O criptorquismo corresponde à localização extra-escrotal do testículo, . que para alguns autores, o testículo retrátil é aquele que está posicionado dentro do . Testicular microlithiasis was found in 5 children with cryptorchidism (% of A associação com a criptorquidia, testículo retrátil e a hipotrofia. Request PDF on ResearchGate | Testículo no descendido | Cuando se consulta al El testículo se denomina retráctil, oscilante o en ascensor cuando puede.
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PDF | To evaluate the prevalence of testicular microlithiasis among pediatric 4 com testículo retrátil (14,8% de 27 pacientes), 1 com hipotrofia testicular e 1. separados del epidídimo y testículo. próstata, los testículos, conductos deferentes e incluso el pene. acorde a edad y sexo, pene medial, prepucio retráctil. to define the epi- demiology of congenital cryptorchidism and testicular ascent . was previously in scrotal position, with or without retractil- ity, in 34 (44%)
Clinically 30 patients had unilateral whereas 11 had bilateral undescended testes. Inguinal testis. Abdominal testis near external iliac vein. Descent of the testis involves two different phases trans-abdominal and inguinal phase. Gubernaculum testes plays major role in descent of testes. Gubernaculum condenses during 7th week. In the trans-abdominal phase between 7th and 12th week the extra inguinal portion of gubernaculum shortens and pulls the testis down to the vicinity of deep inguinal ring.
In inguino-scrotal phase the testis remains in the vicinity of deep inguinal ring from 3rd to 7th month, but then enters the inguinal canal. By 9th month just before normal term delivery the testis have completely entered the scrotal sac Schoenwolf et al. During the trans-abdominal phase the testis is held by the gubernaculum near the inguinal region.
During inguino-scrotal phase the gubernaculum migrates and elongates towards the scrotum under androgenic action which is indirect via genitofemoral nerve GFN and release of calcitonin-Gene Related-peptide CGRP. Rhythmic contractions suggest the presence of possible smooth muscle-like components that may be modulated by CGRP release from the genitofemoral nerve.
The gubernaculum gives rise to both smooth and striated muscles. The testis is descended through processes vaginalis via the propulsive force generated by the muscles. Failure of descent is associated with the diminution of smooth muscle content and decrease in sympathetic tone that depends on androgens Tanyel, In the inguino scrotal phase of descent, androgens and pituitary hormones clearly play essential role.
In the absence of testosterone generated by Leydig cells or in the case of non functional or absent androgen receptors, testicular descent is arrested at inguino scrotal stage. Normal testicular descent is dependent on the intact hypothalamus-pituitary axis. Malformations of CNS and congenital hypogonadotrophic hypogonadism may be associated with cryptorchidism Virtanen et al.
Other factors include increased intra-abdominal temperature and HCG from maternal circulation.
Murphy et al. Maturation of germ cells starts with differentiation of gonocytes in to spermatogonia and is usually completed by the age of 6 months.
Dark A Ad spermatogonia start to appear and steadily increase in number. This number is reduced in testis of cryptorchid boys indicating that there is failure in the maturation process of the spermatogenic cells Kurpisz et al. Therefore early evaluation of this anomaly is required. Ultrasound tops the list of imaging studies for obvious advantages like availability, non-invasive nature and low cost.
The three testes missed by the ultrasound examination were found to be atrophic. Three intra-abdominal testes just proximal to the internal ring were identified by ultrasound preoperatively. Nijs et al. Retractile testis represents hyperactivity of the cremasteric reflex Tanyel. Bierklund et al. Out of undescended testicles, 47 were assessed retractile and 66 truly undescended.
In our study out of 41, 25 had unilateral and 8 had bilateral undescended testis. Incidence was observed more on right side. Phewplung et al. Undescended testes were more commonly found in inguinal canal than abdomen; finally the ultrasound findings can be useful to determine the time and also the type of surgery i.
The role of the gubernaculum in testicular descent. Ultrasound in the evaluation of retractile and truly undescended testes.
