Your article is protected by copyright and all rights are held exclusively by Springer- Verlag Berlin Heidelberg. This e-offprint is for personal use

Size: px
Start display at page:

Download "Your article is protected by copyright and all rights are held exclusively by Springer- Verlag Berlin Heidelberg. This e-offprint is for personal use"

Transcription

1 1 23

2 Your article is protected by copyright and all rights are held exclusively by Springer- Verlag Berlin Heidelberg. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com. 1 23

3 DOI /s ORIGINAL ARTICLE Effects on normalized testicular atrophy index (TAIn) in cryptorchid infants treated with GnRHa pre and post-operative vs surgery alone: a prospective randomized trial and long-term follow-up on 62 cases Claudio Spinelli Silvia Strambi Marga Busetto Valentina Pucci Francesco Bianco Accepted: 29 July 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose The aim of this study was to investigate the effects of gonadotropin releasing hormone analog (GnRHa) therapy on normalized testicular atrophy index (TAIn) using gonadorelin before and after orchiopexy. Methods 62 infants with 87 undescended testes (UDT) were prospectively assigned to two homogeneous groups according to age, position of UDT and TAIn. The patients were randomized to receive either orchiopexy alone or orchiopexy combined with GnRHa as nasal spray at 1.2 mg daily for 4 weeks before surgery and 4 weeks after surgery. Surgical approaches were relative to the position of the UDT: Shoemakers technique in proximal-udt and Bianchi technique in distal-udt. All the patients were evaluated clinically and sonographically 1 month before surgery, at the time of surgery, 1 month, 6 months and 5 years after surgery. Results Ultrasound data in our study have shown a statistically significant decrease of TAIn in children given additional HT only after 5 years of follow-up, in unilateral cases and in the entirety of treated patients; in bilateral cases this difference was not statistically significant. Conclusion Patients with a TAIn [20 % treated with preoperative and post-operative GnRHa therapy have a significant increase in testicular volume after 5 years of follow-up, as shown by the relative reduction of TAIn values. C. Spinelli (&) S. Strambi M. Busetto V. Pucci Department of Surgical, Medical, Molecular pathology and Critical Area, Chair of Pediatric Surgery, University of Pisa, Pisa, Italy c.spinelli@dc.med.unipi.it F. Bianco Department of Physics, University of Siena, Siena, Italy Keywords Cryptorchidism Fertility Gonadotropin releasing hormone analog Human chorionic gonadotropin Luteinizing hormone-releasing hormone Normalized testicular atrophy index Orchiopexy Testicular atrophy index Testicular volume Undescended testicle Abbreviations LH Luteinizing hormone FSH Follicle-stimulating hormone MIS Müllerian inhibitor substance AMH Anti-Müllerian hormone AD-S Adult-dark spermatogonia hcg Human chorionic gonadotropin INSL3 Insulin-like 3 peptide UDT Undescended testes TV Testicular volume GnRHa Gonadotropin-releasing hormone analog LH-RHa Luteinizing hormone-releasing hormone analog TAIn Normalized testicular atrophy index HT Hormone therapy P-UDT Proximal undescended testes D-UDT Distal undescended testes TAI Testicular atrophy index SD Standard deviation Introduction The incidence of cryptorchidism is different by geographical region, ethnic group and socioeconomic status. Low rates (\3.5 per 100,000 births) are found in Tuscany, Italy [1], Atlanta, GA (USA) and Cuba, while high rates ([54 per 100,000 births) are present in Australia and New Zealand [2].

4 The pathogenesis of cryptorchidism includes genetic, hormonal and environmental factors [3]. The regulation of testicular descent is not fully explained, since it is a complex interaction between hormonal and anatomical factors. Human chorionic gonadotropin (hcg) secreted by the placenta and the fetal pituitary LH and FSH are important factors in regulating the testicular production of androgens, as well as the Insulin-like 3 peptide (INSL3) derived from the Leydig cells and MIS and AMH derived from the Sertoli cells. INSL3 is a hormone that influences the transabdominal phase of descent, promoting the growth of fetal gubernaculums [4]. Androgens have an important role in fetal development and inguinoscrotal migration; deficiencies in prenatal androgen secretion secondary to insufficient pituitary gonadotropin stimulation or low production of prenatal gonadotropin are common causes of undescended testes (UDT) [5]. At the age of 3 months, a hormonal surge of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) takes place, followed by a transient rise in testosterone, in Müllerian inhibitor substance (MIS), anti-müllerian hormone (AMH) and inhibin B. This period is known as mini puberty. Levels of testosterone decline slowly thereafter, usually by age 4 6 months, to typical childhood levels. This hormone peak seems to be necessary for the maturation of germ cells to adult-dark spermatogonia (AD-S) [6]. In cryptorchid infants, this process can be altered leading to the rise of the risk of future infertility. Histological abnormalities on UDT are characterized by a reduction of the number of Leydig cells and an altered process of transforming gonocytes into AD-S; similar but less severe histological changes can be found in the controlateral normal descended testis [7]. These data suggest a congenital malfunction of the testis that does not seem to be affected by reducing the duration of the non-scrotal position. This was further evidenced by a comparative study between descended and undescended testes of fetuses that died in the third trimester, which reported a 23 % reduction of germ cells in the undescended ones [8]. Subfertility and testicular hypotrophy are considered the principal long-term consequences of cryptorchidism [9]. Early surgical repositioning of the testis into the scrotum seems to decrease the risk of infertility and to improve subsequent testicular catch-up growth [10]. Current guidelines recommend surgical intervention before 18 months, because this may have positive effects on future fertility by preventing degenerative changes of the testis in early life [11]. The potential advantage of early surgical treatment was shown also comparing the histological and hormonal status between patients that remained cryptorchid for 9 months with those that remained cryptorchid for 3 years [12]. Despite timely and successful orchiopexy, 32 % of the patients with bilateral UDT and 10 % with unilateral UDT developed azoospermia [13]. Adults with history of orchiopexy tend to have lower sperm count than the normal population: 28 % of adult men with bilateral UDT after operation in childhood present at least 20 million sperms/ml of the ejaculate, compared to 70 % of patients underwent surgery for unilateral cryptorchidism. The fertility rate in adults with a history of bilateral UDT or unilateral UDT versus control showed rates of 62, 89 and 94 %, respectively, while the paternity proportion rates were 65.3, 89.7 and 93.2 % [14]. Testicular volume (TV) seems tobecorrelatedwiththe function of the testis in particular with the number of germ cells [12]. TV in adulthood directly and strongly correlates with fertility status, and in particular with the number of germs and Sertoli cells per tubule; these correlations appears to be less strict in childhood, with a wider range of germ cells per tubule associated with a specific TV [15]. In addition, a positive correlation was found between inhibin B levels and TV among the UDT [16]. Inhibin B is produced by Sertoli cells and its serum level reflects the histological state of the seminiferous tubules. In the series by Brakel et al. [17] the mean TV in the group of men with a history of orchiopexy was statistically smaller compared to the control group. In Kollin s study [12] thetvislargerinpatientsoperatedonat 9monthscomparedwithpatientsoperatedonat3years. Niedzielski et al. [18] suggestthatadifferenceofmore than 20 % in volume between testes should be considered as an indicator for surgical intervention even in the presence of retracted testes, in the same way that it is an indicator to treating of varicocele [19]. Gonadotropin-releasing hormone analog (GnRHa) also known as luteinizing hormone-releasing hormone analog (LH-RHa) therapy seems to be able to correct the testicular histological abnormalities of germ cells [16]. The purpose of this study is to investigate the effects on normalized testicular atrophy index (TAIn), in cryptorchid children, with preoperative and post-operative administration of GnRHa versus surgery alone. This evaluation is performed also on unilateral and bilateral UDT subgroups. Materials and methods The study, a prospective randomized trial, included in its final iteration 62 children with 87 UDT who underwent orchiopexy from January 2007 to December 2008 in Pediatric Surgery at the Department of Surgical, Medical, Molecular pathology and Critical Area of University of Pisa, Italy, the same founding institution. The following parameters were analyzed: age (14 52 months, median 28.5), position (low/high),

