Cryptorchidism

[anbuitachi]

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First aid says testosterone is normal b/c leydig cells are unaffected by temperature. later it says testosterone is decreased in bilateral cryptoorchidism and normal in unilateral. Why is testosterone low in bilateral if leydig is not affected??

First aid also says FSH and LH are both increased in cryptorchidism. Again, why is LH increased if testosterone is supposed to be normal?

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Another question: In first aid it mentions embolization as a treatment for Varicocele. Can someone explain how this works please? Since varicocele's are caused by increased resistance to flow... now if you block off the vein.. wont that increase the resistance even more??? I am not understanding how blocking the vein off would treat the varicocele..

Thanks

 

[Myxedema]

First aid says testosterone is normal b/c leydig cells are unaffected by temperature. later it says testosterone is decreased in bilateral cryptoorchidism and normal in unilateral. Why is testosterone low in bilateral if leydig is not affected??

First aid also says FSH and LH are both increased in cryptorchidism. Again, why is LH increased if testosterone is supposed to be normal?

I checked Robbins and Campbell-Walsh (urology textbook), and they don't mention bilateral cryptorchidism associated with loss of testosterone. They do mention, however, that decreased testosterone may cause cryptorchidism (whether uni- or bilateral).

Another question: In first aid it mentions embolization as a treatment for Varicocele. Can someone explain how this works please? Since varicocele's are caused by increased resistance to flow... now if you block off the vein.. wont that increase the resistance even more??? I am not understanding how blocking the vein off would treat the varicocele..

To understand it, one must think about why variocele is treated: Infertility. Distended pampiniform plexus veins are dysfunctional, so instead of draining the venous blood away, retrograde reflux of venous blood increases the venous pressure. The goal of treatment in varicocele is to prevent the retrograde flow of venous blood in the spermatic vein. It is possible to achieve that goal by ligating (surgery) or embolizing (interventional radiology) the vein, so venous blood will not reflux back.

 

[Mcat35]

I checked Robbins and Campbell-Walsh (urology textbook), and they don't mention bilateral cryptorchidism associated with loss of testosterone. They do mention, however, that decreased testosterone may cause cryptorchidism (whether uni- or bilateral).


To understand it, one must think about why variocele is treated: Infertility. Distended pampiniform plexus veins are dysfunctional, so instead of draining the venous blood away, retrograde reflux of venous blood increases the venous pressure. The goal of treatment in varicocele is to prevent the retrograde flow of venous blood in the spermatic vein. It is possible to achieve that goal by ligating (surgery) or embolizing (interventional radiology) the vein, so venous blood will not reflux back.

I learn something new everyday, great anwers 🙂

 

[anbuitachi]

I checked Robbins and Campbell-Walsh (urology textbook), and they don't mention bilateral cryptorchidism associated with loss of testosterone. They do mention, however, that decreased testosterone may cause cryptorchidism (whether uni- or bilateral).


To understand it, one must think about why variocele is treated: Infertility. Distended pampiniform plexus veins are dysfunctional, so instead of draining the venous blood away, retrograde reflux of venous blood increases the venous pressure. The goal of treatment in varicocele is to prevent the retrograde flow of venous blood in the spermatic vein. It is possible to achieve that goal by ligating (surgery) or embolizing (interventional radiology) the vein, so venous blood will not reflux back.

So those books say testosterone is normal? Or simply don't mention it at all? B/c first aid also says LH increases. which wouldnt make that much sense unless it is the increased LH keeping the testosterone normal...

Also for the variocele, if you ligate the vein, how does the blood exit the testes? Since blood is still entering from the artery.

 

[Myxedema]

No, they don't mention that. They do mention however that Leydig cells are spared. Beyond that, they don't mention testosterone levels in bilateral cryptorchidism.

You don't need both veins to drain the scrotum.

 

[anbuitachi]

No, they don't mention that. They do mention however that Leydig cells are spared. Beyond that, they don't mention testosterone levels in bilateral cryptorchidism.

You don't need both veins to drain the scrotum.

Sorry my anatomy must be super weak haha. Do you ligate the veins of the plexus.. or do you ligate the testicular vein? I've been thinking testicular vein this whole time so maybe that's why I'm confused. Do you men ligating the veins of the plexus?

 

[Mkandil]

So I just found this in UWorld
in a case of unilateral cryptorchidism:

"althought the number of leydig calls is reduced when only one testicle is present, androgen levels are not affected due to compensation by the remaining leydig cell mass. the patient has a normal LH level indicating that there's adequate androgenic feedback to the hypothalamus and pituitary. Testosterone, DHT, and DHEA cause LH feedback inhibition, but they're not part of the FSH feedback loop"

Pretty confusing topic :/