RESUMEN
Human male reproductive disorders (cryptorchidism, hypospadias, testicular cancer and low sperm counts) are common and some may be increasing in incidence worldwide. These associated disorders can arise from subnormal testosterone production during fetal life. This has resulted in a focus on in-utero environmental influences that may result in reproductive effects on the offspring in later life. Over recent years, there has been a dramatic increase in the scientific literature describing associations between in-utero environmental exposures (eg, industrial chemicals and pharmaceuticals) and subsequent reproductive outcomes in male offspring. This includes studies investigating a potential role for in-utero analgesic exposure(s) on the fetal testis; however, providing definitive evidence of such effects presents numerous challenges. In this review, we describe an approach to assessing the potential clinical relevance of in-utero (and postnatal) environmental exposures on subsequent male reproductive function using exposure to the analgesic paracetamol as an example.
Asunto(s)
Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Enfermedades de los Genitales Masculinos/inducido químicamente , Efectos Tardíos de la Exposición Prenatal , Anomalías Urogenitales/inducido químicamente , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Enfermedades de los Genitales Masculinos/embriología , Humanos , Masculino , Intercambio Materno-Fetal , Embarazo , Testículo/efectos de los fármacos , Testículo/embriología , Testículo/crecimiento & desarrollo , Anomalías Urogenitales/embriologíaRESUMEN
OBJECTIVE: In view of the implementation of magnetic resonance imaging (MRI) as an adjunct to ultrasonography in prenatal diagnosis, this study sought to demonstrate normal penile growth on prenatal MRI. METHODS: This was a retrospective study of MRI of 194 male fetuses (18-34 weeks' gestation) with normal anatomy or minor abnormalities. On sagittal T2-weighted MRI sequences, we measured penile length from the glans tip to the scrotal edge (outer length) and from the glans tip to the symphyseal border (total length). Descriptive statistics, as well as correlation and regression analysis, were used to evaluate penile length in relation to gestation. T-tests were calculated to compare mean outer/total length on MRI with published ultrasound data. RESULTS: Mean length values, including 95% CIs and percentiles, were defined. Penile length as a function of gestational age was expressed by the following regression equations: outer mean length = - 5.514 + 0.622 × gestational age in weeks; total mean length = - 8.865 + 1.312× gestational age in weeks. The correlation coefficients, r = 0.532 and r = 0.751, respectively, were statistically significant (P < 0.001). Comparison of outer penile length on MRI with published ultrasound penile length data showed no significant differences, while total penile length on MRI was significantly greater than ultrasound penile length (P < 0.001). CONCLUSION: Our MRI results provide a reference range of fetal penile length, which, in addition to ultrasonography, may be helpful in the identification of genital anomalies. Outer penile length on MRI is equivalent to penile length measured on ultrasound, whereas total length is significantly greater.
Asunto(s)
Enfermedades de los Genitales Masculinos/diagnóstico , Imagen por Resonancia Magnética , Pene/crecimiento & desarrollo , Diagnóstico Prenatal/métodos , Biometría , Femenino , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/embriología , Edad Gestacional , Humanos , Masculino , Pene/diagnóstico por imagen , Pene/embriología , Embarazo , Reproducibilidad de los Resultados , Estudios Retrospectivos , Análisis para Determinación del Sexo/métodos , Ultrasonografía PrenatalRESUMEN
Although risk assessments are typically conducted on a chemical-by-chemical basis, the 1996 Food Quality Protection Act (FQPA) required the Environmental Protection Agency (EPA) to consider cumulative risk of chemicals that act via a common mechanism of toxicity. To this end, we are conducting studies with mixtures to provide a framework for assessing the cumulative effects of "antiandrogenic" chemicals. Rats were dosed during pregnancy with antiandrogens singly or in pairs at dosage levels equivalent to about one half of the ED50 for hypospadias or epididymal agenesis. The pairs include: AR antagonists (vinclozolin plus procymidone), phthalate esters (DBP plus BBP and DEHP plus DBP), a phthalate ester plus an AR antagonist (DBP plus procymidone), and linuron plus BBP. We predicted that each chemical by itself would induce few malformations; however, by mixing any two chemicals together, about 50% of the males would be malformed. All binary combinations produced cumulative, dose-additive effects on the androgen-dependent tissues. We also conducted a mixture study combining seven "antiandrogens" together. These chemicals elicit antiandrogenic effects at two different sites in the androgen signaling pathway (i.e., AR antagonist or inhibition of androgen synthesis). In this study, the complex mixture behaved in a dose-additive manner. Our results indicate that compounds that act by disparate mechanisms of toxicity display cumulative, dose-additive effects when present in combination.
