Surgical findings in cryptorchidism in children with Zika-related microcephaly: a case series

Abstract

Background Complications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Pernambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zika-related microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent. Methods A total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchidopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate. Results We found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testis-epididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic gubernacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac. Conclusions We herein describe the surgical findings of these children's orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume.

Zika virus infection leads to hormone deficiencies of the hypothalamic-pituitary-gonadal axis and diminished fertility in mice

“…Newborns exposed to ZIKV have received global attention because of their developmental complications, including delays in cognitive, language, and motor development ( 12 – 15 ) as well as cryptorchidism ( 16 , 17 ). However, the impacts of ZIKV infection on the reproductive health of these children remain unclear.…”

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG–PC): A Cohort Profile

“…This ongoing cohort has contributed to the understanding of the CZS spectrum with an initial description of a large series of 104 cases of children born with microcephaly in 2015 [ 20 ] and, subsequently, the description of EEG patterns and the treatment response in early epilepsy [ 21 , 22 ] and findings of paediatric neurodevelopment [ 23 ]. We also reported the frequency and characteristics of oropharyngeal dysphagia [ 18 ], cryptorchidism and its surgical findings [ 24 , 25 ], endocrine dysfunction [ 26 ], and adenoid hypertrophy in children with Zika-related microcephaly [ 27 ].…”

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

“…Of note, the MERG pediatric cohort is one of the largest single cohort studies of children with CZS in the world. The MERG pediatric cohort study published several case series reporting on microcephaly [ 24 ], prenatal and postnatal brain imaging abnormalities [ 25 , 26 ], oropharyngeal dysphagia [ 27 ], early epilepsy [ 28 , 29 ] and rare complications such as cryptorchidism [ 30 , 31 ], endocrine dysfunctions [ 32 ], and adenoid hypertrophy [ 33 ] over the first years of life. Longer term follow-up of the prenatally exposed infants also found markedly elevated frequencies of seizures, ophthalmologic abnormalities, and hearing deficits in infants born with microcephaly or born small for gestational age relative to exposed infants born without microcephaly and normal or large for gestational age [ 34 ].…”