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Progres En Urologie : Journal de... Nov 2022Updated Recommendations for the management of testicular germ cell cancer. (Review)
Review
OBJECTIVE
Updated Recommendations for the management of testicular germ cell cancer.
MATERIALS AND METHODS
Comprehensive review of the literature on PubMed since 2020 concerning the diagnosis, treatment and follow-up of testicular germ cell cancer (TGCT), and the safety of treatments. The level of evidence of the references was evaluated.
RESULTS
The initial work-up for patients with testicular germ cell cancer is based on a clinical examination, biochemical (AFP, total hCG and LDH serum markers) and radiological assessment (scrotal ultrasound and thoracic-abdominal-pelvic [TAP] CT). Inguinal orchiectomy is the first therapeutic step whereby the histological diagnosis can be made, and the local stage and risk factors for stage I non-seminomatous germ cell tumours (NSGCT) can be determined. For patients with pure stage-I seminoma, the risk of progression is 15 to 20%. Therefore, surveillance in compliant patients is preferable; adjuvant chemotherapy with carboplatin AUC 7 is an option; and indications for para-aortic radiotherapy are limited. For patients with stage I NSGCT, there are various options between surveillance and a risk-adapted strategy (surveillance or 1 cycle of BEP [Bleomycin Etoposide Cisplatin] depending on the absence or presence of vascular emboli within the tumour). Retroperitoneal lymph node dissection for staging has a very limited role. The treatment for metastatic TGCT is BEP chemotherapy in the absence of any contraindication to bleomycin, for which the number of cycles is determined according to the prognostic risk group of the International Germ Cell Cancer Consortium Group (IGCCCG). Para-aortic radiotherapy is still a standard in stage IIA seminomatous germ cell tumours (SGCT). After chemotherapy, the size of residual masses should be assessed by TAP scan for NSGCT: retroperitoneal lymph node dissection is recommended for any residual mass of more than 1 cm, and all other metastatic sites should be excised. For SGCT, reassessment by 18F-FDG PET is required to specify the surgical indication for residual masses>3cm. Surgery is still rare in these situations.
CONCLUSION
By adhering to TGCT management recommendations, excellent disease-specific survival rates are achieved; 99% for stage I and over 85% for metastatic stages.
Topics: Humans; Male; Neoplasms, Germ Cell and Embryonal; Testicular Neoplasms; Orchiectomy; Bleomycin
PubMed: 36400478
DOI: 10.1016/j.purol.2022.09.009 -
Urologie (Heidelberg, Germany) Jul 2022Granulomatous and abscessing testicular inflammations are important differential diagnoses of testicular tumors. Infectious orchitis should always be considered in...
Granulomatous and abscessing testicular inflammations are important differential diagnoses of testicular tumors. Infectious orchitis should always be considered in unclear testicular masses with negative tumor markers. We report the case of a 45-year-old man with abscessing orchitis due to early syphilis diagnosed after orchiectomy with the suspicion of a seminoma.
Topics: Diagnosis, Differential; Humans; Male; Middle Aged; Orchiectomy; Orchitis; Syphilis; Testicular Neoplasms
PubMed: 35166861
DOI: 10.1007/s00120-022-01776-w -
International Braz J Urol : Official... 2021The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular...
PURPOSE
The aim of this paper is to propose a modified surgical technique for immediate intravaginal prosthesis implantation in patients undergoing orchiectomy due to testicular torsion, and to evaluate the wound healing process and patient's satisfaction.
MATERIAL AND METHODS
We prospectively analyzed 137 patients with testicular torsion admitted to our facility between April 2018 and May 2020. Twenty-five patients who underwent orchiectomy were included in this study. Fifteen had a testicular prosthesis implanted at the same time as orchiectomy using a modified intravaginal technique (summary figure) and 10 received implants 6 to 12 months after orchiectomy. Wound healing was evaluated at a minimum of four checkpoints (on days 15, 45, 90 and 180 after surgery). At the end of the study, a questionnaire was administered to measure patients' satisfaction rate. Student's t test was used for comparison of quantitative data between negative vs. positive cultures (p<0.05). The chi-square test was used to verify associations between categorical variables and immediate vs. late prosthesis implantation (p <0.05).