5 Table 1 Mean age, laterality of UDT, position of UDT and surgical technique by groups (surgery alone vs. surgery? HT) Cases (n = 62) Group A (n = 31) surgery alone Group B (n = 31) surgery? HT P value Age in months, mean (SD) UDT laterality, cases (%) 29 (9) 27 (10) NS (0.895) Unilateral 37 (59.7) 19 (61.3) 18 (58.1) NS (0.796) Bilateral 25 (40.3) 12 (38.7) 13 (41.9) NS (0.796) Right 22 (59.5) 10 (52.6) 12 (66.6) NS (0.385) Left 15 (40.5) 9 (47.4) 6 (33.4) NS (0.385) UDT position, cases (%) Low 13 (21) 6 (19.4) 7 (22.6) NS (0.755) High 49 (79) 25 (80.6) 24 (77.4) NS (0.755) Orchiopexy, cases (%) Shoemakers 49 (79) 25 (80.6) 24 (87.4) NS (0.755) Bianchi 13 (21) 6 (19.4) 7 (22.6) NS (0.755) laterality (left/right or bilateral), surgical procedure and testicular volume (Table 1). All the ultrasound examinations have been performed with Toshiba units with linear array 7.5 and 10 MHz transducers. The TV has been calculated utilizing the formula for determining the volume of an ellipsoid, directly from the scrotal ultrasound measurements: TV (ml) = p/ 6 9 (length 9 width 9 height) [20]. TAIn has been calculated as: [(normative values of testis volume from literature - affected testis/es mean volume)/ normative values of testis volume from literature] We used normative values of testicular volume for age measured by ultrasonography in a normal population by Goede et al. [21]. Only patients with TAIn [20 % were included in our study. The a priori exclusion criteria were abdominal testes, retracted testes, previous groin surgery, multi-system anomalies and previous hormonal manipulations or failed orchiopexy. No a priori quantitative hypothesis on the effect of hormone therapy (HT) was possible at the beginning of the study, so no statistical power analysis could be performed to evaluate the population needed. The number of patients is then limited by the availability of cases for the follow-up analysis, which imposes to use cases until We evaluated 78 patients; 5 of them were excluded because they fell within the exclusion criteria. Furthermore, the complete population at disposal is at the present day of 73 children: 11 (4 in the HT group and 7 in the surgery alone) were dropped from this study in the analysis process both by being outliers in regard to the age distribution (4 cases for the HT group and 6 for the surgery alone) and to achieve a 1:1 ratio between the two groups Fig. 1 Flow diagram of study design (another case is then dropped from the surgery alone group) (Fig. 1). The same surgeon has performed all operations. All patients had UDT in intracanalicular position. In case of palpable testes located in the proximal portion of the inguinal tract, proximal undescended testes (P-UDT), Shoemakers procedure was performed [22]; in presence of palpable testes located in the distal portion of the inguinal tract and such as to reach the scrotum without tension, distal undescended testes (D-UDT), Bianchi [23] operation was the choice. The patients were prospectively randomized in two homogenous groups according to a stratified randomization: we kept them balanced in respect to the mentioned parameters of age, UDT position and UDT laterality, whereas the homogenization of the surgical procedure followed as a consequence. After 10 cases for both groups with simple randomization, patients were assigned to a specific one according to a minimization criterion on the difference on clinical parameters, achieved using Minim. Blinding procedure was not performed due to strict indications from our ethics committee. However, the physician responsible for prescription and monitoring HT was different from the surgeon, ultrasound sonographers and physicians in charge of patient care.

6 Table 2 Mean TAIn (%) of unilateral, bilateral and total population by groups, at evaluation time Ultrasound Unilateral, mean (SD) Group A surgery alone Group B surgery? HT P value 1 month (before surgery) 37.0 (22.3) 36.6 (11.9) NS (0.474) Time of surgery 37.3 (27.9) 40.4 (12.7) NS (0.329) 1 month (after surgery) 17.1 (14.3) 18.9 (15.4) NS (0.357) 6 months (after surgery) 23.1 (16.3) 17.3 (14.9) NS (0.134) 5 years (after surgery) 21.3 (18.4) -7.8 (15.7) \0.005 (0.001) Bilateral mean (SD) 1 month (before surgery) 44.9 (17.6) 45.5 (13.2) NS (0.462) Time of surgery 47.6 (28.2) 47.5 (25.3) NS (0.498) 1 month (after surgery) 34.7 (14.5) 31.2 (17.6) NS (0.297) 6 months (after surgery) 32.2 (13.9) 30.2 (21.6) NS (0.393) 5 years (after surgery) 35.7 (24.9) 33.0 (14.9) NS (0.370) Total, mean (SD) Time of surgery 40.2 (27.2) 43.8 (13.6) NS (0.253) 1 month (after surgery) 25.9 (15.3) 25.1 (13.4) NS (0.408) 6 months (after surgery) 27.6 (18.1) 30.2 (13.9) NS (0.269) 5 years (after surgery) 28.5 (17.4) 18.2 (18.4) \0.05 (0.014) Group A included 31 (50 %) patients who underwent orchiopexy alone; the second group (Group B) included 31 patients (50 %) who received A GnRh analog, Gonadorelin, as intranasal spray at 1.2 mg daily for 4 weeks immediately before surgery and for 4 weeks after surgery. Gonadorelin determines the hypothalamic pituitary release of gonadotropins, LH and FSH. Its choice was based on its ease of administration as nasal spray, low rate of side effects and effectiveness. All patients were evaluated clinically and ultrasonographically 1 month before surgery, at the time of surgery, 1 month, 6 months and 5 years after surgery. Statistical comparisons between the two groups were performed using one-tailed Student s t test and Fisher exact test, with statistical significance considered at P \ Parental consent was obtained for all patients for the HT, the surgical treatments and for the inclusion in the trail. The institutional review board and independent ethics committees of our hospital, in accordance with the Helsinki Declaration, approved all aspects of this study. Results Of the 31 children who underwent surgery alone (Group A): 19 presented unilateral cryptorchidism and 12 a bilateral condition. Of the 31 children who underwent surgery plus HT (Group B): 18 presented unilateral cryptorchidism and 13 a bilateral condition (Table 1). No immediate or late post-operative complications occurred in either study group and hormonal treatment was well tolerated without any side effects, except for a slight increase in penis size (Grade I [24]). At the time of follow-up, all patients had testes located in the scrotum, with a 100 % success rate of orchiopexy in both groups. Average TAIn by group of patients with unilateral or bilateral cryptorchidism at every time point is listed in Table 2. The mean TAIn in unilateral cases after 5 years in the surgery alone group (Group A) was 21.3 versus -7.8 in the additional HT group (Group B). The mean TAIn in bilateral patients after 5 years in Group A was 35.7 while it was 33.0 in Group B. Finally, the mean TAIn in the globality of cryptorchid patients after 5 years in Group A was 28.5 whereas it was 18.2 in Group B. The difference in TAIn between the Groups A and B was statistically significant only after 5 years in patients with unilateral cryptorchidism; in case of bilateral cryptorchidism instead, the difference is never statistically significant (Table 2) (Figs. 2, 3). The difference between groups A and B when considered in their entirety (unilateral and bilateral patients together) after 5 years of followup was statistically significant (Table 2) (Fig. 4). Discussion Recently HT has been recommended as an adjuvant to orchiopexy [25], Schwentner [26] performed the first prospective randomized controlled trials assessing the role of preoperative GnRHa therapy in infants with UDT. This study compared a group of infants receiving HT for 4 weeks before surgery to a group of infants undergoing

