Undescended Testes In Children Research Articles

Diagnostic value of high-resolution ultrasound in localization and status of non-palpable undescended testis in children

Diagnostic value of high-resolution ultrasound in localization and status of non-palpable undescended testis in children

CONSIDERATIONS ON EMBRYOLOGY, ANATOMY AND CLASSIFICATION OF INGUINAL HERNIAS IN CHILDREN

Appropriate surgical treatment of inguinal hernia in children requires an extensive review of the embryological developmental and anatomical aspects of the inguinal canal and hernial sac. The given paper represents a broad survey of data from the literature, predominantly from recent years, and incorporates information on the knowledge of anatomy, embryology and classification of inguinal hernias, which have direct clinical implication in surgery for hernia, hydrocele and undescended testis in children.

Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study

PurposeTo evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children.MethodsWe prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus.ResultsNo differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen.ConclusionSingle-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.

Undescended testes in children

Undescended testes in children

The undescended testis in children and adolescents part 2: evaluation and therapeutic approach.

Undescended testis (UDT) is defined as failure of a testis to descend into the scrotum and it is a common reason for consultation in pediatric urology. As extensively discussed in "The undescended testis in children and adolescents: part 1", the failure of a testis to descend alters testicular germ-cells development, increasing the risk of infertility and testicular cancer in adulthood. Here, we present the second part of our review and analysis of this topic with the aim to propose an updated and well-informed approach to UDT together with a treatment flow chart that may be useful to guide pediatric surgeons and urologists in the care of these patients. The main goal of the management of patients with UDT is to diminish the risk of infertility and tumor development and is based on the clinical findings at the time of diagnosis.

The undescended testis in children and adolescents. Part 1: pathophysiology, classification, and fertility- and cancer-related controversies.

Undescended testis (UDT) is defined as failure of a testis to descend into the scrotum. It is one of the most common reasons for consultation in pediatric surgery and urology with an incidence of 3% in live-born male infants. Decades ago, classical studies established that the failure of a testis to descend alters the development of its germ cells increasing the risk of infertility and testicular cancer in adulthood. More recent publications have rebutted some of the myths and raised controversies regarding the management of these patients, which, far from being limited to surgical treatment, should include pathophysiological and prognostic aspects for a comprehensive approach to the condition. Therefore, here we present an updated review divided into two parts: the first assessing the pathophysiological aspects and risks of these patients focused on fertility and cancer, and the second addressing the different treatment options for UDT.

Comparison of Single-Incision Scrotal Orchiopexy and Traditional Two-Incision Inguinal Orchiopexy for Primary Palpable Undescended Testis in Children: A Systematic Review and Meta-Analysis

PurposeTo compare the safety, efficacy, and cosmetic results of single-incision scrotal orchiopexy (SISO) and traditional two-incision inguinal orchiopexy (TTIO) for primary palpable undescended testes (PUDTs) in children.Materials and MethodsA systematic literature search of all relevant studies published on PubMed, Embase, Medline, Cochrane Library, Web of Science database, and Wanfang data until July 2021 was conducted. The operative time, hospitalization duration, conversion rate, wound infection or dehiscence, scrotal hematoma or swelling, testicular atrophy, reascent, hernia or hydrocele, analgesics needs, and cosmetic results were compared between SISO and TTIO using the Mantel–Haenszel or inverse-variance method.ResultsA total of 17 studies involving 2,627 children (1,362 SISOs and 1,265 TTIOs) were included in the final analysis. The conversion rate of SISO was 3.6%. The SISO approach had a statistically significant shorter operative time than the TTIO approach for PUDT (weighted mean difference−11.96, 95% confidence interval −14.33 to −9.59, I2 = 79%, P < 0.00001) and a shorter hospital stay (weighted mean difference−1.05, 95% confidence interval −2.07 to −0.03, P = 0.04). SISO needed fewer analgesics and had better cosmetic results than TTIO. SISO had a similar total, short-term, or long-term complication rate with TTIO.ConclusionCompared with TTIO, SISO has the advantages of shorter operative time, shorter hospitalization duration, less postoperative pain, and better cosmetic appealing results. SISO is a safe, effective, promising, and potential minimal invasive surgical approach for PUDT. SISO is an alternative to TTIO in selected cryptorchid patients, especially for lower positioned ones.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021268562.

Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review

PurposeManagement of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. MethodsA comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. ResultsA total of 825 articles were identified in the initial search, and 260 were included in the final review. ConclusionsPre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.

Role of Laparoscopy in Management of Nonpalpable Undescended Testis in Children

Abstract Background Normal testicular descent relies on a complex interplay of numerous factors. Any deviation from the normal process can result in an undescended testis (UDT). UDT is a common abnormality that carries fertility and malignancy implications. Aim of the Work The aim of this study is Evaluation of the role of laparoscopy in diagnosis and management of clinically impalpable testis. Patients and Methods Nineteen male patients were included in this study with twenty two non-palpable testes. All these patients were subjected to diagnostic laparoscopy &amp; the subsequent decision was then based on the laparoscopic finding. There was no age limit for the procedure. The procedure was carried in Ain Shams University teaching hospital and El-mataria teaching hospital. Results The study included nineteen patients with twenty two non-palpable testes. Age at presentation was averaging 18.5 ± 12.5 months. Our study may present convincing evidence that laparoscopy has significant advantage over imaging procedures. Preoperative imaging proved inaccurate in determining testicular position in 10 of the 22 testes (45.5%) this is in agreement with many studies which reported that ultrasonography helped to identify only 45% of non palpable testis. Conclusion This study tried to assess roughly the effectiveness of laparoscopy as a diagnostic tool and treatment of non-palpable undescended testis. This study dealt with a very small number of patients and this issue still needs more researches to study all the benefits and disadvantage and shall need further study on a wide range of patients.

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

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 in Children: Clinicopathological Study of 32 Cases

Objective: To study the presentation, management, histopathological findings and outcome of undescended testes in children. Method: It was a prospective study done in Rajshahi Medical College Hospital and also private clinic in Rajshahi Metropolitan City during the period of 1st December, 2007 to June, 2010. Thirty two children aged 4 months to 13 years with 40 undescended testes were selected in this study. Interventions like Orchidopexy, orchidectomy, herniotomy were done.Results: The age at surgery was four months to 13 years (mean 5.25 + 0.61 SE years). Nine (28.13%) had corrected before two years, twenty three (71.87%) after two years. Twenty four testes (60%) were palpable and sixteen (40%) were non-palpable, none of then cases was diagnosed at birth. Ultrasonography was performed in all cases. Evaluation was done by clinical, sonological, pre-operation and histopathological findings, Laparoscopy was done in one case. The condition was unilateral in 24(75%) and bilateral in Eight (25%). Forty percent of the testes were in the inguinal canal, 34% at the external ring and 10% at the internal ring and 16% in the abdomen. Fifteen (46.87%) testes were macroscopically smaller in size, four (10%) testes were atrophic (all were canalicular), one was tumour. Orchidopexy was performed in for 35 undescended testes and orchidectomy for five. Scrotal haematoma developed in 2 cases. Histopathological finding showed no spermatogonia in 25 (78.12%), among then 23 were above 2 years, 2 were below 2 years. Follow-up period were 6 months to 18 months, no atrophy/retraction was observed.TAJ 2017; 30(2): 26-31

Experience of Using Shear Wave Elastography Imaging in Evaluation of Undescended Testes in Children: Feasibility, Reproducibility, and Clinical Potential.

We aimed to determine the difference in tissue stiffness, which might reflect histologic damage, by comparing the potential of the shear wave elastography (SWE) values of operated undescended testes (OUT) with those of undescended testes (UT) and normal testes. A total of 120 patients (235 testes) were enrolled in the current study. Quantitative SWE values were measured by manually drawing contours of the entire testis structure with a free region of interest. A group of 66 OUT were classified as group A. Operation age and the period passed over the operation time and SWE values were compared among the testes assigned to group A. The 50 testes having inguinal canal placement were classified as group B, and the 119 testes whose sonography findings were normal were classified as group C. These 3 groups were compared in terms of the SWE values and volume. The SWE values of group A were significantly higher than those of groups B and C (P < 0.001). The SWE values of group B were significantly higher than those of group C (P < 0.001). The SWE values of OUT were significantly higher than those of the contralateral normal testes and UT (P < 0.001). There were no significant differences among operation age and period passed over the operation time and SWE values in the OUT (P > 0.05). There was no significant correlation between SWE values and testes' volume (P > 0.05). The SWE technique can be used effectively as a new parameter to assess stiffness of the OUT and UT to predict interstitial fibrosis and the severity of histologic damage.

