The Cryptorchid Testis

Current knowledge concerning both morphological and functional cryptorchid-related alterations in the various testicular compartments is summarized in this valuable new publication. Damage to the germinal epithelium and resulting infertility in both humans and experimental animals as well as the degree of damage to the different stages of germ cell development is discussed. In addition, information concerning hormonal therapy and orchidopexy to reverse cryptorchid-related damage is provided. Morphological alterations in Sertoli and Leydig cells is discussed in terms of cellular hypertrophy and hyperplasia, alterations in organelle number and characteristics as well as changes in cell-cell junctional complexes. Changes in Sertoli cell and Leydig cell function, including gonadotropin binding, steroidogenesis and other metabolic alterations is also outlined,as well as the influence of altered testicular function on subsequent hypothalamic-pituitary changes. Vascular disruption, the potential role of paracrine substances and direct thermal damage, all of which may be responsible for the resulting detrimental changes in one or more testicular compartments, are considered.

Current knowledge concerning both morphological and functional cryptorchid-related alterations in the various testicular compartments is summarized in this valuable new publication. Damage to the germinal epithelium and resulting infertility in both humans and experimental animals as well as the degree of damage to the different stages of germ cell development is discussed. In addition, information concerning hormonal therapy and orchidopexy to reverse cryptorchid-related damage is provided. Morphological alterations in Sertoli and Leydig cells is discussed in terms of cellular hypertrophy and hyperplasia, alterations in organelle number and characteristics as well as changes in cell-cell junctional complexes. Changes in Sertoli cell and Leydig cell function, including gonadotropin binding, steroidogenesis and other metabolic alterations is also outlined,as well as the influence of altered testicular function on subsequent hypothalamic-pituitary changes. Vascular disruption, the potential role of paracrine substances and direct thermal damage, all of which may be responsible for the resulting detrimental changes in one or more testicular compartments, are considered.

During the past decade extensive investigations have been done on the testis. Since the observations have been published in many different journals. it seemed appropriate to bring together and summarize some of the pertinent findings in a single volume. Twenty-eight scientists and clinicians from nine countries have contributed to this book. They have reviewed the literature and presented their own, new observations on the developmentaL anatomicaL physiologicaL biochemical and pathological aspects of the descended and cryptorchid testis. In addition, several contributors have evaluated the usefulness of certain animals as models for systematically studying specific aspects of cryptorchidism. It is hoped that this volume will serve as a useful summary and reference for those working in this area and that it will encourage further research in testicular physiopathology. The editor thanks the contributors for their enthusiasm, cooperation and meticulous writing of the chapters. The support of the Departments of GynecologyjObstetrics and the Department of Physiology of Wayne State University School of Medicine. Detroit and the assistance from the staff of Martinus Nijhoff are gratefully acknowledged. The cheerful cooperation of Miss Lori Rust and Miss Penny Stoops who helped to type and assemble the volume is most deeply appreciated.

Ferment, a sign of progress in any scientific field, has previously been lacking in the area of cryptorchidism, where the only activity has been in improving operative methods. Now, however, profound changes in the care of boys with cryptorchidism are being brought about; ideas are arising from a fresh look at comparative anatomy, and histological and experimental observa tions are being supplemented by clinical tests made possible by new hormonal agents. The treatment of cryptorchidism begins with its recognition by the pediatri cian, who until now has shown little interest because of disappointing results from chorionic gonadotropin administration. As for the surgeon, his bent toward restoration of normal anatomical relationships has kept his attention focused on the development of better surgical technics to bring the recalci trant testis into the scrotum. Both specialists have avoided the primordial question of why the testis did not descend properly. If this were known they would treat the cause of cryptorchidism, and not be satisfied merely with trying to correct its end result. As one reads this book, one sees that in most patients cryptorchidism is not caused by some anatomical structure blocking the way or by some deformity of the testis interfering with the transport mechanism. Rather, deficiencies in the hormonal environment of the fetus retard the developmen tal sequences essential to the normal differentiation and descent of the testis. The clinical solution is thus to provide the deficient substances.

Cytological techniques have greatly improved in the last twenty years, largely as a result of further development of the microscope. Electron microscopy, in particular, has opened up great prospects for the study of cell morphology, while the develop ment of radio-immuno-assay has brought great progress in endocrinology. The applica tion of these two techniques, which are complementary to each other and provide mutually supporting evidence, is the subject of this monograph. The work is divided into two parts. The first deals with the ultrastructure of normal testicular development, describing four main elements of the testicle - the germ cells, the Sertoli cells, the peri tubular connective tissue and the Leydig cell- with details of their individual development. To make the electron micrographs more easily understandable, diagrams have been used to explain the most important points. The second part deals with cryptorchid testicles, including the primary and sec ondary changes involved and morphometric studies of the secondary changes. The significance of these ultrastructural observations for the treatment of cryptorchidism is emphasized. With the aid of radio-immuno-assay the level of testosterone in cryp torchid mice was determined and comparisons drawn between the ultrastructural changes in cryptorchidism in mouse and man. The experimental studies served as a basis for the hypothesis that, in all probability, a congenital disturbance of the hy pothalamo-hypophyso-gonadal axis is responsible for cryptorchidism. I hope that this monograph will contribute towards a better understanding of normal and cryptorchid testicular development and of the etiology of cryptorchidism.

This book provides a practical guide to the congenital and acquired problems related to pediatric surgery and urology. A range of topics are covered, including; abdominal wall hernias, hemangioma and vascular malformations, gastrochesis, achalasia, congenital gastric outlet obstruction, renal and liver tumors, intestinal malrotation, and hydronephrosis. The book aims to be a quick reference text for the diagnosis and treatment of pediatric surgery conditions and presents information relevant to general surgeons, pediatricians, pediatric surgeons, and medical trainees.

Written in a simple point by point style for ease of use, this volume covers all aspects of pediatric surgery with emphasis on important points for diagnosis and management. Each chapter covers a topic with emphasis on the most common conditions in neonatal and general pediatric surgery. The text is well illustrated with clinical, operative, radiological, and histopathological color figures and illustrations. The book also presents some of the rare conditions encountered in pediatric surgery, as well as common pediatric urology conditions. An Illustrated Guide to Pediatric Surgery is a useful reference to pediatric surgeons, specialists, fellows and residents, as well as general surgeons, pediatricians, neonatologists, medical students and interns interested in pediatric surgery.