51
|
Alsowayan OS, Basalelah JH, Alzahrani AM, Alshaibani AM, Alalyani NS, Alsubiani TA, AlMadi MK. Age at presentation of undescended testicles: a single-center study in Saudi Arabia. Ann Saudi Med 2018; 38:137-139. [PMID: 29620548 PMCID: PMC6074362 DOI: 10.5144/0256-4947.2018.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The undescended testis (UDT) is the most common genital anomaly encountered in pediatrics with an estimated incidence of 1% to 4% in full-term and 1% to 45% in preterm newborn boys. Over the years, studies on progressive histological deterioration and cancer risk has led to a change in recommendations for when orchidopexy should be done. OBJECTIVES Determine age at presentation of patients for UDT to a specialist in Saudi Arabia, age of operation and whether the recommended targeted time frame has been met. DESIGN Descriptive retrospective medical record review. SETTINGS University hospital setting in urban location. SUBJECTS AND METHODS The records of patients presenting to our center with UDT between the years 1996-2015 were reviewed for data on the age at presentation and age of operation. MAIN OUTCOME MEASURES Age at time of evaluation and at time of surgical intervention compared with the international standard. SAMPLE SIZE 331 cases. RESULTS Out of the cases included, 195 met the inclusion criteria. The median age of presentation was 13.7 (range: 0-123.2) months. The median age at time of orchiopexy was 25 (range: 7.5-130.2) months. The median waiting time for elective surgery was 4.8 months ( less than 1 day to 49.4 months). CONCLUSION Despite the international recommendation of carrying out orchidopexy between the ages of 6-12 months, the targeted recommended time frame is not met in Saudi Arabia. This is mainly related to late referral age and the long waiting time for elective surgery. LIMITATIONS Small sample size and retrospective design. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maha Khalid AlMadi
- Maha Khalid AlMadi, Department of Urology, Imam Abdulrahman Bin Faisal University,, Dammam 31311, Saudi Arabia, T: 966567818922, mmadi@ iau.edu.sa, ORCID: http://orcid. org/0000-0002-7639-6668
| |
Collapse
|
52
|
Grinspon RP, Gottlieb S, Bedecarrás P, Rey RA. Anti-Müllerian Hormone and Testicular Function in Prepubertal Boys With Cryptorchidism. Front Endocrinol (Lausanne) 2018; 9:182. [PMID: 29922225 PMCID: PMC5996917 DOI: 10.3389/fendo.2018.00182] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The functional capacity of the testes in prepubertal boys with cryptorchidism before treatment has received very little attention. The assessment of testicular function at diagnosis could be helpful in the understanding of the pathophysiology of cryptorchidism and in the evaluation of the effect of treatment. Anti-Müllerian hormone is a well-accepted Sertoli cell biomarker to evaluate testicular function during childhood without the need for stimulation tests. OBJECTIVE The aim of the study was to assess testicular function in prepubertal children with cryptorchidism before orchiopexy, by determining serum anti-Müllerian hormone (AMH). We also evaluated serum gonadotropins and testosterone and looked for associations between testicular function and the clinical characteristics of cryptorchidism. MATERIALS AND METHODS We performed a retrospective, cross-sectional, analytical study at a tertiary pediatric public hospital. All clinical charts of patients admitted at the outpatient clinic, and recorded in our database with the diagnosis of cryptorchidism, were eligible. The main outcome measure of the study was the serum concentration of AMH. Secondary outcome measures were serum LH, FSH, and testosterone. For comparison, serum hormone levels from a normal population of 179 apparently normal prepubertal boys were used. RESULTS Out of 1,557 patients eligible in our database, 186 with bilateral and 124 with unilateral cryptorchidism were selected using a randomization software. Median AMH standard deviation score was below 0 in both the bilaterally and the unilaterally cryptorchid groups, indicating that testicular function was overall decreased in patients with cryptorchidism. Serum AMH was significantly lower in boys with bilateral cryptorchidism as compared with controls and unilaterally cryptorchid patients between 6 months and 1.9 years and between 2 and 8.9 years of age. Serum AMH below the normal range reflected testicular dysfunction in 9.5-36.5% of patients according to the age group in bilaterally cryptorchid boys and 6.3-16.7% in unilaterally cryptorchid boys. FSH was elevated in 8.1% and LH in 9.1% of boys with bilateral cryptorchidism, most of whom were anorchid. In patients with present testes, gonadotropins were only mildly elevated in less than 5% of the cases. Basal testosterone was mildly decreased in patients younger than 6 months old, and uninformative during childhood. CONCLUSION Prepubertal boys with cryptorchidism, especially those with bilaterally undescended gonads, have decreased AMH production. Although serum AMH may fall within the normal range, there is a considerable prevalence of testicular dysfunction during childhood in this frequent condition.
