Cryptorchidism: Management and Implications

ISBN-13: 9783642860225 / Angielski / Miękka / 2012 / 138 str.

Faruk Hadziselimovic; F. Hinman; W. J. Cromie

Opis

Ferment, a sign of progress in any scientific field, has previously been lacking in the area of cryptorchidism, where the only activity has been in improving operative methods. Now, however, profound changes in the care of boys with cryptorchidism are being brought about; ideas are arising from a fresh look at comparative anatomy, and histological and experimental observa tions are being supplemented by clinical tests made possible by new hormonal agents. The treatment of cryptorchidism begins with its recognition by the pediatri cian, who until now has shown little interest because of disappointing results from chorionic gonadotropin administration. As for the surgeon, his bent toward restoration of normal anatomical relationships has kept his attention focused on the development of better surgical technics to bring the recalci trant testis into the scrotum. Both specialists have avoided the primordial question of why the testis did not descend properly. If this were known they would treat the cause of cryptorchidism, and not be satisfied merely with trying to correct its end result. As one reads this book, one sees that in most patients cryptorchidism is not caused by some anatomical structure blocking the way or by some deformity of the testis interfering with the transport mechanism. Rather, deficiencies in the hormonal environment of the fetus retard the developmen tal sequences essential to the normal differentiation and descent of the testis. The clinical solution is thus to provide the deficient substances."

Spis treści

1 Introduction.- 2 History and Evolution of Testicular Descent.- 2.1 History of Research into Testicular Descent and Maldescent.- 2.2 Evolution of Testicular Descent.- References.- Implications.- 3 Embryology of Testicular Descent and Maldescent.- 3.1 Indifferent Stage of Gonadal Development.- 3.2 Differentiation of the Testis.- 3.2.1 Germ Cells.- 3.2.2 Sertoli Cells.- 3.2.3 Leydig Cells.- 3.3 Male Duct Differentiation and Development.- 3.3.1 Development of the Testis Coverings.- 3.3.2 Comparison of Testicular Descent in Humans and Rodents.- 3.4 Estrogen-Induced Cryptorchidism.- 3.5 Spondaneous Congenital Cryptorchidism in Mice: Treatment with GnRH.- 3.6 Morphology and Histology of the Cryptorchid Epididymis.- References.- 4 Histology and Ultrastructure of Normal and Cryptorchid Testes.- 4.1 Development of the Normal Testis in Children.- 4.1.1 First Year of Life.- 4.1.2 Fourth Year.- 4.1.3 Puberty.- 4.2 Development of the Cryptorchid Testis.- 4.2.1 Behavior of the Number of Spermatogonia in Cryptorchid Gonads.- 4.2.1.1 In Relation to Age.- 4.2.1.2 In Relation to Position.- 4.2.2 Ultrastructure of Cryptorchid Testis.- 4.2.2.1 Germ Cells.- 4.2.2.2 Sertoli Cells.- 4.2.2.3 Peritubular Connective Tissue.- 4.2.2.4 Leydig Cells.- 4.2.3 Congenital or Acquired Lesions? Iatrogenic Cryptorchidism.- 4.2.4 Frequency and Ultrastructure of Carcinoma In Situ Cells in the Testes of Cryptorchid Children.- References.- 5 Endocrinology of the Hypothalamo-Pituitary-Gonadal Axis.- 5.1 Development of the Hypothalamo-Pituitary-Gonadal Axis During Intrauterine Life in Normal Males.- 5.2 Development of the Hypothalamo-Pituitary-Gonadal Axis in Normal Boys.- 5.3 Role of Leydig Cells.- 5.4 Mechanism of Androgen Action.- 5.5 Role of Sertoli Cells.- 5.6 Testing of the Hypothalamo-Pituitary-Gonadal Axis Utilizing GnRH.- 5.7 Development of the Hypothalamo-Pituitary-Gonadal Axis in Cryptorchid Boys.- References.- 6 Fertility in Cryptorchidism.- 6.1 Introduction.- 6.2 Factors Influencing the Interpretation of Infertility Data in Cryptorchid Patients.- 6.2.1 Patient Source.- 6.2.2 Age at Treatment.- 6.2.3 Medical VS Surgical Treatment.- 6.2.4 Location of Testis.- 6.2.5 Injury from Surgery.- 6.2.6 Method of Sperm Analysis.- 6.2.7 Definition of Infertility.- 6.3 Analysis of Extant Fertility Data.- 6.4 Special Considerations Regarding Fertility in Cryptoridism.- 6.5 Correlation of HCG-Induced Descent and Subsequent Fertility.- 6.6 Fertility in Cryptorchid Patients with Compensatory Testicular Hypertrophy.- 6.7 Evidence for a Contralateral Lesion in the Descended Testis.- References.- 7 Cryptorchidism and Malignant Testicular Disease.- 7.1 Etiologic Theories of Malignant Degeneration.- 7.2 General Risk Factors in Testicular Cancer.- 7.3 Premalignant Histologic Changes in the Cryptorchid Gonad.- 7.4 Tumor Cell Types in Undescended Testes.- 7.5 Incidence and Risk Analysis of Malignant Disease with Cryptorchidism.- 7.6 Theoretical Considerations.- References.- Treatment.- 8 Examinations and Clinical Findings in Cryptorchid Boys.- 8.1 Incidence.- 8.2 Position and Side Affected.- 8.3 Concomitant Findings.- 8.3.1 Mental and Somatic Retardation.- 8.3.2 Heredity.- 8.3.3 Torsion of Testis.- 8.3.4 Hernias, Renal Failure, and Genital Malformations.- 8.3.5 Psychic Alterations.- 8.4 Examination Technique.- References.- 9 Indications and Contraindications for Orchiopexy.- 9.1 Perform Orchiopexy.- 9.2 Perform Orchiectomy.- 9.3 Omit Surgical Treatment.- References.- 10 Hormonal Treatment.- 10.1 HCG Treatment.- 10.2 GnRH Treatment.- References.- 11 Surgical Treatment of Cryptorchidism.- 11.1 Introduction.- 11.2 Preoperative Localization of the Testis.- 11.3 Surgical Techniques.- 11.3.1 Standard Orchiopexy.- 11.3.2 Staged Orchiopexy.- 11.3.3 Fowler-Stephens (Long-Loop Vas) Orchiopexy.- 11.3.4 Microsurgical (Autotransplantation) Technique.- 11.3.5 Neonatal Transabdominal Orchiopexy.- References.- 12 Conclusions.- 12.1 The Role of the Epididymis in Testicular Descent.- 12.2 Clinical and Pathophysiological Implications in Cryptorchid Boys.- 13 Treatment Schedule.- 14 Prospectives.- References.