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Ma YL, Wang TX, Feng L, Hu CB, Sun JS, Zhang CF, Yu BH. Diagnoses and Treatment of Acquired Undescended Testes: A Review. Medicine (Baltimore) 2024; 103:e38812. [PMID: 38968470 PMCID: PMC11224853 DOI: 10.1097/md.0000000000038812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
Acquired undescended testes were once considered a sporadic disease. In recent years, reports suggest that they are not uncommon, with an incidence rate about 3 times that of congenital undescended testes. The etiology of acquired undescended testes remains inconclusive, clinical diagnostic standards are unclear, and treatment approaches are still controversial. There is ongoing debate about the mechanism of testicular ascent. The prevailing view is that acquired undescended testes occur due to the partial absorption of the gubernaculum, which forms part of the parietal peritoneum. The residual gubernacular fibers continuously pull on the spermatic cord, preventing the spermatic cord from elongating proportionately to somatic growth, leading to a re-ascent of the testis. Acquired undescended testes may increase the risk of testicular cancer, but this is still debated. The preferred treatment method is also controversial. However, surgical fixation has an immediate effect; no studies have proven that early surgery improves fertility in patients. The etiology of acquired undescended testes is closely related to the continuous pull of the residual gubernacular fibers on the spermatic cord, which prevents the cord from extending proportionately to body growth. There are no clear diagnostic standards for acquired undescended testes yet, and spontaneous descent is possible, so testicular fixation surgery may not be the preferred treatment method.
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Affiliation(s)
- Ya-Long Ma
- Department of Clinical Medicine, Jining Medical University, Jining, Shandong Province, China
| | - Ti-Xue Wang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Lin Feng
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chuan-Bing Hu
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Jin-Song Sun
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Chong-Fang Zhang
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Bao-Hua Yu
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
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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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Kuiri-Hänninen T, Koskenniemi J, Dunkel L, Toppari J, Sankilampi U. Postnatal Testicular Activity in Healthy Boys and Boys With Cryptorchidism. Front Endocrinol (Lausanne) 2019; 10:489. [PMID: 31396156 PMCID: PMC6663997 DOI: 10.3389/fendo.2019.00489] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 01/25/2023] Open
Abstract
Cryptorchidism, or undescended testis, is a well-known risk factor for testicular cancer and impaired semen quality in adulthood, conditions which have their origins in early fetal and postnatal life. In human pregnancy, the interplay of testicular and placental hormones as well as local regulatory factors and control by the hypothalamic-pituitary (HP) axis, lead to testicular descent by term. The normal masculine development may be disrupted by environmental factors or genetic defects and result in undescended testes. Minipuberty refers to the postnatal re-activation of the HP-testicular (T) axis after birth. During the first weeks of life, gonadotropin levels increase, followed by activation and proliferation of testicular Leydig, Sertoli and germ cells. Consequent rise in testosterone levels results in penile growth during the first months of life. Testicular size increases and testicular descent continues until three to five months of age. Insufficient HPT axis activation (e.g., hypogonadotropic hypogonadism) is often associated with undescended testis and therefore minipuberty is considered an important phase in the normal male reproductive development. Minipuberty provides a unique window of opportunity for the early evaluation of HPT axis function during early infancy. For cryptorchid boys, hormonal evaluation during minipuberty may give a hint of the underlying etiology and aid in the evaluation of the later risk of HPT axis dysfunction and impaired fertility. The aim of this review is to summarize the current knowledge of the role of minipuberty in testicular development and descent.