Collapse
Affiliation(s)
- Romina P. Grinspon
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Silvia Gottlieb
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Patricia Bedecarrás
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Rodolfo A. Rey
- Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
- Departamento de Histología, Biología Celular, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
- *Correspondence: Rodolfo A. Rey,
| |
Collapse
|
53
|
Braga LH, Lorenzo AJ, Romao RLP. Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism. Can Urol Assoc J 2017; 11:E251-E260. [PMID: 28761584 DOI: 10.5489/cuaj.4585] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cryptorchidism is one of the most common congenital anomalies in males, characterized by inability to palpate the testicle in the expected normal anatomical position (i.e., within its respective hemi-scrotum). It represents an abnormality of testicular descent and development associated with long-term concerns, including infertility, hypogonadism, and development of neoplasms.
Collapse
Affiliation(s)
- Luis H Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON; Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON; Canada
| | - Rodrigo L P Romao
- Division of Urology, IWK Health Centre and Dalhousie University, Halifax, NS; Canada
| |
Collapse
|
54
|
Abstract
BACKGROUND Cryptorchidism is the most common genital malformation in male newborns. In recent years, guidelines concerning diagnosis and therapy have undergone considerable evolution with the implementation of recent knowledge in pathophysiology, diagnosis, and therapy. OBJECTIVES The aim of this publication is to provide an overview of the current national and international guideline recommendations concerning diagnosis and treatment of cryptorchidism. Critical points are discussed in light of current scientific literature. MATERIALS AND METHODS The current guidelines of the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU), the American Association of Urology (AUA), the pediatric urologic task force of the Austrian Society of Urology (ÖGU), the international consultation on urological disease (ICUD) and the German Society of Urology (DGU)/German Association of Pediatric Surgery (DGKCh) have been analyzed concerning the most important aspects of treatment and diagnosis. RESULTS There is broad consensus concerning most steps and decisions for the treatment of cryptorchidism. However, some aspects of diagnostic imaging, the use of hormonal therapy, and surgical access in nonpalpable testis warrant further discussion and are the fields of considerable changes.
Collapse
Affiliation(s)
- B Haid
- Abteilung für Kinderurologie, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Österreich.
| |
Collapse
|
55
|
A allele of SNP12 in estrogen receptor 1 was a risk factor for cryptorchidism in Asians: a systematic review with meta-analysis and trial sequential analysis. Pediatr Surg Int 2016; 32:981-7. [PMID: 27376826 DOI: 10.1007/s00383-016-3926-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Some studies have been carried out to evaluate the association between SNP12 in estrogen receptor 1 and cryptorchidism, but the results remain inconsistent. We carried out a meta-analysis to explore the association between this polymorphism and cryptorchidism risk. METHODS All eligible studies were searched in PubMed, Web of Science, Embase and Cochrane Library. Pooled odds ratios, with 95 % confidence intervals, were assessed for the association using fixed- and random-effects models. RESULTS Overall, four case-control studies (363 cases, 415 controls) were included in the meta-analysis. No significant publication bias (P Begg = 0.308, P Egger = 0.288) was found. A allele of SNP12 in estrogen receptor 1 was protective factor to cryptorchidism in allele model, dominant genetic model and heterozygote comparison in Caucasians, but the result was turned out to be false positive by trial sequential analysis. However, A in allele model was risk factor to cryptorchidism in Asians (odds ratio 2.02, 95 % confidence interval 1.03-3.01, p = 0.946 for heterogeneity) and the result was turned out to be true positive by trial sequential analysis, even though there were merely two original studies. CONCLUSIONS The results of this meta-analysis suggest that A allele of SNP12 in estrogen receptor 1 may increase the risk of cryptorchidism in Asians. Meanwhile, further well-designed studies with large sample sizes are required to confirm the present findings, especially in Caucasians.
