The Status of Spermatogenesis in Germ Cell Tumor Bearing Testis and Its Association with Metastatic Disease.

INTRODUCTION: We aimed to evaluate the status of spermatogenesis detected by histological examination of non-tumoral testicular tissues in tumor bearing testis and its association with advanced stage disease. PATIENTS AND METHODS: We retrospectively reviewed patients with testicular germ cell tumors (TGCTs) that undergone radical orchiectomy. All non-tumoral areas of the orchiectomy specimens were examined for the status of spermatogenesis. Patients were divided into two groups as localized (stage I) and metastatic (stage II-III) disease and analyzed separately for seminomatous (SGCT) and nonseminomatous germ cell tumors (NSGCT). RESULTS: Four hundred fifty-four patients were included in our final analysis. Of those, 195 patients had SGCT, and 259 patients had NSGCT. Three hundred and six patients had localized disease at the time of diagnosis. Median (Q1-Q3) age was 31 (26 - 38) years and 102 (22.5%) patients had normal spermatogenesis, 177 (39.0%) patients had hypospermatogenesis and 175 (38.5%) patients had no mature spermatozoa. On multivariate logistic regression analysis, embryonal carcinoma >50% (1.944, 95 %CI 1.054-3.585, P = .033) and spermatogenesis status (2.796 95% CI 1.251-6.250, P = .012 for hypospermatogenesis, and 3.907, 95% CI 1.692-9.021, P = .001 for absence of mature spermatozoa) were independently associated with metastatic NSGCT. However, there was not any variables significantly associated with metastatic SGCT on multivariate logistic regression analysis. CONCLUSION: Our study demonstrated that only 22.5% of patients with TGCTs had normal spermatogenesis in tumor bearing testis. Impaired spermatogenesis (hypospermatogenesis or no mature spermatozoa) and predominant embryonal carcinoma are associated with advanced stage NSGCT.

The impact of health care on outcomes of suspected testicular torsion: results from the GRAND study.

BACKGROUND: Suspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter. METHODS: We assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological). RESULTS: A total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3-1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2-2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4-2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department. CONCLUSIONS: Nearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.

Owner survey suggests cats may be undertreated for pain compared to dogs after an elective ovariohysterectomy or orchiectomy.

OBJECTIVE: To investigate differences in pain management between dogs and cats after surgical sterilization. We hypothesized that dogs would be more likely to be discharged with analgesics after sterilization compared to cats and that owner compliance would be better in dogs. ANIMALS: 175 respondents owning 92 dogs and 83 cats from a high-volume, low-cost veterinary clinic in Michigan during August 2022. METHODS: Owners received an online survey designed to assess their pet's postoperative analgesic care. They were asked demographic information about themselves and their pets. Additionally, they were asked if their pet was discharged with analgesics, if they were administered as prescribed, and if their pet was painful at home. Dogs and cats were included if they were sterilized within 6 months of survey completion and in the owner's care at the time of the procedure. RESULTS: The survey was distributed to 5,241 owners and received 227 responses, a response rate of 4.4%. Analgesics were prescribed for 19 of 162 (12%) pets: 14 of 88 (16%) dogs and 5 of 74 (6.7%) cats. There was no difference in the prescription of analgesics between dogs and cats after ovariohysterectomy (P = .09) or orchiectomy (P = .73). 15 of 19 owners reported their compliance in administering analgesics at 78.9%. Owners' subjective assessments showed that 24 of 86 (28%) dogs and 12 of 68 (17%) cats appeared painful at home. CLINICAL RELEVANCE: Postoperative pain in cats may not be appropriately managed.

Hand, foot, and mouth disease presenting with a testicular mass in an adult.

The majority of solid testicular tumors are treated with orchiectomy given the high risk of malignancy. We present a case of a testicular mass in an adult patient in the setting of recent hand, foot, and mouth disease that was managed conservatively with serial ultrasounds. Even though cases of viral-associated testicular masses are rare, this differential diagnosis should be considered in patients with a new testicular mass in the setting of recent viral infection and negative tumor markers. For these patients, observation may be an option instead of immediate orchiectomy.

A unique case of large cell calcifying type sertoli tumor.

Sertoli cells tumors are a rare testicular malignancy, with prevalence estimated to be less than 1% of testicular cancers. Furthermore, testicular cancer only accounts for approximately 0.5% of all diagnosed cancers. This is a unique case of a 19-year-old male where physical exam and ultrasonography findings revealed an intratesticular mass that, after pathologic analysis, demonstrated T1 large cell calcifying type Sertoli cell tumor which is infrequently documented in the literature.

