[Incidence of depression and its related factors in cryptorchidism patients after surgical treatment].

OBJECTIVE: To investigate the incidence of depression and its etiological factors in patients with cryptorchidism 6-16 years after surgical treatment. METHODS: Using Self-Rating Depression Scale and Correlation Factor Questionnaire, we investigated the incidence of depression symptoms among 70 patients with cryptorchidism 6-16 years after surgical treatment and another 70 healthy males as controls, and analyzed the related factors of depression symptoms. RESULTS: The incidence rate of depression symptoms was 50% in the cryptorchidism patients postoperatively, extremely significantly higher than 4.3% in the control group (χ2 = 23.5, P <0.01). Multiple stepwise regression analysis showed that the main risk factors of depression symptoms were worries about natural fertility (F = 15.8992, P <0.01), dissatisfaction with scrotal appearance (F = 4.6003, P <0.05), and the status of being married (F = 4.1002, P <0.05). CONCLUSION: Symptoms of depression often occur in cryptorchidism patients after operation, and the major etiological factors are infertility, dissatisfaction with scrotal appearance, and the status of being married.

Decision making among different treatment options for neurologically impaired boys with undescended testis: a multinational pediatric survey.

OBJECTIVE: To determine the attitude of referring pediatricians towards the decision of treatment modalities for undescended testis (UDT) in neurologic impaired boys (NIB). METHODS AND MATERIALS: An online questionnaire was offered to registered pediatricians in Austria and Germany for online completion. RESULTS: 221 male (61.6%) and 138 female (38.4%) pediatricians completed the survey; 326 (90.8%) believe that UDT should be treated according to national guidelines; 31 (8.6%) believe that UDT should be treated according to the parental wish, whereas only 2 (0.6%) tend to no treatment at all. Tumor prophylaxis, further sexual life, legal concerns, risks of anesthesia, and the choice of the parents have major impact on the perception of UDT. Moreover, fertility and limited life expectancy seem to be of minor importance only. In general, Pearson χ2 test could not identify age and sex of pediatricians as significant predictor of how the importance of the treatment of UDT is appraised. CONCLUSION: From the pediatric point of view UDT in NIB is an important issue and should be treated according to guidelines. Nevertheless, this study indicates the problems in decision-making and choosing the best management for UDT in NIB. Undoubtedly, further ethical discussion is needed to optimize treatment of UDT in NIB.

Testicular volume and masculine identity in men with unilateral cryptorchidism: results of a community-based survey in Korea.

We determined the influence of cryptorchidism on testicular volume and masculine identity in young men living in a community. Of the 27,202 men aged 20 years dwelling in the community, we randomly selected a 10% sampling fraction of whom 2,080 men (a response rate of 77.0%) agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. For the evaluation of the influence of cryptorchidism on masculine identity, we used the Bem Sex Role Inventory (BSRI). Among participants, 38 (1.8%) had cryptorchidism or a history of surgery for cryptorchidism (right 15, left 21, bilateral 2). In total, 29 had had undergone surgery (mean age at the time of operation; 8.9+/-3.9 years, range; 2-19 years). Of 25 men who had undergone orchiopexy due to unilateral cryptorchidism, the testicular volume of the affected side was significantly smaller than that of the contralateral side. Of the 36 patients with unilateral cryptorchidism, the contralateral testicular volume of men who had undergone orchiopexy was not different with that of those who had undergone orchiectomy or had not undergone surgery. When we compared the scores for masculinity and femininity using the BSRI between men with and without testis in the scrotum, there were no differences between the two groups. Our results demonstrate that delayed orchiopexy does not improve the testicular volume of the affected side or the masculine identity in men with unilateral cryptorchidism. In addition, these findings suggest that there is a need to increase the awareness of cryptorchidism among all parties involved in the health care of children.

Does maternal stress induce abnormal descent of the testis in prepubertal rats?

