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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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Kikkawa K, Ueda Y, Yamashita S, Kohjimoto Y, Hara I. The Importance of Follow-Up and Evaluation of Intraoperative Findings to Determine Surgical Indications for Retractile Testis. Adv Urol 2023; 2023:8764631. [PMID: 37720542 PMCID: PMC10504044 DOI: 10.1155/2023/8764631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/03/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis. Methods We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery. Results A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment. Conclusion Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate.
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Affiliation(s)
- Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yuko Ueda
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan
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Hildorf SE. Clinical aspects of histological and hormonal parameters in boys with cryptorchidism: Thesis for PhD degree. APMIS 2022; 130 Suppl 143:1-58. [PMID: 35822689 PMCID: PMC9542020 DOI: 10.1111/apm.13247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Simone Engmann Hildorf
- Department of Pediatric Surgery and Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Ascending testis: A congenital predetermined condition. J Pediatr Urol 2021; 17:192.e1-192.e3. [PMID: 33483293 DOI: 10.1016/j.jpurol.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION About 0.8% of boys have undescended testes at 1 year of age. However, the overall rate of orchidopexy is 2.5 times that expected. While studies have shown ascending testes accounting for a proportion of such discrepancy, the aetiology of this ascent remains controversial. In this study, intra-operative findings of patients underwent orchidopexy for ascending testes are evaluated to infer aetiology. METHODS Patients with confirmed ascending testes from a single paediatric surgery unit over a four-year period from June 2015 till June 2019 were included in this observational study. During orchidopexy procedure, intra-operative findings in terms of gubernacular attachment, and the degree of epididymal attachment to the upper pole of the testicle were primarily evaluated. Secondary findings including the presence and length of patent processus vaginalis (PPV), and the presence of any long looping vas or hydatid of morgangi were also noted. RESULTS Eighty-three children (median age = 79 months [range 38-149]) were included in this study. Two boys had bilateral ascending testes leading to a total of 85 orchidopexy cases performed. All patients were found to have a gubernacular attachment proximal to the junction between the upper lateral wall of scrotum and the medial part of the thigh. PPV was present in all cases, with its length measured from the deep inguinal ring after retracting the conjoint tendon ranging from 4 to 15 mm 84 cases (98.8%) demonstrated complete or partial separation between the head of epididymis and the upper pole of the testicle. Hydatid of morgagni was present in 82 cases (96.4%), and none of the operated testicles demonstrated looping vas. DISCUSSION The varying degrees of PPV length demonstrated during orchiodpexy for ascending testes in this study casts a doubt on the role of processus vaginalis in such ascent. Also, there is considerably a wide-range of reported incidence (13-78%) in literature for PPV in ascending testes. In this study, intra-operative findings demonstrated an abnormal gubernaculum attachment in all ascending testes in keeping with previous reports, and support the hypothesis that ascending testis has always been undescended, yet acquired more apparent undescended position with child age and growth. CONCLUSION Patients with ascending testes seem to share similar intra-operative findings with patients who have true undescended testes. The universal abnormal attachment of the gubernaculum and the omnipresent testicular-epididymal fusion anomalies may indicate that ascending testis is a congenital predetermined condition, and that these testes have always been congenitally undescended, yet obtained a more noticeable position with the child growth.
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Shin J, Jeon GW. Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr 2020; 63:415-421. [PMID: 32252147 PMCID: PMC7642136 DOI: 10.3345/cep.2019.01438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/01/2020] [Indexed: 12/17/2022] Open
Abstract
Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treatment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to protect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intra-abdominal undescended testis, or who underwent delayed orchiopexy. Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population. Self-examination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.
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Affiliation(s)
- Jaeho Shin
- Division of Pediatric Surgery, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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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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de Vasconcelos RAL, Ximenes RAA, Calado AA, Martelli CMT, Gonçalves AV, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Cryptorchidism in Children with Zika-Related Microcephaly. Am J Trop Med Hyg 2020; 102:982-984. [PMID: 32157994 PMCID: PMC7204599 DOI: 10.4269/ajtmh.19-0753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The genitourinary tract was recently identified as a potential site of complications related to the congenital Zika syndrome (CZS). We provide the first report of a series of cryptorchidism cases in 3-year-old children with Zika-related microcephaly who underwent consultations between October 2018 and April 2019 as part of the follow-up of the children cohort of the Microcephaly Epidemic Research Group, Pernambuco, Brazil. Of the 22 males examined, eight (36.4%) presented with cryptorchidism. Among 14 undescended testis cases, 11 (78.6%) could be palpated in the inguinal region. Seven of the eight children had severe microcephaly. Conventional risk factors for cryptorchidism were relatively infrequent in these children. We hypothesize that cryptorchidism is an additional manifestation of CZS present in children with severe microcephaly. As in our cases, for most of the children, the testes were located in the inguinal region, and the possible mechanisms for cryptorchidism were gubernaculum disturbance or cremasteric abnormality.
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Affiliation(s)
| | - Ricardo A A Ximenes
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
| | | | | | - Andreia V Gonçalves
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
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Stein R, Loersch F, Younsi N. [German guideline on undescended testis-what is relevant in daily routine?]. Urologe A 2020; 59:559-564. [PMID: 32274542 DOI: 10.1007/s00120-020-01183-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With an incidence of 0.7-3% in male infants, undescended testicles is one of the most common congenital anomalies. In the first 6 months of life, the testicles may spontaneously descend in up to 70% of individuals. If the testicle is not in a scrotal position afterwards, fertility can gradually be reduced and the risk of a testicular tumor increases. Therefore, the current German guideline for undescended testis recommends that therapy should be take place between 6 and 12 months of life. After extensive information on the advantages and disadvantages, hormone therapy with the aim of a descensus or in those with bilateral anomaly with the aim of improving the germ cell pool can be offered. After the first year of life, hormone therapy is obsolete. Otherwise, surgical intervention is the treatment of choice. In the case of gliding or deep inguinal testis via scrotal or inguinal access, in the case of nonpalpable and sonographically undetectable testis, laparoscopy is carried out for diagnosis and simultaneous therapy. In the first postoperative year, adequate follow-up should be done to detect a re-ascensus and/or insufficient growth. Regular self-examinations from the age of 15 serve for the early detection of a testicular tumor that occurs only very rarely (approximately 0.003%).
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Affiliation(s)
- R Stein
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - F Loersch
- Kinderarztpraxis, Schwanenstraße 25, 68259, Mannheim, Deutschland
| | - N Younsi
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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