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.

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.

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.

This book provides a state of the art overview of all aspects of testicular descent and cryptorchidism, including the mechanisms of descent and the causes, consequences, diagnosis, and treatment of undescended testis. The advances in understanding that have been achieved over the past two decades are clearly explained, covering the latest genetic information on the causes of normal and abnormal testicular descent, the role of INSL3 in transabdominal migration, and the evidence that a neurotransmitter released from the genitofemoral nerve mediates androgenic control of inguinoscrotal descent. Exciting changes in the management of both congenital and acquired cryptorchidism, such as the widespread use of laparoscopy for impalpable testes inside the abdominal cavity, are fully described. Evidence for the benefits of orchidopexy within the first year of life is reviewed, and an individual chapter is also devoted to hormonal treatment. Throughout the book due attention is given to ongoing controversies and divergences of opinion. This new edition of Descent of the Testis will be a timely update and valuable reference for all who are involved in research into testicular descent and management of cryptorchidism.

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.