Jørgensen N, Rajpert-De Meyts E, Main K M, Skakkebaek N E
University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
Int J Androl. 2010 Apr;33(2):298-303. doi: 10.1111/j.1365-2605.2009.01050.x. Epub 2010 Feb 4.
In 2001, when the testicular dysgenesis syndrome (TDS) concept was proposed, it suggested that impaired development of foetal testes could lead to increased risks of cryptorchidism, hypospadias, decreased spermatogenesis or testis cancer. The TDS concept links the pathogenesis of the four disorders together, but does not imply that all affected men develop all four symptoms. The least affected men may merely have a slightly reduced spermatogenic capacity, and only the most severely affected may present all symptoms. A majority of cases of testicular germ cell cancers (TGCC) and cryptorchidism are most likely caused by TDS. However, the frequency of the syndrome in the general population and to what extent poor semen quality and hypospadias are actually biologically related through a foetal mechanism remain unresolved. Hypospadias and impaired spermatogenesis can be classified as TDS if combined with cryptorchidism or TGCC. By contrast, recent studies demonstrated that among men with isolated hypospadias, only a fraction of cases are linked to TDS. There is no doubt that TDS contributes to impaired semen quality. This is most obvious for cases with visible dysgenetic features in testis histology, but in the majority of men with impaired semen quality as the only symptom, an association with TDS is less clear. Such cases have a very heterogeneous aetiology and may be caused by a host of other - often post-natal-factors. In conclusion, the TDS as a holistic concept has inspired new research activities and led to a better understanding of the early origin of male reproductive problems, but it clearly encompasses only a fraction of cases of hypospadias and impaired spermatogenesis.
2001年，睾丸发育不全综合征（TDS）概念被提出时，表明胎儿睾丸发育受损可能导致隐睾、尿道下裂、精子发生减少或睾丸癌风险增加。TDS概念将这四种疾病的发病机制联系在一起，但并不意味着所有受影响的男性都会出现这四种症状。受影响最小的男性可能只是精子发生能力略有下降，只有受影响最严重的男性才可能出现所有症状。大多数睾丸生殖细胞癌（TGCC）和隐睾病例很可能是由TDS引起的。然而，该综合征在普通人群中的发生率以及精液质量差和尿道下裂通过胎儿机制在生物学上实际相关的程度仍未得到解决。如果尿道下裂和精子发生受损与隐睾或TGCC合并出现，则可归类为TDS。相比之下，最近的研究表明，在单纯尿道下裂的男性中，只有一小部分病例与TDS有关。毫无疑问，TDS会导致精液质量受损。这在睾丸组织学中有明显发育异常特征的病例中最为明显，但在大多数仅以精液质量受损为唯一症状的男性中，与TDS的关联不太明确。这些病例病因非常异质，可能由许多其他因素引起，这些因素通常发生在出生后。总之，TDS作为一个整体概念激发了新的研究活动，并使人们对男性生殖问题的早期起源有了更好的理解，但它显然只涵盖了一部分尿道下裂和精子发生受损的病例。