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Affiliation(s)
- Tanja Kuiri-Hänninen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- *Correspondence: Tanja Kuiri-Hänninen
| | - Jaakko Koskenniemi
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Leo Dunkel
- Barts and the London, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Ulla Sankilampi
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
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Wei Y, Wang Y, Tang X, Liu B, Shen L, Long C, Lin T, He D, Wu S, Wei G. Efficacy and safety of human chorionic gonadotropin for treatment of cryptorchidism: A meta-analysis of randomised controlled trials. J Paediatr Child Health 2018; 54:900-906. [PMID: 29655188 DOI: 10.1111/jpc.13920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/19/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
AIM Although human chorionic gonadotropin (hCG) has long been employed in the management of cryptorchidism, its safety and efficacy is still controversial. Hence, in the present study, we conducted a meta-analysis of the treatment of cryptorchidism using hCG. METHODS We searched the Medline, Embase, CINAHL, EBSCO, The Cochrane Library, China National Knowledge Infrastructure and WanFang databases. Data were extracted by two reviewers using the designed extraction form. Data up to July 2015 were obtained using the terms 'cryptorchidism', 'chorionic gonadotropin' and 'randomised controlled trials'. All the publications were downloaded, and the respective authors were contacted for any further details and clarifications, if deemed necessary. The data analysis included randomised controlled trials that compared hCG with other hormone treatments offered to prepubescent males presenting with cryptorchidism. Testicular descent rate was used as the final positive outcome of the treatments offered. The software Review Manager (RevMan 5.3, The Cochrane Collaboration, London, UK) was used to review the management and data analysis. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a fixed effect model if no heterogeneity was present. RESULTS A total of seven trials satisfied the selection criteria. The overall quality of the studies downloaded from various databases was low. Data from these seven studies were divided into three subgroups depending on the design of the trials: Two studies compared hCG with a placebo, and three studies compared hCG with gonadotropin-releasing hormone (GnRH) in unilateral cryptorchidism, whereas two other studies compared hCG with GnRH in bilateral cryptorchidism. Analysis of these trials revealed no significant differences between the effectiveness of hCG treatment and GnRH treatment in bilateral (RR 0.05, 95% CI (-0.29-0.40), two trials, n = 104, P = 0.76) as well as unilateral cryptorchidism (RR 0.04, 95% CI (-0.12, 0.21), three trials, n = 81, P = 0.61). A meta-analysis of these studies showed that hCG treatment is not superior to placebo (RR 7.74, 95% CI (0.14-425.72), two trials, n = 31, P = 0.32). CONCLUSION A meta-analysis of the seven studies led us to conclude that hCG treatment is no more effective than placebo, and there were no significant differences in the effectiveness of hCG versus GnRH treatment.
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Affiliation(s)
- Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Yangcai Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Xiangliang Tang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Bin Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lanju Shen
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Chunlan Long
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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van Brakel J, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ, Dohle GR, de Jong FH. INSL3 and AMH in patients with previously congenital or acquired undescended testes. J Pediatr Surg 2017; 52:1327-1331. [PMID: 28487028 DOI: 10.1016/j.jpedsurg.2017.03.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/20/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In previous reports no differences in Leydig and Sertoli cell function were found between congenital undescended testis (CUDT) and acquired UDT (AUDT) on the basis of serum levels of LH, testosterone, FSH or inhibin B. This study tried to detect differences in Leydig and Sertoli cell function between CUDT and AUDT using insulin-like peptide 3 (INSL3) and anti-Müllerian hormone (AMH). METHOD 118 men with a history of UDT (CUDT N=55 (6/55 bilateral), AUDT N=63 (15/63 bilateral)) were investigated. Differences between CUDT and AUDT, influence of age at surgery in CUDT, and effect of spontaneous descent or orchiopexy in AUDT were evaluated. RESULTS For INSL3, no significant differences were found. AMH levels in bilateral CUDT were significantly lower compared with bilateral AUDT (6.4 (1.7-11.4) vs 13.2 (6.1-30.1) μg/l, p=0.02). AMH levels in unilateral CUDT were significantly higher than in bilateral CUDT (12.1 (2.4-43.7) vs. 6.4 (1.7-11.4) μg/l, p=0.02). CONCLUSION No differences in Leydig cell function on the basis of INSL3 levels between the different UDT groups were found. Sertoli cell function evaluated by AMH, was more negatively affected in bilateral CUDT in comparison with bilateral AUDT and unilateral CUDT. LEVEL OF EVIDENCE RATING Level III Treatment Study.
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Affiliation(s)
- Jocelyn van Brakel
- Department of Urology, P.O. Box 2040, 3000 CA, Erasmus MC, Rotterdam, the Netherlands.
| | | | - Frans W J Hazebroek
- Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Gert R Dohle
- Department of Urology, P.O. Box 2040, 3000 CA, Erasmus MC, Rotterdam, the Netherlands.
| | - Frank H de Jong
- Department of Internal Medicine, Section of Endocrinology, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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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.