OBJECTIVE: To investigate whether prenatal maternal stress, considered to alter plasma testosterone concentration and induce a lack of testosterone surge in male rat fetuses, has any effect on the growth of the processus vaginalis and testicular descent in male offspring. MATERIALS AND METHODS: Pregnant rats were divided into two groups. In group 1, the rats were placed three times daily for 60 min each session in Plexiglas rat holders (13x6x8 cm) illuminated by two 150-W flood lights from day 14 to day 18 of gestation during the dark phase of the animals' light (12 h) and dark (12 h) cycle. In group 2, pregnant females were not handled and acted as controls. After birth, the anogenital distance of both the male and female rats was measured, and the length of the processus vaginalis was measured at 7 days of age in some rats. Thereafter, at 21, 24, 27 and 30 days of age, testicular descent was assessed in the remaining male rats. RESULTS: In group 1, at 21, 24, 27 days of age, testicular descent was delayed in the stressed rats compared with the control rats. At 30 days of age, five of 36 stressed male offspring showed abnormal testicular descent; three testes were in the superficial inguinal position and two were above the scrotum. Both the anogenital distance and the length of the processus vaginalis were significantly less in the stressed male rats than in the controls. CONCLUSIONS: Maternal stress induced a female-like anogenital distance in male rat fetuses, and caused delayed and abnormal descent of the testis, by inhibiting the growth of the processus vaginalis after birth. Prenatal stress may therefore be involved in the delay of testicular descent in neonatal rats by inducing a mild anti-androgenic effect in the fetus.

Gonadotropin treatment of hypogonadotropic hypogonadal adolescents.

Testosterone substitution, needed for normal physical development in male hypogonadal adolescents, does not induce testicular growth. We treated 37 hypogonadal adolescents with gonadotropins (hCG/hMG), to obtain complete virilization during the first two years of treatment, to avoid psychological sequellae and to allow normal sexual development. Testicular volume increased significantly during therapy (from 1.98 +/- 1.2 to 9 +/- 3.3 ml), while testosterone rose from 0.26 +/- 0.04 to 5.3 +/- 0.8 ng/ml, with worse results in adolescents with cryptorchidism. hCG/hMG treatment had a better outcome than testosterone during the induction of puberty, avoiding psychological problems induced by atrophic testes. Further long term studies are necessary to evaluate whether early hCG/hMG treatment facilitates later spermatogenesis even in patients with cryptorchidism.

Psychopathological aspects of cryptorchidism in children and adolescents.

In the male sexual and aggressive drives are mostly centered on the penis, whose real or fantasied features strongly affect the way children and adolescents build up their own personal and gender identity. In some clinical conditions a shift of genital centrality from penis to testicles is evident. The most frequent is abnormality in the descent of testicles, especially cryptorchidism, characterized by an arrested descent of one or two testicles that remain in the abdomen. The aim of this paper is to define mechanisms by which cryptorchidism increases psychological vulnerability. Time of diagnosis and treatment, restoration of genital integrity, personality stability and familial interactions are considered as elements affecting psychopathological outcome. Behavioral and psychological features in children and adolescents with cryptorchidism are reviewed. A case report of an adolescent with unilateral cryptorchidism is reported and discussed, as an example of pubertal distortion in bodily and gender identity.

The role of the testicles in male psychological development.

In this paper the role of the testicles in male psychological development is thoroughly investigated. All previous psychoanalytic studies are reviewed; new clinical material is presented; critical research data from pediatric urology and physiological sex research are utilized. A number of significant conclusions emerge. (1) Certain cases of pathological castration anxiety are explained by a psychosomatic phenomenon (the "testicular vicious cycle") caused by actual and perceived threats to the genitals. (2) Testicular factors may be decisive in various neurotic symptom formations beginning with the early toilet training period. The testicular contribution then takes place along certain preferred pathways of symbolic displacement. (3) Testicular symptoms are observed in many cases of physical and sexual abuse. This finding has application to the treatment of male abuse survivors and to their related sexual dysfunctions. (4) Masturbation involving the testicles is not infrequent in young boys; the most common practice consists of inserting the testes inside the body. (5) The condition of cryptorchism may contribute to psychopathology, especially in the area of masculine self-image; however, cryptorchid boys do not tend to be gender-disordered, effeminate, or prehomosexual. (6) Male body image formation after the phallic stage is a complex emotional and intellectual task involving temporary denial of the inner body and the testicles. Finally it is suggested that a revised account of male sexuality, including both penis and testicles, is a prerequisite for any psychoanalytic theory of gender.

