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Grande-Moreillo C, Fuentes-Carretero S, Margarit-Mallol J, Pérez-López C, Rodríguez-Molinero A. Alterations in testicular positioning after normal descent: acquired cryptorchidism. Andrology 2024; 12:1119-1124. [PMID: 37985433 DOI: 10.1111/andr.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Acquired cryptorchidism or acquired undescended testis (UDT) is defined as the displacement of a testicle outside the scrotal sac after normal descent has been verified. There are still no clear guidelines on its management. OBJECTIVES To analyze patients who underwent surgery for UDT in our setting to determine the prevalence of acquired cryptorchidism and to analyze the demographic and clinical characteristics of the population of children diagnosed with both acquired and congenital cryptorchidism, the age of presentation of both entities and the percentage of bilateral involvement. MATERIALS AND METHODS This was a retrospective descriptive study using data from the clinical history of patients who underwent surgery for cryptorchidism between 2011 and 2022. The type of cryptorchidism, acquired or congenital, was recorded. Demographic and clinical data were collected. RESULTS A total of 367 patients and 442 testicular units were included in the study (75 patients had bilateral involvement). In 54.75% (95% CI: 50.09%-59.40%) of the cases analyzed, cryptorchidism was acquired, and the mean age at the time of surgery was 7.39 years (SD 2.95). Twenty percent (95% CI: 16.29%-24.58%) of the patients presented with bilateral cryptorchidism and 64% (95% CI: 52.88%-75.11%) out of them were acquired on both sides. The diagnosis was metachronous in 42.6% (95% CI: 31.21%-54.12%) of bilateral cryptorchidism cases. DISCUSSION AND CONCLUSION Acquired cryptorchidism accounts for more than half of cryptorchidism cases requiring surgery in our setting, with a clearly different age of presentation than that for congenital cryptorchidism. Therefore, it is necessary to monitor the presence of the testes in the scrotal sac until adolescence. It is also important to monitor patients with a history of cryptorchidism, not only for the management of the operated testicle but also for the early identification of patients who will develop metachronous contralateral cryptorchidism.
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Affiliation(s)
- Carme Grande-Moreillo
- Pediatric Surgery Unit, Consorci Sanitari Alt Penedès i Garraf, Barcelona, Spain
- Pediatric Surgery Department Hospital, Universitari Mútua Terrassa, Terrassa, Spain
| | | | | | - Carlos Pérez-López
- Research Area, Consorci Sanitari Alt Penedès i Garraf, Sant Pere de Ribes, Barcelona, Spain
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Rodprasert W, Virtanen HE, Toppari J. Cryptorchidism and puberty. Front Endocrinol (Lausanne) 2024; 15:1347435. [PMID: 38532895 PMCID: PMC10963523 DOI: 10.3389/fendo.2024.1347435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Cryptorchidism is the condition in which one or both testes have not descended adequately into the scrotum. The congenital form of cryptorchidism is one of the most prevalent urogenital anomalies in male newborns. In the acquired form of cryptorchidism, the testis that was previously descended normally is no longer located in the scrotum. Cryptorchidism is associated with an increased risk of infertility and testicular germ cell tumors. However, data on pubertal progression are less well-established because of the limited number of studies. Here, we aim to review the currently available data on pubertal development in boys with a history of non-syndromic cryptorchidism-both congenital and acquired cryptorchidism. The review is focused on the timing of puberty, physical changes, testicular growth, and endocrine development during puberty. The available evidence demonstrated that the timing of the onset of puberty in boys with a history of congenital cryptorchidism does not differ from that of non-cryptorchid boys. Hypothalamic-pituitary-gonadal hormone measurements showed an impaired function or fewer Sertoli cells and/or germ cells among boys with a history of cryptorchidism, particularly with a history of bilateral cryptorchidism treated with orchiopexy. Leydig cell function is generally not affected in boys with a history of cryptorchidism. Data on pubertal development among boys with acquired cryptorchidism are lacking; therefore, more research is needed to investigate pubertal progression among such boys.