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Affiliation(s)
- B Haid
- Abteilung für Kinderurologie, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4010, Linz, Österreich.
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8
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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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van Brakel J, de Muinck Keizer-Schrama SMPF, van Casteren NJ, Hazebroek FW, Dohle GR. Scrotal ultrasound findings in previously congenital and acquired unilateral undescended testes and their contralateral normally descended testis. Andrology 2015. [DOI: 10.1111/andr.12070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. van Brakel
- Department of Urology; Erasmus MC; Rotterdam The Netherlands
| | | | - N. J. van Casteren
- Department of Urology; Ijsselland Hospital, Capelle aan Den IJssel; Rotterdam The Netherlands
| | - F. W. Hazebroek
- Department of Paediatric Surgery; Erasmus MC-Sophia Children's Hospital; Rotterdam The Netherlands
| | - G. R. Dohle
- Department of Urology; Erasmus MC; Rotterdam The Netherlands
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10
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van der Plas EM, van Brakel J, Meij-de Vries A, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ, Hack WWM, Dohle GR. Acquired undescended testes and fertility potential: is orchiopexy at diagnosis better than awaiting spontaneous descent? Andrology 2015; 3:677-84. [DOI: 10.1111/andr.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/13/2015] [Accepted: 04/01/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | - F. W. J. Hazebroek
- Pediatric Surgery; Erasmus MC-Sophia Children's Hospital; Rotterdam the Netherlands
| | - W. W. M. Hack
- Pediatrics; Medical Center Alkmaar; Alkmaar the Netherlands
| | - G. R. Dohle
- Urology; Erasmus MC; Rotterdam the Netherlands
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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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van den Akker-van Marle ME, Kamphuis M, van Gameren-Oosterom HBM, Pierik FH, Kievit J. Management of undescended testis: a decision analysis. Med Decis Making 2013; 33:906-19. [PMID: 23819984 DOI: 10.1177/0272989x13493145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchidopexy. The age at which orchidopexy should be performed is controversial for both congenital and acquired UDT. METHODS A decision analysis is performed in which all available knowledge is combined to assess the outcomes of orchidopexy at different ages. RESULTS Without surgery, unilateral congenital UDT and bilateral congenital UDT are associated with average losses in quality-adjusted life-years (QALYs) of 1.53 QALYs (3% discounting 0.66 QALYs) and 5.23 QALYs (1.91 QALYs), respectively. Surgery reduces this QALY loss to on average 0.84 QALYs (0.21 QALYs) for unilateral UDT and 1.66 QALYs (0.40 QALYs) for bilateral UDT. Surgery at detection will lead to the lowest QALY loss of 0.91 (0.34) and 1.73 (0.60) QALYs, respectively, for unilateral and bilateral acquired UDT compared with surgery during puberty and no surgery. No sensitivity analysis is able to change the preferences for these strategies. CONCLUSIONS Based on our decision analytic model using societal valuations of health outcomes, surgery for unilateral UDT (both congenital and acquired) yielded the lowest loss in QALYs. Given the modest differences in outcomes, there is room for patient (or parent) preference with respect to the performance and timing of surgery in case of unilateral UDT. For bilateral UDT (both congenital and acquired), orchidopexy at any age provides considerable benefit, in particular through improved fertility. As there is no strong effect of timing, the age at which orchidopexy is performed should be discussed with the parents and the patient. More clinical evidence on issues related to timing may in the future modify these results and hence this advice.
