Management Of Undescended Testis Research Articles

European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes.

The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT). An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA). Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role. Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.

Management of undescended testes in adolescents and young adults

Background: The undescended testes (UDT) are at risk of torsion, trauma and pathologic changes leading to subfertility and malignant transformation. Surgery for UDT should be performed before the age of 2 years.Methods: This was a 5-year retrospective study conducted on patients who presented with features of UDT in Port Harcourt. Ethical approval for the study was sought and gotten from the hospital ethical committee. Data was obtained from ward admission registers, theatre, and discharge records. The information gotten included history, examination findings and treatment received. Patients who had ectopic testes, retractile testes and incomplete records were excluded from the study. The information was collected and analysed. Categorical data was presented in the form of frequencies and percentages using tables. Continuous variables were presented in means and standard deviation. Results were presented in tables and charts.Results: The 15-19-year age group had the highest frequency. The median age was 19 years. Most subjects had at least secondary school education (71.43%). The right testes alone were undescended in 11 cases while the left alone was undescended in 7 cases. Three patients presented with undescended testes. Most (15) patients had their testes located in the inguinal canal. Poverty was the most common reason for late presentation. Orchidopexy was most commonly carried out via an inguinal approach.Conclusions: Late presentation of patients with UDT is common. Inguinal orchidopexy was the most common surgery performed. Health education on the need for scrotal examination after birth can aid earlier presentation.

Overview of Epidemiology and Management of Undescended Testis (Cryptorchidism)

Cryptorchidism (undescended testis, maldescendus testis) is a disorder in which one or together testes miscarry to slope into the bottommost of the scrotum. The study aimed to summarize the updated evidence regards, epidemiology, etiology, classification, diagnosis, and treatments of Cryptorchidism or undescended testis. Several causes can result in developing cryptorchidism. Disruption of any phase of testicular prolapse due to genetic hormonal, structural, ecological, or social issues can lead to cryptorchidism. The diagnosis of undescended testes is clinical. The test should be performed by an experienced person and should always be performed using a two-way technique. In some cases, imaging diagnostics for cryptorchidism may be helpful. The rationale for treating cryptorchidism is to reduce the risk of its long-term consequences. Current treatments for undescended testes include hormone therapy, orchopexy, and surgical correction.

The role of ultrasonography in the management of undescended testes. A 6 year review.

Background: Undescended Testis (UDT) is a common condition that has a potential to cause infertility and may become malignant if not treated surgically in time. Ultrasound is requested by different specialties for diagnosis of UDT before referring to a pediatric urology clinic. Objectives: To evaluate the trends for Ultrasound Scan (USS) requests by particular specialties before referral to a surgical team and to assess the sensitivity and specificity of ultrasound in accurately localizing UDT compared to per operative findings and its impact on the management plan. Methods: We reviewed all the patient between 1st of January 2014 to 1st of January 2019, who were referred to our paediatric urology department for UDT and had an USS testes before referral. Patients with ambiguous genital, hydrocele and redo orchidopexy were excluded. We recorded age at referral, referring specialty, their findings on clinical examination, the USS findings, and per operative findings. The results were expressed as mean/median, percentages, sensitivity, specificity and positive and negative predictive value. Results: We received 670 referrals for UDT to our clinic during this period. Among these 207 patients (31.04%) had an USS done before referral to us. There were nearly equal number of referrals made by the main specialties, which included neonatology, general paediatrics and family medicine. All the decisions as regards to surgery were based on the clinical examination in outpatient and the surgical approach of either open or laparoscopy was based on examination under anaesthesia irrespective of USS findings. The sensitivity and specificity of ultrasonography for correctly diagnosing a testis in the groin was 87.79% and 72.13%, in the abdomen 70.73% and 96.08% and for vanished testes 87% and 94.8% respectively when compared to per operative findings. USS missed diagnosed 43 out of 101 normal testes as either in the groin n=41(16.87%) or abdomen n=2(2.81%). This practice cost our hospital US$ 10350 (US$ 50 per scan). Conclusion: The use of ultrasound does not aid significantly in the accurate diagnosis or management of undescended testes and incur unnecessary additional cost to the health system. Physicians should refrain from requesting ultrasound for localization of testes before referral to surgical team.

