The incidence of impalpable testis is approximately 20 percent of undescended testis population and some may possess vascular pedicle shortening that prohibits scrotal placement in one stage orchiopexy. From July 1987 through April 1988, 12 patients with 17 impalpable testicles were explored by lower midline incision and the following results were obtained : 1. We could identify and prove the location of testis and/or anorchia without postoperative complication : 10 intraabdominal testes (59%), 3 intracanalicular (18%), 4 anorchia (23%). 2. Among 10 intraabdominal testes 5 testes were brought down by transabdominal orchiopexy, 3 testes by Fowler-Stephens method, and 1 testis by staged orchiopexy and remaining testis were removed. 3. Among 3 intracanalicular testes 2 testes were brought down by transabdominal orchiopexy and one testis was removed. 4. Follow up testicular examination of fixed testes revealed no testicular atrophy in all transabdominal orchiopexed testes and no testicular atrophy in 1 of 3 testes which were performed by Fowler-Stephens method.
Atrophy ; Cryptorchidism ; Follow-Up Studies ; Humans ; Incidence ; Male ; Orchiopexy ; Postoperative Complications ; Testis*

Penoscrotal transposition is one of the rare congenital anomalies. We experienced 12 cases of incomplete penoscrotal transposition during the period from January 1978 to September 1983. The obtained results were as follows: 1. The age distribution ranged from 5 to 33 years old, and the average was 15 years old. The n. umber of patients whose age was below 10 years was 5. 2. The associated anomalies were as follows; hypospadia in all cases, undescended testis in 3 cases, utriculus masculine in 3 cases, hydrocele in 1 case and double corpus spongiosum in 1 case. 3. We performed the chordectomy and the scrotoplasty simultaneously as 1st staged operation, and the urethroplasty as 2nd staged operation. In the 1st staged operation, Glenn-Anderson's method was applied in 7 cases, and the combined technique of Glenn-Anderson's method and Byars chordectomy method was applied in 5 cases. 4. The postoperative complications were as follows; Of the 7 cases of Glenn-Anderson's method, 1 case was complicated by ventral curvature of the penis due to scar formation after 1st staged operation, and 2 cases were complicated by urethral fistula after 2nd staged operation. Of the 5 cases of the combined technique of Glenn-Anderson's method and Byars chordectomy method, no complications were found in all cases after 1st and 2nd staged operations.
Adolescent ; Adult ; Age Distribution ; Cicatrix ; Cryptorchidism ; Female ; Fistula ; Humans ; Hypospadias ; Male ; Penis ; Postoperative Complications

Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l^-1 vs 19.3 IU l^-1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.
Adult ; Azoospermia/etiology* ; Cryptorchidism/complications* ; Humans ; Male ; Retrospective Studies ; Sperm Retrieval ; Treatment Outcome

OBJECTIVES: To investigate the clinical phenotypes, genetic characteristics, and pathological features of children with disorders of sex development (DSD). METHODS: A retrospective analysis was conducted on epidemiological, clinical phenotype, chromosomal karyotype, gonadal pathology, and genotype data of 165 hospitalized children with DSD at Children's Hospital of Hebei Province and Tangshan Maternal and Child Health Hospital from August 2008 to December 2022. RESULTS: Among the 165 children with DSD, common presenting symptoms were short stature (62/165, 37.6%), clitoromegaly (33/165, 20.0%), cryptorchidism (28/165, 17.0%), hypospadias (24/165, 14.5%), and skin pigmentation abnormalities/exteriorized pigmented labia majora (19/165, 11.5%). Chromosomal karyotype analysis was performed on 127 cases, revealing 36 cases (28.3%) of 46,XX DSD, 34 cases (26.8%) of 46,XY DSD, and 57 cases (44.9%) of sex chromosome abnormalities. Among the sex chromosome abnormal karyotypes, the 45,X karyotype (11/57, 19%) and 45,X/other karyotype mosaicism (36/57, 63%) were more common. Sixteen children underwent histopathological biopsy of gonadal tissues, resulting in retrieval of 25 gonadal tissues. The gonadal tissue biopsies revealed 3 cases of testes, 3 cases of dysplastic testes, 6 cases of ovaries, 11 cases of ovotestes, and 1 case each of streak gonad and agenesis of gonads. Genetic testing identified pathogenic/likely pathogenic variants in 23 cases (23/36, 64%), including 12 cases of 21-hydroxylase deficiency congenital adrenal hyperplasia caused by CYP21A2 pathogenic variants. CONCLUSIONS Short stature, clitoromegaly, cryptorchidism, hypospadias, and skin pigmentation abnormalities are common phenotypes in children with DSD. 45,X/other karyotype mosaicism and CYP21A2 compound heterozygous variants are major etiological factors in children with DSD. The most commonly observed gonadal histopathology in children with DSD includes ovotestes, ovaries, and testes/dysgenetic testes.
Male ; Humans ; Child ; Disorders of Sex Development/pathology* ; Hypospadias/complications* ; Cryptorchidism/complications* ; Retrospective Studies ; Adrenal Hyperplasia, Congenital ; Steroid 21-Hydroxylase

