The Role of the Epididymis in Testicular Descent

Mininberg, David T.; Schlossberg, Steven M.

doi:10.1016/s0022-5347(17)52645-2

Cited by 54 publications

(21 citation statements)

References 10 publications

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“…Union by canalization of the rete testis and mesonephric tubules begins at 12 weeks and probably is completed at puberty (10). It has been speculated that an epididymal abnormality may interfere with the normal de- scent of the tesis (2,11,12), since the epididymis is normally attached to the gubernaculum, which guides the testis into the scrotum (13). During the process of normal testicular descent, the role of numerous mechanical components has been hypothesized, including a normal gubernaculum, epididymis, intra-abdominal pressure (13), and the innervation of the gubernaculum by the genitofemoral nerve (14).…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of the epididymal anomalies is higher in association with ipsilateral patency of the processus vaginalis (71 to 78%) than with ipsilateral closure (16 to 38%) (2,3,6). Mininberg and Schlossberg found that if there was a patent processus Vaginalis, 78% of boys with undescended testis had epididymal anomalies, whereas only 38% had an abnormal epididymis if there was no associated hernia (2). Elder also showed that 64% of epididymides were abnormal when the processus vaginalis was completely patent, while only 11% were abnormal when the processus vaginalis was incompletely patent in boys with hydrocele/hernia or undescended testis (6).…”

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

“…The epididymal anomalies occur in association with undescended testes in 32 to 79% of cases (1)(2)(3)(4)(5)(6)(7). In the majority of boys with a cryptorchidism, there is a patent processus vaginalis (2).…”

Section: Introductionmentioning

confidence: 99%

“…In the majority of boys with a cryptorchidism, there is a patent processus vaginalis (2). The incidence of the epididymal anomalies is higher in association with ipsilateral patency of the processus vaginalis (71 to 78%) than with ipsilateral closure (16 to 38%) (2,3,6). Mininberg and Schlossberg found that if there was a patent processus Vaginalis, 78% of boys with undescended testis had epididymal anomalies, whereas only 38% had an abnormal epididymis if there was no associated hernia (2).…”

Section: Introductionmentioning

confidence: 99%

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Epididymal Anomalies Associated with Patent Processus Vaginalis in Hydrocele and Cryptorchidism

Han

Kang

2002

J Korean Med Sci

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The epididymal anomalies and patent processus vaginalis are frequently seen in patients with cryptorchidism or hydrocele. We performed a prospective study on the relationship between the epididymal anomalies and the patency of the processus vaginalis in boys with hydrocele (190 cases) or cryptorchidism (89 cases) who were treated from August 1997 to February 2000 (mean age, 51 months; range, 12 to 152 months). The epididymal anomalies were observed with an overall frequency of 48%. Closed, partially closed, and open processus vaginalis were associated with an epididymal anomaly in 14, 38, and 65% of cases, respectively. The epididymal anomalies were more common in association with undescended (61%) than with descended (43%) testes without statistical significance (p=0.415). Incomplete attachment of the caput epididymis was the most common anomaly (35%), followed by detachment of caput and cauda epididymis (31%), cauda epididymis (24%), and long looping epididymis (10%). These data showed that the epididymal anomalies were strongly associated with the patency of the processus vaginalis irrespective of testicular descent (p<0.001), and they provide further evidence for the hypothesis that a common stimulus, possibly androgens, may be required for the epididymal development and obliteration of the processus vaginalis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epididymal Anomalies Associated with Patent Processus Vaginalis in Hydrocele and Cryptorchidism

Han

Kang

2002

J Korean Med Sci

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Ultrastructural study of the gubernacular‐scrotal interface during testicular descent in the newborn rat

et al. 1993

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The gubernaculum has been described as the "rudder" that guides the testis into the scrotum. Prior to inguinoscrotal testicular descent, the gubernaculum rests in the groin and does not attach to the scrotum. Subsequently, it migrates and attaches to the scrotum under control of the genitofemoral nerve. This study evaluates, with electron microscopy, the relationship of the gubernaculum with the developing scrotum during normal testicular descent.Male rats were sacrificed at 0 , 2 , 4 , 7 , 10, 14, and 18 days (n = 2 for each group) and sagittal sections through the gubernacular-scrota1 interface evaluated with transmission electron microscopy. We observed the following with increasing animal age: (1) gubernacular cremaster muscle matured and nuclei shifted to the periphery of cells as connective tissue surrounding myofibers decreased, (2) scrotal fibroblasts initially showed high activity with dilated endoplasmic reticulum, but activity and number subsequently decreased, (3) scrotal collagen increased and organized into defined fibers and bundles, (4) a well-delineated band of collagen developed along the gubernaculum and advanced towards the inferior scrotum, and (5) nerve fibers appeared between the layers of cremaster muscle, increased in number with increasing age, and became myelinated at age 14 days. Gubernacular migration is intimately associated with scrotal development and testicular descent. Knowledge of cellular and intracellular differentiation during migration in the normal animal can further understanding of abnormal development and lead to improvements in treatment for common surgical problems such as cryptorchidism.

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Epididymal Growth and Differentiation Are Altered in Human Cryptorchidism

de MIGUEL,

MARIÑO,

GONZALEZ‐PERAMATO

et al. 2001

Journal of Andrology

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Despite the knowledge and histological classification of testicular lesions, epididymal lesions associated with cryptorchidism are not well defined and only macroscopic alterations have been reported. We have evaluated the alterations in the growth of both the epithelium and muscular wall of efferent ducts and epididymis in human patients with cryptorchidism from infancy to adulthood. In addition, by cytokeratin immunostaining we have also evaluated the stage of differentiation of each segment along the human postnatal life in these patients. A decrease is shown in the size of efferent and epididymal ducts in cryptorchid children compared with normal, age‐matched controls. The height of the epithelium, muscular wall, and lumen of the cryptorchid epididymis were reduced at every age studied. This decrease in all regions was seen even in the testicular quiescent period (1 to 4 years of age). In addition, the cryptorchid epididymis grows more slowly during the transition to the pubertal period. The smaller size of the cryptorchid epididymis in pubertal and adult men compared with that of normal men is due primarily to underdevelopment of the muscular wall and a reduction in epithelial height. The pattern of growth of cryptorchid efferent ducts and ductus epididymides parallels that in normal men, except that development of the lumen and muscular layer in the cauda epididymis region are delayed. Epithelial differentiation, monitored by cytokeratin expression, is minimal in efferent ducts and throughout the epididymis of the cryptorchid male, and this is already seen in children. In conclusion, our immunohistochemical and morphometric results show a reduced development of the human cryptorchid epididymis that is already evident in childhood. They indicate that cryptorchidism is a primary congenital illness of the testis and spermatic ducts, with evident lesions from the first years of life, and suggest that surgical descent would probably not be able to completely reverse these alterations.

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The Role of the Epididymis in Testicular Descent

Abstract: In 54 patients with 70 undescended testes hospitalized for orchiopexy epididymal anatomy was examined intraoperatively. Of the testes 66 per cent had abnormal epididymides, which suggests a possibly significant role for the epididymis in the process of testicular descent.

Cited by 54 publications

References 10 publications

Epididymal Anomalies Associated with Patent Processus Vaginalis in Hydrocele and Cryptorchidism

Epididymal Anomalies Associated with Patent Processus Vaginalis in Hydrocele and Cryptorchidism

Ultrastructural study of the gubernacular‐scrotal interface during testicular descent in the newborn rat

Epididymal Growth and Differentiation Are Altered in Human Cryptorchidism

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