Nonligation and ligation of hernial sac technique during orchiopexy for palpable undescended testis in children: A comparative study

Purpose: We prospectively evaluated the surgical outcomes of non ligation of hernial sac technique in children with a palpable undescended testis compared with the traditional hernial sac ligation technique during orchiopexy.&#x0D; Material and Methods: A total of 34 orchiopexies (30 children with age ranged from 6 months to 5 years) were included and randomly assigned to the non ligation of hernial sac technique orchiopexy group (Group-A, 15 children, 16 testes) and the traditional hernial sac ligation orchiopexy group (Group-B, 15 children, 18 testes). Operation time and surgical complications were compared between the two groups. Complications, testicular location and development of inguinal hernia were assessed at the follow-up evaluation for 6 months postoperatively.&#x0D; Results: The operation time was significantly shorter in Group-A (34.13±10.3 minutes) than Group-B (73.73±28.97 minutes) (&lt;p001). Postoperative complications were found in two cases (wound infection and testicular re-ascent) in Group-B. Wound infection was managed by conservative care and redo surgery was done for testicular re-ascent after 6 months of operation. None of the patients developed post operative inguinal hernia.&#x0D; Conclusion: We conclude that non ligation of hernial sac technique is a simple procedure that is associated with a shorter operation time than the conventional hernial sac ligation technique during open orchiopexy for palpable undescended testis.&#x0D; Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (2): 35-40

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.

Acquired undescended testis and possibly associated testicular torsion in children with cerebral palsy or neuromuscular disease

Torsion of an undescended testis (UDT) associated with cerebral palsy (CP) and neuromuscular disease (NMD) is an uncommon condition that is not well recognized by primary care physicians or healthcare providers. The objective of this study was to highlight the clinical importance of torsion of a UDT in children with CP and NMD. Eleven children with testicular torsion of a UDT operated on at the study institute between 1991 and 2015 were identified. The records of seven children (63.6%) associated with CP or NMD were retrospectively reviewed. Clinical findings of testicular torsion were assessed along with the treatment outcome and testicular salvageability. All seven children were not identified with a UDT by public health checkup for infant and young children. No children with CP or NMD had torsion of a descended testis during the present study period. Median age at surgery was 15 years (range, 1-20 years). The testis location was at the external inguinal ring in five patients, in the inguinal canal in one, and in the superficial inguinal pouch in one. Of the contralateral testes, four were a UDT, one was a retractile testis, and two were descended testes. Orchiectomy was performed in six patients (85.7%). In the remaining patients, the testis was preserved but became atrophic. This study demonstrated that children with CP or NMD may be affected with torsion of a UDT with peak at around puberty with the poor salvage rate, even if the testes appear descended in infancy and young children. Shortcomings of this study were the retrospective design and a small series of children undergoing surgery for torsion of a UDT. Pediatric urologists need to educate primary care physicians and healthcare providers in the recognition of acquired UDTs and possibly associated testicular torsion in children with CP and NMD. Genital examination should be continued regularly until adolescence in these children to detect acquired UDT. These children should be referred to pediatric urologists to promote surgery as soon as the diagnosis of acquired UDT is carried out. It is believed that it is perhaps the best approach to prevent loss of the testis in children with CP and NMD.