Management of cryptorchidism in adolescent and adult males

BackgroundIn developing countries, it is not unusual for patients with undescended testes (UDT) to present in adulthood and the late detection of UDT can be problematic. The limited contribution to fertility and increased potential of malignancy seen in UDT have swayed many authors towards recommending orchidectomy, rather than orchidopexy, for the adult patient presenting with cryptorchidism. With conflicting data, and most guidelines aimed at first world countries with pre-pubertal patients as their focus group, a lot of uncertainty exists regarding the management of adults who present with cryptorchidism. This may result in variation in the approach to management of this patient population.MethodsA retrospective review was conducted of patients with cryptorchidism, aged 12 years or older at the time of surgery. The following data were retrieved: patient’s age, medical and previous surgical history, clinical features of UDT (laterality, position and size), date of surgery, intra-operative findings and procedure performed. Management decisions were compared to the most recent guidelines.ResultsThe mean age of the 106 subjects was 25.4 years. An orchidectomy was performed in a total of 30 (24.2%) of the 124 testicular units. The majority of testes, 91 (73.4%), in this group were preserved. Of these, 43 (47.3%) were older than 18 years of age, 33 (36.2%) were reported as having unilateral UDT with a normal contralateral testis and in 9 (9.8%) of these cases, the preserved testes were described as being atrophic. The majority (59.7%) of UDT in the post-pubertal group (> 18 years) were managed by orchidopexy.ConclusionContrary to the recommended treatment for this group of patients, there was a general tendency towards testicular preservation. The decision on surgical management was made by the attending surgical team. This not only demonstrates variation in the management of UDT, but could also be a reflection of the lack of sufficient guidelines as to the management of the post-pubertal patient presenting with UDT. Further studies, following cryptorchidism through adulthood, are needed to refine guidelines for the optimal management of this group of patients.

AKT answer relating to management of undescended testis

AKT answer relating to management of undescended testis

AKT question relating to management of undescended testis

AKT question relating to management of undescended testis

A single centre experience in the management of undescended testes

Introduction: Undescended testes (UDT) is one of the most common congenital anomalies of the urogenital system. In spite of its common occurrence, lots of variations are still reported regarding the time of surgery, mode of investigation and surgery. The present study tried to report the single centre experience of management of UDT. Materials and Methods: The data of patients with UDT including time of presentation, time of surgery, position of testes, investigations, associated urogenital anomalies, complications were collected over a period of 9 years and 6 months and analysed. Results: A total of 118 children were recorded of which the testes of 6 infants became descended before the age of 6 months. Out of the remaining, 112 children, 24 children had bilateral UDT, 24 children had nonpalpable testes (NPT). Ultrasound could locate 19 NPT pre-operatively. Maximum children were operated between 6 months to 1 year in 43 children (38.39 %). Laparoscopy was done for intra-abdominal testes and NPT whose locations could not be located by US and the rest by open inguinal exploration. Four children had pre-operative complications with obstructed inguinal hernias (2 cases) and testicular torsion (2 cases). Conclusion: Majority of the children were being operated before the age of 1 year and US is a good non-invasive to effectively locate the NPT.

Pattern of presentation and management of undescended testes in adolescent and adults

Background: Undescended testis may present in adolescent and adults due to torsion, hernia or infertility. We present our experience in the management of undescended testes in adolescent and adult patients. Methodology: This is a retrospective study of 30 patients above the age of 10 years managed for undescended testes by our hospital from January 2011 to December, 2020. Data was collected via proforma and analysed using SPSS version 25.0 for windows. Results: The mean age of the patients was 31.1 ± 14.1 years with a range of 12-70 years. There was infertility in 15 patients (50%), groin swelling ± pain in 15 patients (50%). Orchidopexy ± herniorrhaphy and orchidectomy was done for 20 patients (66.7%). Conclusion: Undescended testes in adult and adolescent may present due to infertility, torsion, hernia or malignant transformation. Orchidopexy with or without orchidectomy is done depending on the location, bilaterality and status of the testes.

Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre

Before 2014, there was a lack of recommendations on managing cryptorchidism, or undescended testis (UDT), from a large pediatric urological or surgical organization. We assessed the variability in management of UDT among pediatric urologists and pediatric surgeons at a single tertiary pediatric referral centre before publication of major guidelines. We performed a retrospective review of the electronic records of patients who underwent primary unilateral or bilateral orchidopexy at our centre between January 2012 and January 2014. A total of 488 patients (616 testes) were identified, of whom 405 (83.0%) and 83 (17.0%) were managed by pediatric urologists and pediatric surgeons, respectively. There was no difference in baseline characteristics, including age seen in clinic or at surgery, testis location/palpability and availability of preoperative ultrasonograms, of patients seen by the 2 groups. Pediatric surgeons ordered preoperative ultrasonography more often than pediatric urologists (25.3% v. 3.7%, p < 0.001). With palpable UDTs, although both groups used open approaches, pediatric urologists preferred a scrotal approach (56.9%), and pediatric surgeons approached most testes inguinally (98.8%). With nonpalpable UDTs, laparoscopic approaches were preferred by both groups; however, pediatric urologists used a 2-stage Fowler–Stephens approach more often than pediatric surgeons (48.4% v. 15.8%, p < 0.001). There was wide variation in the management of primary UDT between pediatric urologists and pediatric surgeons before the publication of guidelines. The most prominent difference between the 2 groups was in the ordering of preoperative ultrasonography. Future assessment of change in practice patterns may elucidate whether guidelines are an effective tool for standardization of practice.