7 Fig. 2 Mean TAIn (%) ±SD for unilateral cases by groups, at evaluation time Fig. 3 Mean TAIn (%) ±SD for bilateral cases by groups, at evaluation time Fig. 4 Mean TAIn (%) ±SD for total population by groups, at evaluation time

8 surgery alone; biopsy was taken at the time of surgery for all patients. The overall fertility index was significantly higher in the GnRHa group compared to the control. Similar results were produced in another prospective randomized trial in boys with unilateral UDT [25]. Adjuvant hormone therapy, given 1 month before surgery may reduce certain outstanding surgical difficulties presented when the scrotum is underdeveloped or when the testis is malformed, small or associated with short vessels; GnRHa, in fact, is known to elongate the cord structures and enlarge the inguinal canal by stimulating the natural process of development [26]. Moreover, German guidelines and the European Society of Pediatric Urologists are in favor of using GnRHa, prior to, or after orchiopexy, to improve fertility in UDT children; in contrast, other guidelines suggest that HT is ineffective and should not be recommended [27]. Potential disadvantages of HT are cost, delay of surgery and side effects, as accelerated secondary sexual characteristic, premature epiphyseal closure and an aggressive behavior of the child during the treatment usually recedes after cessation of therapy. Current reports [10, 28] suggest that the cases of cryptorchidism that may benefit from supplementary gonadotropin treatment are those with bilateral cryptorchidism, normal LH and FSH levels and those with a decreased germ cell number in the biopsy. In our study, to discern the presence of an effect of HT we decided to consider the Testicular Atrophy Index (TAI), introduced by Niedzielski et al. and defined as: (contralateral testis volume - affected testis volume)/contralateral testis volume 9 100, expressed as a percent [18]. However, this parameter is applicable only in unilateral cryptorchidism, because it is based on the volumetric difference between the normally descended testis and the affected testis. Due to the necessity to consider also the case of bilateral cryptorchidism, we have introduced a new parameter, the normalized testicular atrophy index (TAIn), based on the difference between the mean volume of normally descended testis from the literature for age [21] and the mean volume of the two affected testes. To unify the data of the study, the employ of TAIn has been extended to unilateral cases. It is worth noting that in our population the TV of the NDT of unilateral cryptorchid, considering both pre-surgery values and follow-up values to widen the age interval, is compatible to the one presented in the literature and used in this study. Ultrasound data in our study have shown a statistical decrease of TAIn in the follow-up only after 5 years in children who received additional HT, in unilateral cases and in the totality of treated patients; in bilateral cases this difference was not statistically significant, probably due to the limited number of cases compared with the unilateral ones. This leads to a lower significance value for total cases, being the sum of the two populations. However, the findings of our study must be taken with caution because we do not know if the decrease in TAIn reached in the group of patients treated with HT after 5 years of follow-up will persist over time into adulthood. For this reason, we are currently evaluating the possibility of longer term follow-up on the subject population of this study with the aim of determining their functional activity in adulthood. Conclusions In our experience, TAIn turned out to be a useful parameter to monitor the results of HT on testicular growth, especially in case of bilateral cryptorchidism. Our results indicate that patients with a TAIn [20 % treated with preoperative and post-operative GnRHa therapy have a significant increase in TV after 5 years of follow-up, as shown by the relative reduction of TAIn values. References 1. Ghirri P, Ciulli C, Vuerich M et al (2002) Incidence at birth and natural history of cryptorchidism: a study of consecutive male infants. J Endocrinol Invest 25: Serrano T, Chevrier C, Multigner L et al (2013) International geographic correlation study of the prevalence of disorders of male reproductive health. Hum Reprod 28(7): Quin XY, Kojima Y, Ueoka K et al (2012) Association of variants in genes involved in environmental chemical metabolism and risk of cryptorchidism and hypospadias. J Human Genetics 57: Bay K, Andersson AM (2011) Human testicular insulin-likefactor 3: in relation to development, reproductive hormones and andrological disorders. Int J Androl 34: Hutson JM, Southwell BR, Li R et al (2013) The regulation of testicular descent and the effects of cryptorchidism. Endocr Rev 34(5): Hadziselimovic F, Zivkovic D, Bica DT et al (2005) The importance of mini-puberty for fertility in cryptorchidism. J Urol 174: Zivkovic D, Bica DG, Hadziselimovic F (2005) Effecs of hormonal treatment on the controlateral descended testis in unilateral cryptorchidism. J Ped Urology 2: Cortes D, Thorup JM, Beck BL (1995) Quantitative histology of germ cells in the undescended testes of human fetuses, neonates and infants. J Urol 154(3): Virtanen HE, Bjerknes R, Cortes D et al (2007) Cryptorchidism: classification, prevalence and long-term consequences. Acta Paediatr 96(5): Kim SO, Hwang EC, Hwang IS et al (2011) Testicular catch up growth: the impact of orchiopexy age. Urology 78(4): Rey RA (2012) Early orchiopexy to prevent germ cell loss during infancy in congenital cryptorchidism. J Clin Endocrinol Metab 97: Kollin C, Stukenborg B, Nurmio M et al (2012) Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at