High (trans) scrotal orchidopexy for palpable undescended testes in children: Influence of age and testicular position

ObjectivesTo assess the influence of increasing age of subjects and testicular position on the outcome of single incision orchidopexy. Subjects and methodsA prospective randomized study of children aged≤15years with palpable undescended testes. The study was conducted between July 2015 and December 2016 in a Nigerian tertiary hospital. Patients were randomized into two groups: single incision orchidopexy and conventional orchidopexy group by simple balloting. The parameters studied were the patients’ bio-data, most caudal position of the testes, duration of surgery, wound complications such as wound infection, scrotal edema and haematoma. Others included testicular position at 6 months post-operatively, testicular hypotrophy and cosmetic appearance of scar. A p-value <0.05 was deemed significant. ResultsThere were 52 patients with 59 testes. Their ages ranged from 1year to 13years with a mean of 6.5±3.5years. The age groups and testicular positions were well matched, p>0.05. There was no conversion from high scrotal to conventional orchidopexy irrespective of the age and testicular position during surgery. The operative time was shorter in the high scrotal group compared to conventional group, p<0.05. The rate of testicular reascent between both groups did not attain statistical significance, p>0.05. Within the high scrotal group, increasing age and testicular location had no influence on the operative time, p>0.05. There was no statistical significant difference in the rate of testicular retraction between the young and relatively older children among the high scrotal group, p>0.05. All wounds healed without wound infection, scrotal edema and haematoma. ConclusionIncreasing age of patients and location of testes had no effect on the outcome of high scrotal orchidopexy in terms of successful placement of testes in the scrotum and rate of testicular retraction when compared to the conventional orchidopexy. However, the operative time was shorter and the cosmetic appearance of scar was better in the high scrotal group compared to the conventional orchidopexy.

Short Term Outcom e of Orchiopexy for Undescended Testis in Children

This prospective study was conducted in the department of pediatric surgery, BIRDEM General Hospital and other Private Hospital in Dhakato evaluate the morphological parameters after orchiopexy in Undescended testis (UDT). Fifty five children of cryptorchidism in the age group of 6 months to12 years were included in the study from September 2012 to March 2017. Patients' clinical characteristics, age at the time of orchiopexy, pre-operative ultrasonogram finding and intraoperative findings were recorded. On follow up postoperative complications and scrotal ultrasonogram findings were also recorded. Total 45 patients received regular ultrasound follow-up in next 6 months. Testicular length, width, position of the testes and any abnormal findings were documented. The testicular volume was then calculated with Hansen formula:Testicular volume= length (L) x width (W)2 x 0.52. The mean age at operation was 4.15 years. Sixty eightpercent of undescended testes were palpable, 97% of which could be initially placed in the scrotal position by surgery. Ninety threepercent remained in the scrotum at 6-month follow up. In 32% of cases, the testes were impalpable, 47% were intra-abdominal and 15.7% were absent. Eighty seven percent of all impalpable testes could be placed in the scrotum. At 6 months follow up, only 69% were in the scrotal position. Eighteen percent of impalpable testes and 2.4% of palpable testes underwent atrophy. The volume of scrotalized testis increased significantly after orchiopexy though the volume of undescended testis was smaller than that of normal descended testis in all age subgroups and revealed a slow growing trend.Medicine Today 2017 Vol.29(1): 35-38

Age at surgical referral and anatomical position of undescended testis in children presenting to the day surgical unit at Lady Ridgeway Hospital for Children, Colombo

Undescended testis (UDT) carries an increased risk of malignant transformation and sub fertility in adulthood compared to a naturally descended testis. Higher risk of malignant transformation is observed in high anatomical locations of UDT. Timely orchidopexy around six months is recommended by the British association of Paediatric Urologists. However, this is not practised widely. The objectives were to study the anatomical locations of UDT and to determine the age of child at surgical referral for orchidopexy, intending to utilise this data to motivate clinicians to refer for timely orchidopexy. Data was collected from hospital records of 200 consecutive children managed in a paediatric surgical unit. There were 217 UDT in 200 children as 17 were bilateral. Only 27% (54/200) children were referred for orchidopexy before six months of age. 9.7% (21/217) UDT were located intra- abdominally. Drafting of a national policy on timely orchidopexy is necessary. The data on anatomical positions of UDT in children would be useful to future researches with interests on malignant risk and sub fertility associated with UDT.