RESULTS
Patient's ages ranged from 13 to 23 years (mean 16.44 years). Overall time lapse from symptoms to orchiectomy ranged from 10 hours to 25 days (mean 7.92 days). Only one extrusion occurred and it happened in the late implant group. All wounds were healed in 72%, 88%, 95.8% and 100% of the cases on the 15th, 45th, 90th and 180th days after implant, respectively. At the end of the study, all patients stated they would recommend it to a friend or relative. The only patient that had prothesis extrusion asked to have it implanted again.
CONCLUSION
There was no prosthesis extrusion using the modified intravaginal surgical technique for immediate testicular prosthesis implantation, which proved to be an easily performed and safe procedure that can avoid further reconstructive surgery in patients whose testicle was removed due to testicular torsion.
Topics: Adolescent; Adult; Humans; Male; Orchiectomy; Prostheses and Implants; Prosthesis Implantation; Retrospective Studies; Spermatic Cord Torsion; Testis; Young Adult
PubMed: 34469675
DOI: 10.1590/S1677-5538.IBJU.2021.9917 -
PloS One 2020The creation of species-specific valid tools for pain assessment is essential to recognize pain and determine the requirement and efficacy of analgesic treatments. This...
The creation of species-specific valid tools for pain assessment is essential to recognize pain and determine the requirement and efficacy of analgesic treatments. This study aimed to assess behaviour and investigate the validity and reliability of an acute pain scale in pigs undergoing orchiectomy. Forty-five pigs aged 38±3 days were castrated under local anaesthesia. Behaviour was video-recorded 30 minutes before and intermittently up to 24 hours after castration. Edited footage (before surgery, after surgery before and after rescue analgesia, and 24 hours postoperatively) was analysed twice (one month apart) by one observer who was present during video-recording (in-person researcher) and three blinded observers. Statistical analysis was performed using R software and differences were considered significant when p<0.05. Intra and inter-observer agreement, based on intra-class correlation coefficient, was good or very good between most observers (>0.60), except between observers 1 and 3 (moderate agreement 0.57). The scale was unidimensional according to principal component analysis. The scale showed acceptable item-total Spearman correlation, excellent predictive and concurrent criterion validity (Spearman correlation ≥ 0.85 between the proposed scale versus visual analogue, numerical rating, and simple descriptive scales), internal consistency (Cronbach's α coefficient >0.80 for all items), responsiveness (the pain scores of all items of the scale increased after castration and decreased after intervention analgesia according to Friedman test), and specificity (> 95%). Sensitivity was good or excellent for most of the items. The optimal cut-off point for rescue analgesia was ≥ 6 of 18. Discriminatory ability was excellent for all observers according to the area under the curve (>0.95). The proposed scale is a reliable and valid instrument and may be used clinically and experimentally to assess postoperative acute pain in pigs. The well-defined cut-off point supports the evaluator´s decision to provide or not analgesia.
Topics: Analgesia; Animals; Male; Observer Variation; Orchiectomy; Pain Measurement; Pain, Postoperative; Principal Component Analysis; Software; Swine
PubMed: 32480399
DOI: 10.1371/journal.pone.0233552 -
Theriogenology Jul 2021The objective was to compare effects of immunological, chemical and surgical castrations on testicular characteristics, scrotal surface temperatures, sperm quality, and...
