BACKGROUND: Traditional open orchiopexy remains the standard treatment for palpable undescended testicles (UDT). However, laparoscopic orchiopexy has recently gained attention as an alternative approach.
OBJECTIVE: This study aimed to compare the outcomes of laparoscopic versus open orchiopexy for high-inguinal undescended testes.
METHODS: A prospective randomized comparative study was conducted, involving 208 children with high inguinal undescended testes. The patients were divided into two groups: group A (104 patients) underwent laparoscopic orchiopexy and group B (104 patients) underwent open orchiopexy.
RESULTS: There was a significant difference in the final testicular position between the two groups. The follow-up after 1 year showed that 100% of patients in group A had a lower testicular position, compared to 72.6% in group B. Laparoscopic orchiopexy demonstrated better outcomes in terms of achieving a lower testicular position.
CONCLUSIONS: Both Laparoscopic and Open Orchiopexy are safe and effective for the treatment of high inguinal undescended testes. However, Laparoscopic Orchiopexy was superior to Open Orchiopexy because it was associated with better outcomes with regard to the final testicular position at the bottom of the scrotum or at a lower level below the mid-scrotal point.

UNASSIGNED: Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes.
UNASSIGNED: Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys\' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group.
UNASSIGNED: Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group\'s echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes.
UNASSIGNED: The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.

UNASSIGNED: Undescended testes (UDT) or cryptorchidism is a common congenital disability characterised by the absence of at least one testicle from the scrotum. The primary aim of surgical correction is to preserve fertility potential and prevent complications including trauma, malignancy, hernia and torsion. Often, children, especially in developing countries, present late with UDT. The effect of surgical correction in the recovery of Sertoli cell function in children aged more than 2 years is not apparent. The present study was conducted to study the change in inhibin-B level as a marker of Sertoli cell function in surgically corrected UDT in a heterogeneous population.
UNASSIGNED: A prospective observational study conducted over a 3-year period at a tertiary care paediatric surgery centre recruited 76 children with UDT undergoing surgical correction. Inhibin-B as a marker for Sertoli cell function was studied preoperatively and postoperatively. Continuous variables were summarised by calculating mean, standard deviation, median and interquartile range (IQR). Quantile versus quantile plotting was done to assess the distribution of the data. Data were analysed in two groups, with participants aged <2 years (Group A) and more than 2 years (Group B). Wilcoxon signed-rank test was used to compare the pre-operative and post-operative value.
UNASSIGNED: In Group A (n = 39), the median (IQR) of pre-operative inhibin-B was 181 pg/ml (148-254) and post-operative inhibin-B was 230 pg/ml (176-296). In Group B, the median (IQR) of pre-operative inhibin was 70 pg/ml (44-104) and post-operative inhibin was 102 pg/ml (46-176). There was a significant increase in post-operative inhibin when compared to the pre-operative inhibin (P = 0.015 and 0.012, respectively, in Group A and B). Luteinizing hormone (LH) showed a significant decrease (P = 0.002) in Group A following surgery but bordering on significance in Group B (P = 0.43). On the other hand, follicle-stimulating hormone showed a significant decrease (P < 0.01) in Group B following surgery but not in Group A (P = 0.87).
UNASSIGNED: The mean post-operative inhibin-B levels were increased significantly as compared to the pre-operative levels indicating either a successful orchiopexy/adequate germ cell number or both. The benefit of orchiopexy may extend even to children presenting late for evaluation.

BACKGROUND: Congenital lipoid adrenal hyperplasia is a rare disease that causes disorders of sex development. The 46,XY patient presents with female external genitalia and inguinal testes. We describe the case of a patient with congenital lipoid adrenal hyperplasia and investigated the testes of this patient in detail.
METHODS: A 15-day-old 46,XY neonate presented with severe adrenal insufficiency. Congenital lipoid adrenal hyperplasia was diagnosed after detection of steroidogenic acute regulatory gene mutations. At 2 years and 5 months, she underwent bilateral gonadectomy. Leydig cells were observed both with and without lipid droplets in the testes of this patient. We also demonstrated immunohistochemically that some testosterone-synthesizing enzymes were maintained in this patient.
CONCLUSIONS: The results indicated transcription of testosterone-synthesizing enzymes remained despite lipid accumulation in this patient. The pattern of expression of testosterone-synthesizing enzymes suggested fetal Leydig cells may have remained after birth in the testes of this patient.