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Affiliation(s)
| | - Mascha Kamphuis
- Netherlands Organization for Applied Scientific Research, Leiden/Utrecht, The Netherlands (MK, HBMVG, FHP),Youth Health Care South Holland West (GGD-ZHW), Zoetermeer, The Netherlands (MK)
| | | | - Frank H Pierik
- Netherlands Organization for Applied Scientific Research, Leiden/Utrecht, The Netherlands (MK, HBMVG, FHP)
| | - Job Kievit
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands (MEVDAM, JK)
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Kollin C, Granholm T, Nordenskjöld A, Ritzén EM. Growth of spontaneously descended and surgically treated testes during early childhood. Pediatrics 2013; 131:e1174-80. [PMID: 23530172 DOI: 10.1542/peds.2012-2902] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate whether in congenital unilateral cryptorchidism the growth of a spontaneously descended testis is normal, compared with the contralateral scrotal testis or similar to the growth of testes that failed to descend spontaneously and later underwent orchidopexy. METHODS Ninety-one boys with congenital unilateral cryptorchidism with later spontaneous descent of the initially retained testis were followed from birth (0-3 weeks) up to 5 years of age and compared with boys randomized to surgery at either 9 months (n = 78) or 3 years (n = 85) of age. Testicular volume was determined with ultrasonography. RESULTS Eighty-two percent of spontaneous descent occurred before 2 months of age. Twenty-two percent of these descended testes were later again found in a retained position. The spontaneously descended testis was smaller than its scrotal counterpart at all ages (P < .001). We also showed a significant difference in the testicular volume between the early and late treated boys from age 2 years and onward. At 2, 4, and 5 years of age, the volumes of the spontaneously descended testes were significantly larger than those of boys operated on at 3 years but similar to those operated on at 9 months. CONCLUSIONS We have shown that in boys with congenital unilateral cryptorchidism with later spontaneous descent, the originally retained testes show impaired growth compared with its scrotal counterpart from birth and onwards. Also, they are prone to later ascent to a retained position. Furthermore, the longer testes remain untreated the more they exhibit impaired growth.
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Affiliation(s)
- Claude Kollin
- Department of Women's and Children's Health, Center of Molecular Medicine, Karolinska Institutet, SE-17176, Stockholm, Sweden.
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Afolabi AO, Olotu OO, Alagbonsi IA. Vitamins e and C alleviate the germ cell loss and oxidative stress in cryptorchidism when administered separately but not when combined in rats. ISRN PHARMACOLOGY 2012; 2012:843569. [PMID: 23213563 PMCID: PMC3503317 DOI: 10.5402/2012/843569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/10/2012] [Indexed: 11/23/2022]
Abstract
The antioxidant effects of vitamins C and E on cryptorchidism-induced oxidative stress were investigated in male Sprague-Dawley rats. Forty rats (200-250 g) were randomly divided in a blinded fashion into five groups (n = 8). Group 1 was sham operated and treated with vehicle (corn-oil, 10 mL/kg). Groups 2, 3, 4, and 5 were rendered unilaterally cryptorchid and treated with vehicle (10 mL/kg), vitamin E solution (75 mg/kg), vitamin C solution (1.25 g/kg), and combination of vitamin E (75 mg/kg) and vitamin C (1.25 g/kg) solutions, respectively. Germ cell count, superoxide dismutase (SOD), total protein (TP), and testicular weight (TW) were lower, but malondialdhyde (MDA) was higher in the cryptorchid rats than the sham-operated rats. When administered separately, vitamins C and E increased germ cell count, SOD, TP, and TW but did not reduce MDA in the cryptorchid rats when compared to the vehicle-treated cryptorchid rats. However, there was no significant difference in these parameters between vehicle-treated and combined vitamins C- and E-treated rats. This suggests that vitamins E and C alleviate the germ cell loss and oxidative stress in cryptorchidism when administered separately but not when combined in rats.
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Affiliation(s)
- Ayobami Oladele Afolabi
- Department of Physiology, College of Health Sciences, Ladoke Akintola University of Technology, PMB 4000, Ogbomoso, Oyo, Nigeria
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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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Abstract
PURPOSE We determined the incidence of acquired undescended testes in boys with hypospadias. MATERIALS AND METHODS We retrospectively reviewed the records of 566 boys with hypospadias who were referred to our outpatient clinic between January 2000 and September 2009. Acquired undescended testes were defined as testes that were documented at the bottom of the scrotum at least once after birth by the pediatric urologist at our institution but were subsequently documented to have moved from a satisfactory scrotal position by the same pediatric urologist or an equally experienced pediatric urologist. However, this definition did not include undescended testes after inguinoscrotal surgery. We excluded boys with gender development disorders with testicular dysgenesis, those who underwent bilateral inguinoscrotal surgery and those without congenital cryptorchidism who were followed less than 3 months. RESULTS Of the 566 boys with hypospadias 100 met study exclusion criteria. Of the 466 boys included in analysis 29 (6.2%) had congenital cryptorchidism and 15 (3.2%) had acquired undescended testes. Urethroplasty was performed in 413 boys, including 91 with distal, 132 with mid and 181 with proximal hypospadias. The incidence of congenital cryptorchidism and acquired undescended testes in boys with proximal hypospadias was significantly higher than that in boys with other types of hypospadias (p = 0.03 and 0.001, respectively). CONCLUSIONS Boys with proximal hypospadias are at a higher risk for acquired undescended testes than those with other mild types of hypospadias. Thus, testicular location should be monitored regularly until after puberty.