Asunto(s)
Antagonistas de Andrógenos/toxicidad , Mezclas Complejas/toxicidad , Enfermedades de los Genitales Masculinos/inducido químicamente , Genitales Masculinos/efectos de los fármacos , Animales , Compuestos Bicíclicos con Puentes/toxicidad , Dibutil Ftalato/toxicidad , Dietilhexil Ftalato/toxicidad , Combinación de Medicamentos , Sinergismo Farmacológico , Femenino , Fungicidas Industriales/toxicidad , Enfermedades de los Genitales Masculinos/embriología , Genitales Masculinos/anomalías , Hipospadias/inducido químicamente , Masculino , Exposición Materna , Oxazoles/toxicidad , Ácidos Ftálicos/toxicidad , Embarazo , Ratas , Receptores Androgénicos/efectos de los fármacos , Receptores Androgénicos/metabolismo , Maduración Sexual/efectos de los fármacosRESUMEN
In spite of its prevalence in neonates, an inguino-scrotal hernia is a rarely detected condition in prenatal life. The sonographic findings, i. e., a scrotal mass with intestinal peristalsis, the differential diagnosis, and possible associations between a scrotal hernia and chromosomal aberrations are described by presenting the case of a fetus with trisomy 18 and major structural anomalies.
Asunto(s)
Anomalías Múltiples/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Hernia Inguinal/diagnóstico por imagen , Escroto/diagnóstico por imagen , Escroto/embriología , Anomalías Múltiples/embriología , Adulto , Resultado Fatal , Femenino , Enfermedades de los Genitales Masculinos/embriología , Hernia Inguinal/embriología , Humanos , Recién Nacido , Masculino , Pene/anomalías , Cambios Post Mortem , Embarazo , Diagnóstico Prenatal/métodos , Trisomía/fisiopatología , UltrasonografíaRESUMEN
Whereas inguinal hernia is a common pediatric disease, fetal inguinal hernia is rarely diagnosed because intra-abdominal pressure usually occurs only after birth. We report a case of prenatal diagnosis of a scrotal mass at 35 weeks' gestation. The initial differential diagnosis included hydrocele, testicular teratoma and testicular torsion, but inguinoscrotal hernia was considered the most likely diagnosis when further ultrasound imaging using a high-frequency probe demonstrated bowel loop movements around the mesenteric artery. This diagnosis was confirmed postnatally.
Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Hernia Inguinal/diagnóstico por imagen , Escroto/diagnóstico por imagen , Adulto , Ecocardiografía Doppler en Color/métodos , Femenino , Enfermedades de los Genitales Masculinos/embriología , Hernia Inguinal/embriología , Humanos , Masculino , Embarazo , Tercer Trimestre del Embarazo , Enfermedades Testiculares/diagnóstico por imagen , Ultrasonografía Prenatal/métodosRESUMEN
Cystic dysplasia of the rete testis with associated ipsilateral renal agenesis is a very rare congenital abnormality, mainly described in the paediatric literature. In addition, the presence of a seminal vesicle cyst with ipsilateral renal agenesis is a rare but well-described entity. We present an adult who was found to have a unique pentad of mesonephric duct abnormalities on radiological imaging, including cystic dysplasia of the rete testis, seminal vesicle cyst, ipsilateral renal agenesis, partial hemitrigonal development and epididymal dilatation. We review and discuss the relevant literature of this case and discuss in detail the embryological basis for this unusual combination of findings.