Collapse
|
56
|
Abstract
In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.
Collapse
Affiliation(s)
- Kristina D Suson
- Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
| |
Collapse
|
57
|
Naouar S, Braiek S, El Kamel R. Testicular torsion in undescended testis: A persistent challenge. Asian J Urol 2016; 4:111-115. [PMID: 29264215 PMCID: PMC5717970 DOI: 10.1016/j.ajur.2016.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/26/2016] [Accepted: 05/16/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the management and outcomes of patients who presented with torsion of an undescended testis and review the reported series in the literature. Methods The case records of 13 patients operated for testicular torsion involving undescended testis were retrospectively reviewed. The medical records included age at presentation, medical history, physical examination, operative findings and the results of follow-up. The diagnosis of torsion of undescended testis was made clinically and confirmed by inguinal exploration. Results In six cases the testis was preserved and orchiopexy was performed, while in seven cases orchidectomy was performed due to testicular gangrene in six patients and testicular tumor discovered peroperatively in one case. Mean duration of symptoms at time of surgery in the orchiopexy group was 6.5 h and in the orchidectomy group was 21.2 h. From six patients treated by orchiopexy, two patients suffered from testicular atrophy at a mean of 24 months. Conclusion Testicular torsion in undescended testis is still diagnosed with delay which may affect testicular salvage. The importance of examination of external genital organs is highlighted which should be routinely included by emergency physicians in physical examination for abdominal or groin pain.
Collapse
Affiliation(s)
- Sahbi Naouar
- Urology Department, Les Aghlabites Surgical Division, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Salem Braiek
- Urology Department, Les Aghlabites Surgical Division, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Rafik El Kamel
- Urology Department, Les Aghlabites Surgical Division, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| |
Collapse
|
58
|
Hartigan S, Tasian GE. Unnecessary diagnostic imaging: a review of the literature on preoperative imaging for boys with undescended testes. Transl Androl Urol 2016; 3:359-64. [PMID: 26816791 PMCID: PMC4708136 DOI: 10.3978/j.issn.2223-4683.2014.11.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cryptorchidism or undescended testis is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. Ultrasound is commonly ordered for boys with undescended testes prior to referral to a surgical specialist, but its sensitivity and specificity is insufficient to reliably localize non-palpable testes and thus confers unnecessary costs to the patient and the healthcare system. We review the ability of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) to reliably locate undescended testes and emphasize whether diagnostic imaging should change the decision to operate or the surgical approach for boys with cryptorchidism.
Collapse
Affiliation(s)
- Siobhán Hartigan
- 1 Department of Surgery, Division of Urological Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA ; 2 Division of Pediatric Urology, 3 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory E Tasian
- 1 Department of Surgery, Division of Urological Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA ; 2 Division of Pediatric Urology, 3 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
59
|
Abstract
Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or specific to aid in management decisions. Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. This allows testes to descend spontaneously if they are to do so while facilitating early intervention to decrease the risk of subfertility and testicular malignancy for those patients in whom spontaneous descent does not occur. The surgical approach is often dependent on the location of the testis on physical exam. Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. Finally, patients with bilateral non-palpable UDTs require a more extensive preliminary evaluation to rule out congenital adrenal hyperplasia (CAH) and disorders of sexual development (DSD). This involves serum electrolytes, karyotype analysis and hormonal testing including a serum müllerian inhibiting substance (MIS), in order to determine if testicular tissue is present and functional.
Collapse
Affiliation(s)
- David Kurz
- Urology Resident, University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
60
|
Chung JM, Lee SD. Individualized Treatment Guidelines for Postpubertal Cryptorchidism. World J Mens Health 2016; 33:161-6. [PMID: 26770935 PMCID: PMC4709431 DOI: 10.5534/wjmh.2015.33.3.161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/06/2015] [Accepted: 11/04/2015] [Indexed: 11/15/2022] Open
Abstract
Cryptorchidism is a well-known congenital anomaly in children. However, its diagnosis is often delayed for reasons including patient unawareness or denial of abnormal findings in the testis. Moreover, it has been difficult to establish an optimal treatment strategy for postpubertal cryptorchidism, given the small number of patients. Unlike cryptorchidism in children, postpubertal cryptorchidism is associated with an increased probability of neoplasms, which has led orchiectomy to be the recommended treatment. However, routine orchiectomy should be avoided in some cases due to quality-of-life issues and the potential risk of perioperative mortality. Based on a literature review, this study proposes individualized treatment guidelines for postpubertal cryptorchidism.