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Meij-de Vries A, Hack WWM, Heij HA, Meijer RW. Perioperative surgical findings in congenital and acquired undescended testis. J Pediatr Surg 2010; 45:1874-81. [PMID: 20850635 DOI: 10.1016/j.jpedsurg.2010.02.121] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/02/2010] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Perioperative surgical findings in congenital and acquired undescended testis (UDT) were prospectively assessed. METHODS We included all boys with congenital or acquired UDT who underwent orchidopexy at our hospital between January 2006 and August 2009. Perioperatively, we scored the position and volume of the testis, the insertion of the gubernaculum, the patency of the processus vaginalis, and the obtained position. RESULTS We included 69 boys (aged 0.9-14.6 years) with 76 congenital UDT and 28 boys (aged 2.2-18.5 years) with 30 acquired UDT. In the congenital group, the testis was in intracanalicular position in 55 cases (72%), whereas in the acquired UDT group, this was in 11 cases (37%; P < .001). The insertion of the gubernaculum was at the bottom of the scrotum in 13 cases (17%) of the congenital UDT group and in 12 cases (40%) of the acquired UDT group (P < .05). The processus vaginalis was open in 63 cases (83%) of the congenital and in 9 cases (30%) of the acquired UDT group (P < .001). CONCLUSION Compared to congenital UDT, acquired UDT are more likely to be situated in the superficial inguinal pouch, to have a normal insertion of the gubernaculums, and to have a closed processus vaginalis.
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Abstract
Cryptorchidism is a very common anomaly of the male genitalia, affecting 2%-4% of male infants and is more common in premature infants. There are two separate stages of testicular descent. The first stage occurs at 8-15 weeks' gestation in the human fetus and is characterized by enlargement of the genito-inguinal ligament, or gubernaculum, and regression of the cranial suspensory ligament. The testis remains close to the future inguinal region as the fetal abdomen grows. Leydig cells in the testis produce insulin-like hormone 3, which stimulates the caudal gubernaculum to grow and become thicker. Mullerian inhibiting substance may have a role in the first phase of descent by stimulating the swelling reaction in the gubernaculum. The second phase of testicular descent requires migration of the gubernaculum and testis from the inguinal region to the scrotum, between 25 and 35 weeks' gestation. The genitofemoral nerve releases calcitonin gene-related peptide, a neurotransmitter that provides a chemotactic gradient to guide migration. The exact cause of cyrptorchidism remains elusive. Information is mainly derived from animal studies (especially in rodents), which may not extrapolate to the human setting. These findings, however, do have some similarities among mammalian species. The current recommended timing for orchidopexy is between 6 and 12 months of life in an effort to preserve the spermatogonia--the stem cells for subsequent spermatogenesis. Despite surgical treatment by orchidopexy, the long-term outcome still remains problematic and controversial. Impaired fertility (33% in unilateral cases and 66% in bilateral undescended testes) and a cancer risk 5-10 times greater than normal is observed over time. Further research into the cause and management of undescended testes is necessary.
