Hosie S, Wessel L, Waag K L
Department of Pediatric Surgery, Klinikum Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
Eur J Pediatr Surg. 1999 Feb;9(1):37-41. doi: 10.1055/s-2008-1072210.
Gubernaculum testis and androgens play an important role in physiologic testicular descent. A direct androgen stimulation of the gubernaculum is only possible in the presence of specific receptors, which have not yet been demonstrated. We have determined the androgen-binding capacity in 61 samples of gubernaculum testis from 48 patients, 34 samples belonging to patients with maldescended testes. In 43 out of 61 instances we found androgen binding with values up to 72 fmol/mg, with a mean of 13.08 fmol/mg. In 27 samples from patients with a deep scrotal positioned gonad the mean androgen-binding capacity was 18.74 fmol/mg. In 10 samples from patients with a gonad in the proximal scrotum and 19 patients with epifascial ectopy or a low inguinal position the mean androgen-binding capacities decreased progressively to 9 fmol/mg and 5.95 fmol/mg. In the 5 samples from patients with high inguinal or abdominal testes the binding capacity of 17.8 fmol/mg did not significantly differ from the value obtained in the samples of the normal-positioned gonads, suggesting that transabdominal descent is probably not androgen-dependent. We divided the probes into receptor status positive for a binding capacity higher than or equal to 10 fmol/mg, and receptor status negative for a binding capacity under 10 fmol/mg. 63% of the samples from patients with scrotal positioned testes were receptor status positive, 85% of the samples belonging to patients with maldescended testes were receptor status negative. Receptor status was negative in patients with high scrotal, epifascial or low inguinal and high inguinal or abdominal testes in 90%, 95% and 40% of the samples respectively. Immunohistochemical examination of 10 samples showed small cell groups with stained nuclei in 2 out of 5 patients with normal-positioned testes. All other samples were negative. These findings prove that hormone binding was accomplished by specific intranuclear receptors. These findings allow for the first time the hypothesis of a direct androgen stimulation of the human gubernaculum testis. The probable mechanism is an increase in mucopolysaccharides leading to a swelling of the gubernaculum, dilating the inguinal canal and promoting testicular descent. Although certainly a multifactorial process, quality and quantity of androgen receptors would influence the extent of transinguinal testicular descent.
睾丸引带和雄激素在生理性睾丸下降过程中发挥着重要作用。只有在存在尚未被证实的特定受体时，雄激素才能直接刺激睾丸引带。我们测定了48例患者的61份睾丸引带样本中的雄激素结合能力，其中34份样本来自睾丸下降异常的患者。在61例样本中，有43例检测到雄激素结合，结合值高达72飞摩尔/毫克，平均为13.08飞摩尔/毫克。在阴囊深部有性腺的患者的27份样本中，平均雄激素结合能力为18.74飞摩尔/毫克。在阴囊近端有性腺的患者的10份样本以及19例筋膜上异位或腹股沟低位的患者的样本中，平均雄激素结合能力逐渐下降至9飞摩尔/毫克和5.95飞摩尔/毫克。在高位腹股沟或腹腔内睾丸患者的5份样本中，17.8飞摩尔/毫克的结合能力与正常位置性腺样本所获得的值无显著差异，这表明经腹下降可能不依赖雄激素。我们将样本分为结合能力高于或等于10飞摩尔/毫克的受体状态阳性和结合能力低于10飞摩尔/毫克的受体状态阴性。阴囊内有睾丸的患者的样本中63%为受体状态阳性，睾丸下降异常的患者的样本中85%为受体状态阴性。高位阴囊、筋膜上或低位腹股沟以及高位腹股沟或腹腔内睾丸患者的样本中，受体状态阴性的比例分别为90%、百分之九十五和40%。对10份样本进行免疫组织化学检查显示，在5例正常位置睾丸的患者中，有2例的小细胞群细胞核呈染色阳性。所有其他样本均为阴性。这些发现证明激素结合是由特定的核内受体完成的。这些发现首次提出了雄激素直接刺激人类睾丸引带的假说。可能的机制是黏多糖增加导致睾丸引带肿胀，扩张腹股沟管并促进睾丸下降。尽管这肯定是一个多因素过程，但雄激素受体的质量和数量会影响经腹股沟睾丸下降的程度。