Collapse
Affiliation(s)
- Jae Min Chung
- Department of Urology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
61
|
Hamidi N, Telli O, Bagci U, Esen B, Karagoz MA, Hascicek AM, Soygur T, Burgu B. Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes. Front Pediatr 2016; 4:13. [PMID: 26973822 PMCID: PMC4778551 DOI: 10.3389/fped.2016.00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To date, laparoscopy has gradually become the gold standard for treatment of non-palpable testicles (NPT) with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT. MATERIALS AND METHODS We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy (LAO) and two-stage Fowler-Stephens technique (FST) was performed for 45 and 37 patients, respectively. Age (at surgery), follow-up time, laterality of testes, and postoperative complications were analyzed. Modified Clavien classification system (MCCS) was used for evaluating complications. RESULTS The median age (at surgery) and median follow-up time were 18 (range: 6-56) and 60 (range: 9-130) months, respectively. Overall success rate for two laparoscopy techniques was 87.8% during the maximal follow-up time. We observed wound infection in two, hematoma in one, testicular atrophy in five, testicular re-ascending in two patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade I (five vs. two patients, p = 0.14) and grade IIIb MCCS complications (five vs. two patients, p = 0.44). CONCLUSION Our results have shown that two laparoscopic approaches have low complication rates.
Collapse
Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Onur Telli
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Uygar Bagci
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Baris Esen
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital , Ankara , Turkey
| | | | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| |
Collapse
|
62
|
Hensel KO, Caspers T, Jenke AC, Schuler E, Wirth S. Operative management of cryptorchidism: guidelines and reality--a 10-year observational analysis of 3587 cases. BMC Pediatr 2015; 15:116. [PMID: 26357871 PMCID: PMC4566496 DOI: 10.1186/s12887-015-0429-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background Undescended testis (UDT) is the most common disorder in pediatric surgery and one of the most important risk factors for malignancy and subfertility. In 2009 local guidelines were modified and now recommend treatment to be completed by the age of 1. Aim of this study was to analyze age distribution at the time of orchidopexy, whether the procedure is performed according to guideline recommendations and to assess primary care pediatricians’ attitude regarding their treatment approach. Methods We retrospectively analyzed 3587 patients with UDT regarding age at orchidopexy between 2003 and 2012 in 13 German hospitals. Furthermore, we conducted an anonymized nation-wide survey among primary care pediatricians regarding their attitude toward management of UDT. Results Before modification of the guideline 78 % (n = 1245) of the boys with UDT were not operated according to guideline recommendations. After the modification that number rose to 95 % (n = 1472). 42 % of the orchidopexies were performed on patients aged 4 to 17 years. 46 % of the primary care pediatricians were not aware of this discrepancy and 38 % would only initiate operative management after the first year of life. In hospitals with pediatric surgery departments significantly more patients received orchidopexy in their first year of life (p < .001). Conclusion The guideline for UDT in Germany has not yet been implemented sufficiently. Timing of orchidopexy must be optimized in order to improve long-term prognosis. Both primary care providers and parents should be educated regarding the advantages of early orchidopexy in UDT. Prospective studies are needed to elucidate the high rate of late orchidopexies. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0429-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kai O Hensel
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Tawa Caspers
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Andreas C Jenke
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| | - Ekkehard Schuler
- Institute for Quality Management, HELIOS Kliniken GmbH, Berlin, Germany.
| | - Stefan Wirth
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Children's Hospital, Centre for Clinical & Translational Research (CCTR), Faculty of Health, Witten/Herdecke University, Heusnerstr. 40, D-42283, Wuppertal, Germany.