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Affiliation(s)
- Wiwat Rodprasert
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Helena E. Virtanen
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology and Centre for Population Health Research, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Department of Growth and Reproduction, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
- Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
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Morizawa Y, Aoki K, Fukui S, Tomizawa M, Shimizu T, Onishi K, Hori S, Gotoh D, Nakai Y, Miyake M, Torimoto K, Fujimoto K, Otani T, Fujimoto K. Assessment of diagnostic accuracy for cryptorchidism and risk factors for delayed orchidopexy. Int J Urol 2024; 31:170-176. [PMID: 37934938 DOI: 10.1111/iju.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Cryptorchidism (CO) diagnosis by palpation is challenging. Patients with suspected CO are primarily referred to pediatric urologists by general pediatricians and urologists. Currently, surgical treatment for CO is recommended earlier than in previous guidelines. In this study, we evaluated factors that lead to diagnosis discordance and delayed orchidopexy in patients referred with suspected CO in addition to timing of initial screening. METHODS In total, 731 patients (1052 testes) with suspected CO were included. Risk factors for diagnostic discrepancy in CO diagnosis by pediatric urologists and risk of delayed orchiopexy were evaluated. RESULTS Herein, 659 (90%) patients were diagnosed during routine public health checkups for infants and young children, and 419 (57%) patients were referred by pediatric practitioners. Of 1052 testes, 374 (36%) were diagnosed with CO by pediatric urologists. In multivariate analysis, risk factors of diagnostic discrepancy for CO diagnosis by pediatric urologists were bilateral testis (odds ratio [OR] = 9.17, p < 0.0001), >6 months old at initial diagnosis (OR = 1.036, p < 0.0001), and pediatric referral (OR = 4.60, p < 0.0001). In total, 296 patients underwent orchiopexy for CO. In multivariate analysis, risk factors for delayed orchiopexy were presence of comorbidities (OR = 3.43, p = 0.003) and >10 months old at referral (OR = 12.62, p < 0.0001). CONCLUSIONS Pediatric referral is a risk factor for discordant CO diagnostics, and late age at referral brings a risk of delayed orchiopexy. It is necessary to enlighten pediatricians, who are mainly responsible for routine health checkups, in teaching CO diagnostic techniques to ensure early referral.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Katsuya Aoki
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
| | - Takeshi Otani
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Joshi NM, Shah RS. Long-term Outcome of Laparoscopic Surgery for Nonpalpable Undescended Testis. J Indian Assoc Pediatr Surg 2024; 29:39-42. [PMID: 38405236 PMCID: PMC10883188 DOI: 10.4103/jiaps.jiaps_46_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 02/27/2024] Open
Abstract
Aims and Objectives The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). Materials and Methods All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 × length × breath × height. Results A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm3) was smaller than the normal nonoperated side (mean = 2.524 cm3). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm3), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Conclusion Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT.
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Affiliation(s)
- Nachiket Milind Joshi
- Department of General Surgery, Worthing Hospital, Worthing, UK
- Department of General Surgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Rasik Shamji Shah
- Department of Paediatric Surgery, SRCC Children’s Hospital Managed by Narayana Health, Mumbai, Maharashtra, India
- Department of Surgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
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Ademaj I, Jashari H, Gjonbalaj N, Syla A. Acquired intra abdominal testis due to adhesions after necrotizing enterocolitis. Urol Case Rep 2023; 49:102445. [PMID: 37334263 PMCID: PMC10276248 DOI: 10.1016/j.eucr.2023.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Undescendent testis happens usually due to the stagnation during testicular descends. Stagnation of a testicle in the abdomen may be the target of adhesions with intestinal segments. Our case report a very rare variant of acquired intra-abdominal cryptorchidism due to adhesions after necrotizing enterocolitis. Newborn baby after NEC has a significant risk of developing intraperitoneal adhesions. In this report we will describe a case of previously palpable testis in the inguinal canal at neonatal age which was pulled inside the abdomen at seventh month of age through adhesions between test and the segment of sigmoid colon after NEC.