Embryonal rhabdomyosarcoma of the testis in a 17-year-old male.

Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a 17-year-old male patient presented with massive scrotal swelling that had been progressively enlarging over seven-months. Scrotal ultrasound and contrast-enhanced CT revealed a 10 × 10cm left testicular heterogeneously enhancing mass that extends into the spermatic cord. A left inguinal orchiectomy was performed, and histopathological examinations showed findings consistent with Rhabdomyosarcoma, Embryonic-type. Primary embryonal testicular rhabdomyosarcoma has poor prognosis, particularly for adolescents, and tumour size greater than 10cm. Early diagnosis and radical orchiectomy improve the prognosis.

Paratesticular cellular angiofibroma: a case report.

INTRODUCTION: Paratesticular cellular angiofibroma is a rare benign mesenchymal tumor. The optimal management is surgical resection due to the difficulty of preoperative accurate diagnosis. CASE PRESENTATION: A 51-year-old Japanese male visited our hospital complaining of asymptomatic left scrotal swelling. Physical examination revealed a nontender elastic paratesticular mass (5.5 cm in diameter). Although testicular germ cell tumor was ruled out clinically, the possibility of malignant potential remained for the tumor. Since the patient consented to complete resection, a transinguinal radical orchiectomy was performed. The pathological diagnosis revealed cellular angiofibroma. The patient recovered without perioperative complications, and no apparent recurrence was observed at 5 years after surgery. CONCLUSION: The pathological findings were compatible for cellular angiofibroma. The tumor was successfully resected, and no apparent recurrence was observed at 5 years after surgery.

Epidermoid cyst of the testis: A report of three cases.

Testicular epidermoid cysts have characteristic findings. Testicular tumor markers are negative in patients with epidermoid cysts. Clear margins and sole and small testicular tumors (20 mm or less) suggest the possibility of epidermoid cyst. Testicular-sparing surgery with intraoperative frozen section examination should be performed when suspecting epidermoid cysts. Testicular epidermoid cysts are rare tumors that account for 1% of all testicular tumors and are often clinically misdiagnosed as malignant lesions. We report three cases of epidermoid cysts. The chief manifestations were scrotal induration in two patients and pruritus scrotum in one. The median age of the patients was 23 years (18-30). All tumors were determined to be sole lesions (<20 mm in diameter). Testing for tumor markers in all patients revealed negative results. We could not rule out malignancy; hence, we performed high inguinal orchiectomy in all cases. Histologically, the inner walls of the cysts were lined with stratified squamous epithelium; their contents were keratinized. All patients were diagnosed with epidermoid cysts.

Self-perceptions of masculinities and testicular cancer: Qualitative explorations.

OBJECTIVE: Masculinities have been explored in men with testicular cancer (TC), though limited contemporary research is available on traditional masculine norms important to masculine self-perception. The purpose of this research was to explore the discourse of TC experience in relation to masculine self-perception. METHODS: A qualitative descriptive study was conducted consisting of semi-structured interviews with 21 men. Men were aged between 31 and 47 (Mage = 35.7). Most men were diagnosed with Stage 1 cancer (66.6%), all men had finished active treatment and time since diagnosis ranged from 17.3 to 71.8 months (M = 47.2). Independent coding was conducted by two researchers and was refined in coding meetings with authors. Themes were developed in a predominantly deductive manner, and analysis of themes was undertaken using a reflexive analysis approach. RESULTS: Traditional masculine norms showed differing relationships to masculine self-perception. Two main themes were identified [1] Maintained or enhanced masculine self-perception and [2] threats to masculine self-perception. Subthemes demonstrated that maintaining emotional control, strength and 'winning' was important to men, and reduced physical competencies (i.e., strength, sexual dysfunction, virility) challenged self-perception. Strict adherence to traditional norms in response to threatened self-perception related to psychological distress. CONCLUSION: Leveraging traditionally masculine norms such as physical strength and control and developing flexible adaptations of masculinities should be encouraged with men with TC to retain self-perception and potentially enable better coping. Masculine self-perception of gay/bisexual men may centre around sexual functioning, though further research is required.

A nomogram for predicting risk factors of testicular salvage after testicular torsion in children.

