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Undescended Testis in Relation with Parental Occupations

Zavate Andrei Calin¹ , Ovidiu Ciobanu¹ , Ion Georgescu² , Livioara Zavate³ , Corneliu Sabetay¹

¹Department of Pediatric Surgery, Emergency Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Romania

²Department of General Surgery, Emergency Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Romania

³Compartiment of Occupational Health, Public Health Department of Dolj County, Romania

 

Correspondence:

Zavate Andrei Călin

Department of Pediatric Surgery

Emergency Hospital of Craiova

Tabaci Street No.1 200642

Craiova Dolj County, Romania

Tel: 0040742486732

E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Abstract

Introduction

An important role in the genesis of malformations in general and of the undescended testis in particular is played by the chemical, physical or biological teratogenic factors which are present both in the professional and in the domestic environment with which both partners of the couples enter into contact during the pre-conception period or after.

Material and methods

The authors assessed, in a retrospective study, from the patients’ files, the parental occupation in a group of 1233 patients with undescended testis admitted during a period of 20 years (between 1994 and 2013) in the Pediatric Surgery Department of the Emergency County Hospital of Craiova.

Results

It seems that the parents with professions that imply manipulation of pesticides, fertilizers and organic solvents are in general most likely to give birth to male descendents with undescended testis.

Conclusions

The daily professional contacts with chemical substances with potential endocrine disruption role which interfere with the hormonal mechanisms of the testicular descend may seem one of the multiple causes of this birth defect.

Keywords: undescended testicle, chemicals, parental occupation


Introduction

Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth [1].

Congenital undescended testicle, unilateral or bilateral has an occurring rate of up to 20% in preterm and about 4-5 % for term newborn. In the first 12 weeks after birth, the “descent” of the testicle may continue, so at the age of three months the UDT frequency rate reaches 1-2% [2].

UDT has been hypothesized to partly share its etiology with other disorders of male reproductive health, including hypospadias, reduced semen quality and testicular cancer, collectively referred to as the testicular dysgenesis syndrome (TDS). TDS and its component disorders may result from prenatal exposure to endocrine disruptors (EDs), possibly combined with a genetic susceptibility [3, 4].

In enterprising our study we have encountered several difficulties such as the lack of precise data regarding the occupation of the parents. Also another major impediment was the wide range of parental professions in our group which was very difficult to process from a statistical point of view.

Material and methods

In a period of 20 years (between 1994 and 2013) in the Pediatric Surgery Department of the Emergency County Hospital of Craiova we have had a number of 1536 of patients admitted with undescended testis. Unfortunately data regarding the parental occupation of our patients was not available for all the admitted cases, so in order to study the genitor`s profession in relation with the undescended testis we have found the necessary data in only 1233 cases. Also another problem in analyzing this group of patients from a statistical point of view rose from the great variety of professions that we have encountered. Given this constraint we have decided to restrain systematically the data on parental occupations by resorting to CAEN (National Classification of Economic Activities) based on which we have gathered the activities in occupational groups.

Results

Aspects regarding the maternal occupation

Concerning the congenital malformations and in particular the troubles of testicular migration, the mother has a very important role in their occurrence, because she has a greater vulnerability to occupational risk factors to which she is exposed during the preconception period and mostly during pregnancy.

The majority of cases of testicular migration disorders in our study had mothers belonging to the occupational group of agriculture 245 cases (15.95 %), (Fig. 1). They were followed in order of frequency by the reported unemployed mothers 228 cases (14.84 %) and mothers employed in manufacturing industry 216 cases (14.06 %).

Figure 1. Distribution of cases according to mother`s occupational groups.

fig 1

Aspects regarding the paternal occupation

Influences on the new-born are mainly exerted by the mother during pregnancy and even after birth during lactation, but when it comes to overall fertility disorders and genetic risk both partners of the couple are involved.

Because spermatogenesis is a continuous process, frequent exposure to toxics interferes especially with stage reduction division (meiosis). In contrast, in women, mitosis and meiosis take place prenatally so at birth there is a finite population of eggs and this fact somehow protects the egg from the toxic actions.

Regarding paternal occupations of our patients with testicular migration disorders most of the fathers belonged to the occupational group of agriculture 194 cases (12.63%), as seen in Fig. 2, they were followed in order of frequency by the fathers working in manufacturing industry 183 cases (11.91%) and fathers working in the construction sector 162 cases (10.54%).

Figure 2. Distribution of cases according to father`s occupational groups

Fig 2

About the types of undescended testicles encountered in the patients admitted to the Pediatric Surgery Department of the Emergency County Hospital Nr. 1 of Craiova between 1994-2013 they were mostly unilateral forms - localized predominantly on the right side (611 cases - representing 39.78% of all cases of abnormal migration of the testicle which constituted the study group) (Fig. 3).

Figure 3. The undescended testicle types encountered in our study

Fig 3

Discussions

Testicular descent is a complex morphological process that occurs in at least 2 stages, with different hormonal control. Insulin like 3 (Insl3) controls the first step of gubernacular enlargement and androgens control inguinoscrotal migration, which may be triggred by local signaling from the mammary line and which requires the genitofemoral nerve [5].

Since the hormones play such an important role in the development of the fetal genitourinary system, supposedly “in utero” exposure to chemicals can cause a disruption of the endocrine balance that may contribute to the appearance of the testicular migration disorders.

Concerns regarding the toxicology of the human reproduction have already been the highlight of the public health issues in the developed countries, allowing the establishment of effective management policies which will minimize the effects of risk factors encountered in the professional environment. In Romania such occupational studies have been scarce so far, although they are the only ones that after the first stage of evaluation will be a benchmark to report the results seen from the application of preventive measures [6].

Some chemicals may have an antagonist effect of estrogen or even an androgen-like effect. In utero exposure to synthetic estrogen products such as diethylstilbestrol is a known risk factor for the disorders of testis migration, hypospadias and other genitourinary malformations. Also, exposure to other progesterone compounds, such as those used in oral contraception and in assisted reproduction techniques has been associated with an increased risk of cryptorchidism and hypospadias, in some studies [7, 8].

Some products such as viclozolin – a dicarboximidic fungicide used in viticulture until recently to combat white rot and gray mold proved to be a substance with a particular toxicity to reproduction. Studies on laboratory mice have shown that vinclozolin can alter the genetic code and defects can be passed on to the fourth generation [9]. There is growing evidence that paternal exposure to teratogenic factors play an important role during fertilization and even after. Over 100 chemicals, mostly pesticides and solvents, have been linked to adverse outcomes mediated male reproductive [10]. Several modes of action of the chemicals have been demonstrated, most likely they appear to have a direct genetic (e.g. modifying the germ line DNA) and epigenetic (e.g., DNA repair, chromatin structure, apoptosis) effects or they interfere with the embryonic cells, and direct exposure to contaminated semen of the embryo or of the ovocite also seems to play an important role [11, 12].

Conclusion

The most frequently encountered parental professional occupation regarding the mothers and the fathers of the children with undescended testis from our study was agriculture (245 of the mothers and 194 of the fathers). We hypothesize that this is mostly due to the fact that this profession implies the manipulation and contact with many chemicals such as pesticides, fertilizers and so on. Also a frequent encountered professional occupation was in the manufacturing industry (216 of the mothers and 183 of the fathers) which also implies the manipulation of many chemicals such as organic solvents for instance.

 

 

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