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Affiliation(s)
- Isber Ademaj
- University Clinical Center of Kosovo, Pediatric Surgery Clinic, Prishtina, Republic of Kosovo
| | - Hysni Jashari
- University Clinical Center of Kosovo, Pediatric Surgery Clinic, Prishtina, Republic of Kosovo
| | - Naser Gjonbalaj
- University Clinical Center Of Kosovo, Radiology Clinic, Prishtina, Republic of Kosovo
| | - Arta Syla
- University Clinical Center of Kosovo, Pediatric Surgery Clinic, Prishtina, Republic of Kosovo
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de Vasconcelos RAL, Ximenes RAA, Calado AA, Martelli CMT, Gonçalves AV, Brickley EB, de Araújo TVB, Rocha MAW, Miranda-Filho DDB. Surgical findings in cryptorchidism in children with Zika-related microcephaly: a case series. BMC Urol 2020; 20:186. [PMID: 33225931 PMCID: PMC7681962 DOI: 10.1186/s12894-020-00721-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Complications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Pernambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zika-related microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent. Methods A total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchidopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate. Results We found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testis-epididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic gubernacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac. Conclusions We herein describe the surgical findings of these children's orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume.
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Affiliation(s)
| | - Ricardo A A Ximenes
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.,Universidade Federal de Pernambuco, Recife, Brazil
| | - Adriano A Calado
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | | | - Andreia V Gonçalves
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.,Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Maria A W Rocha
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
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Boehme P, Degener S, Wirth S, Geis B, Aydin M, Lawrenz K, Troebs RB, Schmittenbecher P, Beume J, Pötzsch S, Schwarz B, Hensel KO. Multicenter Analysis of Acquired Undescended Testis and Its Impact on the Timing of Orchidopexy. J Pediatr 2020; 223:170-177.e3. [PMID: 32532648 DOI: 10.1016/j.jpeds.2020.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess whether late orchidopexy for undescended testis represents delayed treatment of primary undescended testis or later-occurring acquired undescended testis. STUDY DESIGN We examined boys undergoing orchidopexy for cryptorchidism regarding age at surgery and entity of undescended testis. We characterized differences between primary undescended testis and acquired undescended testis and evaluated the knowledge regarding the diagnosis and management of acquired undescended testis among practicing physicians. We conducted an observational study using a mixed-method multicenter cross-sectional design. A total of 310 consecutive boys undergoing orchidopexy for undescended testis at 6 pediatric medical centers in Germany between April 2016 and June 2018 were investigated regarding testicular position at birth and age at surgery. In addition, a survey on acquired undescended testis management was carried out in 1017 multidisciplinary physicians and final-year medical students. RESULTS Only 13% of all patients were operated on in their first year of life. Among patients with known previous testicular position (67%), primary undescended testis (n = 103) and acquired undescended testis (n = 104) were equally frequent. More than one-half (56%) of orchidopexies performed after the first year of life were due to acquired undescended testis. Remarkably, only 15% of physicians considered acquired undescended testis as an indication for late surgery. CONCLUSIONS Acquired undescended testis is more common than previously perceived and accounts for a significant proportion of "late" orchidopexies in patients with undescended testis. Acquired undescended testis needs to be better recognized in clinical practice and screening should continue in older children with previously descended testes. TRIAL REGISTRATION German Clinical Trials Registry: DRKS00015903.