9 9 months or 3 years of age. J Clin Endocrinol Metab 97: Hadziselimovic F, Hadziselimovic NO, Demougin P et al (2011) Testicular gene expression in cryptorchid boys at risk of azoospermia. Sex Dev 5: Lee PA, O Leary LA, Songer NJ et al (1997) Paternity after cryptorchidism. A controlled study. Arch Pediatr Adolesc Med 151: Noh PH, Cooper CS, Snyder HM 3rd, Zderic SA, Canning DA, Huff DS (2000) Testicular volume does not predict germ cell count in patients with cryptorchidism. J Urol 163(2): Hadziselimovic F (2008) Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue. Int Braz J Urol 34(3): Brakel JV, Kranse R, de Muinck Keizer-Schrama SMPF et al (2013) Fertility in men with a history of congenital undescended testes: a long-term follow-up study. Andrology 1: Niedzielski J, Pisarska K, Przewratil P (2003) The usefulness of testicular atrophy index in the assessment of undescended testicle-preliminary report. Rocz Akad Bialymst 48: Spinelli C, Di Giacomo M, Lo Piccolo R et al (2010) The role of testicular volume in adolescents with varicocele: the better way and time of surgical treatment. J Urol 184: Kuijper EA, van Kooten J, Verbeke JI et al (2008) Ultrasonographically measured testicular volumes in 0 6-year-old boys. Hum Reprod 23(4): Goede J, Hack WW, Sijstermans K et al (2011) Normative values for testicular volume measured by ultrasonography in a normal population from infancy to adolescence. Horm Res Paediatr 76(1): Thorup J, Haugen S, Kollin C et al (2007) Surgical treatment of undescended testes. Acta Paediatr 96(5): Gordon M, Cervellione RM, Morabito A et al (2010) 20 years of transcrotal orchidopexy for undescended testis: results and outcomes. J Pediatr Urol 6(5): Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240: Jallouli M, Rebai T, Abid N et al (2009) Neoadjuvant gonadotropin-releasing hormone therapy before surgery and effects on fertility index in unilateral undescended testes. A prospective randomized trial. Urology 73: Schwentner C, Oswald J, Kreczy A et al (2005) Neoadiuvant gonadotropin-realising hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 173: Ludwikowski B, Gonzales R (2013) The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature. Eur J Pediatr 172(1): Thorup J, Kvist K, Clasen-Linde E et al (2013) The relation between adult dark spermatogonia and other parameters of fertility potential in cryptorchid testes. J Urology 190:

Neoadjuvant human Chorionic Gonadotropin (hcg) therapy may improve the position of undescended testis: a preliminary report

Neoadjuvant human Chorionic Gonadotropin (hcg) therapy may improve the position of undescended testis: a preliminary report 224 Original Paper PEDIATRIC UROLOGY Neoadjuvant human Chorionic Gonadotropin (hcg) therapy may improve the position of undescended testis: a preliminary report Piotr Kucharski, Jerzy Niedzielski Department

More information

Maldescended testis in Adults. Dr. BG GAUDJI Urologist STEVE BIKO ACADEMIC HOSPITAL

Maldescended testis in Adults. Dr. BG GAUDJI Urologist STEVE BIKO ACADEMIC HOSPITAL Maldescended testis in Adults Dr. BG GAUDJI Urologist STEVE BIKO ACADEMIC HOSPITAL Definitions Cryptorchid: testis neither resides nor can be manipulated into the scrotum Ectopic: aberrant course Retractile:

More information

Role of Human Chorionic Gonadotropin (HCG) Hormone in Undescended Testis a Prospective Study in 100 Children

Role of Human Chorionic Gonadotropin (HCG) Hormone in Undescended Testis a Prospective Study in 100 Children Role of Human Chorionic Gonadotropin (HCG) Hormone in Undescended Testis a Prospective Study in 100 Children BA CHEECHAK 1 MY WANI 2 A HUSSAIN 3 G HASSAN 4 This is a prospective study of 100 children (122

More information

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1 CASE REPORT Cryptorchidism and its impact on male fertility: a state of art review of current literature Eric Chung, MBBS, FRACS; Gerald B. Brock, MD, FRCSC Division of Urology, University of Western Ontario,

More information

UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA DOCTORAL SCHOOL. PHD THESIS UNDESCENDED TESTICLE IN CHILD CLINICAL AND THERAPEUTIC ASPECTS - Abstract -

UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA DOCTORAL SCHOOL. PHD THESIS UNDESCENDED TESTICLE IN CHILD CLINICAL AND THERAPEUTIC ASPECTS - Abstract - UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA DOCTORAL SCHOOL PHD THESIS UNDESCENDED TESTICLE IN CHILD CLINICAL AND THERAPEUTIC ASPECTS - Abstract - SCIENTIFIC COORDINATOR: Prof. Dr. Ion GEORGESCU PHD

More information

The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment

The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment Claudio Spinelli, Martina Di Giacomo, Roberto Lo Piccolo, Alessandra Martin and Antonio Messineo

More information

Personal Practice. Cryptorchidism: What s New?

Personal Practice. Cryptorchidism: What s New? Personal Practice Cryptorchidism: What s New? Anup Mohta Undescended testis (UDT), also known as cryptorchidism, is defined as a condition in which testis cannot be made to reach the bottom of the scrotum.

More information

W.S. O University of Hong Kong

W.S. O University of Hong Kong W.S. O University of Hong Kong Development of the Genital System 1. Sexual differentiation 2. Differentiation of the gonads a. Germ cells extragonadal in origin b. Genital ridge intermediate mesoderm consisting

More information

DISORDERS OF MALE GENITALS

DISORDERS OF MALE GENITALS Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 9. Testicular disorders/disorders of male genitals. Horm Res 2007;68(suppl 2):63 66 ESPE Code Diagnosis OMIM ICD10

More information

Different surgical findings in congenital and acquired undescended testes

Different surgical findings in congenital and acquired undescended testes BJUI BJU INTERNATIONAL Different surgical findings in congenital and acquired undescended testes Jocelyn van Brakel, Gert R. Dohle, Sabine M.P.F. de Muinck Keizer-Schrama * and Frans W. Hazebroek Urology,

More information

Undescended Testicles, Retractile Testicles, and Testicular Torsion

Undescended Testicles, Retractile Testicles, and Testicular Torsion Undescended Testicles, Retractile Testicles, and Testicular Torsion This guideline, developed by Ashay Patel, D.O., in collaboration with the ANGELS team, on October 14, 2013. Last reviewed by Ashay Patel,

More information

Reproduction. AMH Anti-Müllerian Hormone. Analyte Information

Reproduction. AMH Anti-Müllerian Hormone. Analyte Information Reproduction AMH Anti-Müllerian Hormone Analyte Information - 1-2011-01-11 AMH Anti-Müllerian Hormone Introduction Anti-Müllerian Hormone (AMH) is a glycoprotein dimer composed of two 72 kda monomers 1.