A rare case is presented where a dysgenetic testis with microinvasive carcinoma in situ (CIS, also known as intratubular germ cell neoplasm of unclassified type [IGCNU] and testicular intraepithelial neoplasia [TIN]) with microinvasion to rete testis and the interstitial tissue was found in a 32-year-old man presenting with mild scrotal pain and ultrasonic testicular microlithiasis. Knowledge of the association of ultrasound and CIS is important to diagnose patients at the stage prior to development of an overt germ cell tumor. The patient had three of four disorders considered symptoms of the testicular dysgenesis syndrome (TDS): a dysgenetic left testicle with CIS, a mild left-sided cryptorchidism (high positioned scrotal hypotrophic testis) and a slightly reduced semen quality. Therefore, it should be kept in mind that a patient with one TDS symptom may harbour the other, even CIS or testicular cancer. Accordingly, patients with one TDS symptom ought to be examined for the presence of the others, and if more that one is present, extra concern is warranted.
Adult ; Carcinoma in Situ ; complications ; diagnostic imaging ; pathology ; Cryptorchidism ; complications ; diagnostic imaging ; pathology ; Humans ; Male ; Testicular Neoplasms ; complications ; diagnostic imaging ; pathology ; Testis ; abnormalities ; diagnostic imaging ; pathology ; Ultrasonography

PURPOSE: We prospectively evaluated the surgical outcomes of single scrotal incision orchiopexy in children with a palpable undescended testis compared with the traditional two incision orchiopexy. MATERIALS AND METHODS: A total of 398 orchiopexies (292 children) were included and randomly assigned to the single scrotal incision orchiopexy group (Group I, 147 children, 201 testes) or the traditional inguinal incision orchiopexy group (Group II, 145 children, 197 testes). The final number of patients enrolled (excluding those lost to follow-up) was 107 children (146 testes) in group I and 105 children (141 testes) in group II. Success was defined as no complications, postoperative intrascrotal location of the testis, and no conversion to the traditional inguinal approach. Surgical outcomes and complications were compared between the two groups. Testicular location, complications, and subjective satisfaction rate were assessed at the follow-up evaluation at least 12 months postoperatively. RESULTS: The overall success rate in group I was 92.5% in 135 of 146 testes; the remaining 9 testes required conversion to traditional two incision orchiopexy. In group II, orchiopexy was successful in 136 of 141 testes (96.5%). The operation time and hospital stay were significantly shorter in group I (40.5+/-25.9 minutes, 2.1+/-0.8 days) than in group II (62.3+/-35.6 minutes, 2.5+/-0.7 days), respectively (p<0.001, p=0.03). Postoperative complications were found in two cases (hematoma, wound dehiscence) in group I and in one case (wound dehiscence) in group II; all cases with complications recovered with conservative care. The subjective rate of satisfaction with the cosmetic result was 96.6% in group I and 96.5% in group II (p=0.97). CONCLUSIONS: We conclude that single scrotal incision orchiopexy is a simple technique that is associated with a shorter operation time and hospital stay than the traditional method and that is more feasible cosmetically.
Child ; Cosmetics ; Cryptorchidism ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Orchiopexy ; Postoperative Complications ; Prospective Studies ; Scrotum ; Testis

Authors performed the chordectomy using Blair, Byars and Glenn-Anderson method, the urethroplasty with Denis-Browne-Crawford method and one-stage repair of hypospadia with Allen-Spence method. The following results are obtained from 40 cases of urethroplasty and 10 cases of one-stage repair of hypospadia which were done in the Department of Urology, Busan National Univ. Hospital during recent 7 yrs (71~77). The results were as follows : 1. The most common age group of hypospadia was observed in 11-20 year old (40.0 %) and that of less than 5 year old was only 12.0 %. 2. The most common type of hypospadia was observed in ponoscrotal type (26.0 %) while the hypospadia without chordee was 2.0 %. 3. The most common anomaly associated with hypospadia was cryptorchism (40.0 %). 4. Average of the period of postoperative hospitalization was 9.5 days in chordectomy. 10.8 days in urethroplasty and 10.2 days in one-stage repair of hypospadia. The interval between chordectomy and urethroplasty was 13.9 months. 5. Average of the period of postoperative urethral catheterization was 7.6 days in chordectomy, 3.2 days in urethroplasty and 7.5 days in one-stage repair of hypospadia. 6. The postoperative complications were 2 cases of persistent chordee in Blair method, 1 case of fistula and 3 cases of stricture in Denis-Drowne-Crawford urethroplasty and 2 cases of fistula in one-stage repair of hypospadia. The success rate was 91.9 % in Blair method. 100 % in Byars method and Glenn-Anderson method, 90.0 % in Denis-Browne-Crawford urethroplasty and 80.0 % in one stage repair of hypospadia.
Busan ; Child, Preschool ; Constriction, Pathologic ; Cryptorchidism ; Female ; Fistula ; Hospitalization ; Humans ; Hypospadias* ; Male ; Postoperative Complications ; Urinary Catheterization ; Urinary Catheters ; Urology

