There has been no consensus regarding the best surgical strategy for patients with cryptorchidism involving high-level intra-abdominal testes. This systematic review and meta-analysis compared the outcomes of Fowler-Stephens orchiopexy (FSO) conducted as 1-stage or 2-stage, open or laparoscopic. The databases PubMed, Cochrane Library, Web of Science Database, Russian Science Citation Index, SciELO Citation Index, China National Knowledge Infrastructure, WanFang Data, and China Biology Medical disc were systematically searched for relevant articles. Sixty studies involving 1991 operated testes were included in the final analysis. The overall success rates for 1- and 2-stage FSOs were 85% and 87%, respectively; overall atrophy rates for both were 10%. The success rates of 1-stage FSOs, open and laparoscopic, were 83% and 87%; with atrophy rates of 12% and 8%. The corresponding success rates of 2-stage FSOs were 81% and 89%; with atrophy rates of 17% and 8%. The odds ratios indicated that 2-stage FSO was significantly superior to 1-stage, and laparoscopic superior to open. Evaluating laparoscopic FSO over time, the success rates prior to year 2000, 2000 through 2010, and after 2010 were 85%, 89%, and 88%, and atrophy rates were 15%, 9%, and 6%, with no heterogeneity in the reports, and the funnel plot showed no publication bias. Each surgical technique for correcting high-level intra-abdominal testes (IATs) had an acceptable success rate, from 81% to 89%. However, in terms of highest success rate and lowest atrophy rate, 2-stage laparoscopic FSO is the first choice for treating high intra-abdominal cryptorchidism.

Automobile exhaust-derived particulate matter 2.5 (PM2.5) can cause spermatogenic cell damage, potentially resulting in male infertility. This study uses male prepubertal Sprague Dawley (SD) rats to explore the molecular mechanisms by which automobile exhaust-derived PM2.5 causes spermatogenic cell damage and induces spermatogenesis dysfunction during sexual maturity by disrupting the mitochondrial unfolded protein response (UPR^mt) in spermatogenic cells. Male prepubertal SD rats were randomly divided into four groups: control (intratracheal instillation of normal saline), low-dose PM2.5 (5 mg/kg), high-dose PM2.5 (10 mg/kg), and PM2.5 10 mg/kg +Vit (100 mg/kg of vitamin C and 50 mg/kg of vitamin E). The rats were treated for four weeks, with five consecutive treatment days and two non-treatment days, followed by cohabitation. Testicular and epididymal tissues were harvested for analysis. The mitochondria in spermatogenic cells were observed under an electron microscope. UPR^mt-, oxidative stress-, and apoptosis-related markers in spermatogenic cells were examined. Spermatogenic cell numbers and conception rate declined significantly with increasing PM2.5 dose, with their mitochondria becoming vacuolated, swollen, and degenerated to varying degrees. The apoptosis of spermatogenic cells was abnormally enhanced in PM2.5 exposed groups compared to the control group. Spermatogenic cell numbers of conception rate gradually recovered, mitochondrial damage in spermatogenic cells was alleviated, and spermatogenic cell apoptosis was significantly reduced after vitamin intervention. In addition, protein levels of superoxide dismutase 1 (Sod1), nuclear factor erythroid 2-related factor 2 (Nrf2), and B-cell lymphoma 2 (Bcl-2) were significantly lower, while those of Bcl2-associated X apoptosis regulator (Bax), cleaved caspase 3 (Casp3), and cytochrome c (Cyt-c) and malondialdehyde (MDA) levels were significantly higher in the high-dose PM2.5 group than in the control group. The levels of UPR^mt-related proteins C/EBP homologous protein (Chop), heat shock protein 60 (Hsp60), and activating transcription factors 4 (Atf4) and 5 (Atf5) were higher in the low-dose PM2.5 group, lower in the high-dose PM2.5 group, and gradually recovered in PM2.5 10 mg/kg +Vit group. Our results show that exposure to automobile exhaust-derived PM2.5 induces oxidative stress responses, leads to post-sexual maturation UPR^mt dysfunction and mitochondrial impairment, and abnormally enhances spermatogenic cell apoptosis in prepubertal rats, resulting in male infertility.

PM2.5 derived from automobile exhaust can cause reproductive impairment in adult males, but the toxic effects of PM2.5 exposure on reproductive function in juvenile male rats and its relationship with ferroptosis have not been reported. In this paper, 30-day-old juvenile male Sprague-Dawley (SD) rats were divided into four groups (blank control, vitamin control, PM2.5, and PM2.5+Vitamin). The blank control group was fed normally, and the vitamin control group was given intragastric administration of vitamins in addition to normal feeding. PM2.5 was administered via tracheal intubation. When the rats were treated for 4 weeks until reaching the period of sexual maturity. A mating test was performed first, and then their testicular and epididymal tissues were studied. Compared with control rats, juvenile male rats exposed to PM2.5 showed a decreased sperm count and fertility rate, redox imbalance, damaged mitochondria, a metabolic disorder of intracellular iron ions, and a significant rise in ferroptosis during the period of sexual maturity. After antioxidative vitamins intervention, the redox imbalance, metabolic disorder of intracellular iron ions, and ferroptosis were all alleviated, leading to the following conclusions: after being exposed to PM2.5 from automobile exhaust, male juvenile rats during the period of sexual maturity have significantly decreased reproductive function. The reproductive toxicity of PM2.5 is closely related to oxidative stress and ferroptosis. In addition, ferroptosis decreases and reproductive function is recovered to some degree after antioxidative vitamins intervention. Graphical

The mechanism by which NQO1 antagonizes PM2.5-induced apoptosis in Sertoli cells through activation of the mitochondrial unfolded protein response (UPR^mt) was investigated. A reproductive toxicity model was established using TM4 cells exposed to PM2.5 (50 μg/mL, 24 h). Transcriptome sequencing and bioinformatics analysis identified NQO1 as the target gene, playing a key role in redox regulation and apoptosis. Phenotypic analysis showed that PM2.5 exposure significantly increased intracellular ROS levels (P < 0.01), induced structural disintegration of mitochondrial cristae (as observed by TEM), and activated apoptosis pathways. Overexpression of NQO1 effectively mitigated these effects. The mechanistic analysis demonstrated that NQO1 overexpression significantly upregulated UPR^mt-related proteins (HSP60, ATF5, and CLPP) (P < 0.05), increased SOD activity, and reduced MDA levels (P < 0.01). On the other hand, NQO1 knockout led to mitochondrial membrane potential loss and Cytochrome C release via UPR^mt inhibition (P < 0.01), resulting in an increased Bax/Bcl-2 ratio and enhanced apoptosis. Overall, these findings suggest that the NQO1-UPR^mt axis protects against PM2.5-induced germ cell damage by maintaining mitochondrial protein homeostasis and redox balance. This study identifies potential therapeutic targets for male infertility associated with environmental pollutants.

Objective: To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor.Materials and methods: Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups.Results: All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced.Conclusion: Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.