OBJECTIVES: This study aimed to establish a nomogram for predicting the probability of testicular salvage after testicular torsion in children. METHODS: We retrospectively collected data of children with testicular torsion who were treated at Shenzhen Children's Hospital between September 2005 and August 2022. Of the training cohort, 113 patients who underwent orchiectomy and five with testicular atrophy after orchiopexy were included in the failed testicular salvage group. Additionally, 37 patients who underwent orchiopexy without postoperative testicular atrophy were included in the successful testicular salvage group. The predictive factors affecting testicular salvage were determined using univariate and multivariate logistic regression analyses; a nomogram was constructed. The nomogram was verified using data from the validation group. RESULTS: Using multivariate logistic regression analysis, the independent risk factors of testicular salvage after testicular torsion were symptom duration (p = 0.034), intratesticular blood flow (p = 0.003), spermatic cord torsion degree (p = 0.037), and monocyte count (odds ratio: 0.012, p = 0.036). A nomogram was established based on these four risk factors. In the training cohort, the area under the receiver operating characteristic curve was 0.969. The area under the receiver operating characteristic curve of the verification cohort was 0.965, indicating good discrimination ability of the nomogram. Increased symptom duration without intratesticular blood flow increased the monocyte count and spermatic cord torsion degree and decreased the success rate of testicular salvage. CONCLUSION: This prediction model could obtain the corresponding probability of testicular salvage according to the clinical characteristics of different patients with testicular torsion, providing reference for clinicians and parents.

Genistein and sex hormone treatment alleviated hepatic fat accumulation and inflammation in orchidectomized rats with nonalcoholic steatohepatitis.

Testosterone deficiency has been reported to accelerate nonalcoholic fatty liver disease (NAFLD). However, there are minimal data on the risk of NAFLD in transgender women and the treatment of NAFLD in this population. This study aimed to investigate the treatment effects and the mechanisms of action of genistein and sex hormones in orchiectomized (ORX) rats with nonalcoholic steatohepatitis (NASH) induced by a high fat high fructose diet (HFHF). Seven-week old male Sprague-Dawley rats were randomly divided into 7 groups (n = 6 each group); 1) control group, 2) ORX + standard diet group, 3) HFHF group, 4) ORX + HFHF group, 5) ORX + HFHF diet + testosterone group (50 mg/kg body weight (BW) once weekly), 6) ORX + HFHF diet + estradiol group (1.6 mg/kg BW daily), and 7) ORX + HFHF diet + genistein group (16 mg/kg BW daily). The duration of treatment was 6 weeks. Liver tissue was used for histological examination by hematoxylin and eosin staining and hepatic fat measurement by Oil Red O staining. Protein expression levels of histone deacetylase3 (HDAC3) and peroxisome proliferator-activated receptor delta (PPARδ) were analyzed by immunoblotting. Hepatic nuclear factor (NF)-ĸB expression was evaluated by immunohistochemistry. Rats in the ORX + HFHF group had the highest degree of hepatic steatosis, lobular inflammation, hepatocyte ballooning and the highest percentage of positive Oil Red O staining area among all groups. The expression of HDAC3 and PPARδ was downregulated, while NF-ĸB expression was upregulated in the ORX + HFHF group when compared with control and ORX + standard diet groups. Testosterone, estradiol and genistein treatment improved histological features of NASH together with the reversal of HDAC3, PPARδ and NF-ĸB protein expression comparing with the ORX + HFHF group. In summary, genistein and sex hormone treatment could alleviate NASH through the up-regulation of HDAC3 and PPARδ, and the suppression of NF-ĸB expression.

Rare pediatric synchronous bilateral testicular germ cell tumors of different pathological types: a case report.

The occurrence of synchronous bilateral testicular germ cell tumors (BTGCTs) of different pathologic histologic types in pediatric patients is rare. We reported a case of a left testicular yolk sac tumor (YST) combined with a right testicular mature teratoma. Left orchiectomy and right testis-sparing surgery were performed. Retroperitoneal recurrence was noted 6 months after surgery. The patient underwent reoperation for the resection of a retroperitoneal mass, which was pathologically diagnosed as a recurrent YST. A full cycle of chemotherapy was then administered. No tumor metastasis or recurrence has yet been detected. We present this new case, and we review the previous literature on synchronous BTGCTs to explore the clinicopathologic features and summarize the diagnostic and therapeutic experience. Radical orchiectomy, as the standard treatment for YSTs, should be considered with caution in patients with bilateral testicular tumors. Rapid intraoperative frozen pathology provides support for timely surgical planning. In patients with intraoperative frozen pathologic specimens suggestive of benign lesions, testis-sparing surgery is the preferred treatment option.

Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy.

The use of local anesthetics for castration is both simple and cost-effective, and it may contribute to reducing the anesthetic requirements. Despite its common use in clinical practice, the literature regarding the effects of intratesticular lidocaine in rabbits is limited. In this study, nine rabbits per group were assigned to intratesticularly receive either 2% lidocaine (0.05 mL/kg into each testicle) or an equivalent volume of saline prior to elective orchiectomy. Anesthesia was induced by intranasal administration of ketamine, medetomidine, and butorphanol. During intraoperative assessment, no significant differences in vital parameters (heart rate, respiratory rate, and peripheral saturation of oxygen) were observed between the groups. However, rabbits receiving intratesticular saline displayed a higher incidence of responses to surgical stimuli. Postoperative pain was evaluated using the composite Centro Animali Non Convenzionali Rabbit Scale (CANCRS), revealing a significantly lower score at the initial post-surgery assessment in rabbits treated with intratesticular lidocaine. All subjects exhibited rapid resumption of food intake and fecal output. While all rabbits demonstrated satisfactory perioperative performances, the use of intratesticular lidocaine was associated with a diminished response to surgical stimuli. Consequently, this practice has the potential to reduce the requirement for additional anesthetics or analgesics, promoting faster recovery.

Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review.

Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.

[Psychiatric, socio-legal and perioperative aspects of vaginoplasty]. / Psychiatrische, sozialrechtliche und perioperative Aspekte bei der Vaginoplastik.

The number of scientific papers on gender-confirming surgeries as well as the surgeries themselves have increased by leaps and bounds in recent years. This leads to sometimes considerable waiting times for people seeking treatment. Social media and the internet do not always provide reliable and high-quality information. Therefore, it is necessary that both surgically and conservatively active urologists are familiar with topics regarding transgender persons. The establishment of structured training, the guarantee of minimum quality standards in the treatment of transgender persons and the further education and training of medical staff pose particular challenges. The German Society for Urology (DGU) and the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) have already founded their own working groups on the surgical side, which coordinate their work. Under the auspices of the professional societies DGU and DGPRÄC, a guideline on surgical procedures for gender incongruence was developed under the umbrella of the AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") which is currently being finalised. For a long time, the health care of transgender people has been moving in a field of tension between the right of self-determination of those seeking treatment, on the one hand, and the fear of making the wrong medical decisions, on the other. In contrast to most other conditions in urology, the goal of treatment is largely determined by the person seeking treatment and does not necessarily follow predetermined schedules or content. The treatment should primarily aim at reducing the individual's suffering and promoting quality of life.

Malignancy, masculinities, and psychological distress: Comparisons made between men with testicular cancer and healthy controls.

OBJECTIVE: Psychological distress is common in men with testicular cancer (TC), and masculinities may work to explain this. This study aimed to compare masculinities and distress in TC and healthy control (HC) populations and explore relationships between correlates of distress (psychological flexibility and coping style) and masculinities in TC. METHODS: A cross-sectional, online survey was completed by 92 men with TC (Mage  = 34.8) and 90 HC (Mage  = 30.7). Measures included psychological distress (Patient-Reported Outcomes Measurement Information System Depression/Anxiety, fear of cancer recurrence inventory-short form), masculinities (gender role conflict-short form, inventory of subjective masculinity experiences/subjective masculinity stress scale, masculinity in chronic disease inventory), coping style (mini-mental adjustment to cancer ) and psychological flexibility (comprehensive assessment of acceptance commitment therapy). Linear regressions were conducted to compare groups and analyse associations. RESULTS: There were no differences in masculinities or psychological distress between populations (all p > 0.05 and all Cohen's d < 0.20), except for subjective masculine stress and restrictive affectionate behaviour between men. For men with TC, restrictive affection/emotion, conflicts between family/work and subjective masculine stress were associated with psychological distress (rs 0.21-0.58). Optimistic action was negatively associated with depression/anxiety, helplessness/hopelessness coping (rs -0.27 to -0.42) and positively associated with psychological flexibility (r = 0.35). CONCLUSIONS: Masculinities are implicated in psychological distress in men with TC. Psychological flexibility as well as leveraging masculine beliefs (e.g., optimistic action) may be modifiable targets to reduce distress in men with TC.

