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Human Reproduction (Oxford, England) Apr 2024Do different boys with different types of cryptorchidism exhibit different anogenital distances (AGDs)?
STUDY QUESTION
Do different boys with different types of cryptorchidism exhibit different anogenital distances (AGDs)?
SUMMARY ANSWER
Length of AGD seemed to differ in different groups of patients with cryptorchidism.
WHAT IS KNOWN ALREADY
AGD, which is used as an indicator of prenatal androgen action, tends to be shorter in boys with cryptorchidism compared to unaffected boys. Shorter AGDs have also been reported in boys with hypospadias, in men with poor semen quality, and in men with testicular cancer.
STUDY DESIGN, SIZE, DURATION
A prospective descriptive cohort study was performed using data from consecutively selected boys with cryptorchidism (n = 169) operated in a single center over a period of 3 years (September 2019 to October 2022).
PARTICIPANTS/MATERIALS, SETTING, METHODS
AGD was measured in 169 infant boys, at 3 to 26 months of age, during anesthesia with a vernier caliper measuring the distance from the anus to the base of the scrotum (AGDAS) and from the anus to the anterior base of the penis (AGDAP) in two body positions according to the methods by 'The Infant Development and the Environment Study' (TIDES) and 'Cambridge Baby Growth Study', resulting in four mean values per patient (TIDES AGDAS/AP and Cambridge AGDAS/AP). Normal values for AGD by age were set by our hospital Department of Growth and Reproduction based on a large cohort of healthy infant boys (n = 1940). Testicular biopsies were performed at orchidopexy as a clinical routine. The germ cell number (G/T) and type Ad spermatogonia number (AdS/T) per cross-sectional tubule of at least 100 and 250 tubules, respectively were measured and related to normal samples. Blood samples were obtained by venipuncture for measuring serum LH, FSH, and inhibin B. They were analyzed in our hospital Department of Growth and Reproduction where the normal reference was also established. Correlations between the four mean AGD measurements for each boy were evaluated by Spearman rank correlation analyses. The AGD measurement of every boy was transferred to the multiple of the median (MoM) of the normal AGD for age and named MoM AGD.
MAIN RESULTS AND THE ROLE OF CHANCE
There were 104 boysoperated for unilateral, and 47 boys operated for bilateral, undescended testes, whereas 18 boys had vanished testis including one boy with bilateral vanished testes. Only 6% of cases with vanished testes had a MoM AGD higher than the normal median compared to 32% with undescended testes (P < 0.05). MoM AGD increased with the age at surgery for boys with vanished testis (Spearman r = 0.44), but not for boys with undescended testes (Spearman r = 0.14). Boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism (P < 0.005) and (P < 0.000001).
LIMITATIONS, REASONS FOR CAUTION
Although being the largest published material of AGD measurements of infant boys with cryptorchidism, one limitation of this study covers the quite small number of patients in the different groups, which may decrease the statistical power. Another limitation involves the sparse normal reference material on G/T and AdS/T. Finally, there are currently no longitudinal studies evaluating AGD from birth to adulthood and evaluating childhood AGD in relation to fertility outcome. Our study is hypothesis generating and therefore the interpretation of the results should be regarded as exploratory rather than reaching definite conclusions.
WIDER IMPLICATIONS OF THE FINDINGS
The study findings are in agreement with literature as the total included group of boys with cryptorchidism exhibited shorter than normal AGDs. However, new insights were demonstrated. Boys with vanished testis had shorter AGDs compared to unaffected boys and to boys with undescended testes. This finding challenges the current concept of AGD being determined in 'the masculinization programming window' in Week 8 to 14 of gestation. Furthermore, boys with bilateral cryptorchidism had longer AGDs and more often had hypogonadotropic hypogonadism than boys with unilateral cryptorchidism, suggesting that the lack of fetal androgen in hypogonadotropic hypogonadism is not that significant.
STUDY FUNDING/COMPETING INTEREST(S)
No external funding was used and no competing interests are declared.
TRIAL REGISTRATION NUMBER
The trial was not registered in an ICMJE-recognized trial registry.
Topics: Male; Pregnancy; Infant; Female; Child; Humans; Cryptorchidism; Testicular Neoplasms; Androgens; Semen Analysis; Cohort Studies; Cross-Sectional Studies; Prospective Studies; Hypogonadism; Gonadal Dysgenesis, 46,XY; Testis
PubMed: 38373213
DOI: 10.1093/humrep/deae025 -
Cureus Mar 2024Although findings related to codominant coronary artery circulation, patent foramen ovale (PFO), and Chiari network (CN) have been documented in isolation, there is a...
Although findings related to codominant coronary artery circulation, patent foramen ovale (PFO), and Chiari network (CN) have been documented in isolation, there is a gap in literature detailing the unique case with the presence of all three cardiac anomalies concomitantly present in a single heart. The purpose of this case report is to detail a unique cadaveric heart case, to serve as reference to provide useful data for interventionalists and clinicians. This observational cadaveric study assessed a single donor heart obtained through the University of Houston College of Medicine's Willed Donor Program. After meticulous dissection, relevant heart surface structures were isolated and identified. Morphometric analysis and measurements were obtained via a digital vernier caliper. The donor heart exhibited a typical codominant coronary arterial scheme, in that the posterior interventricular artery arose as a merger between the right coronary and the circumflex on the postero-inferior surface of the heart when placed in the valentine orientation. Interestingly, the antero-lateral surface of the heart was supplied via a left marginal artery (LMA) and an accessory left anterior interventricular artery.Contribution to the existing knowledge base of unique concomitant cardiac anomalies, may prove to be a beneficial future reference for interventionalists in hopes that an expanded knowledge base may lead to comprehensive and safe implementation of a wide variety of procedures.
PubMed: 38567208
DOI: 10.7759/cureus.55434