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Affiliation(s)
- John M Hutson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
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Goede J, Hack WW, van der Voort-Doedens L, Pierik FH, Looijenga LH, Sijstermans K. Testicular Microlithiasis in Boys and Young Men With Congenital or Acquired Undescended (Ascending) Testis. J Urol 2010; 183:1539-43. [DOI: 10.1016/j.juro.2009.12.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Joery Goede
- Department of Pediatrics, Medical Center Alkmaar, Alkmaar, The Netherlands
| | - Wilfried W.M. Hack
- Department of Pediatrics, Medical Center Alkmaar, Alkmaar, The Netherlands
| | | | - Frank H. Pierik
- Netherlands Organization for Applied Scientific Research TNO, Delft, The Netherlands
| | - Leendert H.J. Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands
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Hack WWM, van der Voort-Doedens LM, Goede J, van Dijk JM, Meijer RW, Sijstermans K. Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy. BJU Int 2010; 106:1052-9. [PMID: 20151964 DOI: 10.1111/j.1464-410x.2010.09226.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess prospectively the natural history and long-term testicular growth of acquired undescended testis (UDT) after spontaneous descent or pubertal orchidopexy in case of nondescent. PATIENTS AND METHODS From 1996 until 2008, 391 boys with 464 acquired UDT were included in the study. In accordance with Dutch consensus on non-scrotal testes, spontaneous descent at puberty was awaited; if this did not take place, orchidopexy was performed at puberty. Acquired UDT was defined as a testis previously residing in the scrotum that can no longer be manipulated into a stable scrotal (high scrotal) or nonscrotal (inguinal, impalpable) position. After referral, testis position, testis volume and puberty stage were monitored annually until adolescence. Testis volume was assessed using an orchidometer and compared with the Dutch standard. All investigations were carried out by the same physician (W.H.). Of these boys, 84 (mean age 12.9 years, range 6.4-21.3) were also clinically assessed by a second physician (J.G.), unaware of the results of the first examination. In addition, these boys were assessed with testicular ultrasonography, carried out by both physicians. RESULTS Currently the mean (range) follow-up is 4.7 (0.1-12.0) years, and 253 acquired UDT have reached the scrotum. In 196 of these 253 cases (77.5%), there was spontaneous descent at puberty (mean age at descent 12.9 years, range 9.8-16.9); in the other 57 cases (22.5%), pubertal orchidopexy was required due to nondescent; five cases required orchidectomy. Of the 494 testis volume measurements after spontaneous descent, 458 (92.7%) were at ≥10th centile for age, of which 311 (63.0%) were ≥50th centile, and 107 (21.7%) ≥90th centile. After pubertal orchidopexy for nondescent, of the 85 measurements, 79 (92.9%) were at ≥10th centile, 53 (62.4%) ≥50th centile and 12 (14.1%) ≥90th centile. In unilateral cases, after spontaneous descent 174 of the 294 (59.2%) retained testes were found to be smaller than their counterpart and 90 of 294 (30.6%) were equal in size. After pubertal orchidopexy in unilateral cases, 40 of the 51 (78.4%) testes were smaller, and nine (17.6%) were equal in size. There was a strong correlation between both investigators for the measurement of testicular volume by orchidometer, and for the main investigator (W.H.) between his measurements by ultrasonography and the Prader orchidometer. CONCLUSION Acquired UDT has a 77.5% tendency of spontaneous descent at puberty. In nearly all cases, after spontaneous descent as well as after pubertal orchidopexy, long-term testicular growth is within the normal range.
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Affiliation(s)
- Wilfried W M Hack
- Department of Paediatrics, Medical Centre Alkmaar, Alkmaar, the Netherlands.
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Haimov-Kochman R, Prus D, Farchat M, Bdolah Y, Hurwitz A. Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques. ACTA ACUST UNITED AC 2009; 33:e139-43. [PMID: 19622071 DOI: 10.1111/j.1365-2605.2009.00977.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aetiology of cryptorchidism is still undiscernible in the majority of cases. It has long been argued that cryptorchidism reflects a primary testicular maldevelopment, where the contralateral scrotal testis also suffers from aspermatogenesis and low spermatogonia count. The aim of the study was to determine the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy after testicular sperm extraction (TESE) and intracytoplasmatic sperm injection (ICSI). In a retrospective analysis, we compared the sperm retrieval, fertilization, pregnancy and live birth rates after ICSI of consecutive ex-cryptorchid azoospermic patients (n = 15) undergoing TESE between Jan 2000 and Dec 2007 vs. non-cryptorchid azoospermic men (n = 142). Sperm retrieval rate of ex-cryptorchid men by TESE (66%) was comparable with non-cryptorchid men (47%) (p = 0.15) despite significantly higher FSH levels (30.7 +/- 25.4 vs. 17.9 +/- 14.8 respectively) (p = 0.018) and a more prevalent histopathology diagnosis of aspermatogenesis (75% vs. 40%, p = 0.046). Fertilization (43.3%), pregnancy (30%) and live birth (20%) rates after TESE-IVF-ICSI in the ex-cryptorchid group were not different from the non-cryptorchid group (48.7, 43 and 29%, p = 0.26, p = 0.21, p = 0.29 respectively). We conclude that the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy employing TESE-IVF-ICSI is comparable with non-cryptorchid azoospermic men.