Testicular neoplasia in undescended testes of cryptorchid boys-does surgical strategy have an impact on the risk of invasive testicular neoplasia? Is there a relationship with anomalous insertions of the distal gubernaculum testis and testicular ectopia? Analysis in human fetuses and patients with cryptorchidism. High-resolution sonography of the undescended testis in childhood: an analysis of 45 cases. Advantages of video-assisted approach in detecting epididymal anomalies and treatment of nonpalpable testis.
Historical review of theories on testicular descent. A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials.
Pediatr Surg Int Pediatr Res. HCG treatment increases intratesticular pressure in the abdominal testis of unilaterally cryptorchid rats. J Androl Human chorionic gonadotrophin-induced testicular inflammation may be related to increased sensitivity to interleukin Int J Androl Acute hCG administration induces seminiferous tubule damage in the adult rat.
Acta Physiol Pharmacol Latinoam Does hCG treatment induce inflamation like changes in undescendent testes in boys? Apoptotic cell death in the normal and cryptorchid human testis: the effect of human chorionic gonadotropin on testicular cell survival.
Pediatr Res J Clin Invest Hormonal Therapy for Subfertility of Cryptorchidism. Effects of hormonal treatment on the contralateral descended testis in unilateral cryptorchidism J. Pediatric Urology 2 Nordic consensus on treatment of undescended testes. Acta Paediatr. Laparoscopic orchiopexy for the high palpable undescended testis: preliminary experience. Failed orchiopexy.
Urol Int The importance of both an early orchidopexy and germ cell maturation for fertility. Leydig cell function after Cryptorchidism: Evidence of the beneficial result of early surgery. Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome.
Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. Orchidopexy of the high undescended testis testis by division of the espermatic vessels: a critical review of 38 selected transactions.
Orchidopexy: the younger the better? J R Coll Surg Edinb Cryptorchidism is the most frequent congenital anomaly of males, and a well recognized risk factor for infertility and testicular cancer in adulthood.
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In most cases etiology is unknown. Probably, in these cases, the origin is multifactorial.
A role has been proposed for environmental agents interacting with genetic factors which disrupt the process of testicular descent. Two types of approach have been used for decades: hormonal and surgical treatment. The first reports about these therapies go back to year 2, 3. More than articles have been published so far. However, despite this large literature, strong controversies remain regarding the most convenient treatment. This is due to the lack of well designed long-term studies that would provide valid conclusions.
Presently, the optimal treatment for cryptorchidism is an important subject in international meetings. The aim of this review is to update the physiology and etiopathogenesis of cryptorchidism and to discuss pros and cons of present therapeutical options.
During the 5th-6th week of gestational age GE the undifferentiated gonad starts to develop in the mesonephros. These cells aggregate around primordial germ cells which had arrived from the yolk sac and have been differentiated into fetal gonocytes.
Thus, sex cords are formed around the th week, the first sign of differentiation of the bipotential gonad. Around the 8th week, also, the first steroid secreting Leydig cells are differentiated from interstitial cells. Testosterone induces the development of the Wolfian ducts into male gonaducts, and through its metabolite dihydrotestosterone, the differentiation of male external genitalia, between weeks th of gestation.
Leydig cell also secrete the peptide insulin-like factor 3 INSL3 , a member of the relaxin-insulin family, which plays a major role in the masculinization of gubernaculum testis, a ligament necessary for testicular descent.
The gonad is caudally bound to the mesonephros which later differentiates into the gubernaculum reaching the internal inguinal orifice. On the other hand, another ligament the cranial suspensory ligament CSL sustains the gonad to the posterior abdominal wall.
The elevation of the kidney during the th week also determines a partial descent of the testis. Around the 13th week the testis is anchored to the internal inguinal orifice by the gubernaculum testis.
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Classically, two phases are described: 1 transabdominal phase and 2 inguinal phase. In humans, these phases are completed at birth.