More information

DAX1, testes development role 7, 8 DFFRY, spermatogenesis role 49 DMRT genes, male sex differentiation role 15

DAX1, testes development role 7, 8 DFFRY, spermatogenesis role 49 DMRT genes, male sex differentiation role 15 Subject Index N-Acetylcysteine, sperm quality effects 71 Ambiguous genitalia, origins 1, 2 Anti-Müllerian hormone function 13 receptors 13 Sertoli cell secretion 10, 38 Apoptosis assays in testes 73, 74

More information

UCSF Pediatric Urology Child and Family Information Material

UCSF Pediatric Urology Child and Family Information Material UCSF Pediatric Urology Child and Family Information Material ------------------------------------------------------------------------ The Undescended Testicle What is an Undescended Testicle? The undescended

More information

International Journal of Scientific & Engineering Research Volume 8, Issue 9, September ISSN

International Journal of Scientific & Engineering Research Volume 8, Issue 9, September ISSN International Journal of Scientific & Engineering Research Volume 8, Issue 9, September-2017 1031 Undescended Testicle Surgical Repair procedures, efficiency and outcomes, Review Authors: Nawal Swailem

More information

Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience pissn: 8748 / eissn: 87469 World J Mens Health 4 August (): 5 http://dx.doi.org/.554/wjmh.4... Original Article Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

More information

Management of undescended testis may be improved with educational updates and new transferring model

Management of undescended testis may be improved with educational updates and new transferring model Yi et al. Italian Journal of Pediatrics (2018) 44:58 https://doi.org/10.1186/s13052-018-0499-4 RESEARCH Open Access Management of undescended testis may be improved with educational updates and new transferring

More information

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth Link to publication Citation for published version (APA): de Vries, A. (2014). Testing the undescended testis General

More information

Prevalence and Pathological Features of Cryptorchidism among Iranian Children in Yazd Province, Central Iran

Prevalence and Pathological Features of Cryptorchidism among Iranian Children in Yazd Province, Central Iran http:// ijp.mums.ac.ir Original Article (Pages: 7615-7621) Prevalence and Pathological Features of Cryptorchidism among Iranian Children in Yazd Province, Central Iran Abdolhamid Amooei 1, *Saeid Kargar

More information

Comparison of penile length at 6 24 months between children with unilateral cryptorchidism and a healthy normal cohort

Comparison of penile length at 6 24 months between children with unilateral cryptorchidism and a healthy normal cohort Original Article - Pediatric Urology Investig Clin Urol 2018;59:55-60. pissn 2466-0493 eissn 2466-054X Comparison of penile length at 6 24 months between children with unilateral cryptorchidism and a healthy

More information

Undescended testis varying presentation - Clinical research study

Undescended testis varying presentation - Clinical research study Original Research Article Undescended testis varying presentation - Clinical research study S. C. Naren Kumar 1*, Bharathidasan 2, G. Ambujam 3 1 Postgraduate, 2 Associate Professor, 3 Professor and Head

More information

Case Based Urology Learning Program

Case Based Urology Learning Program Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 5 CBULP 2011 021 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,

More information

TESTOSTERONE DEFINITION

TESTOSTERONE DEFINITION DEFINITION A hormone that is a hydroxyl steroid ketone (C19H28O2) produced especially by the testes or made synthetically and that is responsible for inducing and maintaining male secondary sex characteristics.

More information

Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism

Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism Journal of Reproduction & Contraception (2004) 15 (3):139-143 Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism P. Tzvetkova 1, Wei-Jie ZHU 2, D. Tzvetkov 3 1. Department of Immunoneuroendocrinology,

More information

Descent of the Testis

Descent of the Testis Descent of the Testis John M. Hutson Jørgen M. Thorup Spencer W. Beasley Descent of the Testis Second Edition John M. Hutson Royal Children s Hospital University of Melbourne Parkville, Victoria Australia

More information

IN SUMMARY HST 071 NORMAL & ABNORMAL SEXUAL DIFFERENTIATION Fetal Sex Differentiation Postnatal Diagnosis and Management of Intersex Abnormalities

IN SUMMARY HST 071 NORMAL & ABNORMAL SEXUAL DIFFERENTIATION Fetal Sex Differentiation Postnatal Diagnosis and Management of Intersex Abnormalities Harvard-MIT Division of Health Sciences and Technology HST.071: Human Reproductive Biology Course Director: Professor Henry Klapholz IN SUMMARY HST 071 Title: Fetal Sex Differentiation Postnatal Diagnosis

More information

MANAGEMENT OF UNDESCENDED TESTES IN A TERTIARY CARE HOSPITAL: A STUDY FROM CENTRAL INDIA M. Maheshwari 1, Roshan Chanchlani 2

MANAGEMENT OF UNDESCENDED TESTES IN A TERTIARY CARE HOSPITAL: A STUDY FROM CENTRAL INDIA M. Maheshwari 1, Roshan Chanchlani 2 MANAGEMENT OF UNDESCENDED TESTES IN A TERTIARY CARE HOSPITAL: A STUDY FROM CENTRAL INDIA M. Maheshwari 1, Roshan Chanchlani 2 HOW TO CITE THIS ARTICLE: M. Maheshwari, Roshan Chanchlani. Management of Undescended

More information

Testicular microlithiasis and testicular volume in boys with Down syndrome

Testicular microlithiasis and testicular volume in boys with Down syndrome Chapter 2.5 Testicular microlithiasis and testicular volume in boys with Down syndrome J Goede ME Weijerman CJM Broers JP de winter LM van der Voort-Doedens WWM Hack J Urol, in press 81 Chapter 2.5 Abstract

More information

Chapter 28: REPRODUCTIVE SYSTEM: MALE

Chapter 28: REPRODUCTIVE SYSTEM: MALE Chapter 28: REPRODUCTIVE SYSTEM: MALE I. FUNCTIONAL ANATOMY (Fig. 28.1) A. Testes: glands which produce male gametes, as well as glands producing testosterone 2. Seminiferous tubules (Fig.28.3; 28.5) a.

More information

Long-Term Outcomes of Retractile Testis

Long-Term Outcomes of Retractile Testis www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53.9.649 Pediatric Urology Long-Term Outcomes of Retractile Testis Jae Jun Bae, Bum Soo Kim, Sung Kwang Chung Department of Urology, Kyungpook National

More information

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth Link to publication Citation for published version (APA): de Vries, A. (2014). Testing the undescended testis General

More information

Outline. Male Reproductive System Testes and Sperm Hormonal Regulation

Outline. Male Reproductive System Testes and Sperm Hormonal Regulation Outline Male Reproductive System Testes and Sperm Hormonal Regulation Female Reproductive System Genital Tract Hormonal Levels Uterine Cycle Fertilization and Pregnancy Control of Reproduction Infertility

More information

Chapter 14 Reproduction Review Assignment

Chapter 14 Reproduction Review Assignment Date: Mark: _/45 Chapter 14 Reproduction Review Assignment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Use the diagram above to answer the next question.