Barriers to implementation of guidelines for the diagnosis and management of undescended testis.

Cryptorchidism or undescended testis (UDT) is one of the most common genital disorders identified at birth. The gold standard for treatment in the US is to surgically bring the UDT into the scrotal sac. In 2014, the American Urologic Association (AUA) presented a guideline for evaluation and treatment of cryptorchidism. We reviewed some of the most recent domestic and international studies examining the results of implementing the AUA and similar guidelines for the diagnosis and management of UDT. In addition, we reviewed some of the more common barriers to the implementation of the AUA guidelines and offered recommendations on how to increase the rate of early detection of UDT, thereby increasing the rate of surgical correction at the appropriate age.

Management of Undescended Testis in Children in Aba Nigeria

Introduction: The anomalies of descent of the testes are common problem in newborn male infants. An absence of the testis in the scrotal sac is defined as cryptorchidism. Ectopic testis occurs when it migrates from its usual path of descent to lie in an unusual location. it affects 2–5% of the infants at birth and 1–2% of them at 3 months of age, the incidence is even higher in preterm infants, reported at 30%. Methodology: This was a prospective cross-sectional study of all male children above 3 months of age with undescended testes who were managed by the Paediatric Surgery Unit of the Abia State University Teaching Hospital Aba from January 2016 to December 2018. Results: Thirty children aged ≤ 15 years with 40 undescended testes managed in 3 years The age at surgery was fourteen months to 15 years (median six years); five (17%) had correction before two years, 10 (33%) before five years and 15 (50%) at age ≥ 5 years. Thirty (75%) testes were palpable and ten (25%) non-palpable. Evaluation was mainly clinical. Ultrasonography was performed for six non-palpable testes but was not helpful. Laparoscopy was not used in any patient. The condition was unilateral in twenty (67%) and bilateral in ten (33%). Forty per cent of the testes were in the inguinal canal, 25% at the external ring, and 15% each at the internal ring and abdomen respectively. Six (20%) testes were macroscopically atrophic (canalicular three, abdominal two, internal ring one). Orchidopexy was performed for 34 undescended testes and orchidectomy forsix testes. Groin and scrotal haematoma developed following one orchidopexy. Following orchidopexy, two (6%) testes retracted necessitating repeat surgery. Conclusion: There is a need to educate parents, traditional birth attendants, midwives and doctors in our sub-region to ensure earlier presentation and treatment.

Undescended testes: What general practitioners need to know

Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. Management in a timely fashion may reduce the risk of malignancy and infertility The aim of this article is to summarise the key points of assessment and management of UDT in the primary care setting. By reviewing key definitions, such as undescended, retractile, ectopic and ascending testes, we aim to provide updated information for the ongoing management of these conditions. The exact pathophysiology of UDT is still an area of ongoing research, and there remains much controversy regarding the exact mechanisms leading to congenital and acquired UDT. Current evidence does not support the use of ultrasonography prior to referral. Hormone therapy has shown no significant benefit, and surgery remains the treatment of choice.

Management of undescended testes (our experience in 60 cases)

Management of undescended testes (our experience in 60 cases)

Management of undescended testis may be improved with educational updates and new transferring model

BackgroundTo investigate whether management of undescended testis (UDT) may be improved with educational updates and new transferring model among referring providers (RPs).MethodsThe age of orchidopexies performed in Children’s Hospital of Chongqing Medical University were reviewed. We then proposed educational updates and new transferring model among RPs. The age of orchidopexies performed after our intervention were collected. Data were represented graphically and statistical analysis Chi-square for trend were used.ResultsA total of 1543 orchidopexies were performed. The median age of orchidopexy did not matched the target age of 6–12 months in any subsequent year. Survey of the RPs showed that 48.85% of their recommended age was below 12 months. However, only 25.50% of them would directly make a surgical referral to pediatric surgery specifically at this point. After we proposed educational updates, tracking the age of orchidopexy revealed a statistically significant trend downward.ConclusionsThe management of undescended testis may be improved with educational updates and new transferring model among primary healthcare practitioners.

Disorders of sex development: timing of diagnosis and management in a single large tertiary center.

