S80 ESPU Programme 2009

# S13-4 (O)

CRYPTORCHIDISM AND MALE FERTILITY POTENTIAL: HISTOLOGICAL FEATURES AND CORRELATION TO TIMING OFORCHIOPEXY AND LOCATION OF TESTES

Laurence BASKIN1, Greg TASIAN1, Grace KIM2 and Michael DISANDRO1

1UCSF, Urology, San Francisco, USA, 2UCSF, pathology, San Francisco, USA

PURPOSE

Cryptorchidism affects ~ 3% of termnewborn and adversely affects futurefertility. This study was designed toidentify clinical features that correlatewith pathologic changes in children withcryptorchidism with the ultimate goal ofdetermining the optimal time to performorchiopexy.

MATERIAL AND METHODS

A retrospective review of all patients(n ¼ 241) who underwent orchiopexy andconcurrent testicular biopsy between1991 and 2001 was conducted. For thiscohort, multipredictor logistic regressionwas used to determine if age atorchiopexy, testis location prior tosurgery, unilateral vs. bilateral disease,

were predictors of three differentpathologic outcomes (germ celldepletion, Leydig cell depletion, andpresence or absence of significantfibrosis).

RESULTS

Germ cell depletion was associated withincreased age at orchiopexy andintraabdominal/non-palpable testes. Whenadjusted for testis location, the odds ratio(OR) for significant germ cell depletion was1.02 (p < 0.005) for each month increase inage. After adjusting for age, children withpalpable testis had much lower odds of germcell depletion than those with non-palpabletestis (OR 0.46; p < 0.002). For Leydig cellabsence, the OR was 1.01 (p < 0.005) foreach month increase in age. These resultscorrespond to a significant 1-2% increase in

the development of germ cell depletion orLeydig cell absence for each month of age ina child with cryptorchidism and a 50%increased risk of germ cell depletion inintraabdominal testes relative to palpabletestes.

CONCLUSIONS

Non-palpable testes and testes that remainundescended for an increased duration areassociated with histologic changes thatcould be the cause for decreased fertility inadulthood. By operating on these testesearly, especially the non-palpable ones, itis conceivable that the number of germcells and Leydig cells in the adult testismight be improved, and the risk ofinfertility reduced.

# S13-5 (O)

TESTICULAR PROSTHESIS, FIRST SYSTEMATIC REVIEW IN PAEDIATRIC POPULATION

Taqi ZAIDI1, Lucy HENDERSON2, Asher AZIZ3, Antonino MORABITO4 and Alan DICKSON3

1Royal Manchester children hospital, Manchester, paediatric urology, Manchester, UNITED KINGDOM, 2Royal Manchester ChidrenHospital, Manchester, student, Manchester, UNITED KINGDOM, 3Royal Manchester Chidren Hospital, Paediatric Urology, Manchester,UNITED KINGDOM, 4Royal Manchester Chidren Hospital, paediatric surgery, Manchester, UNITED KINGDOM

PURPOSE

To systematically review the insertion ofpaediatric testicular prosthesis at ourinstitute over last 14 years and to definea safe protocol for insertion.

MATERIAL AND METHODS

A retrospective medical record review wasperformed of all patients who had receivedtesticular prosthesis between 1994 and2007. Comparative analysis was performedusing Chi-squared test and Fischer’s exacttest.

RESULTS

72 patient’s notes were reviewed. Reasonfor testicular absence was testicular atrophyin 30 (42%), orchidectomy in 27 (37%) andcongenital absence in 15 (20%). Increase inthe trend of prosthesis insertion was noted(one prosthesis in 1994 to 13 in 2007). 39 (54%) patients received large size prosthesis(mean age at insertion 14.4 years) 19 (26 %)medium (14.2 years) and 10 (13 %) small(11.5 years). 2 patients with small prosthesishad it replaced with larger one. Surgicallyscrotal route was used in 38 (53%) and groinroute in 34 (47%). 10 patients (13.8 %) hadcomplications. Complications were infection5 (7%) extrusion 4 (5.6%), discomfort 4(5.6%), and malposition 2 (2.8%).

Complication rate was higher in scrotalgroup compared to groin: 8 (21%) patientsversus 2 (5.8%) though only the resultsregarding deep infection were statisticallysignificant (P ¼ 0.0707).

CONCLUSIONS

Commonest reason of testicular absence wastesticular atrophy. The use of testicularprosthesis is increasing. A large adult sizedprosthesis can be placed safely atadolescence (11-17 years) without theneed of it later being replaced with alarger size. Groin route should bepreferred as it is associated with fewercomplications.