The objective was to compare effects of immunological, chemical and surgical castrations on testicular characteristics, scrotal surface temperatures, sperm quality, and serum testosterone concentrations in Bos indicus bulls. Eighty Nelore bulls (∼20 mo) were grazed on pasture, fed a supplement and slaughtered at ∼480 kg. Bulls were allocated into four groups (n = 20/group). The control group (CON) was non-castrated and there were three castration methods: immune (IMM - Bopriva®), injected on D-30, D30 and D60; chemical (CHE), an intratesticular injection of 40% CaCl + 0.5% dimethylsulfoxide on D0; and surgical (SUR) on D0. The CHE group were surgically castrated on D60, due to testicular swelling and necrosis of scrotal skin. Most scrotal surface temperatures (infrared thermography) were significantly higher on D15 in CHE and SUR compared to CON, due to inflammation. All bulls were subjected to a breeding soundness evaluation on D-7 and slaughtered on D220. Scrotal circumference and testicular volume did not differ among groups (P > 0.05) at D0, but at D15, both end points were highest (P < 0.05) in the CHE group (due to swelling), although both end points were smaller for IMM versus CON (P < 0.05) at D60 and D150. Sperm motility in the IMM group was ∼50 and 10% of that in the CON group on D60 and D150, respectively. For the IMM group, serum testosterone concentrations were similar on D0 and D15 (but ∼50% of CHE or SUR on D0, attributed to the first treatment on D-30), and had decreased ∼70% on D60 and D150, whereas in the CHE and SUR groups, there were ∼80-90% decreases in testosterone after D0. In conclusion, immunological castration was a viable alternative to surgical castration, as it supressed testosterone production and spermatogenesis, with the benefits of being much less invasive, with better animal welfare and less stress.
Topics: Animals; Cattle; Male; Orchiectomy; Scrotum; Sperm Motility; Spermatogenesis; Spermatozoa; Testis
PubMed: 33887521
DOI: 10.1016/j.theriogenology.2021.03.021 -
Scandinavian Journal of Urology Oct 2021Speedy diagnosis are mandatory in testicular torsion, nevertheless some cases of irreversible ischemia still occur. In this study we analysed the results of patients...
INTRODUCTION AND AIM
Speedy diagnosis are mandatory in testicular torsion, nevertheless some cases of irreversible ischemia still occur. In this study we analysed the results of patients undergoing surgical exploration for acute scrotum.
MATERIALS AND METHODS
A multicentric retrospective clinical evaluation was carried out on patients who underwent urgent scrotal exploration at 12 different departments in North-Eastern Italy. Data included complete anagraphic information, clinical presentation, numeric pain rating scale, previous testicular surgery, Doppler serial ultrasonography (US) evaluation and concordance with surgical findings, testicular mobility, surgical treatment, staged or concurrent treatment of the contralateral gonad. Statistical analysis was conducted both for descriptive and inferential statistics with SPSS v26.
RESULTS
Three hundred and sixty-eight cases were collected between January 2010 and June 2019. The time between symptom onset and ER access time was within 6 h in majority of patients. However, 17.4% of subject presented after more than 12 h. In patients undergoing US, this showed signs of ischemia in 237 patients (77.2%) and normal vascularisation in 70 (22.8%) of whom 26 had signs of testicular torsion at surgical exploration. Overall, the US data were concordant with the surgical findings in 254 cases (82.7%). A significant association was found between time-to-evaluation and time-to-treatment and the need for orchiectomy ( < 0.01).
CONCLUSION
Testicular torsion management is still challenging in terms of time-saving decision making. Scrotal US is helpful, but even in the contemporary its sensitivity is low era in a non-neglectable number of cases, therefore surgical exploration is warranted in acute scrotum when torsion cannot be ruled out, even when US shows vascularisation.
Topics: Humans; Male; Orchiectomy; Retrospective Studies; Scrotum; Spermatic Cord Torsion; Testis
PubMed: 33620015
DOI: 10.1080/21681805.2021.1889026 -
Urogynecology (Philadelphia, Pa.) Feb 2023Gender-affirming orchiectomy may be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty for transgender and nonbinary persons,...
IMPORTANCE
Gender-affirming orchiectomy may be performed in isolation, as a bridge to vaginoplasty, or concurrently with vaginoplasty for transgender and nonbinary persons, although there is a paucity of data on immediate postoperative outcomes on the various procedural approaches.
OBJECTIVE
The aim of the study is to compare 30-day surgical outcomes after gender-affirming orchiectomy and vaginoplasty as separate and isolated procedures.
