Reconstructive Urology

Abstract

values 24 h after the second injection of hCG (when the response was most pronounced). Those with a normal Ad/T had a mean (sd) testosterone level of 199.5 (97.6) ng/dL vs 99.6 (85) ng/dL in those with an inadequate Ad/T response to hormonal therapy (P < 0.003). Conclusion: We have confirmed that there are two subgroups of cryptorchid boys. Patients with a sufficient Leydig cell secretory capacity will have normal testicular histology and Ad spermatogonia count after hormonal treatment. While those with a suboptimal Leydig cell capacity will have a low Ad spermatogonia count and consequently poor prognosis for future fertility, despite successful surgery. As to whether different types and durations of the hormonal therapy in patients with impaired Leydig cell response could lead to improved testicular histology and consequently improved prognosis for future fertility, remains to be answered. Editorial CommentThis paper presents new important insights on the understanding of cryptorchidism and its treatment and I will highlight some important points.The authors demonstrated for the first time, that the transformation of gonocytes into Ad spermatogonia is a testosterone-dependent process. If an adequate increase in plasma testosterone follows hormonal stimulation, normal germ-cell maturation occurs. Patients that have an insufficient Leydig cell response to hormonal stimulation, resulting in an inadequate testosterone increase, will have poor testicular histology and a low Ad spermatogonia count.Interesting, the authors concluded that appears to be two subgroups of cryptorchid boys; those with a sufficient Leydig cell secretory capacity and those with a suboptimal Leydig cell secretory capacity. Dr. Francisco J.B. Sampaio Full-Professor and Chair, Urogenital Research Unit State University of Rio de Janeiro Rio de Janeiro, RJ, Brazil RECONSTRUCTIVE UROLOGY ___________________________________________________ Resurfacing and reconstruction of the glans penisPalminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy Eur Urol. 2007; 52: 893-8 Objectives: To describe the techniques and results of surgical reconstruction of glans penis lesions. Methods: Seventeen patients (mean age: 53.2 yr) were treated by resurfacing or reconstruction of the glans penis for benign, premalignant and malignant penile lesions. The aetiology of the lesions was one Zoon's balanitis, four lichen sclerosus, one carcinoma in situ, five squamous cell carcinomas, and six squamous cell carcinomas associated with lichen sclerosus. Five cases were treated by glans skinning and resurfacing; five cases by glans amputation and reconstruction of the neoglans, and seven cases by partial penile amputation and reconstruction of the neoglans. Glans resurfacing and reconstruction were performed with the use of a skin graft harvested from the thigh. Results: The mean follow-up was 32 mo. All patients were free of local premalignant/malignant recurrence. Patients who underwent glans r...