Treatment Of Undescended Testes Research Articles

Day Surgery in Paediatric Urology in Private Practice for Paediatric Surgery: Treatment of Undescended Testis in Our Private Practice for Paediatric Surgery

This article describes the reality of paediatric urology treatment in a private practice for paediatric surgery based on the example of undescended testis. It stresses the importance of a paediatric setting as well as treatment according to the guidelines for diagnostic evaluation, treatment and follow-up. German paediatric surgeons in private practise are mostly organised in the BNKD e.V. ("Berufsverband der niedergelassenen Kinderchirurgen Deutschlands", Professional Association of Private-Practice Paediatric Surgeons in Germany) and they have long-standing experience in the treatment of undescended testis. Reactions to guideline developments and changes in therapy have become evident in the statistical data of the BNKD, which shows that the age of children at the time of day surgery for undescended testis has decreased in keeping with the guideline. Further improvement is necessary in this regard. High-quality day-surgical treatment in paediatric urology cases depends on the quality and expertise of the treating teams and treatment continuity in the paediatric setting. Private practices of paediatric surgery in Germany can contribute greatly to the treatment of undescended testis.

Trends in the treatment of undescended testes: a pediatric tertiary care center experience from Croatia

ObjectiveUndescended testes (UDT) is the most common anomaly of the male genitourinary tract. The guidelines suggest that orchidopexy in congenitally UDT should be performed between 6 months and 18 months...

Open controversies on the treatment of undescended testis: An update.

Cryptorchidism is a common congenital malformation in pediatric urology. Although there have been many studies on the etiology of the disease, it has not been fully clarified, and while its diagnostic and treatment models have gradually approached standardization and systematization, some controversies regarding treatment remain. Additionally, although ultrasound is a non-invasive examination without ionizing radiation, its role in the evaluation of cryptorchidism remains controversial. The main basis for treating cryptorchidism is orchidopexy, and the main view on treatment age is that treatment should be performed between 6 and 12 months after birth, but no more than 18 months after birth. The view on hormone therapy is still controversial because most scholars believe that early surgery is the key to treatment. There are many surgical treatment methods for cryptorchidism, including traditional open surgery and laparoscopic surgery, which provide satisfactory results. In conclusion, the treatment of undescended testis (UDT) had been largely standardized, apart from the treatment of high intra-abdominal testis (IAT), which remains a matter of debate.

Evaluation of Undescended Testes in Newborns: It Is Really Simple, Just Not Easy

Introduction: The evaluation of the testicular position in newborns is important to ensure timely initiation of therapy. The aim of our study was to assess the reliability of a routinely performed screening examination. Patients and Methods: Newborns were examined by a pediatrician between 48 and 72 h after birth. Boys with suspected cryptorchidism were double-checked by a pediatric urologist within 24 h. Results: 1,181/2,353 children included in the study between June 2015 and December 2017 were male. Eight hundred sixty-one boys could be included in this analysis; 5.8% (n = 50) were diagnosed with undescended testis (UDT) by the pediatrician. 30/50 boys were double-checked at the Department of Pediatric Urology. Forty percent (20/50) were lost to follow-up. In 43% (13/30), the diagnosis could be confirmed. Three former studies had shown a relevant discrepancy in the results of the diagnosis of UDT made by health care providers and urologists/pediatric surgeons. To our knowledge, this is the first study evaluating the testicular position in male newborns in such a large prospective birth cohort study by physicians with ranging expertise within 1 day. Conclusion: Further treatment for UDT is based on clinical examination. Ours and previous studies can clearly show the various findings in boys suspected having UDT. Therefore, it is essential that the diagnosis is confirmed by a specialist before a therapy is initiated.

Hormonal treatment of undescended testes

Undescended testes are a very common congenital problem of the urogenital tract. Altered spermatogenesis and fertility as well as an elevated risk for oncologic degeneration are known facts associated with testicular malposition. There is broad international consensus among the various disciplines that the treatment of undescended testes should be completed by the age of 12 months. Following the guideline of the German Working Group of Scientific Medical Societies (AWMF), hormonal treatment should be offered to patients with bilateral undescended testicles. This article reviews the literature and disputes the reasoning of the recommendation to treat undescended testes hormonally.

Oxidative DNA Damage and NOX4 Levels in Children with Undescended Testes.

