Testicular Histology in Fetuses with the Prune Belly Syndrome and Posterior Urethral Valves

Abstract

Intra-abdominal cryptorchidism and infertility are universal features of the prune belly syndrome but they usually are not seen with posterior urethral valves. To understand further the differences between these patients we reviewed testicular histology in 5 fetuses from each of 3 groups: prune belly syndrome, posterior urethral valves and normals. Spermatogonia were noted in all but the numbers were significantly reduced in those with the prune belly syndrome and posterior urethral valves compared to normals: 8.6 and 13.4 versus 31.2 per 10 high power fields, respectively. The fetuses with the prune belly syndrome also had marked Leydig cell hyperplasia in contrast to the other groups. These findings suggest that the testicular pathological condition in patients with the prune belly syndrome is caused by more than mechanical cryptorchidism.

Study of Testicular Structure in Fetuses with Prune Belly Syndrome

“…Despite surgical treatment, impaired fertility (33% in unilateral cases and 66% in bilateral undescended testes) and a cancer risk 5–10 times greater than normal is observed over time [ 15 ]. In PBS, the germinative epithelium is significantly reduced so testis descent should be performed in the newborn period to enhance the chances of fertility [ 5 – 8 , 17 ]. There are reports about live births of male infants resulting from intracytoplasmic sperm injection (ICSI) using spermatozoa from patients with PBS [ 18 ].…”

“…Previous studies have shown that the germinative epithelium is significantly reduced and that seminiferous tubule diameter increases with age in sufferers of prune belly syndrome [ 5 – 8 ]. Nevertheless, structural and quantitative analyses of seminiferous tubules, extracellular matrix, and interstitial cells during the human fetal period in PBS are scarce in the literature.…”

Why do undescended testes and posterior urethral valve occur together?

“…Orvis et al also found that the numbers of foetal germ cells were reduced in foetuses with PUV [18]. However, this may be a consequence of the state of cryptorchidism, or an unrelated anomaly rather than part of the causative mechanism of cryptorchidism [19].…”

Prune belly syndrome

“…Orvis et al [67] studied the testes from fetal specimens and noted reduced spermatogonia and Leydig cell hyperplasia. Conversely Nunn and Stephens [66] described normal testicular histology for age in autopsy specimens from newborns and prepubertal children.…”