STUDY DESIGN
This was a retrospective cohort study of patients in the American College of Surgeons National Surgical Quality Improvement Program database to compare surgical outcomes of orchiectomy alone and vaginoplasty alone to concurrent orchiectomy with vaginoplasty using bivariate and adjusted multivariable regression statistics.
RESULTS
Concurrent orchiectomy and vaginoplasty were associated with greater 30-day surgical complications compared with orchiectomy alone (15.4% vs 2.9%, P < 0.01) and similar odds of 30-day surgical complications compared with vaginoplasty alone (15.4% vs 11.1%, P = 0.15). On multivariable logistic regression analysis, compared with orchiectomy alone, concurrent orchiectomy and vaginoplasty were associated with higher increased odds of 30-day surgical complications (adjusted odds ratio, 6.48; 95% confidence interval, 2.83-14.86) as well as vaginoplasty alone (adjusted odds ratio 4.30; 95% confidence interval, 1.85-10.00).
CONCLUSIONS
This study highlights the perioperative outcomes for isolated versus concurrent gender-affirming orchiectomy and vaginoplasty, demonstrating lower morbidity for orchiectomy alone and similar morbidity for vaginoplasty alone when compared with concurrent procedures. These data will aid health care providers in preoperative counseling and surgical planning for gender-affirming genital surgery, particularly for patients considering concurrent versus staged orchiectomy and vaginoplasty.
Topics: Female; Humans; Male; Orchiectomy; Retrospective Studies; Sex Reassignment Surgery; Transgender Persons; Transsexualism
PubMed: 36735435
DOI: 10.1097/SPV.0000000000001312 -
JAMA Network Open Aug 2020It remains unclear whether androgen deprivation therapy (ADT) is associated with subsequent dementia risk in patients with prostate cancer. There are limited data...
IMPORTANCE
It remains unclear whether androgen deprivation therapy (ADT) is associated with subsequent dementia risk in patients with prostate cancer. There are limited data regarding dementia risk across ADT types.
OBJECTIVE
To examine the association between all-cause dementia, including Alzheimer disease (AD), and different ADT types in patients with prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used linked data from the Taiwan National Cancer Registry, the National Health Insurance Research Database, and the Taiwan National Death Registry. A cohort of 23 651 patients with newly diagnosed prostate cancer between January 1, 2008, and December 31, 2015, was identified and followed up from 1 year after diagnosis until December 31, 2017. Data analysis was performed between January 2019 and May 2020.
EXPOSURES
Patients who received and did not receive ADT, including gonadotropin-releasing hormone (GnRH) agonists, orchiectomy, or antiandrogen monotherapy.
MAIN OUTCOMES AND MEASURES
The primary outcomes were all-cause dementia or AD. Stabilized inverse probability of treatment weighting was used to balance baseline covariates. The association between dementia and various ADT types was examined using the Cox proportional hazards model. Furthermore, a multivariate Cox proportional model with age as the time scale was conducted for complementary comparison.
RESULTS
In the cohort of 23 651 male patients (median [interquartile range] age, 73 [66-79] years), 6904 (29.2%) did not receive ADT, 11 817 (50.0%) received GnRH agonists, 876 (3.7%) received orchiectomy, and 4054 (17.1%) received antiandrogen monotherapy. Overall, 1525 patients were diagnosed with incident dementia (1.72 per 100 person-years) during a median (interquartile range) follow-up of 3.46 (1.92-5.51) years. Compared with those who did not receive ADT, those using antiandrogen monotherapy showed an increased risk of dementia (weighted hazard ratio [HR], 1.34; 95% CI, 1.16-1.55) and AD (weighted HR, 1.52; 95% CI, 1.13-2.04). The risk of dementia was similar between GnRH agonist use or orchiectomy and no ADT use (GnRH agonist: weighted HR, 1.13; 95% CI, 1.00-1.28; orchiectomy: 1.00; 95% CI, 0.74-1.37). Several sensitivity analyses revealed consistent findings for both outcomes.
CONCLUSIONS AND RELEVANCE
In this study, the use of antiandrogen monotherapy was associated with increased risk of dementia or AD, while GnRH agonist use and orchiectomy had no significant difference compared with patients who did not receive ADT. Further prospective studies are warranted to confirm these findings.