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Affiliation(s)
- Philip Boehme
- Center for Clinical and Translational Research, Department of Pediatrics, Helios University Hospital Wuppertal, Faculty of Health, Witten/Herdecke University, Wuppertal, Germany; Cardiovascular Research, Bayer Pharma, Wuppertal, Germany
| | - Stephan Degener
- Center for Clinical and Translational Research, Department of Urology, Helios University Hospital Wuppertal, Faculty of Health, Witten/Herdecke University, Wuppertal, Germany
| | - Stefan Wirth
- Center for Clinical and Translational Research, Department of Pediatrics, Helios University Hospital Wuppertal, Faculty of Health, Witten/Herdecke University, Wuppertal, Germany
| | - Berit Geis
- Institute of Medical Biometry and Epidemiology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Malik Aydin
- Center for Clinical and Translational Research, Department of Pediatrics, Helios University Hospital Wuppertal, Faculty of Health, Witten/Herdecke University, Wuppertal, Germany
| | - Karin Lawrenz
- Department for Pediatric Surgery and Pediatric Urology, Helios Hospital Krefeld, Krefeld, Germany
| | - Ralf-Bodo Troebs
- Department for Pediatric Surgery, Marien Hospital Herne, University of Bochum, Bochum, Germany
| | | | - Jan Beume
- Department for Pediatric Surgery, City Hospital Karlsruhe, Karlsruhe, Germany
| | - Simone Pötzsch
- Department of Pediatrics, Helios Hospital Plauen, Plauen, Germany
| | - Beate Schwarz
- Department of Pediatrics, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Kai O Hensel
- Center for Clinical and Translational Research, Department of Pediatrics, Helios University Hospital Wuppertal, Faculty of Health, Witten/Herdecke University, Wuppertal, Germany; Department of Pediatrics, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom; University of Cambridge, Department of Pediatrics, Cambridge, United Kingdom.
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Elsherbeny MS, Abdelhay S. Human chorionic gonadotrophin hormone for treatment of congenital undescended testis: Anatomical barriers to its success. J Pediatr Surg 2019; 54:2413-2415. [PMID: 30867099 DOI: 10.1016/j.jpedsurg.2019.01.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/19/2018] [Accepted: 01/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND/PURPOSE Although the surgical treatment was proved to be the recommended line of management for congenital undescended testis, hormonal therapy with human chorionic gonadotrophin hormone has been started long years ago and is still used in some areas with variable degrees of success. The factors responsible for treatment failure are not well explored. In this study, we aimed to highlight the anatomical abnormalities in the congenital undescended testis that might contribute to treatment failure. METHODS During the period from January 2014 to December 2015, 75 boys with congenital undescended testes received treatment with human chorionic gonadotrophin, in pediatric surgery department, Faculty of medicine, Ain Shams University. Their age ranged between 6 months and 4 years (mean 1.6 years, median 2 years). In 70 boys, the testes were palpable and in the remaining 5 boys, the testes were impalpable. Fifty boys had unilateral and 25 had bilateral undescended testes. Seven of the palpable testes were high scrotal in position and the remaining 83 were palpated in the inguinal canal. The patients were followed up for 6 months to determine the position of the testis after the treatment and surgical intervention was done for those who did not respond to the hormonal treatment either partially or completely. RESULTS Only 7 testes showed complete descent (7%) (2 bilateral and 3 unilateral) and they were initially high scrotal in position, 8 testes showed partial descent (8%) (2 bilateral and 4 unilateral) and they were inguinal in 6 which became high scrotal and impalpable in 2 which became peeping. The remaining 85 (85%) did not respond to the hormonal treatment. Upon surgical exploration, abnormal attachment of the gubernaculum was found in 83 testes (83%), 2 testes were peeping (2%), short testicular vessels were found in 4 testes (4%), 3 testes were vanishing (3%) and a closed internal ring was found in one testis (1%). CONCLUSIONS Treatment of congenital undescended testis with human chorionic gonadotrophin hormone had low success rates. Anatomical abnormalities in the congenital undescended testis might contribute to this treatment failure. TYPE OF THE STUDY Clinical research paper. LEVEL OF EVIDENCE level III.