| |
Collapse
|
63
|
Testicular Tumors in Undescended Testes in Children Below 5 y of Age. Indian J Pediatr 2015; 82:549-52. [PMID: 25575910 DOI: 10.1007/s12098-014-1667-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the presentation, treatment and outcome of testicular tumors in undescended testes (UDT) in boys below 5 y of age. METHODS Case records of boys below 5 y of age, diagnosed to have germ cell tumors (GCT) in the UDT were reviewed. RESULTS Seven children in the age range of 05-54 mo (mean 26 mo) were included. While five of these 7 (71 %) presented with abdominal mass [one antenatally detected], 2 (29 %) were detected to have a GCT during orchiopexy. In three of these five with abdominal mass, the alpha-fetoprotein (αFP) was markedly elevated. Two of these three with elevated αFP were endodermal sinus tumors while the third was embryonal carcinoma. The 4th patient with an abdominal mass was diagnosed to have an immature teratoma (IMT) while the patient with antenatally diagnosed mass had a mature cystic teratoma (MT). Both the patients with incidentally detected mass during the orchiopexy had mature teratoma (MT). All the seven children are alive and disease free at last follow-up. CONCLUSIONS Though rare, boys with impalpable undescended testes may develop germ cell tumors early in childhood. These can be managed with chemotherapy and resection and have a good disease free outcome.
Collapse
|
64
|
Jorgez CJ, Rosenfeld JA, Wilken NR, Vangapandu HV, Sahin A, Pham D, Carvalho CMB, Bandholz A, Miller A, Weaver DD, Burton B, Babu D, Bamforth JS, Wilks T, Flynn DP, Roeder E, Patel A, Cheung SW, Lupski JR, Lamb DJ. Genitourinary defects associated with genomic deletions in 2p15 encompassing OTX1. PLoS One 2014; 9:e107028. [PMID: 25203062 PMCID: PMC4159299 DOI: 10.1371/journal.pone.0107028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/06/2014] [Indexed: 02/08/2023] Open
Abstract
Normal development of the genitourinary (GU) tract is a complex process that frequently goes awry. In male children the most frequent congenital GU anomalies are cryptorchidism (1-4%), hypospadias (1%) and micropenis (0.35%). Bladder exstrophy and epispadias complex (BEEC) (1∶47000) occurs less frequently but significantly impacts patients' lives. Array comparative genomic hybridization (aCGH) identified seven individuals with overlapping deletions in the 2p15 region (66.0 kb-5.6 Mb). Six of these patients have GU defects, while the remaining patient has no GU defect. These deletions encompass the transcription factor OTX1. Subjects 2-7 had large de novo CNVs (2.39-6.31 Mb) and exhibited features similar to those associated with the 2p15p16.1 and 2p15p14 microdeletion syndromes, including developmental delay, short stature, and variable GU defects. Subject-1 with BEEC had the smallest deletion (66 kb), which deleted only one copy of OTX1. Otx1-null mice have seizures, prepubescent transient growth retardation and gonadal defects. Two subjects have short stature, two have seizures, and six have GU defects, mainly affecting the external genitalia. The presence of GU defects in six patients in our cohort and eight of thirteen patients reported with deletions within 2p14p16.1 (two with deletion of OTX1) suggest that genes in 2p15 are important for GU development. Genitalia defects in these patients could result from the effect of OTX1 on pituitary hormone secretion or on the regulation of SHH signaling, which is crucial for development of the bladder and genitalia.
