</i></b> The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.

Five different cases of ectopic testes in children: a self-experience with literature review

BackgroundEmpty scrotum may be due to many reasons; besides true undescended testis these are monorchia, retractile testis, atrophy of testis due to torsion and ectopic testis. The location of testis in an aberrant site after passing through the inguinal canal and leaving it via external ring is a condition called ectopic testis. The most common aberrant locations of ectopic testes are superficial inguinal pouch (Denis Browne pouch), within anterior abdominal wall, perineum, femoral canal, contralateral scrotum (transverse testicular ectopia) and prepenile area.MethodsDescription of management of five different cases of ectopic testes over a period of 10 years’ experience in pediatric surgery have been done with review of the literature about this rarity.ResultsFive different cases of ectopic testes were as follows: infants 3 months of age with right ectopic testis in anterior abdominal wall near anterior superior iliac spine, 4 months of age with left perineal testis, 6 months of age with an ectopic femoral testis on left side, 8 months of age with transverse testicular ectopia on left side and 10 months of age with right true undescended testis and left perineal testis.ConclusionsSearch for ectopic sites of testes should always be in mind during examination of patients with empty scrotum. Early surgical repair of ectopic testes is recommended, as there is no chance of spontaneous correction to the normal location. Long-term follow-up is necessary due to relatively high incidence of infertility and malignant transformation. Surgeons should be aware of the rare possibility of transverse testicular ectopia in cases of inguinal hernia with impalpable testis on the contralateral side.

Scrotal Ultrasound Is Not Routinely Indicated in the Management of Cryptorchidism, Retractile Testes, and Hydrocele in Children

Cryptorchidism, or undescended testes, is the most common congenital genitourinary anomaly. A failure or delay of treatment may result in reduced fertility or an increased risk of testicular cancer. The American Urological Association (AUA) recommends that a scrotal ultrasound (SUS) not be performed in the preoperative management of cryptorchidism. This study investigated how likely pediatricians were to perform SUS despite the AUA guidelines. We retrospectively studied 243 patients referred to a single pediatric urology practice for clinically diagnosed testis pathology including undescended testis, hydrocele, and retractile testis over a 4-year period (January 1, 2015, to December 30, 2018). A total of 72 patients (29.6%) underwent a SUS ordered by their pediatrician prior to the pediatric urology visit. Pediatricians should be aware that SUS performed prior to pediatric urological evaluation does not alter management and is associated with a significant financial cost in patients with cryptorchidism or hydrocele.

A study of clinical profile of hypospadias cases at a medical college hospital of South Gujarat, India

Background: Hypospadias is a common congenital anomaly in which the anterior urethra is incompletely developed and does not extend to the tip of the glans penis. The present study was aimed to study clinical profile of hypospadias cases at a medical college hospital of southern Gujarat.Methods: This prospective study was conducted at a tertiary care hospital of South Gujarat, India including 32 patients of hypospadias. Data collected for each patient included age, sex, demography, and major symptoms, duration of symptoms and relevant past and treatment history.Results: Out of 32, 9 (28%) patients are between 4 years to 6 years of age and mean age of presentation of patients of hypospadias is 7.55 years. Twenty seven (84%) patients of Hypospadias were associated with prepucial hood, 17 (53%) patients of Hypospadias were associated with meatal stenosis, 6 (19%) patients of hypospadiasis were associated with severe chordee and 2 (6%) patients associated with narrow urethral plates.Conclusions: T Most cases of hypospadias were presented at age 9 years and below. Most common type of hypospadias was coronal and distal penile followed by penoscrotal type. Hypospadias was associated with prepucial hood (84%), meatal stenosis (53%), Chordee (19%) and narrow urethral plates (6%) out of total cases. Hypospadias was associated with undescended testis, bilateral retractile testis, cervical rib, mental retardation and microcephaly with mental retardation, squint and bifid tongue.