Is there a difference in testicular function in early adulthood between men born with cryptorchidism and men born with normally descended testes?
In men from the general population, a history of cryptorchidism was associated with lower total testis volume and impaired semen quality as well as altered serum levels of reproductive hormones.
The association between cryptorchidism and testicular function is well documented in studies based on sub-fertile or infertile men recruited from a clinical setting. However, the association has not previously been investigated in men from the general population, who were unselected regarding fertility status.
This is a cross-sectional population-based study of 6376 young Danish men examined from 1996 to 2017.
This study is based on young men from the greater Copenhagen area, Denmark (median age of 19 years) who were unselected regarding fertility status and semen quality. The young men delivered a semen sample, had a blood sample drawn and underwent a physical examination including assessment of testis volume. Participants completed a questionnaire regarding cryptorchidism at birth, current lifestyle and their mother\'s pregnancy, after consulting their mother. The differences in markers of testicular function, including testis volume, semen parameters and reproductive hormones between men with and without a history of cryptorchidism were investigated with multiple linear regression analyses.
The participation rate was 24% for the entire study period. Overall, a history of cryptorchidism was associated with reduced testicular function. In the adjusted models, a history of cryptorchidism was associated with a 3.5 ml lower total testis volume, determined by orchidometer (P < 0.001), 28% lower sperm concentration (95% CI: -37 to -20) and 26% lower inhibin B/FSH ratio (95% CI: -50 to -22) compared to men without a history of cryptorchidism, suggesting a reduced spermatogenetic capacity. Men with a history of cryptorchidism also had a slightly reduced Leydig cell function expressed as a 6% lower testosterone/LH ratio (95% CI: -12 to -0.7). The significant effect sizes and different markers of testicular function pointing in the same direction across the different models based on a large sample size support that the results are not chance findings.
Information on cryptorchidism at birth and treatment modus was obtained by retrospective self-report, and each participant only delivered one semen sample.
The results suggest that men with a history of cryptorchidism could be at increased risk of experiencing fertility problems. However, among these men there is a wide variation in semen quality and further research is needed in order to identify the subgroup of boys born with cryptorchidism who are at the greatest risk of impaired semen quality when reaching adulthood.
The study received financial support from the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603. FP7/2007-2013, DEER Grant agreement no. 212844); the Danish Ministry of Health; the Danish Environmental Protection Agency; A.P. Møller and wife Chastine McKinney Møllers Foundation; and Svend Andersens Foundation. None of the founders had any role in the study design, collection, analysis or interpretation of data, writing of the paper or publication decisions. The authors have nothing to declare.
N/A.

Chlordecone is an organochlorine pesticide that was extensively used to control the banana root borer population in the French West Indies until 1993. Its persistence in soil has led to widespread pollution of the environment, and human beings, including pregnant women, are still exposed to this chemical. High levels of exposure to chlordecone during gestation have been shown to cause congenital anomalies, including undescended testes in rodents. We assessed the associations between chlordecone concentrations in maternal and cord plasma and the risk of congenital anomalies in the Timoun Mother-Child Cohort Study (2004-2007) that included 1068 pregnant women in Guadeloupe. Odds ratios were estimated using unconditional logistic regression analysis, controlling for confounding factors. The median plasma concentrations in maternal and cord plasma were 0.39 μg/L and 0.20 μg/L, respectively. Thirty-six children were diagnosed with malformations according to the European Registration of Congenital Anomalies guidelines and 25 with undescended testes. There was no association between maternal or cord plasma concentration of chlordecone and the risk of overall malformations nor undescended testes. These results suggest that prenatal exposure to the currently observed environmental levels of chlordecone in French West Indies does not increase the risk of birth defects.

OBJECTIVE: To evaluate the diagnostic value of shear wave elastography (SWE) in the evaluation of undescended and retractile testes (RT) in a pediatric population.
METHODS: We prospectively evaluated a total of 37 undescended testes (UDT), 15 RT, and 56 normal testes using SWE. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the mean stiffness values of groups were compared with each other.
RESULTS: The mean stiffness values of the UDT (13.80 ± 4.14 kPa, 2.14 ± 0.29 m/s) were higher than the mean SWE values of the normal testes (7.44 ± 2.11 kPa, 1.57 ± 0.21 m/s) (p < 0.0001). The mean stiffness values of the RT (9.64 ± 3.71 kPa, 1.75 ± 0.35 m/s) exceeded those of the normal testes (p = 0.004 for elasticity and p = 0.02 for speed). The mean stiffness value of the UDT was higher than the retractile ones (p < 0.0001 for elasticity and speed).
CONCLUSIONS: The higher stiffness values of the UDT and the RT compared to normal testes are likely reflective of underlying pathological alterations; hence, we suggest that SWE might serve as a valuable adjunct for the management of UDT and RT by assessing and monitoring ultrastructural changes.