Orchiectomy after testicular trauma in a 45-year-old man: A case report.

Testicular trauma is a rare but significant condition that can result in severe damage to the testicles. In some cases, when the trauma is extensive and irreparable, orchiectomy, which refers to the surgical removal of one or both testicles, may be necessary. A 45-year-old man experienced testicular trauma as a result of a sporting event. Upon examination, it was determined that the trauma had caused severe damage to the affected testicle, leading to compromised blood supply and persistent pain. The presence of compromised blood supply was assessed through a combination of clinical evaluation and diagnostic imaging (scrotal ultrasound). The imaging findings indicate reduced blood flow to the testicle. Considering alternative treatment options and potential complications, the medical team decided to proceed with orchiectomy. Orchiectomy is a significant surgical procedure performed as a last resort when other treatments are not viable or when complications such as infection or severe pain are present. The decision to perform orchiectomy depends on the extent of the testicular trauma and the patient's overall health. It has implications for fertility and hormone production, with the remaining testicle typically compensating for the functions of the removed testicle. Prompt medical intervention is crucial in evaluating the severity of the injury and determining the appropriate course of treatment. Orchiectomy should be considered when the testicle is extensively damaged and irreparable, making testicular trauma resulting in the need for orchiectomy a complex and challenging situation.

Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review.

Sarcoidosis is a disease characterised primarily by lung tissue involvement. Extrapulmonary involvement, particularly in the genitourinary tract, is extremely rare, particularly when it comes to primary disease detection in this location. The gold standard in establishing a definitive diagnosis of sarcoidosis is a combination of the clinical picture, the results of imaging methods, and histopathological examination from the biopsy taken (thus ruling out other causes of granulomatous inflammation). However, it is common for the biopsy to be infeasible or for the patient to refuse such an examination, resulting in the neglect of this critical verification. We introduce the case of a young 29-year-old man of Czech nationality who had been complaining for some time about non-specific pain above the pubic bone and in the lower abdomen, which was combined with a painless enlargement of the right half of the scrotum. Due to suspected malignancy, it was, after considering clinical, imaging, and laboratory findings, decided to perform a radical orchiectomy as a treatment option. The histological examination revealed that it was not cancer, but rather a rare genitourinary form of extrapulmonary sarcoidosis. In this case, radical resection had been, therefore, unnecessary. We also present a review of the literature on published extrapulmonary, genitourinary, and testicular sarcoidosis cases. All the above demonstrates the importance of considering a possible atypical sarcoidosis manifestation and histological confirmation before pursuing radical solutions.

Informe de un caso de liposarcoma paratesticular

Los liposarcomas son neoplasias que se originan de las células mesenquimales, y su localización paratesticular es infrecuente. Se dividen en cuatro subtipos histológicos, siendo el mixoide el más raro. Se muestra el informe de un caso de liposarcoma paratesticular mixoide y una revisión de la literatura, con el objetivo de brindar información sobre esta rara enfermedad. El caso es un paciente masculino de 70 años de edad, que acude a consulta por tumefacción escrotal derecha e indolora de 13 meses de evolución, diagnosticado inicialmente como una hernia inguinal unilateral. Se realizó orquiectomía inguinal radical derecha y ligadura de cordón alto. En anatomía patológica se recibe la pieza quirúrgica de 2500 g. Al estudio histológico se evidencia liposarcoma mixoide. La tomografía computarizada de tórax, abdomen y pelvis no mostró metástasis. La presencia de un liposarcoma debe tenerse en cuenta durante el estudio diagnóstico de masas escrotales, para minimizar la tasa de diagnóstico erróneo y manejo inadecuado.

Liposarcoma are neoplasms that originate from mesenchymal cells, and their paratesticular location is infrequent. They are divided into four histological subtypes, the myxoid being the rarest. The report of a case of myxoid paratesticular liposarcoma and a review of the literature are shown, with the aim of providing information on this rare disease. The case is a 70-years-old male patient who assists the clinic due to painless right scrotal swelling of 13 months evolution, who was initially diagnosed with a unilateral inguinal hernia. Right radical inguinal orchiectomy and high cord ligation were performed. The pathological piece of 2500g is received in pathological anatomy. Myxoid liposarcoma is evidenced at histological study. Chest, abdomen and pelvis computed tomography showed no metastasis. The presence of liposarcoma should be taken into account during the diagnostic study of scrotal masses to minimize the rate of misdiagnosis and inadequate management.