Collapse
Affiliation(s)
- Carolina J. Jorgez
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (CJJ); (DJL)
| | - Jill A. Rosenfeld
- Signature Genomic Laboratories, PerkinElmer, Inc., Spokane, Washington, United States of America
| | - Nathan R. Wilken
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Hima V. Vangapandu
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Aysegul Sahin
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Dung Pham
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Claudia M. B. Carvalho
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Anne Bandholz
- Signature Genomic Laboratories, PerkinElmer, Inc., Spokane, Washington, United States of America
| | - Amanda Miller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - David D. Weaver
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Barbara Burton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States of America
| | - Deepti Babu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Timothy Wilks
- Madigan Army Medical Center, Department of Pediatrics, Tacoma, Washington, United States of America
| | - Daniel P. Flynn
- Department of Children's Endocrinology, St. Luke's Children's Specialty Center, Boise, Idaho, United States of America
| | - Elizabeth Roeder
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Ankita Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sau W. Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Dolores J. Lamb
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail: (CJJ); (DJL)
| |
Collapse
|
65
|
Jeong SC, Lee S, Ku JY, Lee SD. Clinical characteristics and treatment of cryptorchidism in adults: a single center experience. World J Mens Health 2014; 32:110-5. [PMID: 25237662 PMCID: PMC4166369 DOI: 10.5534/wjmh.2014.32.2.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/12/2014] [Accepted: 07/24/2014] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We evaluated the clinical and therapeutic characteristics of adult cryptorchidism, which have been difficult to establish, given the small number of patients presenting to outpatient clinics. MATERIALS AND METHODS A retrospective study of 20 adult patients with cryptorchid testis was performed. We analyzed their palpation of testis, location, surgical method, marital status, number of children, histologic findings, and semen analysis. RESULTS In 17 cases with unilateral cryptorchidism, the mean age at surgery was 31.1±12.5 years. Fourteen patients had a palpable, small cryptorchid testis. The location of the testis, as verified, was inguinal in 14, prepubic in 2, and intra-abdominal in 1, respectively. We performed orchiopexy in 14 out of 15 patients who sought to have this procedure. Four among 6 married patients had children. Testis biopsy was performed in 12 patients, and all showed abnormal histologic findings. Three among 4 patients, performed semen analysis, showed abnormal findings. In three cases of bilateral cryptorchidism, the mean age at surgery was 35.7±12.5 years. All of these patients had palpated cryptorchid testes in the inguinal area and sought to have a bilateral orchiopexy. Two patients have been married but had no children. All showed abnormal findings in both testis biopsy and semen analysis. No testicular neoplasm was detected during the duration of follow-up. CONCLUSIONS Most adult patients with cryptorchidism preferred orchiopexy to orchiectomy. However, most of patients showed abnormal histology of the testis and semen analysis. Therefore, orchiopexy with regular scrotal examination may be considered a suitable treatment options for adult cryptorchidism.
Collapse
Affiliation(s)
- Seung Chan Jeong
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seungsoo Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Busan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
66
|
Armanian AM, Kelishadi R, Ardalan G, Taslimi M, Taheri M, Motlagh ME. Prevalence of genitalia malformation in Iranian children: findings of a nationwide screening survey at school entry. Adv Biomed Res 2014; 3:36. [PMID: 24627844 PMCID: PMC3949344 DOI: 10.4103/2277-9175.125648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/25/2013] [Indexed: 11/06/2022] Open
Abstract
Background: Ambiguous genitalia is a hereditary disorder that usually requires early attention and detection. The discovery of ambiguous genitalia in a neonate is situation that could be difficult to manage, not only because of complications such as salt-losing, but also due to the importance of sex determination before psychological gender could be established. Awareness of the prevalence of ambiguous genitalia can affect the attitude and consideration of physicians and related medical personnel about disease in different communities. So in this study, the prevalence of ambiguous genitalia and undescended testes (UDT) in Iran was reported. Materials and Methods: This national study was conducted in 2009-2010 as part of the routine screening examinations at school entry in Iran. The physical examinations were performed for students at entry to three school levels by physicians and medical personnel. Execution and conduction of this program was the duty of the University of Medical Sciences in each province. Results: On average, the prevalence of ambiguous genitalia was 0.04% at national level (0.03%, 0.05%, and 0.03% at 6, 12, and 15 year olds, respectively). The prevalence of ambiguous genitalia was not significantly different according to age group and living area. The average of UDT) prevalence in the whole country was 0.13%. The prevalence of UDT was higher at elementary school level than in the other two levels. Conclusion: Although the prevalence of genitalia abnormalities was not high in the school students in Iran, given the importance of the issue and in order to find the ambiguous genitalia or UDT, medical examinations and parental notification should be taken seriously at an earlier age.
Collapse
Affiliation(s)
- Amir-Mohammad Armanian
- Department of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Professor of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gelayol Ardalan
- Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mahnaz Taslimi
- Department of School Health, Bureau of Health and Fitness, Ministry of Education, Tehran, Iran
| | - Majzoubeh Taheri
- Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad-Esmaeil Motlagh
- Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran and Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran
| |
Collapse
|
67
|
Castillo-Ortiz J, Muñiz-Colon L, Escudero K, Perez-Brayfield M. Laparoscopy in the surgical management of the non-palpable testis. Front Pediatr 2014; 2:28. [PMID: 24783184 PMCID: PMC3986523 DOI: 10.3389/fped.2014.00028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/24/2014] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). METHODS From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient's age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher's exact test for two independent proportions was used for statistical analysis and reported our results. RESULTS One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. CONCLUSION Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings.
