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Cryptorchidism associated with meningomyelocele
P Ferrara1, A Rossodivita, A Ruggiero
1Department of Pediatrics, Catholic University of Rome, Italy.
Objective:
The authors studied 75 male infants with meningomyelocele (MMC) to analyse the association with cryptorchidism.
Methods:
All infants were diagnosed at birth and surgically corrected after 24-48 h. Testes were classified undescended in accordance with Kaplan. The associated malformations, the exact levels of the lesion (surgical report) and the presence of hydrocephalus and the cremasteric reflex have each been assessed.
Results:
In these patients a higher incidence of cryptorchidism (14.8%) was found than in the normal population. Lesion level (L2-L3) and absence of cremasteric reflex was higher in children with associated cryptorchidism. Infants with MMC and undescended testes showed no increased incidence of hydrocephalus and sexual hormone levels remained within the normal range. These results suggest that the cremaster muscle could be a major factor involved in testis descent through the inguinal canal.
Conclusions:
The authors propose that spinal cord lesion, as well as neurologic dysfunction, is of major importance in the pathophysiology of cryptorchidism in spina bifida.
Insights
Male infants with meningomyelocele (MMC) have a higher incidence of cryptorchidism. Spinal cord lesion level and absent cremasteric reflex are associated with undescended testes in these patients.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Spina bifida, specifically meningomyelocele (MMC), is a complex congenital condition.
- Cryptorchidism, or undescended testes, is a common concern in pediatric urology.
- The relationship between neurological conditions and genitourinary development requires further investigation.
Purpose of the Study:
- To investigate the association between meningomyelocele (MMC) and cryptorchidism in male infants.
- To identify specific factors related to MMC that correlate with the presence of undescended testes.
Main Methods:
- Study included 75 male infants diagnosed with meningomyelocele at birth.
- Surgical correction was performed within 24-48 hours.
- Assessment included classification of undescended testes, associated malformations, lesion level, and cremasteric reflex presence.
Main Results:
- A higher incidence of cryptorchidism (14.8%) was observed in infants with MMC compared to the general population.
- Undescended testes were more frequent in patients with L2-L3 lesion levels and absence of the cremasteric reflex.
- No increased incidence of hydrocephalus or abnormal sexual hormone levels was noted in infants with MMC and cryptorchidism.
Conclusions:
- Spinal cord lesions and associated neurological dysfunction play a significant role in the development of cryptorchidism in spina bifida.
- The cremaster muscle's function, influenced by neurological input, may be crucial for testicular descent.
- These findings highlight the complex interplay between neurological development and genitourinary anomalies.