Authors' reply: Natural course of acquired undescended testis in boys (Br J Surg 2003; 90: 728–731)

Medisch Centrum Alkmaar, Alkmaar, North Holland, Netherlands
British Journal of Surgery (Impact Factor: 5.54). 12/2003; 90(12):1609 - 1610. DOI: 10.1002/bjs.4494
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    ABSTRACT: To investigate the significance of the acquired undescended testis (UDT), which is differentiated into congenital and acquired forms, by assessing the previous testicular position in affected boys. The study comprised 261 boys who had been referred for a non-scrotal testis to the outpatient clinic during an 8-year period (1993-2000). There was a bimodal distribution of age, with peaks at 2.0 and 10.0 years. In each boy with UDT the previous testicular position was ascertained. On referral, 340 testes were not in the scrotum (182 uni- and 79 bilateral). Of the 340 testes, 82 (24%) in 61 boys were diagnosed as retractile, whereas the remaining 258 in 221 boys were undescended. The previous testicular position was known in 208 of 221 boys (94%), with 244 UDTs. In 65 of these 244 (26.6%) the testis had never been scrotal (congenital UDT); in 179 (73.4%) a previous intrascrotal position was recorded in early childhood (acquired UDT) at least once, in 149 (61%) at least twice and in 117 (48%) at least three times. The mean age at referral for congenital UDT was 2.1 years and for acquired UDT was 8.4 years. These results show that acquired UDT is frequent, and occurs at about three times the rate of congenital UDT. Because these boys are referred for treatment later in childhood, the acquired UDT probably accounts for the high rate of (late) orchidopexy.
    BJU International 09/2003; 92(3):293-6. DOI:10.1046/j.1464-410X.2003.04317.x · 3.53 Impact Factor
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    ABSTRACT: The development of the testis is characterised by dramatic changes between birth and adulthood. The most conspicuous changes take place during puberty, when the seminiferous tubule diameter increases significantly owing to an important proliferation of germ cells, giving rise to spermatozoa, and to the development of a tubular lumen; in the interstitial tissue characteristic Leydig cells appear and secrete high levels of testosterone. These pubertal changes of the testis can be detected clinically since they result in testicular volume and serum androgen level increments. The prepubertal testis has classically been defined as a quiescent organ. However, since adequate stereological methods for microscopic analysis are available, it has been shown that the male gonad triplicates its volume between birth and the onset of puberty. Sertoli cells and spermatogonia proliferate intensely; this is critical for the development of quantitatively normal adult spermatogenesis. Seminiferous tubule volume increases owing to an increment in tubular length, not diameter. Sertoli cells are also functionally active during childhood: they produce high amounts of anti-Müllerian hormone during the whole prepubertal period, and inhibin B until the age of 2-4 years. Anti-Müllerian hormone and inhibin seem to play a role as modulators of the proliferation and differentiation of Leydig cell precursors.
    Histology and histopathology 08/1999; 14(3):991-1000. · 2.10 Impact Factor