To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism, a randomized controlled trial was conducted involving boys who were 6-12 months old at surgery and were diagnosed with clinically palpable, inguinal undescended testis. Between June 2021 and December 2021, these boys at Fujian Maternity and Child Health Hospital (Fuzhou, China) and Fujian Children's Hospital (Fuzhou, China) were enrolled. Block randomization with a 1:1 allocation ratio was employed. The primary outcome was testicular function assessed by testicular volume, serum testosterone, anti-Müllerian hormone (AMH), and inhibin B (InhB) levels. Secondary outcomes included operative time, amount of intraoperative bleeding, and postoperative complications. Among 577 screened patients, 100 (17.3%) were considered eligible and enrolled in the study. Of the 100 children who completed the 1-year follow-up, 50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy. The testicular volume, serum testosterone, AMH, and InhB levels in both groups increased markedly after surgery (all P < 0.05), but there were no apparent differences between groups at 6 months and 12 months after operation (all P > 0.05). No differences between the scrotal and inguinal groups were noted regarding the operative time ( P = 0.987) and amount of intraoperative bleeding ( P = 0.746). The overall complication rate (2.0%) of the scrotal group was slightly lower than that of the inguinal group (8.0%), although this difference was not statistically significant ( P > 0.05). Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism, with similar operative status and postoperative complications. Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism.
Female ; Pregnancy ; Male ; Infant ; Humans ; Child ; Cryptorchidism/surgery* ; Orchiopexy ; Scrotum/surgery* ; Postoperative Complications ; Anti-Mullerian Hormone ; Testosterone

We evaluated the clinical outcome of surgical repairs for 59 patients with proximal hypospadias with chordee. Out of 59 cases, there were 6 cases with proximal penile type, 39 with penoscrotal type, 11 with scrotal type and 3 with perineal type. Associated anomalies were bifid scrotum in 21, penoscrotal transposition in 17, cryptorchidism in 12, imperforated anus in 2 and congenital heart disease in 2 cases. Thirty-nine cases were treated with one-stage repair and 20 cases with multi-stage repair. Surgical methods for one-stage repair were transverse preputial flap (TPF, 30 cases), onlay island flap (OIF, 8 cases) and bladder mucosa graft (1 case). And surgical methods for multi-stage repair were Belt-Fugua method (11 cases), Thiersch-Duplay method (4 cases), bladder mucosa graft (3 cases) and scrotal-penile tube graft (2 cases). The overall complication rate was 40.7%. The most common complications were urethrocutaneous fistula (17 cases) and urethral stricture (7 cases). Complication rates of one-stage and multi-stage operations were 35.9% and 50%, respectively. In our series, there were 24 cases whose penile length was shorter than 2.5 cm. Out of these patients, 14 cases recieved 25 mg of testosterone cypionate at intervals of 3 weeks for a total period of three months preoperatively. Although testosterone provided some increment of penile size, postoperative complications were developed in 7 patients of testosterone-treated group exclusively. Despite relatively high complication rate in our series, our final results based on cosmesis and function were excellent in all cases. Our experience indicates that multi-stage operation may not be superior to one-stage procedure in proximal hypospadias repair, and that preoperative administration of testosterone may not decrease complication rate in cases with short penile length.
Anal Canal ; Cryptorchidism ; Female ; Fistula ; Heart Defects, Congenital ; Humans ; Hypospadias* ; Inlays ; Male ; Mucous Membrane ; Postoperative Complications ; Scrotum ; Testosterone ; Transplants ; Urethral Stricture ; Urinary Bladder

The majority of hypospadias repairs can now be accomplished in one-stage, providing a better result with reduced morbidity and hospitalization costs. One-stage repair of hypospadias using Hodgson`s type III urethroplasty was performed on 22 of 47 cases with hypospadias treated at the Departrnent of Urology, Chonnam University Hospital during 10 years between 1976 and 1985. The following results were obtained. 1. The age of all 22 patients ranged from 4 to 30 years at the time of operation and about a half of the patients were in the age group between 6 and 10 years. 2. The most common type of hypospadias was penoscrotal one (55%) 3. Associated anomalies were bifid scrotum in 5 cases (23%) and cryptorchidism in 3 (14%). 4. Urinary diversion was performed on all cases with suprapubic Troca Cystocath in 16 cases (73%) and indwelling urethral silastic catheter in 6(27 %). 5. Postoperative complications were partial skin necrosis in 1 cases (4%), urethrocutaneous fistula in 6 (27%) and urethral stricture in 3 (14%). 6. Opening of the external urethral meatus after surgery was unsatisfactory in 5 cases, of which 3 underwent meatal advancement later. Tumors of the epididymis are rare. The most common one is adenomatoid tumor. At least more than two hundred cases have been reported in the literature but only one was reported by us last year in this country. We add another one which is involving bilateral epididymis simultaneously and review literature briefly.
Adenomatoid Tumor ; Catheters ; Cryptorchidism ; Epididymis ; Female ; Fistula ; Hospitalization ; Humans ; Hypospadias* ; Jeollanam-do ; Male ; Necrosis ; Postoperative Complications ; Scrotum ; Skin ; Urethral Stricture ; Urinary Diversion ; Urology