Social and medical aspects of undescended testes in Turkey.

In this study, 6,381 primary school boys were examined in Turkey in the years 1990 and 1991 and families and medical personnel were questioned about the information they had on undescended testes and their behavior regarding this matter was noted. Undescended testes were found in 91/6,381 pupils (1.43%) Forty-six families (58.7%) were aware of the abnormality. In 36 of these 46 cases (78%), the mother was the first who noticed the problem. Only 3 cases were first diagnosed by medical staff (nurses or doctors). Eighteen cases were diagnosed under 2 years of age, but apparently they had not been managed correctly because of ignorance regarding possible complications. Of the 46 families, who were aware of the problem, only 29 (63%) had seen a physician. In other words, only 31% (29/91) of the boys with undescended testes received medical help. This study has shown that no genital organ examination of the newborn is performed after most deliveries and there is a considerable unawareness of undescended testes both by the families and by medical personnel.

[A comparative evaluation of the efficacy of certain types of premedication in children]. / Sravnitel'naia otsenka éffektivnosti nekotorykh vidov premedikatsii u detei.

Mathematical analysis of the heart rhythm and expressive methods of emotional stress determination have been used in 90 children prepared for surgical intervention with the help of three types of premedication. It has been shown that premedication with diazepam and droperidol (according to scheme) was effective for the elimination of preoperative psychoemotional stress in children.

Infant testicular prostheses.

Traditionally, the parents of young boys with an absent testis are advised to let the child decide whether he wants a testicular prosthesis after he enters puberty. Unfortunately, the decision by an adolescent to undergo prosthesis insertion often is made only after experiencing ridicule and embarrassment about the genital appearance. Accordingly, we have offered to implant an infant size prosthesis in patients with cryptorchidism when inguinal and abdominal exploration demonstrates that the testis is absent. A total of 41 boys less than 5 years old with an absent testis underwent simultaneous insertion of a testicular prosthesis. The only complication was a superficial wound infection that did not necessitate removal of the prosthesis. Two boys report mild scrotal discomfort. In long-term followup 91 per cent of the families rated the cosmetic appearance as "good" and 94 per cent were content with the decision regarding placement of a prosthesis. Although many assume that these boys will desire a larger prosthesis after puberty, this consideration seems to be irrelevant. Longer followup will be necessary to ascertain whether this approach alters the psychosexual development of these patients. We believe that young boys with an absent testis should be considered for simultaneous testicular prosthesis insertion at inguinal exploration or orchiectomy.

On the psychopathology of patients with disorders in the descent of the testis.

The authors deal with disorders in the descent of the testis and analyse the causes and manifestations from the point of view of fertility and indications to medical treatment or early surgery. Thirty-nine patients were examined and diagnosed as unilateral or bilateral cryptorchism and retention of the testis. The spermatogenetic functions in individual diagnosis and type of operation are described. They wish to ascertain a mutual connection between sexual function and neurotic symptoms in operated patients with regard to the 3 diagnostic groups.

Alternatives to orchiopexy.

With improved surgical techniques orchiopexy has become possible in patients with cryptorchidism who previously were forced to alternatives, including no treatment at all, a trial of hormonal therapy or orchiectomy. However, the mere presence of a testis in the scrotum may not benefit some patients, that is neither enhancing fertility nor reducing malignancy. A prosthesis may provide comparable appearance and psychologic support. No treatment is indicated in cases of severe mental retardation, ejaculatory failure (as with the prune belly syndrome) and certain endocrine syndromes. Hormonal therapy, helpful in bilateral prepubertal cases, also may be useful in certain endocrine disorders. Orchiectomy is indicated in unilateral cases with severe neurogenic disturbances that preclude ejaculation, in prepubertal patients with 1 abdominal testis and in postpuberal boys with unilateral cryptorchidism at any site. If risk versus benefit is assessed for each patient these alternatives may be better for him than orchiopexy.

Unilateral abdominal cryptorchidism.

The unilateral non-palpable undescended testis is considered separately from other forms of cryptorchidism. It is less likely to be fertile, it is more prone to malignancy and it is more difficult to place. Removal rather than orchiopexy often is in the best interests of the child.