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Affiliation(s)
- Mohammed S Elsherbeny
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sameh Abdelhay
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Bey E, Gaget O, Jund J, Overs C, Skowron O. [Congenital undescended testis: Should open processus vaginalis have any impact on the elected surgical approach?]. Prog Urol 2016; 26:1185-1190. [PMID: 28029537 DOI: 10.1016/j.purol.2016.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/17/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Compare the position of the undescended testis at clinical examination and under general anesthesia with the patency of an open processus vaginalis. PATIENTS AND METHODS We included children from 2 to 18 years of age operated for a unilateral or bilateral undescended testis between January 2006 and April 2014 at the Annecy Genevois hospital, France. The analysis was conducted considering that the individual was the testis. Testicular position before surgery, under general anesthesia and patency of open processus vaginalis as a surgical finding were prospectively recorded. RESULTS Three hundred and six children were included. The analysis was conducted over 401 testes. The position at clinical examination was significantly linked to a persistent open processus vaginalis (P=0.0045). Over the 282 testes considered as candidate for Bianchi's procedure, as to say intra- or supra-scrotal under general anesthesia, 154 had a persistent processus vaginalis (55%). CONCLUSION There is a link between a persistent processus vaginalis and the location of the undescended testis which should encourage us not to neglect the inguinal approach, and eventually to question the relevance of Bianchi's procedure. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E Bey
- Département de chirurgie urologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - O Gaget
- Département de santé publique, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - J Jund
- Département de santé publique, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - C Overs
- Département de chirurgie urologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - O Skowron
- Département de chirurgie urologie, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
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Promm M, Schröder A, Neissner C, Eder F, Rösch WH, Schröder J. Acquired cryptorchidism: More harm than thought? J Pediatr Urol 2016; 12:236.e1-6. [PMID: 27318547 DOI: 10.1016/j.jpurol.2016.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Acquired cryptorchidism (AC) has been recognized as a subgroup of undescended testes (UDT). There is growing evidence that the compromising effect equals that of congenital UDT (cUDT). This prospective study included an extensive histological examination of biopsies taken from AC patients. PATIENTS AND METHODS From August 2013 to December 2014, 21 boys (3-12 years of age) underwent testicular biopsy during orchiopexy for AC. Patient and family histories were taken. The amount of germ cells (GC) per tubule (T) and the amount of adult dark spermatogonia (Ad-S) per T were determined by resin semi-thin sections examination. The samples were also scanned for signs of malformation. Immunohistochemical stains were performed as markers for atypical germ cells. RESULTS Four (19%) boys were born prematurely, two (9.5%) were small for gestational age (SGA), and nine (43%) had a positive family history of UDT. The median of GC/T was 1.06 in boys <9 years, and 0.60 in boys ≥9 years. The median of Ad-S/T was 0.02 in boys <9 years and 0.01 in boys ≥9 years. There were no signs for malformation and no atypical cells. The immunohistochemical stains were negative in all specimens. CONCLUSIONS Prematurity, SGA, and a positive family history appeared to be predictors for AC. Extensive histopathological examination of AC revealed a significant reduction of germ cell count and fertility markers, comparable with that in cUDT. The alterations were more severe in boys aged ≥9 years. It is unclear as to whether or not this was possibly caused by a longer duration of inguinal position, but this finding suggests that routine checks of testicular position throughout childhood are needed, and that there is a cause for continued efforts in educating parents and primary care physicians regarding AC. Current data support the notion of surgical correction once the diagnosis is made.
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Affiliation(s)
- M Promm
- Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany.