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Affiliation(s)
- R Haimov-Kochman
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel.
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Hack WM, Goede J, Pierik FH, Sijstermans K. ASCENT OF THE TESTIS REVISITED: FACT NOT FICTION. BJU Int 2008; 102:1477-8; author reply 1478. [DOI: 10.1111/j.1464-410x.2008.08188_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bonney T, Hutson J, Southwell B, Newgreen D. UPDATE ON CONGENITAL VERSUS ACQUIRED UNDESCENDED TESTES: INCIDENCE, DIAGNOSIS AND MANAGEMENT. ANZ J Surg 2008; 78:1010-3. [DOI: 10.1111/j.1445-2197.2008.04721.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guven A, Kogan BA. Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg 2008; 43:1700-4. [PMID: 18779010 DOI: 10.1016/j.jpedsurg.2008.03.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 03/01/2008] [Accepted: 03/02/2008] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We recommend orchiopexy between 9 and 18 months of age for surgical, testicular, and psychological reasons. However, in practice, we observed many patients coming to orchiopexy at a later age. To understand this difference better, we reviewed our experience with patients undergoing late orchiopexy. METHODS We reviewed retrospectively the office medical records of all boys who had undergone an orchiopexy between July 1997 and April 2006. We defined a "late" orchiopexy as that performed at 4 years of age or later. Each boy was examined carefully by a pediatric urologist, and preoperative, intraoperative, and postoperative findings were reviewed. RESULTS There were 191 late orchiopexies in 177 patients (from a total of 587 orchiopexies in 552 patients). Median age at the operation was 7.2 years (range, 4.0-16.2). Preoperatively, the testes were palpable in 140 (72%) and nonpalpable in 51 (28%). The apparent reason for the late orchiopexy was an ascending testis (previously descended) in 85 (45%), parental delay in 41 (22%), late referral in 39 (20%), and iatrogenic cryptorchidism in 18 (9%). Ascended testes were more likely to have a history of being retractile (85% vs 30%), to have a patent processus vaginalis (78% vs 54%), and to be localized to the superficial inguinal area (87% vs 50%). CONCLUSIONS Primary care provider and parent education on the benefits of early orchiopexy is important, but in addition, ascending testes are much more common than previously thought. Patients with retractile testes should be followed regularly.
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Affiliation(s)
- Ahmet Guven
- Department of Pediatric Surgery, Gulhane Military Medical Academy, Etlik, Ankara 06018, Turkey
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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
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Eijsbouts SW, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ. Further Evidence for Spontaneous Descent of Acquired Undescended Testes. J Urol 2007; 178:1726-9. [PMID: 17707013 DOI: 10.1016/j.juro.2007.03.184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE It is still controversial whether acquired undescended testis can best be managed by orchiopexy or by the wait and see method. We prospectively evaluated spontaneous descent of acquired undescended testes and possible predictive factors in prepubertal boys. MATERIALS AND METHODS From 1982 to 2004 spontaneous descent was awaited until at least Tanner stage P2G2 in 109 boys with a total of 83 unilateral and 52 bilateral acquired undescended testes. Annually we established testis position and size. After Tanner stage P2G2 orchiopexy was done for all testes in an unstable scrotal position. RESULTS Two boys (3 acquired undescended testes) were excluded from analysis. Of 132 acquired undescended testes 75 descended spontaneously (57%, 95% CI 48-65), including 40 of 75 (57%) in early puberty or before puberty and 32 of 75 (43%) in mid puberty. Orchiopexy was performed in 57 of 132 acquired undescended testes (43%). Acquired undescended testes showed an increasing chance of descending spontaneously with increasing age (p trend = 0.002). In 63 of 82 unilateral undescended testes we were able to compare testis volume at the onset of puberty with that of the healthy contralateral side. Of 17 testes that needed orchiopexy 12 (71%) had a volume that was more than 1 ml smaller than the healthy testis. This was noted in only 18 of 46 spontaneously descended acquired undescended testes (39%, p = 0.053). Other factors, such as the most caudal testicular position at referral or the frequency of confirmed descended testicular position before referral, were not predictive of spontaneous descent. CONCLUSIONS A conservative wait and see approach to acquired undescended testis until puberty could prevent more than half of the boys from undergoing orchiopexy and it does not seem detrimental in terms of testicular volume.
