This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Mar 2022This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Malignancy Yield of Testis Pathology in Older Boys and Adolescents with Cryptorchidism Patients with undescended testicles are typically operated on early in life. This is done to help maximize future fertility. Intervention also brings the testicles into a position where self-examination can be done. Cryptorchid males are known to have a markedly increased risk of malignancy. This risk appears to be related to age at intervention. Postpubertal intervention appears to double the risk as compared to prepubertal treatment. These concerns can lead to orchiectomy being chosen over orchiopexy for older males presenting with cryptorchidism. Xu et al (page 694) from Boston, Massachusetts look at this question in a single-institution retrospective review of pathology reports.1 Excluding patients with differences of sexual development, they compared the malignancy rates and types between intra-abdominal testicles and all other undescended testicles. With a median age of intervention of 15 years, 12.5% of the intra-abdominal testicles had a malignancy, whereas none of the other undescended testicles had a malignancy. The results suggest that for adolescents and peripubertal boys, late presentation of an inguinal testicle may not necessarily lead to orchiectomy. There are limitations that should be considered by the reader. The design of the study introduces sampling bias because pathology specimens are only available in those patients who underwent orchiectomy or had sampling, an action that is itself uncommon. The study also does not distinguish between patients who present with an undescended testicle from birth and those with ascended testicles. An ascended testicle would probably not have the same malignancy risk. Low Serum Inhibin B/FSH and AMH/FSH Ratios of Markers of Decreased Germ Cells in Infants with Bilateral Cryptorchidism As noted above, intervention for cryptorchidism occurs usually early on with the hopes of improving future fertility outcomes after puberty. While early intervention can help, are there other markers that can assist in predicting the risk of infertility in individual patients, particularly boys with bilateral cryptorchidism? Kato et al (page 701) from Japan look at the pre-treatment testicular position, serum hormone levels and the mean number of germ cells per tubule on transverse section in a retrospective study drawing data from over 300 boys who underwent orchiopexy from 2014 to 2019.2 All boys aged 9 years or older were excluded. Testicular biopsies were obtained from each cryptorchid patient at the time of orchiopexy. They found that patients with bilateral undescended testicles had significantly lower serum inhibin B and germ cell per tubule values. The ratios of inhibin B to FSH (follicle-stimulating hormone) levels and AMH (anti-Müllerian hormone) to FSH levels were found to be positively correlated with germ cell per tubule count in boys with bilateral cryptorchidism. For boys with unilateral cryptorchidism, these ratios did not offer any prognostic help. The key limitation of this study is that actual sperm counts and paternity rates are not available. While it may not immediately affect how we manage patients with undescended testicles, the paper suggests directions for further investigations on how to predict the long-term fertility benefits in individual patients.