Undescended testis (UDT) is a common urological disorder. Patients with UDT have a risk of malignancy and infertility. The development of these conditions may be due to oxidative stress mediated by reactive oxygen species. The aim of this study was to investigate the relationship between these parameters by detecting oxidative DNA damage (8-hydroxy 2 deoxyguanosine/106 deoxyguanosine), ischemia-modified albumin (IMA), malondialdehyde (MDA), and nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) levels in children with UDT and healthy control group. The blood samples were obtained from 30 patients with UDT and 40 healthy male subjects. The levels of oxidative DNA damage were detected by high-pressure liquid chromatography method. We used commercially available kits that use enzyme-linked immunosorbent assay method to measure IMA, MDA, and NOX4 levels. The levels of MDA, IMA, NOX4, and oxidative DNA damage in children with UDT were statistically significantly higher than control group. In addition, we found that the levels of NOX4, IMA, and oxidative DNA damage after 12 months of age was significantly higher than before 12 months of age. We identified increased lipid peroxidation, oxidative DNA damage, IMA, and NOX4 levels in children with UDT. Delay in the treatment of UDT may cause oxidative damage. That is why, according to us the antioxidant treatment may be beneficial in children with UDT.

Role of laparoscopic in diagnosis and treatment of undescended testis in children at Viet Duc Hospital

Abstract Introduction: Evaluating the role of laparoscopic for diagnosis and treatment of undescended testis in children. Material and Methods: Restrospective study, between 6/ 2014 and 6/2017. All the patients are aged from 1 to 16 years with undescended testis underwent laparoscopic surgery for diagnosis and treatment in Deparment of pediatric surgery – Viet Duc hospital enrolled. Results: Of 95 patiens in total had 106 undescended testis diagnosed and treated by laparoscopy. The mean age of patients was 7,5 ± 3,8 years. 44,2% undescended were on the left side, 44,2% were on the right and 11,6% were undescended bilateral. The correct diagnosis by ultrasound accounted in 79,4%. The locations of testis diagnosed by laparoscopic are : intra abdomen in 45,3%, deep inguinal orifice in 16,9%, extra inguinal orifice in 26,4%, no testicle found in 11,4%. The mean time of operation were 67,33± 28,01 pht. Scrotal positions were achieved 74,5%, remove atrophic testis accounted in 7,6%. Stephen- Flowler technique including step I were in 4,7%, step II in 1,9%. The outcome evaluated by testicular positions following 3 months after operation are : good in 79,2%, moderate 13,2%, poor in 7,6%; By classification of Aubert are : good in 81,1%, moderate in 11,3% and poor in 7,6 %. Conclusion: Laparoscopic surgery is not only a highly sensitive diagnostic method to find accurately the location and size of the testes, but also the most effective method to treat impalpable undescended testes.

Undescended Testes: Contemporary Factors Accounting for Late Presentation

IntroductionEarly detection and treatment of undescended testes by orchiopexy by 6–12 months of age is important to minimize germ cell loss and improve the individuals’ fertility index. Decades since after the adverse relationship between the delayed treatment and infertility was established, we are still having young boys presenting very late with undescended testes. ObjectiveTo understand the current reasons behind the increasing rate of late presentation of boys with undescended testes. Patients and methodsClinical records of patients managed for undescended testis from January 2011 to December 2016 were reviewed. In addition, where the needed information was not recorded in the case files, telephone interviews and/or invitation for a clinical examination were employed when necessary to obtain complete data. ResultsThere were 39 patients with 50 undescended testes (16 left, 12 right and 11 bilateral). The age range at presentation to the hospital was from 1day to 11 years. Undescended testes were noticed in 27 (69%) children at the age one year or less. Of this number, 19 (70%) sought medical attention at any hospital within one year of age of the child, 11(41%) were presented to our unit for treatment within the child’s first birthday, and 7 (26%) had surgical treatment within 2 years of age. Age at surgery ranges from 16days to 11 years.The delay in presentation progressively declined as the parental academic level increases.Only 7 (18.0%) and 2 (5.1%) children were examined by a doctor after birth and at 6 weeks post natal visits, respectively. A majority of the empty scrotum was first noticed by the parents/grand mother in 25(64%) children as against 12 (31%) by health workers.Causes of late presentation include: parental ignorance of the abnormal position of the testes, 14 (35.9%); wrong information by clinicians at the hospital of first visit, 9 (23.1%) and erroneous belief that the testes will still descend, 8 (20.5%).At surgery, more testes in those aged 2 years and above were of low volume when compared with those aged less than 2 years. ConclusionMajority of children with undescended testes are still being presented late for surgical correction, with its attendant adverse consequences on fertility. Non examination of the newborn by clinicians, inadequate parental health education and delayed or neglected referral are the major responsible factors.

Comments to Recent Guidelines on Undescended Testis.