Hormonal regulation of the two phases is different. The testis remains anchored to the internal inguinal orifice by the gubernaculum arising from the growth of other embryonic structures. Testis and epidydimis, involved in the peritoneum, slide into the inguinal canal guided by the gubernaculum.
This phase is completed by the 15th week of gestation. Animal studies, later on confirmed in humans, identified the central role of INSL3 and its receptor LGR8 leucine-rich repeat containing G protein-coupled receptor 8 , in this phase.
INSL3 secretion increases during fetal life and during minipuberty, it then declines up to the onset of puberty when it increases again under LH stimulation. INSL3 is a sensitive marker of Leydig cell function. This is in line with the observation, in previous decades, of an increase of cryptorchidism in babies of mothers who had received the estrogen dietiletilbestrol diethylbestrol to avoid miscarriage.
These observations suggest that certain environmental factors with estrogen activity might act as endocrine disruptors to inhibit INSL3 and induce lack of testicular descent.
During this phase androgens have a lesser role, acting mainly on CSL regression. AMH might also have an effect, even though the evidence is weak. The gubernaculum is enlarged by increasing its water contents widening the inguinal canal reaching a maximum around the 7th months of fetal life. Subsequently, abdominal pressure and the retraction of the gubernaculum induce the descent of the testis along the inguinal canal. It has been described that the descent down the inguinal canal is rapid and it is completed around the 28th week.
Finally, inguino-scrotal descent is completed around the 35th week. After testicular localization at the base of the scrotum, there is fibrosis of the gubernaculum and obliteration of the peritoneal connection. Studies in mice put in evidence that AR expression in the gubernaculum is lignad-dependent.
This is why the gubernaculum is stabilized in males while it regresses in females. Human models of cryptorchidism in which there is a deficiency in androgen production are: hypogonadotropic hypogonadism, gonadotropic resistance, steroidogenic enzyme deficiency.
On the other hand, from studies in animals, it has been proposed that the effect of testosterone is indirect, mediated by calcitonin gene related peptide CGRP production in the genitofemoral nerve 5. Finally, Hoxa 10 gene mutations generate lack of development of the posterior region of the embryo including criptorchidism 6. Indeed, caudal region defects in humans are associated with criptorchidism. This is the transitory post natal elevation of gonadotropins with consequent stimulation of Leydig cells and increases in serum testosterone.
The role of this early activation of the hypothalamo-piyuitary-gonadal H-P-G axis is not clear yet, but it is postulated that it would favor the future development of fertility, among other possible functions. During this period, first semester of life, most cryptorchid testes descend. During the rest of prepuberty, gonadotropins remain very low up to the onset of puberty.
Leydig cells proliferate during minipuberty with a maximum between months of age, but they regress thereafter. Sertoli cells mature and proliferate partially but they enter full maturation at puberty when another population of Sertoli cells replace them.
These cells support a number of germ cells, and their number define future spermatogenic capacity. They secrete AMH and inhibin B. Inhibin B is the most important inhibin in males and it reflexes the functional capacity of Sertoli cells. Serum inhibin B levels remain elevated up to 15 moths of age. In advanced puberty and in adulthood there is a negative correlation between inhibin B and FSH serum levels.
Determination of serum inhibin B is useful to evaluate the testicular interstitial-tubular function. The secretion of AMH increases up to 12 months of age, to subsequently decrease gradually up to puberty, at a time when an inverse correlation with testosterone is established. In the case of a defect in testosterone synthesis, AMH levels increase significantly, both in the neonatal period and in puberty 8, 9. Development of germinal epithelium takes place in several steps starting during fetal life.
In figure 2, a brief description of this process is shown.Evaluation of oxidative DNA damage in human sperm and its association with male infertility. Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Full Text Available Objetivo. Testicular dysgenesis syndrome may be caused by genetic disorders as well as by environmental factors [ 21 ].
Orchidopexy: the younger the better? Kogan S. Nowadays, the surgical therapy for the palpable UDT is orchiopexy with creation of a subdartos pouch [ 82 ]. Best PDF online creation.