More information

Yutaka; SAKAMOTO, Hiromi. Citation 泌尿器科紀要 (1986), 32(10):

Yutaka; SAKAMOTO, Hiromi. Citation 泌尿器科紀要 (1986), 32(10): Title46XX male; report of case OKUYAMA, Akihiko; KONDO, Nobuyuki; Author(s) NAKAMURA, Masahiro; SONODA, Takao; Yutaka; SAKAMOTO, Hiromi Citation 泌尿器科紀要 (1986), 32(10): 1539-1542 Issue Date 1986-10 URL

More information

Hormones of brain-testicular axis

Hormones of brain-testicular axis (Hormone Function) Hormones of brain-testicular axis anterior pituitary drives changes during puberty controlled by GnRH from hypothalamus begins to secrete FSH, LH LH targets interstitial endocrinocytes

More information

Laparoscopy in the Management of Impalpable Testicle

Laparoscopy in the Management of Impalpable Testicle Acta chir belg, 2005, 105, 662-666 Laparoscopy in the Management of Impalpable Testicle N. Satar, Y. Bayazıt, Ş. Doran Çukurova University, Faculty of Medicine, Department of Urology, Balcalı Hospital,

More information

Optimum Time for Orchiopexy in Cryptorchidism

Optimum Time for Orchiopexy in Cryptorchidism Optimum Time for Orchiopexy in Cryptorchidism Frank Hinman, Jr., M.D. THE RESULTS of orchiopexy are disappointing. Is it that the surgical procedure is faulty, or can the defect be in the patient or in

More information

ESUR SCROTAL AND PENILE IMAGING WORKING GROUP MULTIMODALITY IMAGING APPROACH TO SCROTAL AND PENILE PATHOLOGIES 2ND ESUR TEACHING COURSE

ESUR SCROTAL AND PENILE IMAGING WORKING GROUP MULTIMODALITY IMAGING APPROACH TO SCROTAL AND PENILE PATHOLOGIES 2ND ESUR TEACHING COURSE ESUR SCROTAL AND PENILE IMAGING WORKING GROUP MULTIMODALITY IMAGING APPROACH TO SCROTAL AND PENILE PATHOLOGIES 2ND ESUR TEACHING COURSE NORMAL ANATOMY OF THE SCROTUM MICHAEL NOMIKOS M.D. F.E.B.U. UROLOGICAL

More information

Nordic consensus on treatment of undescended testes

Nordic consensus on treatment of undescended testes Acta Pædiatrica ISSN 0803 5253 REVIEW ARTICLE Nordic consensus on treatment of undescended testes E. Martin Ritzén (Martin.Ritzen@ki.se) 1, A Bergh 2, R Bjerknes 3, P Christiansen 4, D Cortes 4,5, SE Haugen

More information

A COMPARATIVE STUDY OF GERM CELL KINETICS IN THE TESTES OF CHILDREN WITH UNILATERAL CRYPTORCHIDISM: A PRELIMINARY REPORT*

A COMPARATIVE STUDY OF GERM CELL KINETICS IN THE TESTES OF CHILDREN WITH UNILATERAL CRYPTORCHIDISM: A PRELIMINARY REPORT* FERTILITY AND STERILITY Copyright 1970 by the Williams & Wilkins Co. Vol. 21, No. 11, November 1970 Printed in U.S.A. A COMPARATIVE STUDY OF GERM CELL KINETICS IN THE TESTES OF CHILDREN WITH UNILATERAL

More information

Reproductive FSH. Analyte Information

Reproductive FSH. Analyte Information Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary

More information

PERSISTANT MULLERIAN DUCT SYNDROME ASSOCIATED WITH TRANSVERSE TESTICULAR ECTOPIA

PERSISTANT MULLERIAN DUCT SYNDROME ASSOCIATED WITH TRANSVERSE TESTICULAR ECTOPIA PERSISTANT MULLERIAN DUCT SYNDROME ASSOCIATED WITH TRANSVERSE TESTICULAR ECTOPIA Dr. Abdulrahman A. Al-Bassam, FRCS(Ed) Assistant Professor & Consultant Paediatric Surgeon King Khalid University Hospital

More information

Management of gonads in DSD

Management of gonads in DSD Management of gonads in DSD Martine Cools, paediatric endocrinologist, Katja Wolffenbuttel and Piet Hoebeke, paediatric urologists, all at University Hospital Ghent, Belgium Sten Drop, paediatric endocrinologist

More information

Ultrasonographically measured testicular volumes in 0- to 6-year-old boys

Ultrasonographically measured testicular volumes in 0- to 6-year-old boys Human Reproduction Vol.23, No.4 pp. 792 796, 2008 Advance Access publication on February 15, 2008 doi:10.1093/humrep/den021 Ultrasonographically measured testicular volumes in 0- to 6-year-old boys E.A.M.

More information

Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy

Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy Chapter 4.1 Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy WWM Hack LM van der Voort-Doedens J Goede JM van Dijk RW Meijer

More information

MALE INFERTILITY & SEMEN ANALYSIS

MALE INFERTILITY & SEMEN ANALYSIS MALE INFERTILITY & SEMEN ANALYSIS DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential

More information

Prevalence of testicular microlithiasis in boys aged 0 to 19 years referred for scrotal pathology

Prevalence of testicular microlithiasis in boys aged 0 to 19 years referred for scrotal pathology Chapter 2.3 Prevalence of testicular microlithiasis in boys aged 0 to 19 years referred for scrotal pathology J Goede HA Hofman AM Wagenvoort FH Pierik WWM Hack Nephro-Urol Mon, in press 59 Chapter 2.3

More information

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring HUMAN REPRODUCTION Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring Asexual vs Sexual Reproduction Remember: Asexual reproduction:

More information

Different aspects of congenital undescended testis

Different aspects of congenital undescended testis Different aspects of congenital undescended testis chapter : DIFFERENT ASPECTS OF CONGENITAL UNDESCENDED TESTIS Synopsis: In this chapter the surgical aspects of congenital undescended testis, as found

More information

Male History, Clinical Examination and Testing

Male History, Clinical Examination and Testing Male History, Clinical Examination and Testing Dirk Vanderschueren, MD, PhD Case Jan is 29 years old and consults for 1 year primary subfertility partner 28 years old and normal gynaecological investigation

More information

Surgical management of the undescended testis is performed

Surgical management of the undescended testis is performed Undescended Testes/Orchiopexy James C.Y. Dunn, MD, PhD, 1 Akemi L. Kawaguchi, MD, 2 and Eric W. Fonkalsrud, MD 1 Surgical management of the undescended testis is performed to prevent the potential complications

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,

More information

10.7 The Reproductive Hormones

10.7 The Reproductive Hormones 10.7 The Reproductive Hormones December 10, 2013. Website survey?? QUESTION: Who is more complicated: men or women? The Female Reproductive System ovaries: produce gametes (eggs) produce estrogen (steroid

More information

Plasma testosterone response at 1 st and 4 th day after shortand long-term hcg stimulation test

