Testicular fixation

Methods of testicular fixation

The blood–testis barrier represents a structural and func- tional separation of developing spermatocytes from sub- stances within the blood stream [34]. Blood vessels, lymphatics and nerves do not penetrate the seminiferous tubule. Specialised junctions between adjacent Sertoli cells near the basement membrane of the seminiferous tubule divide the tubule into basal and adluminal compartments that restrict the paracellular ‘flow’ of substances [34]. It sequesters germ cell-specific antigens that arise or appear transiently during meiosis and spermiogenesis. Orchido- pexy itself, by breaching the blood–testis barrier, can be responsible for formation of anti-sperm antibodies that may affect both the descended and undescended testes, exac- erbating potential subfertility [34, 35].

To assess the contribution of testicular fixation to infertility in undescended testis, a questionnaire-based follow-up was conducted in 1998 of 387 men who attempted to father a child from among 619 men who had previously had UDT [36]. All had an orchidopexy per- formed between 1955 and 1972 at the University of Pitts- burgh, USA. Infertility was defined as failure to conceive a child for 1 year or more. Logistic regression analysis identified a relative risk of infertility of 7.56, with a 95 % CI of 1.66 for suture fixation.

In a study, by Srinivas et al. [35], to establish a surgi- cally created model for undescended testis in rats, suture fixation of the testis through the tunica albuginea resulted in elevated anti-sperm antibodies and significant histolog- ical changes, including lower Johnsen scores and reduced seminiferous tubular diameter of the contralateral testis in experimental rats. The failure to form spermatozoa was objectively shown by DNA flow cytometry as a significant decrease in haploid cell population [35]. While not strictly comparable to the standard orchidopexy for a palpable UDT performed by the majority of paediatric surgeons, these data remain of concern.

Testes can be retained in subdartos pouch without transfixing the testis [37]. This has been achieved by everting the tunica vaginalis and lodging the testis in a subdartos pouch with the hole in the dartos snug or snug- ged around the spermatic cord. When suture fixation is used, dartos tissue was fixed to the tunica vaginalis reflected from the lower pole of the testis to the epididymis.