| | - A Schröder
- Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany
| | - C Neissner
- Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany
| | - F Eder
- Department of Pathology, University Medical Center of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - W H Rösch
- Department of Paediatric Urology, Klinik St. Hedwig, University Medical Center of Regensburg, Steinmetzstr. 1-3, 93049 Regensburg, Germany
| | - J Schröder
- Department of Pathology, University Medical Center of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Durell J, Johal N, Burge D, Wheeler R, Griffiths M, Kitteringham L, Stanton M, Manoharan S, Steinbrecher H, Malone P, Griffin SJ. Testicular atrophy following paediatric primary orchidopexy: A prospective study. J Pediatr Urol 2016; 12:243.e1-4. [PMID: 27422375 DOI: 10.1016/j.jpurol.2016.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND With the Nordic consensus statement advocating orchidopexy at an earlier age, the present study sought to investigate the outcomes of primary paediatric orchidopexy at a tertiary UK centre. OBJECTIVE To prospectively assess testicular atrophy following primary orchidopexy for undescended testes in a paediatric population. Secondary outcomes were complication rates and whether outcomes were dependent on grade of operating surgeon. STUDY DESIGN Prospective data regarding age at operation, classification of the undescended testis, length of follow-up, and subjective comparison of intraoperative and postoperative testicular volumes compared with the contralateral testis were collected. Testicular atrophy was defined as >50% loss of testicular volume or a postoperative testicular volume <25% of the volume of the contralateral testis. Patients were excluded for incomplete data and follow-up <6 months. RESULTS Data for 234 patients were analysed. Testicular atrophy occurred in 2.6% of cases. There was no reported testicular re-ascent. All secondary acquired cases underwent a previous ipsilateral hernia repair. There was no significant difference in outcomes comparing the grade of surgeon (consultant n = 8, trainee/staff-grade surgeon n = 7-8). There was a trend towards postoperative catch-up growth in approximately one fifth of cases. DISCUSSION Previous studies have reported a testicular atrophy rate of 5%. The present study reported a similar rate of 2.6%. In agreement with a previous publication, it was also found that testicular atrophy was not dependent on the grade of operating surgeon. The mechanism for testicular catch-up growth is not well understood. Animal studies have supported the hypothesis that increased temperature has a detrimental effect on testicular volume. However, follow-up in the present cohort was short (median 6.9 months), making interpretation of this finding difficult. It is acknowledged that clinical palpation alone to determine testicular volume potentially introduces intra-observer and inter-observer error. However, prospective studies using ultrasound to determine testicular volumes following orchidopexy have reported catch-up growth. CONCLUSION This study represented one of the larger collections of prospective assessments of outcomes following primary orchidopexy. It was acknowledged that subjectively assessing testicular volume is not ideal; however, the data correlated with similar studies.
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Affiliation(s)
- J Durell
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - N Johal
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - D Burge
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - R Wheeler
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - M Griffiths
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - L Kitteringham
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - M Stanton
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - S Manoharan
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - H Steinbrecher
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - P Malone
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK
| | - S J Griffin
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, University Hospital Southampton, Tremona Road, Southampton, UK.
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12
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Abstract
Congenital cryptorchidism, that is, undescended testis, is one of the most common urogenital abnormalities observed in newborn boys. In addition to the congenital form, there is also acquired form of cryptorchidism. Fertility potential of patients with cryptorchidism has been evaluated by testicular histology and volume, semen quality, reproductive hormone levels, time to conception, and paternity rates. Cryptorchidism is associated with abnormalities in testicular development, and early treatment is recommended to optimize the fertility potential of the patients.
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Affiliation(s)
- Helena E Virtanen
- Department of Physiology, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 4-8, Turku FI-20520, Finland.
| | - Jorma Toppari
- Department of Physiology, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 4-8, Turku FI-20520, Finland; Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 10, Turku FI-20520, Finland
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13
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van Brakel J, Kranse R, de Muinck Keizer-Schrama SMPF, Hendriks AEJ, de Jong FH, Hack WWM, van der Voort-Doedens LM, Bangma CH, Hazebroek FW, Dohle GR. Fertility potential in a cohort of 65 men with previously acquired undescended testes. J Pediatr Surg 2014; 49:599-605. [PMID: 24726121 DOI: 10.1016/j.jpedsurg.2013.09.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/19/2013] [Accepted: 09/11/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate testicular function in men with previously acquired undescended testes (AUDT) in whom spontaneous descent was awaited until puberty followed by orchiopexy in case of nondescent. METHODS Andrological evaluation including paternity, scrotal ultrasound, reproductive hormones, and semen analysis was performed in three groups: men with AUDT, healthy controls, and men with previously congenital undescended testes (CUDT). RESULTS In comparison with controls, men with AUDT more often had significantly abnormal testicular consistency, smaller testes, lower sperm concentration, and less motile sperm. Except for more often a normal testicular consistency in men with AUDT, no differences were found between men with AUDT and men with CUDT. Also, no differences were found between men with AUDT which had spontaneously descended and men who underwent orchiopexy. CONCLUSIONS Fertility potential in men with AUDT is compromised in comparison with healthy controls, but comparable with men with CUDT. This suggests that congenital and acquired UDT share the same etiology. No significant difference was found between men who had spontaneous descent and men needing orchiopexy. However, fertility potential is unknown for men after immediate surgery at diagnosis, and this should be a subject for future studies.