During the past couple of decades, our understanding of the treatment of undescended testis (UDT) has hugely expanded and it is still dynamically changing: new diagnostic tools are available, and experimental procedures are becoming a real-life treatment options. Our community needs to continuously update our guidelines. It is also our responsibility to build up, not a uniform, but a patient-oriented guideline which can provide information for both primary care providers and pediatric surgeons. Here, in Europe, we endeavor to change the different national guidelines to one common European pediatric surgical guideline in the treatment of UDT.

For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed.

ObjectiveData on the prevalence of patent processus vaginalis (PPV) and hernia in patients with cryptorchidism are controversial. While some pediatric surgeons do not dissect the processus vaginalis (PV), most prefer to do so to prevent hernia formation and to achieve an effective orchiopexy outcome. This study was performed to evaluate the importance of dissection and high ligation of the PV during treatment of undescended testis (UT).MethodsThe clinical findings and surgical procedures of 55 patients with UT were retrospectively investigated.ResultsThe mean patient age was 2.5 (range 1.0–12.0) years. Non-palpable testis (NPT) was located on the right and left side in 39 and 16 patients, respectively. Ultrasonography revealed no testis in 10 patients and an atrophic testis in 7 patients. Seven patients had a parent with an inguinal hernia, and the silk sign or a PPV was detected during inguinoscrotal examination in 22 patients. Undescended testis repair was performed by an inguinal approach in all patients. The inguinal canal was opened in all patients; 42 patients had a wider-than-normal internal ring (>2.5 cm), and the posterior wall of the inguinal canal was consequently weakened. Two-stage orchiopexy was performed in 2 patients, and 15 underwent the Prentiss maneuver. In the remaining patients, the dissection was easily done, and the orchiopexy was performed without any difficulty. Scrotal edema and wound infection occurred in five and two patients, respectively. One patient presented with an atrophic testis, and three had recurrent UT. Inguinal hernia was not observed in any of the patients during the study period, and all procedures were performed on an outpatient basis.ConclusionHigh ligation of the PV is an effective method for successful orchiopexy and prevention of inguinal hernia in patients with NPT and UT.

Putting the pieces together: cryptorchidism - do we know everything?

Cryptorchidism is one of the most common birth defects in male children, and it has a potential impact on future health. It is the best-characterized risk factor for reduced fertility and testicular cancer. However, the etiology of cryptorchidism remains largely unknown. In the literature, we find different opinions and theories on this topic. Probably, the etiology is multifactorial, and hormonal, genetic and environmental factors may regulate testicular development and descent from intra-abdominal location into the bottom of the scrotum. The descent of the testis is a complex, two-stage process. A critical role in testicular descent has been attributed to androgens, insulin-like hormone 3 (insl3) and anti-Müllerian hormone. It is believed that interaction between Leydig and Sertoli cells may cause impaired spermatogenesis. Based on recent knowledge of germ cell development, it is believed that the best treatment for undescended testis is orchiopexy between 6th and 12th month of life. Long follow-up studies are needed to focus on the effect of this recommendation.

Embryonal Carcinoma in Cryptorchid Abdominal Testis of an Infant.

Cryptorchidism is a known predisposing factor for the development of testicular tumors in adults. Age of patient at the time of treatment of undescended testes has some bearing on the risk of neoplasia. Testicular neoplasia at the time of primary surgery for cryptorchidism has been reported rarely in prepubertal period. We report a case where embryonal carcinoma was detected in a cryptorchid testis of an infant.

High Undescended Testis Treatment with Distal Espermatic Vessel Ligation (Koff-Sethi Technique)

Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni- or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

Open Surgical Treatment of Undescended Testis

Open Surgical Treatment of Undescended Testis

Accuracy of Cryptorchidism Diagnoses and Corrective Surgical Treatment Registration in the Danish National Patient Registry

In recent years several Danish studies of the etiology, time trends and long-term health consequences of cryptorchidism have relied on diagnoses and surgical treatments registered in the National Patient Registry. We evaluated the diagnostic accuracy of these registry data. According to the Danish National Patient Registry, 16,168 males were diagnosed with cryptorchidism and 9,244 surgical treatments for cryptorchidism were performed between January 1, 1995 and October 10, 2009. We randomly selected 500 diagnosed cases, of which 284 had been managed surgically. We requested the medical records from the departments making the diagnoses and performing the surgery. We successfully retrieved medical records for 452 diagnosed cases (90%) and 249 operations (88%). Overall positive predictive value of a registry diagnosis of cryptorchidism was 80% (95% CI 77-84) using the testicular position described by the physician performing the clinical examination as the gold standard. Similarly the positive predictive value of the surgical treatment registration was 99% (95% CI 98-100) using the type of procedure performed. The data on cryptorchidism in the Danish National Patient Registry are quite accurate. In etiological research the limited misclassification will in most cases only slightly attenuate estimates of the true relative association. Thus, the registry has the potential to serve as a valuable research tool, although caution should be exercised when studying time trends or geographical differences.