BackgroundWe describe the phenotypic spectrum and timing of diagnosis and management in a large series of patients with disorders of sexual development (DSD) treated in a single pediatric tertiary center.MethodsDSD patients who had visited our tertiary center during the survey period (between 2004 and 2014) were identified based on an ICD-10 inquiry, and their phenotypic and molecular genetic findings were recorded from patient charts.ResultsAmong the 550 DSD patients, 53.3% had 46,XY DSD; 37.1% had sex chromosome DSD and 9.6% had 46,XX DSD. The most common diagnoses were Turner syndrome (19.8%, diagnosed at the mean age of 4.7 ± 5.5 years), Klinefelter syndrome (14.5%, 6.8 ± 6.2 years) and bilateral cryptorchidism (23.1%). Very few patients with 46,XY DSD (7%) or 46,XX DSD (21%) had molecular genetic diagnosis. The yearly rate of DSD diagnoses remained stable over the survey period. After the release of the Nordic consensus on the management of undescended testes, the age at surgery for bilateral cryptorchidism declined significantly (P < 0.001).ConclusionsOur results show that (i) Turner syndrome and Klinefelter syndrome, the most frequent single DSD diagnoses, are still diagnosed relatively late; (ii) a temporal shift was observed in the management of bilateral cryptorchidism, which may favorably influence patients’ adulthood semen quality and (iii) next-generation sequencing methods are not fully employed in the diagnostics of DSD patients.

Presentation and management of undescended testes: a prospective study

Background: Cryptorchidism is one of the most common disorders encountered in pediatric urology. This can lead to infertility, higher risk of testicular trauma, testicular malignancy, torsion testis, and strangulation of associated inguinal hernia. Hence a study was conducted to evaluate the presentation, complications, and the management of undescended testis.Methods: Patients presented with undescended testis to the General Surgery Department in a tertiary center from November 2012 to May 2014 were included in the study.Results: A total of 40 patients studied during the study period. Thirty-four (85%) testes were palpable. Twenty-four (60%) testes were intracanalicular in position. Thirty-eight (95%) patients underwent orchidopexy and two (5%) underwent ochidectomy (one gangrenous torsion testis and one nubbin). Three (8%) patients developed hematoma; one had superficial surgical site infection. No patient developed testicular atrophy, and no one developed ascending testis.Conclusions:Cryptorchidism is one of the most common disorders of pediatric age. Early diagnosis and treatment is of paramount importance. Correction of cryptorchidism is indicated to optimize testicular function, potentially reduce and/or facilitate diagnosis of testicular malignancy, provide cosmetic benefits, and prevent complications such as a clinical hernia or torsion.  

Clinical Study and Role of Diagnostic Laparoscopy in the Management of Undescended Testis: Our Experience

Clinical Study and Role of Diagnostic Laparoscopy in the Management of Undescended Testis: Our Experience

Current Trends and Guidelines in Surgical Management of Undescended Testis

Current Trends and Guidelines in Surgical Management of Undescended Testis

Management of undescended testes: a retrospective study from a tertiary hospital in Ethiopia

Background: Undescended testis is one of the commonest congenital malformations seen in boys. The aim of this study is to evaluate the pattern of presentation, approach to diagnosis, treatment and follow up in Tikur Anbesa Specialized Hospital, a tertiary teaching hospital in Ethiopia.Methods: This is a retrospective cross sectional study of all boys with undescended testis operated in Tikur Anbesa Specialized Hospital between September 2012 and August 2014.Results: Of 82 boys operated within the study period, 66 boys with 78 undescended testes are studied. Twenty-six percent (17/66)came before the age of 2 years, while the majority of the study group, 50% (33/66), presented beyond 5 years of age. Of the 17 boys brought to the hospital before 2 years, only 41% (7/17) them were treated before the age of two years. The majority 89% (59/66) of the boys were treated after 2 years of age. Seventy-one testes of 78 [91%] were in the inguinal canal, 5 were intra-abdominal and 2 were absent. 46% (36/78) were on the left side, 29% (23/78) on the right side and the rest were bilateral. Among the 54 boys who had ultrasound examination, the ultrasound report is consistent with operative findings in 33 [61%]. Associated congenital malformations were found in 31.8% (21/66) of the boys. Hypospadia was the predominant malformation comprising 38% (8/21) of the total congenital malformations. Orchidopexy was done for 82% (64/78) of the total testes, orchiectomy was done for 9% (7/78) and biopsy was taken in 1 case. Among the total operated boys only 62% (41/66) were followed in our clinic; of those who had follow up 10% (4/41) testes atrophied and 1 [2%] testis retracted.Conclusion: Boys with undescended testes present and are treated late in Tikur Anbesa Hospital. As opposed to the literatures most of the undescended testes were found on the left side. Ultrasound examination cannot be the only mode of examination for undescended testes as it misses more than one third of the cases. Hypospadia is the commonest associated congenital malformation. Post operative follow up is very poor after treatment for undescended testes