Hadziselimovic F, Snyder H M, Huff D S
Kindertagesklinik, Liestal, Switzerland.
J Urol. 1999 Sep;162(3 Pt 2):983-5. doi: 10.1016/S0022-5347(01)68039-X.
A paucity of germ cells exists in the cryptorchid gonad that usually correlates with a similar finding in the contralateral descended testis. However, we have noted a small number of boys with cryptorchidism in whom there is a significant difference between the histological evaluation of the cryptorchid testis and the normal descended testis that may indicate a different etiology.
From 1986 to 1991, 1,426 boys with unilateral cryptorchidism underwent orchiopexy, of whom 752 also underwent bilateral testicular biopsy. Testicular volume and position, and patency of the processus vaginalis were examined. Biopsies were fixed in 2% glutaraldehyde and embedded in Epon. Semithin tissue sections were analyzed by 2 independent investigators. The number of total germ cells, gonocytes, adult dark and pale spermatogonia, primary spermatocytes and Leydig cells was assessed.
Of the 1,426 boys the undescended testis was on the right side in 726 and on the left side in 658 (52 versus 48%, p = 0068). Of the 752 boys who underwent bilateral biopsy 42 (5.6%) 1.1 to 16 years old (mean age plus or minus standard deviation 0 5.2 +/- 3.65) had a poor fertility index of less than 0.2 germ cell per tubule in the cryptorchid gonad, although the germ cell count in the descended testis was normal. Of the 42 testes in this special group of boys 30 (71%) were on the right side (Fisher's exact test p <0.23), including 16 (38%) in an intra-abdominal or high canalicular position. The processus vaginalis was patent in 86% of the intra-abdominal testes and in 100% of those located at the tubercle but in only 25% of those in a pre-scrotal position. While average germ cell count in the cryptorchid testis was 0.06 per tubule with abnormal germ cell maturation, number was normal (greater than 2 germ cells per tubule) in the contralateral descended testis with a normal distribution of adult dark and pale spermatogonia, and primary spermatocytes. Average volume of the cryptorchid testis was significantly less than that of the descended testis (1.20 +/- 0.35 versus 1.60 +/- 0.68 mm.3, p <0.0001).
Based on the normal scrotal testis the fertility prognosis is good in this small subgroup of boys with cryptorchidism. Rather than the usual endocrinopathy of cryptorchidism, the undescended testis in these boys may be the result of end organ failure. These patients with favorable fertility potential may be recognized only if each testis is biopsied at unilateral orchiopexy.
隐睾性腺中生殖细胞数量稀少，这通常与对侧下降睾丸中的类似发现相关。然而，我们注意到少数隐睾男孩的隐睾组织学评估与正常下降睾丸之间存在显著差异，这可能表明病因不同。
1986年至1991年，1426名单侧隐睾男孩接受了睾丸固定术，其中752名还接受了双侧睾丸活检。检查了睾丸体积、位置以及鞘突的通畅情况。活检组织用2%戊二醛固定，包埋于环氧树脂中。由2名独立研究人员分析半薄组织切片。评估了生殖细胞总数、生殖母细胞、成年深色和浅色精原细胞、初级精母细胞以及 Leydig 细胞的数量。
在1426名男孩中，未降睾丸在右侧的有726例，在左侧的有658例（52%对48%，p = 0.068）。在接受双侧活检的752名男孩中，42名（5.6%）年龄在1.1至16岁（平均年龄±标准差为5.2±3.65岁），其隐睾性腺中每小管生殖细胞生育指数低于0.2，尽管下降睾丸中的生殖细胞计数正常。在这一特殊男孩组的42个睾丸中，30个（71%）在右侧（Fisher精确检验p<0.23），其中16个（38%）位于腹腔内或高位管状位置。鞘突在86%的腹腔内睾丸和100%位于结节处的睾丸中是通畅的，但在阴囊前位置的睾丸中仅25%通畅。隐睾中平均每小管生殖细胞数为0.06，生殖细胞成熟异常，而对侧下降睾丸中数量正常（每小管大于2个生殖细胞），成年深色和浅色精原细胞以及初级精母细胞分布正常。隐睾的平均体积明显小于下降睾丸（1.20±0.35对1.60±0.68mm³，p<0.0001）。
基于阴囊内正常睾丸，这一小群隐睾男孩的生育预后良好。这些男孩的未降睾丸可能不是通常的隐睾内分泌病，而是终末器官衰竭的结果。只有在单侧睾丸固定术时对每个睾丸进行活检，才可能识别出这些具有良好生育潜力的患者。