Management of cryptorchidism: a survey of clinical practice in Italy.

BackgroundAn evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.MethodsOurs is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.ResultsOverall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.ConclusionsOur study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.

The role of cremaster muscle in testicular descent in humans and animal models

Testicular descent is a complex developmental process involving anatomical and hormonal regulation. The gubernaculum undergoes a "swelling reaction" during the transabdominal phase and is mainly under the control of Insulin-Like Peptide 3 (INSL-3) and Mullerian Inhibitory Substance/Anti-Mullerian Hormone (MIS/AMH). The second phase of testicular descent is regulated by androgens and calcitonin gene-related peptide (CGRP) release from the sensory nucleus of the genitofemoral nerve (GFN). In rodents, the active proliferation of the gubernacular tip and cremaster muscle, its rhythmic contraction, as well as the chemotactic gradient provided by the CGRP result in eventual migration of the testis into the scrotum. This review illustrates the structural aspects and hormonal control of cremaster muscle development to better understand the mechanism of testicular descent in normal rodents and humans, compared to diseased rodent models. The analysis showed the cremaster muscle is formed from mesenchymal differentiation of the gubernacular tip and is not a direct passive extension of internal oblique muscle. Cremaster muscle matures slower than other body muscles, and the persistence of immature myogenic proteins seen in cardiac muscle allows rhythmic contraction to guide the testis into the scrotum. Finally, remodelling of the cremaster muscle enables gubernacular eversion. Further understanding of the molecular regulators governing the structural and hormonal changes in the cremaster muscle may lead to new advances in the treatment of undescended testes.

Impact of Anatomical and Socioeconomic Factors on Timing of Urological Consultation for Boys With Cryptorchidism

Cryptorchidism is a common finding in infants and young boys. Early repair lessens the extent of testicular injury. We hypothesized that anatomical and socioeconomic factors affect the timing of consultation and treatment for boys with cryptorchidism. Under an institutional review board approved protocol we reviewed the records at a single institution of children who underwent exploration for unilateral or bilateral cryptorchidism. Demographic and anatomical factors were recorded. The median age of 677 boys at consultation and surgery was 20.3 and 28.9 months, respectively. Median age at consultation for boys with nonpalpable and palpable testicles was 12.3 and 20.9 months, respectively (p = 0.03). Boys with a concomitant penile anomaly had a younger median age at consultation than boys without a penile anomaly (8.5 vs 20.3 months, p <0.01). Demographic factors did not vary with respect to time to consultation and surgery (p >0.05). Multivariate analysis showed that abdominal site and concomitant penile anomaly were associated with earlier time to consultation (p = 0.02 and <0.01, respectively). The timing of consultation for boys with undescended testicles does not vary in regard to race, language or insurance type at this tertiary care institution. Instead, anatomical factors influenced age at consultation for boys with cryptorchidism. This suggests that in some geographic regions access to care is not restricted for minorities or noncommercially insured children.

Patterns of referral and treatment of undescended testis: a 12-year experience in a single centre

It is now recommended that orchidopexy be performed by 18months. To examine trends in the referral pattern and treatment of cryptorchidism in the south of Ireland. Secondly, to see how well EAU guidelines on orchidopexy management are being implemented in current practice. A total of 145 orchidopexies performed over two periods, 1997-1998 (n=31) and 2007-2008 (n=114), were reviewed. There was a decrease in the mean age at referral, review in OPD and orchidopexy from 5.88, 6.26, and 6.98years, respectively, in the first period, to 2.74, 3.45 and 4.1years between 2007 and 2008. The proportion of boys having surgery before the age of 18months was minimal and showed no improvement over time. Although there was a reduction in the age at orchidopexy, only a marginal number of boys underwent the surgery by 18months of life.

Hodenhochstand

Undescended testis (UDT) is the most frequent congenital malformation affecting 1% of 1-year-old mature birth boys. If untreated UDT leads to progressive histological changes with impaired spermatogenesis and an increasing risk of testicular cancer. For clinical reasons palpable testes should be differentiated from impalpable testes. Spontaneous testicular descent can be expected only before 6 months of age. Subsequently, treatment should start without delay and be finished before the child has reached the age of 1 year. Surgery is the cornerstone of treatment. Inguinal approaches are standard practice for palpable testes, whereas laparoscopy is used in non-palpable testes. Hormonal treatment is ineffective for inducing testicular descent but facilitates germ cell maturation and an improvement in fertility potential. Only early treatment of UDT reduces germ cell loss, improves fertility and reduces the risk of testicular cancer.