Plasma testosterone response at 1 st and 4 th day after shortand long-term hcg stimulation test ---> The Turkish Journal of Pediatrics 2004; 46: 309-314 Original Plasma testosterone at 1 st and 4 th day after shortand long-term hcg stimulation test Pelin Adýyaman, Gönül Öcal, Merih Berberoðlu, Zehra

More information

Testicular Toxicity: Evaluation During Drug Development Guidance for Industry

Testicular Toxicity: Evaluation During Drug Development Guidance for Industry Testicular Toxicity: Evaluation During Drug Development Guidance for Industry DRAFT GUIDANCE This guidance document is being distributed for comment purposes only. Comments and suggestions regarding this

More information

Clinical Study Laparoscopic Management of Intra-Abdominal Testis: 5-Year Single-Centre Experience A Retrospective Descriptive Study

Clinical Study Laparoscopic Management of Intra-Abdominal Testis: 5-Year Single-Centre Experience A Retrospective Descriptive Study Minimally Invasive Surgery Volume 2012, Article ID 878509, 4 pages doi:10.1155/2012/878509 Clinical Study Laparoscopic Management of Intra-Abdominal Testis: 5-Year Single-Centre Experience A Retrospective

More information

Male Reproductive System

Male Reproductive System 21-1 21-2 Reproductive System Male Reproductive System Genital Tract In males the testes, held outside the body in the scrotum (optimum temp of about 35 0 C), produce sperm. Sperm mature in coiled tubes

More information

Biology of Reproduction-Biol 326

Biology of Reproduction-Biol 326 Biology of Reproduction-Biol 326 READ ALL INSTRUCTIONS CAREFULLY. ANSWER ALL THE QUESTIONS ON THE ANSWER SHEET. THE ANSWER ON THE ANSWER SHEET IS YOUR OFFICIAL ANSWER REGARDLESS OF WHAT YOU MARK ON THE

More information

Clinical evaluation of infertility

Clinical evaluation of infertility Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST Definition: inability to achieve conception despite one year of frequent unprotected intercourse. Male

More information

On the descent of the epididymo-testicular unit, cryptorchidism, and prevention of infertility

On the descent of the epididymo-testicular unit, cryptorchidism, and prevention of infertility Hadziselimovic Basic and Clinical Andrology (2017) 27:21 DOI 10.1186/s12610-017-0065-8 REVIEW ARTICLE On the descent of the epididymo-testicular unit, cryptorchidism, and prevention of infertility Faruk

More information

Physiologic Anatomy of the Male Sexual Organs

Physiologic Anatomy of the Male Sexual Organs Reproductive and Hormonal Functions of the Male The reproductive functions of the male can be divided into three major subdivisions: (1) spermatogenesis, which means simply the formation of sperm; (2)

More information

Chapter 14 The Reproductive System

Chapter 14 The Reproductive System Biology 12 Name: Reproductive System Per: Date: Chapter 14 The Reproductive System Complete using BC Biology 12, page 436-467 14. 1 Male Reproductive System pages 440-443 1. Distinguish between gametes

More information

Abstract. Introduction. RBMOnline - Vol 19. No Reproductive BioMedicine Online; on web 12 October 2009

Abstract. Introduction. RBMOnline - Vol 19. No Reproductive BioMedicine Online;   on web 12 October 2009 RBMOnline - Vol 19. No 6. 2009 778 783 Reproductive BioMedicine Online; www.rbmonline.com/article/4178 on web 12 October 2009 Article Does age at orchidopexy impact on the results of testicular sperm extraction?

More information

Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization

Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization Male Reproductive Structures I. Overview A. Main functions: 1. Produce a haploid male gamete (sperm) 2. Deposit sperm in the female so fertilization may occur! A. Scrotum 1. Muscular pouch that holds the

More information

What are Varicoceles?

What are Varicoceles? What are Varicoceles? A varicocele is when veins become enlarged inside your scrotum (the pouch of skin that holds your testicles). These veins are called the pampiniform plexus. Ten to 15 of every 100

More information

What You Need to Know

What You Need to Know UW MEDICINE PATIENT EDUCATION What You Need to Know Facts about male infertility This handout explains what causes male infertility, how it is diagnosed, and possible treatments. Infertility is defined

More information

Endocrine System Hormones & Homeostasis. Regents Biology

Endocrine System Hormones & Homeostasis. Regents Biology Endocrine System Hormones & Homeostasis 2009-2010 Homeostasis Homeostasis maintaining internal balance in the body organism must keep internal conditions stable even if environment changes also called

More information

Study Guide Answer Key Reproductive System

Study Guide Answer Key Reproductive System Biology 12 Human Biology Textbook: BC Biology 12 Study Guide Answer Key Reproductive System 1. Distinguish between a gamete and a gonad using specific examples from the male and female systems. Gonads

More information

Reproductive System Purpose General Structures Male Structures Functions Female Anatomy Structures Functions Clinical Applications

Reproductive System Purpose General Structures Male Structures Functions Female Anatomy Structures Functions Clinical Applications The Reproductive System: Male, Ch 23 Outline of class lecture After studying the male reproductive system you should be able to: 1. Define the purpose of reproduction and identify the general organs of

More information

Undescended Testicle

Undescended Testicle What is the normal descending testis? The testicle begins to form just before the second fetal month and starts to look like a testicle around the fourth fetal month. By then it has migrated down from

More information

EXCEPTIONAL DIAGNOSTICS FOR REPRODUCTIVE DISEASE STATE MANAGEMENT. Anti-Müllerian Hormone (AMH)

EXCEPTIONAL DIAGNOSTICS FOR REPRODUCTIVE DISEASE STATE MANAGEMENT. Anti-Müllerian Hormone (AMH) EXCEPTIONAL DIAGNOSTICS FOR REPRODUCTIVE DISEASE STATE MANAGEMENT Anti-Müllerian Hormone (AMH) Table of Contents» Introduction... 3» Biosynthesis... 3» Physiological Function... 4 Fetal Stage... 4 Postnatal

More information

Sexual Development. 6 Stages of Development

Sexual Development. 6 Stages of Development 6 Sexual Development 6 Stages of Development Development passes through distinct stages, the first of which is fertilization, when one sperm enters one ovum. To enter an ovum, a sperm must undergo the

More information

When testes make no testosterone: Identifying a rare cause of 46, XY female phenotype in adulthood

When testes make no testosterone: Identifying a rare cause of 46, XY female phenotype in adulthood When testes make no testosterone: Identifying a rare cause of 46, XY female phenotype in adulthood Gardner DG, Shoback D. Greenspan's Basic & Clinical Endocrinology, 10e; 2017 Sira Korpaisarn, MD Endocrinology

More information

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring

Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring Quiz: Evolution Human Reproduction Why Reproduce? In order to ensure the continuation of the species and the continuation of life in general by producing offspring Asexual vs Sexual Reproduction Remember:

More information

Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment?

Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? J Clin Res Pediatr En docrinol 2013;5(2):65-72 DO I: 10.4274/Jcrpe.883 Review Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? Ayhan Abacı,

More information

Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature

Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature REPRODUCTION Testes (male gonads) -Produce sperm -Produce sex hormones -Found in a sac called the scrotum -Suspended outside of the body cavity for temperature reduction -Testes wall made of fibrous connective

More information

The beginning of puberty is marked by the progressive increase in the production of sex hormones.

The beginning of puberty is marked by the progressive increase in the production of sex hormones. Puberty is characterized by the changes that prepare the human body for the ability to reproduce. This stage generally occurs between the ages of 10 and 14 years old. The beginning of puberty is marked

More information

Functions of male Reproductive System: produce gametes deliver gametes protect and support gametes

Functions of male Reproductive System: produce gametes deliver gametes protect and support gametes Functions of male Reproductive System: produce gametes deliver gametes protect and support gametes Spermatogenesis occurs in the testes after puberty. From the testes they are deposited into the epididymas

More information

Scrotal pain and Swelling

Scrotal pain and Swelling Scrotal pain and Swelling Color index : Important Further explanation Done By: Nada Alamri Editing link Acute Scrotal Pain DDx: 1) Testicular torsion : Twisting and strangulation of the testicle on the

More information

Aromatase Inhibitors in Male Infertility:

Aromatase Inhibitors in Male Infertility: Aromatase Inhibitors in Male Infertility: The hype of hypogonadism? BEATRIZ UGALDE, PHARM.D. H-E-B/UNIVERSITY OF TEXAS COMMUNITY PHARMACY PGY1 03 NOVEMBER 2017 PHARMACOTHERAPY ROUNDS Disclosures No conflicts

More information

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G.R. Dohle, Z. Kopa, A. Jungwirth, T.B. Hargreave. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 Definition Infertility is the

More information

9.4 Regulating the Reproductive System

9.4 Regulating the Reproductive System 9.4 Regulating the Reproductive System The Reproductive System to unite a single reproductive cell from a female with a single reproductive cell from a male Both male and female reproductive systems include

More information

Chapter 11 Guidelines and Best Practice Statements for the Evaluation and Management of Infertile Adult and Adolescent Males with Varicocele

Chapter 11 Guidelines and Best Practice Statements for the Evaluation and Management of Infertile Adult and Adolescent Males with Varicocele Chapter 11 Guidelines and Best Practice Statements for the Evaluation and Management of Infertile Adult and Adolescent Males with Varicocele With the continuous growth of medical knowledge and the need

More information

HCG (human chorionic gonadotropin); Novarel Pregnyl (chorionic gonadotropin); Ovidrel (choriogonadotropin alfa)

HCG (human chorionic gonadotropin); Novarel Pregnyl (chorionic gonadotropin); Ovidrel (choriogonadotropin alfa) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.08.09 Subject: HCG Page: 1 of 5 Last Review Date: June 19, 2015 HCG Powder, Novarel, Pregnyl, Ovidrel

More information

Reproductive Hormones

Reproductive Hormones Reproductive Hormones Male gonads: testes produce male sex cells! sperm Female gonads: ovaries produce female sex cells! ovum The union of male and female sex cells during fertilization produces a zygote

More information

REPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings

REPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings REPRODUCCIÓN La idea fija How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development, birth

More information

Chapter 4.2. Acquired undescended testis: putting the pieces together. WWM Hack J Goede LM van der Voort-Doedens RW Meijer K Sijstermans

Chapter 4.2. Acquired undescended testis: putting the pieces together. WWM Hack J Goede LM van der Voort-Doedens RW Meijer K Sijstermans Chapter 4.2 Acquired undescended testis: putting the pieces together WWM Hack J Goede LM van der Voort-Doedens RW Meijer K Sijstermans Int J Androl; 2011 Jun 9. doi: 10.1111/j.1365-2605.2011.01155.x. [Epub

More information

STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM

STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM Unit 7A STRUCTURE AND FUNCTION OF THE MALE REPRODUCTIVE SYSTEM LEARNING OBJECTIVES 1. Learn the structures of the male reproductive system. 2. Learn the functions of the male reproductive system. 3. Learn

More information

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany

Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof.

More information

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G. Dohle (chairman), A. Jungwirth and W. Weidner. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 1. Introduction Infertility is

More information

SISTEMA REPRODUCTOR (LA IDEA FIJA) Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings

SISTEMA REPRODUCTOR (LA IDEA FIJA) Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings SISTEMA REPRODUCTOR (LA IDEA FIJA) How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development,

More information

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands

Reproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty

More information

Male Factor Infertility

Male Factor Infertility Male Factor Infertility Simplified Evaluaon and Treatment* ^ * In 20 minutes or less In 20 slides ^ 5 minute office visit ALWAYS EVALUATE THE MALE & THE FEMALE Why 1. To help the coupleachieve a pregnancy

More information

Reproductive Endocrinology. Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007

Reproductive Endocrinology. Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007 Reproductive Endocrinology Isabel Hwang Department of Physiology Faculty of Medicine University of Hong Kong Hong Kong May2007 isabelss@hkucc.hku.hk A 3-hormone chain of command controls reproduction with

More information

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania STEVEN KADILO 1, MANGE MANYAMA 2, NEEMA M. KAYANGE 3 and PHILLIPO L. CHALYA 1* 1 Department

More information

Sample Provincial exam Q s: Reproduction

Sample Provincial exam Q s: Reproduction Sample Provincial exam Q s: Reproduction 11. Functions Testosterone Makes the male sex organs function normally, and also inhibits hypothalamus s release of GnRH and thus LH & FSH and thus testosterone

More information

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication

UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth. Link to publication UvA-DARE (Digital Academic Repository) Testing the undescended testis de Vries, Annebeth Link to publication Citation for published version (APA): de Vries, A. (2014). Testing the undescended testis General

More information

Why is my body not changing? Conflicts of interest. Overview 11/9/2015. None

Why is my body not changing? Conflicts of interest. Overview 11/9/2015. None Why is my body not changing? Murthy Korada Pediatrician, Pediatric Endocrinologist Ridge Meadows Hospital Surrey Memorial Hospital None Conflicts of interest Overview Overview of normal pubertal timing

More information

Published in: Pediatrics. DOI: /peds Document Version Peer reviewed version. Link to publication in the UWA Research Repository

Published in: Pediatrics. DOI: /peds Document Version Peer reviewed version. Link to publication in the UWA Research Repository Age at surgery and outcomes of an undescended testis Schneuer, F. J., Holland, A. J. A., Pereira, G., Jamieson, S., Bower, C., & Nassar, N. (2016). Age at surgery and outcomes of an undescended testis.

More information

Information for Patients. Male infertility. English

Information for Patients. Male infertility. English Information for Patients Male infertility English Table of contents What is male infertility?... 3 Diagnosis... 3 Medical history... 3 Physical examination... 3 Hormone blood tests... 3 Semen analysis...

More information