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Affiliation(s)
- Jocelyn van Brakel
- Department of Urology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | - Ries Kranse
- Department of Urology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | | | - A Emile J Hendriks
- Departments of Pediatrics, Endocrinology, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CA Rotterdam, the Netherlands.
| | - Frank H de Jong
- Departments of Internal Medicine, Endocrinology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | - Wilfried W M Hack
- Department of Pediatrics, Medical Center Alkmaar, 1800AM Alkmaar, the Netherlands.
| | | | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
| | - Frans W Hazebroek
- Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, 3000 CA Rotterdam, the Netherlands.
| | - Gert R Dohle
- Department of Urology, Erasmus University Medical Center, 3000 CA Rotterdam, the Netherlands.
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14
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Hougaard KS, Larsen AD, Hannerz H, Andersen AMN, Jørgensen KT, Toft GV, Bonde JP, Jensen MS. Socio-occupational class, region of birth and maternal age: influence on time to detection of cryptorchidism (undescended testes): a Danish nationwide register study. BMC Urol 2014; 14:23. [PMID: 24581337 PMCID: PMC4016268 DOI: 10.1186/1471-2490-14-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/15/2014] [Indexed: 11/25/2022] Open
Abstract
Background Cryptorchidism (undescended testes) is associated with poor male fertility, but can be alleviated and fertility preserved to some degree by early detection and treatment. Here we assess the influence of socio-occupational class, geographical region, maternal age and birth cohort on time to detection and correction of cryptorchidism. Methods All boys born in Denmark, 1981 to 1987 or 1988 to 1994, with a diagnosis of cryptorchidism were identified in nationwide registers. The boys were followed for a diagnosis until their 16th birthday. The age at first diagnosis was noted and used as proxy for time to detection of cryptorchidism. Parental employment in the calendar year preceding birth was grouped into one of five socio-occupational classes. Geographical region was defined by place of birth in one of 15 Danish counties. Detection rate ratios of cryptorchidism were analyzed as a function of parental socio-occupational group, county, maternal age and birth cohort by use of Poisson regression. Results Some 6,059 boys in the early and 5,947 boys in the late cohort received a diagnosis of cryptorchidism. Time to detection was independent of parental socio-occupational group and maternal age but differed slightly between geographical regions. A similar pattern was obtained for surgical correction after a diagnosis. Age at diagnosis decreased by 2.7 years from the early to the late cohort. Conclusions These results indicate that childhood socio-occupational inequality in detection and correction of cryptorchidism would play a negligible role in male infertility in a life course perspective. Geographical region may have exerted some influence, especially for the oldest cohort.
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Affiliation(s)
- Karin Sørig Hougaard
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
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15
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Ein SH, Nasr A, Wales PW, Ein A. Testicular atrophy after attempted pediatric orchidopexy for true undescended testis. J Pediatr Surg 2014; 49:317-22. [PMID: 24528976 DOI: 10.1016/j.jpedsurg.2013.11.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND/PURPOSE A normal testis in the scrotum is the most important outcome of the attempted pediatric orchidopexy for a true undescended testis. The reports of post-orchidopexy testicular atrophy in the literature have ranged from non-existent to unclear. Our purpose in this study was to estimate the incidence of and associated risk factors for post-orchidopexy testicular atrophy. METHODS We performed a retrospective review of data from children who had an attempted orchidopexy for a true undescended testis from 1969 to 2003 inclusive. REB approval 1000011987. RESULTS There were 1400 attempted orchidopexies involving common (low) type (n=1135), ectopic type (n=174), and high type testes (n=91). There were a total of 111/1400 (8%) atrophic testes, mostly right-sided. 66/111 (59%) were MADE atrophic, and 45 (41%) were FOUND atrophic. Of the 1135 common type, 56 (5%) were MADE atrophic. In the ectopic and high types, the incidence of post-operative testicular atrophy was 1% and 9%, respectively. The most significant risk factors associated with testes MADE atrophic were high testicle, vas problems, and pre-operative torsion. CONCLUSIONS In this series, the incidence of post-operative testicular atrophy that was MADE was 5% in the common (low) type and 9% in the high type. These numbers and the above risk factors should be quoted to the caregiver during pre-operative informed consent.