Asunto(s)
Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Riñón/anomalías , Red Testicular/anomalías , Adulto , Quistes/diagnóstico por imagen , Quistes/embriología , Enfermedades de los Genitales Masculinos/embriología , Humanos , Masculino , Vesículas Seminales/anomalías , Vesículas Seminales/diagnóstico por imagen , Espermatocele/diagnóstico por imagen , Espermatocele/embriología , Enfermedades Testiculares/diagnóstico por imagen , Enfermedades Testiculares/embriología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The testicular dysgenesis syndrome (TDS) hypothesis proposes that a proportion of the male reproductive disorders-cryptorchidism, hypospadias, infertility and testicular cancer-may be symptoms of one underlying developmental disease, TDS, which is most likely a result of disturbed gonadal development in the embryo. TDS may be caused by genetic factors, environmental/life-style factors, or a combination of both. Some rare disorders of sex development of genetic origin are among the best-known examples of severe TDS. Among the environmental and life-style factors that are suspected to influence the hormonal milieu of the developing gonad are the endocrine disrupters. A prenatal exposure to commonly used chemicals, e.g. phthalates, may result in a TDS-like phenotype in rats. Currently, this animal model is the best model for TDS. In humans the situation is much more complex, and TDS exists in a wide range of phenotypes: from the mildest and most common form, in which impaired spermatogenesis is the only symptom, to the most severe cases, in which the patient may develop testicular cancer. It is of great importance that clinicians in different specialties treating patients with TDS are aware of the association between the different symptoms.
Asunto(s)
Carcinógenos Ambientales/toxicidad , Disruptores Endocrinos/toxicidad , Disgenesia Gonadal/embriología , Disgenesia Gonadal/genética , Neoplasias Testiculares , Animales , Carcinoma in Situ/inducido químicamente , Carcinoma in Situ/embriología , Carcinoma in Situ/epidemiología , Carcinoma in Situ/genética , Femenino , Enfermedades de los Genitales Masculinos/embriología , Enfermedades de los Genitales Masculinos/genética , Humanos , Masculino , Neoplasias de Células Germinales y Embrionarias/inducido químicamente , Neoplasias de Células Germinales y Embrionarias/embriología , Neoplasias de Células Germinales y Embrionarias/epidemiología , Neoplasias de Células Germinales y Embrionarias/genética , Ratas , Espermatogénesis/fisiología , Neoplasias Testiculares/inducido químicamente , Neoplasias Testiculares/embriología , Neoplasias Testiculares/epidemiología , Neoplasias Testiculares/genética , Testículo/embriología , Testículo/fisiopatología , Población BlancaRESUMEN
Ultrasonographic demonstration of bowel peristalsis within the fetal scrotum has been described as a pathognomonic sign of inguinoscrotal bowel herniation. We present the sonographic features and neonatal outcome of a fetus with a scrotal mass seen at 34 weeks of gestation in a twin pregnancy. This mass was diagnosed postnatally as a non-reducible inguinoscrotal hernia, in which bowel peristalsis had not been observed by real-time ultrasound in utero.
Asunto(s)
Enfermedades de los Genitales Masculinos/diagnóstico , Hernia Inguinal/diagnóstico , Trillizos , Ultrasonografía Prenatal , Adulto , Cesárea , Diagnóstico Diferencial , Femenino , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/embriología , Hernia Inguinal/diagnóstico por imagen , Hernia Inguinal/embriología , Humanos , Recién Nacido , Masculino , Embarazo , EscrotoAsunto(s)
Eyaculación , Enfermedades de los Genitales Masculinos , Conductos Eyaculadores/anomalías , Conductos Eyaculadores/embriología , Enfermedades de los Genitales Masculinos/embriología , Enfermedades de los Genitales Masculinos/etiología , Enfermedades de los Genitales Masculinos/terapia , Genitales Masculinos/inervación , Humanos , Infecciones/complicaciones , Masculino , Disfunciones Sexuales Fisiológicas/embriología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/terapiaRESUMEN
We report 2 recent cases of midline cysts of the genitoperineal raphe in children, and discuss the embryogenesis, diagnosis and management. Congenital anomalies of an unclear etiology, median raphe cysts are probably more common than has been reported in the literature. Medical attention is usually sought for secondary infections or pain with intercourse. Awareness and prompt identification of these entities by urologists are essential for proper management when differentiation from other more formidable lesions, including urethral diverticula, becomes important. Simple surgical excision is effective in most cases.