Topics: Adult; Aged; Aged, 80 and over; Androgen Antagonists; Cohort Studies; Dementia; Humans; Male; Middle Aged; Orchiectomy; Prostatic Neoplasms; Risk Factors; Taiwan
PubMed: 32865575
DOI: 10.1001/jamanetworkopen.2020.15189 -
Poultry Science Aug 2019The aim of this study was to determine the effect of age and caponization on the growth performance and carcass quality characteristics of Leghorn cockerels. The...
The aim of this study was to determine the effect of age and caponization on the growth performance and carcass quality characteristics of Leghorn cockerels. The experiment was conducted on 224 Leghorn cockerels. At 8 wk of age, 112 birds were surgically castrated by a qualified veterinarian in accordance with Commission Regulation (EC) No. 543/2008. The birds were divided into 2 sex categories (with 8 replications per group and 14 birds per replication). The birds were raised to 28 wk of age, and were fed commercial diets ad libitum. From 12 wk of age, at 4-wk intervals, 8 intact cockerels and 8 capons (1 bird per replication) were selected randomly and slaughtered. Caponization had a beneficial influence on the feed conversion ratio (FCR). FCR (kg/kg) based on body weight (BW) gain, carcass weight gain, and edible weight gain was lower in capons from 24 wk of age (P < 0.05), and FCR based on lean weight gain was lower in capons from 21 wk of age (P < 0.05). The content of edible components expressed as a percentage of the total BW of cockerels and capons was similar in the corresponding age groups. Caponization had no effect on the total lean meat content of the carcass (P = 0.744), but differences were found between the weights of breast muscles and leg muscles. In week 24 and 28, the weight of breast muscles was higher in capons than in cockerels (P < 0.05). Cockerels had higher leg muscle weight than capons, and significant differences were noted in week 16 and in 28 (P < 0.05).
Topics: Age Factors; Animals; Body Composition; Body Weight; Chickens; Male; Meat; Orchiectomy
PubMed: 30941421
DOI: 10.3382/ps/pez146 -
Journal of Smooth Muscle Research =... 2022This study aimed to verify whether Adjuvant-Induced Arthritis (AIA) and/or Orchiectomy (ORX) modify the expression of the Nox1, Nox2 and Nox4 isoforms, the endothelial...
PURPOSE
This study aimed to verify whether Adjuvant-Induced Arthritis (AIA) and/or Orchiectomy (ORX) modify the expression of the Nox1, Nox2 and Nox4 isoforms, the endothelial function or the structure of rat aortas.
METHODS
Sixty-three Wistar rats were distributed into four groups: 1) Control; 2) ORX; 3) AIA; 4) Orchiectomy plus to Arthritis-induction (ORX/AIA). Thus, 21 days after the onset of AIA (by intradermal injection of Mycobacterium tuberculosis), the presence of Nox1, Nox2 and Nox4, the acetylcholine (ACh)-induced relaxation and the media layer thickness were assessed in the aorta taken from these animals.
RESULTS
The Nox1, Nox2 and Nox4 were immunostained in intima, media and adventitia layers of aortas taken from all studied groups and AIA apparently increased this immunostaining. These modifications of Nox1, Nox2 or Nox4 expression, however, were not confirmed by Western blotting. In addition, neither AIA nor ORX changed the endothelial function, but ORX increased the media layer thickness in the studied aortas.
CONCLUSION
The present study showed weak clues of increased expression of Nox1, Nox2 and Nox4 as a result of AIA, as well as of Nox1 reduction caused by ORX. In addition, the endothelial function was not modified in the aortas of these animals by both AIA and/or ORX. On the other hand, ORX increased significantly the aorta media layer thickness in the studied animals, which was apparently mitigated by AIA.
Topics: Animals; Aorta; Arthritis, Experimental; Endothelium, Vascular; Male; Orchiectomy; Rats; Rats, Wistar
PubMed: 35944980
DOI: 10.1540/jsmr.58.63