Effects of laparoscopic division of spermatic vessels on histological changes of testes: long-term observation in the model of prepubertal rat

Abstract

Laparoscopic Fowler-Stephens and Palomo procedures are now commonly performed in children with high positioned intra-abdominal cryptorchidism and varicocele, respectively. During the procedures, the spermatic vessels are ligated and therefore the question of risk related to testicular atrophy is often raised. The long-term follow-up of the histology after the procedures is rare. In this study, we simulated a laparoscopic spermatic vessels clipping and division (SVCD) in a prepubertal rat model, and examined the histological alterations of the testes with regard to spermatogenic arrest between prepuberty and middle age. Thirty-day-old Wistar rats divided randomly into three groups underwent laparoscopic sham operation, unilateral SVCD and unilateral SVCD with additional contralateral orchiectomy, respectively. Histological investigations observed on semithin and paraffin sections were performed at seven different postoperative intervals between day 9 and day 540. We defined partial, most and complete spermatogenic arrest of the seminiferous tubules to correspond with mild, severe spermatogenic arrest and atrophy, respectively. Laparoscopic SVCD induced testicular spermatogenic arrest in a total of 85% of the operated testes with different severity; 27% of operated testes with mild or severe spermatogenic arrest were seen between puberty and middle age (day 45-540 postoperative), and their size was only slightly reduced. Of the operated testes, 51% showed atrophic signs with a striking decrease in size, and their contralateral testes revealed in all cases mild or severe spermatogenic arrest started as early as day 45 postoperatively. Parallel to the spermatogenic arrest, Leydig cell hyperplasia developed frequently in impaired testes, especially in those without contralateral testes, finally reaching a typical adenoma size. Laparoscopic SVCD in prepubertal rats could disturb spermatogenesis with differing severity in most cases. This impairment could persist from peripuberty to middle age, and even involve the contralateral testes, in the case of operated testes and show complete spermatogenic arrest. This study showed that laparoscopic SVCD may have high risk in compromising the operated testis.

Histopathological Features of Vanishing Testes in 332 Boys: What Is Its Significance? A Retrospective Study From a Tertiary Hospital

“…This hypothesis was supported in our study by the frequent presence of fibrosis, dystrophic calcification, and hemosiderin deposition in the vanishing testis specimens. These pathological features are similar to the results of our previous animal experiment (15). Furthermore, as stated in our study and in other reports (5), testicular remnants are found more commonly on the left.…”

Percutaneous retrograde endovascular occlusion for pediatric varicocele

“…Also, experimental studies in rats have raised concern about possible long-term deleterious effects of spermatic artery ligation on testis growth and development [29]. Spermatic artery-sparing surgical procedures have been developed but have led to persistent varicocele in 17% and hydrocele in 12.5% of patients [15].…”

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

“…In patients with IAT who have epididymo-testicular dissociation, the FSLO should not be performed, as a collateral vascular supply to the testis will not develop [27]. In rat studies, dividing the main testicular blood vessels results in atrophic changes in up to 51% of peri-pubertal rat testes [28]. It can be inferred that this is, therefore, not an optimal technique in humans and that preserving the main testicular vessels would be preferable.…”