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Volker Loy - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of contralateral Testicular intraepithelial neoplasia tin in patients with Testicular germ cell cancer systematic two site biopsies are more sensitive than a single random biopsy
European Urology, 2007Co-Authors: Klauspeter Dieckmann, Magdalena Kulejewski, Uwe Pichlmeier, Volker LoyAbstract:Abstract Objectives Searching for Testicular intraepithelial neoplasia (TIN; carcinoma in situ) in the contralateral testis of patients with germ cell tumour (GCT) may early disclose contralateral GCT. A single biopsy of the testis is thought to accurately detect TIN. Reports on false-negative biopsies have challenged this view. We investigated whether systematic two-site biopsies are more sensitive than single biopsies. We also studied the prevalence of contralateral TIN in a large patient sample. Methods A total of 2318 patients with Testicular GCT underwent contralateral double biopsy. All of the biopsy pairs were examined histologically for spermatogenesis and for presence of TIN. Statistical analysis involved first, overall prevalence of contralateral TIN; second, associations of clinical factors with TIN; third, frequency of discordant findings regarding TIN among biopsy pairs; and finally, associations of discordance with clinical factors. Results A total of 119 patients (5.13%; 95% confidence interval [CI], 4.27–6.11) had contralateral TIN. TIN is associated with poor spermatogenesis (relative risk [RR] 15.74; 95%CI, 10.38–23.86) and with Testicular Atrophy (RR 3.78). According to TIN, 31.1% of biopsy pairs were discordant. Discordance was significantly less frequent in atrophic testes and in patients with poor spermatogenesis. Conclusions We confirmed the prevalence of contralateral TIN to be about 5%. TIN is significantly associated with poor spermatogenesis and with Testicular Atrophy. The diagnostic extra yield imparted by double biopsies is 18%. Discordant results regarding TIN are predominantly encountered in normal-sized testicles. The new standard in diagnosing TIN is two-site biopsy.
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prevalence of contralateral Testicular intraepithelial neoplasia carcinoma in situ in patients with Testicular germ cell tumour results of the german multicentre study
European Urology, 1993Co-Authors: Volker Loy, K P DieckmannAbstract:Controlateral biopsies taken from 1, 188 patients with Testicular germ-cell tumour were examined immunohistologically by staining for placental alkaline phosphatase. Testicular intraepithelial neoplasia (TIN; carcinoma in situ) was detected in 53 patients (4.5%; 95% confidence interval 3.3-5.7%). Testicular Atrophy was found in 45.7% of cases with TIN and in 14.1% of cases without TIN (p<0.01). History of undescended testis was present in 21.3% of cases with TIN and in only 9.3% in cases without (p<0.05). Patients with contralateral TIN presented at an earlier age (31.0 vs 33.7 years)
K P Dieckmann - One of the best experts on this subject based on the ideXlab platform.
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prevalence of contralateral Testicular intraepithelial neoplasia carcinoma in situ in patients with Testicular germ cell tumour results of the german multicentre study
European Urology, 1993Co-Authors: Volker Loy, K P DieckmannAbstract:Controlateral biopsies taken from 1, 188 patients with Testicular germ-cell tumour were examined immunohistologically by staining for placental alkaline phosphatase. Testicular intraepithelial neoplasia (TIN; carcinoma in situ) was detected in 53 patients (4.5%; 95% confidence interval 3.3-5.7%). Testicular Atrophy was found in 45.7% of cases with TIN and in 14.1% of cases without TIN (p<0.01). History of undescended testis was present in 21.3% of cases with TIN and in only 9.3% in cases without (p<0.05). Patients with contralateral TIN presented at an earlier age (31.0 vs 33.7 years)
C O Record - One of the best experts on this subject based on the ideXlab platform.
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quantitative studies of Testicular Atrophy following portacaval shunt in rats
Hepatology, 1998Co-Authors: A M Zaitoun, Gustav Apelqvist, Cecilia Wikell, Hanan Almardini, Finn Bengtsson, C O RecordAbstract:To evaluate the differential effects of portacaval shunting (PCS) on the morphological changes that occur in humans with portal-systemic encephalopathy, male rats underwent either PCS (13) or sham operations (10). Normal adult rats (6) were used as controls. All animals were killed 5 to 7 weeks after the surgery. The wet weight of the testes was obtained. Hematoxylin-eosin (HE)-stained sections at 5-micrometers thickness were used for stereological analysis using an image analysis system. Apoptosis was assessed quantitatively in HE and in in situ end-labeling (ISEL)-stained slides, while mitotic activity and mast cell numbers were assessed in 20 high-power fields. There was a significant reduction in the Testicular mass (664 mg) in PCS rats in comparison with sham (2,199 mg) and control (1,937 mg) rats (P <.00001). The thickness of germinal epithelium was significantly reduced in PCS rats (64 micrometers) compared with sham (126 micrometers) and control groups (108 micrometers). The number of tubules per square millimeter and the mean curvature were significantly increased in PCS rats (P <.00001). There was a 112-fold increase in apoptosis in PCS rats (112) in comparison with the control and sham-operation groups (1.2 and 0.7, respectively). Mitosis was significantly reduced in the PCS group (P =.0089), but mast cells were unchanged. The results suggest that PCS in the absence of liver dysfunction produces Testicular Atrophy by reduction in mitosis, maturation arrest, and increased apoptosis of the germinal epithelium. PCS may therefore be responsible for gonadal Atrophy that occurs with advanced liver disease in humans.