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Affiliation(s)
- S W Eijsbouts
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Myrup C, Schnack TH, Wohlfahrt J. Correction of cryptorchidism and testicular cancer. N Engl J Med 2007; 357:825-7; author reply 825-7. [PMID: 17715418 DOI: 10.1056/nejmc071510] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hack WWM, van der Voort-Doedens LM, Sijstermans K, Meijer RW, Pierik FH. Reduction in the number of orchidopexies for cryptorchidism after recognition of acquired undescended testis and implementation of expectative policy. Acta Paediatr 2007; 96:915-8. [PMID: 17537024 DOI: 10.1111/j.1651-2227.2007.00302.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since the mid-1990s, acquired undescended testis has gradually been recognised as a separate entity for which the efficacy of prepubertal surgery has not been univocally been demonstrated. Therefore, in our hospital, orchidopexy was no longer routinely performed for acquired undescended testis. AIM To investigate the effect of expectative policy in our hospital on the number of orchidopexies. METHODS Two 5-year periods were compared. Period A (1991-1995), in which undescended testis was treated surgically, and period B (2000-2004), in which prepubertal orchidopexy in our hospital was no longer performed for acquired undescended testis. In addition, a comparison was made between the percentage reduction in hospital and national figures. RESULTS In period B, the number of orchidopexies in our hospital was reduced by 61.8% (from 387 to 148), mainly in the age group >6 years. Nationally, during the same period, the number of orchidopexies decreased only by 2.4% (from 18 024 to 17 591). CONCLUSION The results of this study confirm that recognition of acquired undescended testis is crucial for reducing the high number of (late) orchidopexies.
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Affiliation(s)
- W W M Hack
- Department of Paediatrics, Medical Centre Alkmaar, Alkmaar, The Netherlands
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Sijstermans K, Hack WWM, Meijer RW, van der Voort-Doedens LM. The frequency of undescended testis from birth to adulthood: a review. ACTA ACUST UNITED AC 2007; 31:1-11. [PMID: 17488243 DOI: 10.1111/j.1365-2605.2007.00770.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We performed a systematic review and critique of the literature on the frequency of undescended testis (UDT) among boys from birth to adolescence. Special attention was given to whether previous testicular position was taken into account to distinguish between congenital and acquired UDT. We searched Medline, Embase, Cinahl and the Cochrane Library. Any study reporting on the frequency of UDT was included. Study population age, number of boys studied, period of examination, primary examiner, area of study, study design, ethnicity, definitions used and previous testicular position were analysed. A total of 46 studies met the inclusion criteria. Twenty-three of the 46 (50%) studies involved newborns. Definitions were described in half of the studies; however, the definitions used were heterogeneous. Previous testis position was described in 11% (5/46) of the studies. At birth, in term and/or birth weight >2.5 kg infants, the UDT rate ranged from 1.0 to 4.6%, and in premature and/or birth weight <2.5 kg infants from 1.1 to 45.3%. At the age of 1 year UDT in term and/or birth weight >2.5 kg infants was seen in 1.0-1.5%, at 6 years in 0.0-2.6%, at 11 years in 0.0-6.6% and at 15 years in 1.6-2.2% of boys. The frequency of UDT shows variable figures in the literature. The actual frequency of acquired UDT essentially remains unclear because of the shortage of studies performed at an older age, and of studies reporting on previous testicular position.
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Affiliation(s)
- K Sijstermans
- Department of Paediatrics, Medical Centre Alkmaar, Alkmaar, The Netherlands.
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