Asunto(s)
Quistes/congénito , Enfermedades de los Genitales Masculinos/congénito , Perineo/anomalías , Escroto/anomalías , Niño , Preescolar , Quistes/embriología , Enfermedades de los Genitales Masculinos/embriología , Humanos , MasculinoRESUMEN
Ureteral seminal vesicle anomaly associated with ipsilateral renal agenesis is a rare occurrence. Cystic anomaly of the seminal vesicle may be asymptomatic or discovered by rectal examination and cystoscopy for evaluation of bladder irritative symptoms, perineal and testicular pain, ejaculatory disturbances and rarely infertility. The condition was diagnosed in three patients with various clinical presentations.
Asunto(s)
Anomalías Múltiples/diagnóstico por imagen , Riñón/anomalías , Vesículas Seminales/anomalías , Uréter/anomalías , Anomalías Múltiples/fisiopatología , Adulto , Quistes/embriología , Enfermedades de los Genitales Masculinos/embriología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Vesículas Seminales/diagnóstico por imagen , Uréter/diagnóstico por imagen , Enfermedades Ureterales/embriología , Vejiga Urinaria/diagnóstico por imagenRESUMEN
The spermatic cords (SCs) obtained from: (a) autopsies of 67 adults and 50 children; (b) 3 fetuses; (c) 12 surgical specimens from 9 adults and 3 children with testicular tumors, and (d) 26 surgical specimens (14 adults and 12 children) with diagnosis of SC cysts, were studied by light microscopy. The histological study revealed the occurrence of tubular embryonal remnants (TERs) in 19 autopsied adults, 14 autopsied children, 3 fetuses, 2 surgical specimens (1 adult and 1 child) owing to testicular tumors, and 6 surgical specimens with diagnosis of SC cysts. The TERs were found in the low, middle or high thirds of the SC and consisted of a cuboidal or columnar, often ciliated epithelium surrounded by connective tissue. In the 3 fetuses and in 3 autopsied children renal glomeruli were found in close relation with the TERs. In 2 cases of SCs showing cysts and TERs both structures contained spermatozoa. The histological pattern of the TERs suggest that they are wolffian derivatives which might give rise to SC cysts.
Asunto(s)
Enfermedades de los Genitales Masculinos/patología , Cordón Espermático/patología , Adulto , Anciano , Niño , Preescolar , Enfermedades de los Genitales Masculinos/embriología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Cordón Espermático/embriologíaRESUMEN
A case of seminal vesicle cyst with ipsilateral agenesis is presented. The embryologic events, clinical symptoms, and diagnosis are discussed, emphasizing the value of sonography and computer tomography in identifying the cyst. Surgical resection is the treatment of choice.
Asunto(s)
Quistes/embriología , Riñón/anomalías , Vesículas Seminales/embriología , Adolescente , Quistes/diagnóstico , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/embriología , Humanos , Riñón/embriología , Masculino , Tomografía Computarizada por Rayos X , Ultrasonografía , Enfermedades de la Vejiga Urinaria/diagnósticoRESUMEN
Congenital seminal vesicle cysts represent a rare but illustrative type of embryological malformation. They often are combined with ipsilateral upper urinary tract abnormalities. In most of the cases described in the literature the diagnosis has been made with rather invasive procedures. On the basis of our experience with 3 cases we recommend pelvic ultrasonography as the initial study in patients in whom such a malformation is suspected. Although other radiological procedures may be required to confirm the diagnosis, this approach appears to be cost-effective and accurate in most instances. The treatment of such malformations should be restricted to symptomatic cases and usually consists of vesiculectomy with or without removal of the ipsilateral dysplastic or hypoplastic kidney.