Kenneth I Glassberg - One of the best experts on this subject based on the ideXlab platform.
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adolescent varicocelectomy does artery sparing influence recurrence rate and or catch up growth
Journal of Andrology, 2014Co-Authors: Angela M Fast, Shannon N Nees, Christopher M Deibert, Jason P Van Batavia, Kenneth I GlassbergAbstract:Summary The prevalence of varicocoeles is 15% in the general adolescent and adult male population and in 35–40% of men evaluated for infertility. While varicocelectomy can be performed using various methods and techniques, the laparoscopic approach allows for clear visualization of the Testicular artery and lymphatics. Amongst urologists, particularly paediatric urologists, and andrologists there is much debate regarding the significance of Testicular artery sparing when performing a varicocelectomy, with some believing that ligating the Testicular artery impairs catch-up growth and future fertility. On the other hand, several studies have reported higher failure rates with artery preservation. To help resolve the debate regarding the significance of artery sparing, we sought to compare varicocoele recurrence rate and catch-up growth in patients who underwent artery sparing laparoscopic varicocelectomy compared with those who had the artery sacrificed. We identified 524 laparoscopic varicocelectomies in 425 patients from our adolescent varicocoele database. Only patients who had ultrasound determined Testicular volume measurements pre-operatively and at least 6 months post-operatively were included. Post-operative persistence/recurrence of varicocoele, Testicular Atrophy and repeat varicocelectomy were noted. Catch-up growth was compared between procedures in those with significant pre-operative asymmetry. Four hundred and forty primary laparoscopic varicocelectomies were performed in 355 patients (mean age: 15.5 years, range 9.3–20.6; mean follow-up: 32.9 months, range 6.0–128.9) who had both pre- and post-varicocelectomy scrotal Duplex Doppler ultrasound performed. The Testicular artery was preserved in 54 varicocoeles (41 patients) and ligated in 384 varicocoeles (312 patients). We observed an increased rate of persistent/recurrent varicocoele in the artery-sparing vs. artery ligating patients (12.2% vs. 5.4%, p = 0.09). In addition, there was no difference in catch-up growth and no instance of Testicular Atrophy. As artery sparing varicocelectomy offered no advantage in regards to catch-up growth and was associated with a higher incidence of recurrent varicocoele, preservation of the artery does not appear to be routinely necessary in adolescent varicocelectomy.
Marc Goldstein - One of the best experts on this subject based on the ideXlab platform.
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incidence and postoperative outcomes of accidental ligation of the Testicular artery during microsurgical varicocelectomy
The Journal of Urology, 2005Co-Authors: Peter T K Chan, James E Wright, Marc GoldsteinAbstract:PURPOSE: In this study the frequency and outcomes of unintentional Testicular artery ligation during microsurgical varicocelectomy were evaluated. MATERIALS AND METHODS: From 1984 to 2002, 2,102 cases of microsurgical varicocelectomy were evaluated. Accidental artery ligation was confirmed intraoperatively by observation of pulsatile twitching of the ligated vessel stump under 25x magnification. RESULTS: The complication was identified in 19 cases (0.9%) and all occurrences were unilateral, with 74% on the left side and 42% on the right side. In addition to the vasal artery at least 1 alternative artery was identified in all cases. Average testis volume before surgery was 15.8 ml. Azoospermia was found in 26% of cases. After surgery during the median followup of 19 months Testicular Atrophy developed in 1 patient (5%). In this cohort significant improvement was found in serum total testosterone in 80% (from 362 to 493 ng/dl) and in sperm count in 80% (from 12 to 22 x 10 per ml). Return of motile sperm to the ejaculate was found in 40% of azoospermic cases. The natural pregnancy rate was 14%, which is significantly lower than the 46% previously reported in the historical cohort of varicocelectomy cases. CONCLUSIONS: The incidence of accidental Testicular artery ligation in microsurgical varicocelectomy was approximately 1%. Testicular Atrophy developed in 1 patient (5%). Preservation of cremasteric and/or secondary internal spermatic arteries likely contributed to a low incidence of adverse outcomes. The natural pregnancy rate was low which may be due to the high proportion of azoospermic men before surgery. It is possible that the smaller testes usually associated with azoospermia indicate smaller Testicular arteries, thus posing a greater risk of accidental ligation.