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Affiliation(s)
- Sigmund H Ein
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8.
| | - Ahmed Nasr
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Paul W Wales
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | - Arlene Ein
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
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16
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Meij-de Vries A, Goede J, van der Voort L, Heij HA, Meijer RW, Hack WWM. Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy. J Pediatr Surg 2012; 47:727-35. [PMID: 22498388 DOI: 10.1016/j.jpedsurg.2011.10.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/29/2011] [Accepted: 10/23/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of the study was to determine long-term testicular position and growth of acquired undescended testis (UDT) after prepubertal orchidopexy. METHODS Patients who had undergone prepubertal orchidopexy for acquired UDT at our hospital between 1986 and 1999 were recruited to assess long-term testicular position and volume. Testis position was assessed by physical examination. Testis volume was measured with Prader orchidometry and ultrasound and was compared with normative values reported in the literature. RESULTS A total of 105 patients (aged 14.0-31.6 years) were included with 137 acquired UDT (32 bilateral, 33 left sided, and 40 right sided). All but 1 of the orchidopexied testes (99.3%) were in low scrotal position. The mean volume of the orchidopexied testes in unilateral UDT (n = 73, 10.57 ± 3.74 mL) differed significantly from the size of the testes at the contralateral side (14.11 ± 4.23 mL) (P = .000). The operated testes (10.28 ± 3.45 mL) were smaller than the mean adult testis volume reported in the literature (13.4-13.6 mL; cutoff, 13.2 mL). CONCLUSION Testis position after prepubertal orchidopexy for acquired UDT was nearly always low scrotal. The volume of the orchidopexied testes was smaller than both the volume of the contralateral testes and the normative values reported in the literature.
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Affiliation(s)
- Annebeth Meij-de Vries
- Department of Surgery Wilhelminalaan, Medical Centre Alkmaar, 12 1815 JD Alkmaar, The Netherlands.
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van Brakel J, Dohle GR, de Muinck Keizer-Schrama SM, Hazebroek FW. Different surgical findings in congenital and acquired undescended testes. BJU Int 2012; 110:E387-91. [DOI: 10.1111/j.1464-410x.2011.10888.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Hack WWM, Goede J, van der Voort-Doedens LM, Meijer RW. Acquired undescended testis: putting the pieces together. ACTA ACUST UNITED AC 2011; 35:41-5. [PMID: 21651571 DOI: 10.1111/j.1365-2605.2011.01155.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acquired undescended testis is now a well-recognized disorder. It is seen in 1.5% of pre-pubertal boys and accounts for the 1-2% orchidopexy rate in older boys. Its pathogenesis remains largely unclear, but it may be caused by a fibrous remnant of the processus vaginalis. There is much controversy over its management, and the proper management awaits a randomized-controlled trial. Until now, follow-up data are available only for cases of spontaneous descent or pubertal orchidopexy. It is speculated that acquired undescended testis is in fact congenital and because of a short funiculus at birth, allowing a low-scrotal position early in life. However, as the boy grows, the testis might evolve into an undescended state. When testosterone surges at puberty, spontaneous descent occurs in three of every four cases.
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Affiliation(s)
- W W M Hack
- Department of Paediatrics, Medical Centre Alkmaar, The Netherlands.
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19
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Meij-de Vries A. Reply to Letter to the Editor. J Pediatr Surg 2011; 46:787. [PMID: 30021264 DOI: 10.1016/j.jpedsurg.2010.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 11/16/2022]
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20
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Acquired undescended testis and open processus vaginalis: what we do not see and the "wait-and-see" policy. J Pediatr Surg 2011; 46:786-787. [PMID: 21496558 DOI: 10.1016/j.jpedsurg.2010.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 10/31/2010] [Indexed: 11/21/2022]
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