Collapse
Affiliation(s)
| | - Luis Muñiz-Colon
- Division of Urology, University of Puerto Rico , San Juan, PR , USA
| | - Karina Escudero
- Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
| | - Marcos Perez-Brayfield
- Division of Urology, University of Puerto Rico , San Juan, PR , USA ; Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
| |
Collapse
|
68
|
Carruthers M. Time for international action on treating testosterone deficiency syndrome. Aging Male 2009; 12:21-8. [PMID: 19326293 PMCID: PMC2670553 DOI: 10.1080/13685530802699067] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 12/17/2008] [Indexed: 10/26/2022] Open
Abstract
AIM Testosterone deficiency is having an increasing impact on men's health because of global aging, higher levels of obesity, diabetes and metabolic syndrome and adverse environmental factors such as stress xenoestrogens and anti-androgens. The question addressed is to what extent the large body of evidence on the benefits and safety of testosterone therapy is applied in clinical practice. METHODS Demographic data for men over the age of 50 from different regions of the world have been compared with the number of men in that age group estimated from sales figures to be receiving testosterone treatment. RESULTS On the basis of estimate that 20% of men over 50 in the general population of each region could be expected to have testosterone deficiency symptoms, on average only these men (0.69%) in most European countries were receiving treatment. Proportion was higher in the UK (1.00%) and Germany (1.89%), but lower in France (0.49%), Italy (0.51%) and Russia (0.54%). Interestingly, Australia had higher figures (1.64%), in spite of tight state control measures on androgen use. The USA has the highest treatment rate (7.96%) and this is increasing rapidly. If the basis for the diagnosis was the more conventional combination of symptoms plus biochemical evidence of low total and free testosterone levels, androgen deficiency would be expected in at least 5% of men over 50, and percentage treatment rates therefore four times higher. However, even on that basis, only in the USA do these exceed 10%. CONCLUSIONS International action is urgently needed to raise awareness in the medical profession in the various countries of these remarkably low levels of testosterone treatment. Improvement in this requires education and motivation of doctors and those regulating the healthcare systems. A public awareness campaign is needed to educate men about the symptoms of testosterone deficiency and its impact on their health.
Collapse
|
69
|
Kumanov P, Tomova A, Robeva R, Hubaveshki S. Prevalence of cryptorchidism among Bulgarian boys. J Clin Res Pediatr Endocrinol 2008; 1:72-9. [PMID: 21318067 PMCID: PMC3005639 DOI: 10.4008/jcrpe.v1i2.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 11/27/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cryptorchidism is the most common congenital defect of the male urogenital system. It may be an important cause for male infertility. The data about its prevalence in South-eastern European countries and especially for the Balkan region are still incomplete. OBJECTIVE The aim of the present study was to establish the prevalence of the abnormality in the Bulgarian population living in the different areas of the country. METHODS In a population-based cross-sectional study in Bulgaria 6200 Caucasian boys (aged under 1 year to 19 years) from five regions of the country were included. One physician examined all children in order to reduce the inter-observer error. RESULTS The prevalence of cryptorchidism was 1.52% for the total group. It was 3.2% for boys under one year of age, 2.1% for those between one and ten years and dropped significantly in older boys (0.6%). No regional or seasonal trends were established. CONCLUSIONS Our study suggests a relatively higher prevalence of cryptorchidism in Bulgaria for children younger than one year of age, while the overall prevalence is comparable to those reported for other countries. The prevalence of cryptorchidism did not differ significantly from the prevalence reported thirty years ago.
Collapse
Affiliation(s)
- Philip Kumanov
- Clinical Center of Endocrinology, Medical University-Sofia, Sofia, Bulgaria.
| | - Analia Tomova
- Clinical Center of Endocrinology, Medical University−Sofia, Sofia, Bulgaria
| | - Ralitsa Robeva
- Clinical Center of Endocrinology, Medical University−Sofia, Sofia, Bulgaria
| | | |
Collapse
|
70
|
Virtanen H, Toppari J. Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 2007; 14:49-58. [DOI: 10.1093/humupd/dmm027] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|