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Pediatric Surgery International

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21.03.2022 | Review Article

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

verfasst von: María Pilar Echeverría Sepúlveda, Francisca Yankovic Barceló, Pedro-Jose López Egaña

Erschienen in: Pediatric Surgery International | Ausgabe 6/2022

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Abstract

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.

Elder JS (2016) Surgical management of the undescended testis: recent advances and controversies. Eur J Pediatr Surg 26(5):418–426PubMedCrossRef

Sepúlveda X, Egaña PL (2016) Current management of non-palpable testes: a literature review and clinical results. Transl Pediatr 5(4):233–239PubMedPubMedCentralCrossRef

Mäkelä JA, Koskenniemi JJ, Virtanen HE et al (2019) Testis development. Endocr Rev 40(4):857–905PubMedCrossRef

- Berkowitz GS, Kapiński, Dolin SE, et al. Prevalence and natural history of Cryptorchidism. Pediatrics 1993; 92:44–49

Vikraman J, Hutson JM, Li R, Thorup J (2016) The undescended testis: clinical management and scientific advances. Semin Pediatr Surg 25(4):241–248PubMedCrossRef

Van der Plas EM, Zijip GW, Frieling FM et al (2013) Long-term testicular volume after orchidopexy at diagnosis of acquired undescended testis. J Urol 190(1):257–262PubMedCrossRef

Clarnette TD, Rowe D, Hasthorpe S, Hutson JM (1997) Incomplete disappearance of the processes vaginalis as a cause of ascending testis. J Urol 157(5):1889–1891PubMedCrossRef

Belman A, Rushton H (2001) Is the vanished testis always a scrotal event? BJU Int 87:480–483PubMedCrossRef

Zhang L, Wang X, Zheng X (2015) Reserch article: maternal gestational smoking, diabetes, alcohol drinking, pre-pregnancy obesity and the risk of cryptorchidism: a systematic review and meta-analysis of observational sudies. PloS One 10:e0119006PubMedPubMedCentralCrossRef

10.

Hakonsen LB, Ernst A, Ramlau-Hansen CH (2014) Maternal cigarette smoking during pregnancy and reproductive health in children: a review of epidemiological studies. Asian J Androl 16(1):39–49PubMedCrossRef

11.

Kolon T, Herndon A, Baker L et al (2021) Evaluation and treatment of cryptorchidism: AUA guideline. Pract Guidel 192(2):337–345. https://doi.org/10.1016/j.juro.2014.05.005CrossRef

12.

Hurwitz R, Kaptein J (2001) How well does contralateral testis hypertrophy predict the absence of nonpalpable testis? J Urol 165:588–592PubMedCrossRef

13.

Tasian GE, Copp HL (2011) Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics 127(1):119–128PubMedCrossRef

14.

Tasian GE, Copp HL, Baskin LS (2011) Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatric Surg 46(12):2406–2413CrossRef

15.

Desireddi NV, Liu DB, Maizels M, Rigsby C, Casey JT, Cheng EY (2008) Magnetic resonance arteriography/venography is not accurate to structure management of the impalpable testis. J Urol 180:1805–1808PubMedCrossRef

16.

Radmayr C, Bogaert G, Dogan HS, Nijman JM, Silay MS, Stein R, Tekgül S (2020) European Association of Urology Guidelines on Pediatric Urology, pp 13–19

17.

Toppari J (2014) Paediatrics: new cryptorchidism guidelines reach a consensus. Nat Rev Urol 11(8):432–433PubMedCrossRef

18.

Abdelhalim A, Chamberlin JD, McAleer IM (2018) A survey of the current practice patterns of contralateral testis fixation in unilateral testicular conditions. Urology 116:156–160PubMedCrossRef

19.

Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O (2007) Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 356(18):1835–1841PubMedCrossRef

20.

Walsh TJ, Dall’Era MA, Croughan MS, Carroll PR, Turek PJ (2007) Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol 178(4 Pt 1):1440–1446PubMedCrossRef

21.

Park KH (2007) Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis. Int J Urol 14:616PubMedCrossRef

22.

Hadziselimovic F, Hoecht B (2008) Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism. Klin Padiatr 220(5):302–327PubMedCrossRef

23.

Hadziselimovic F, Herzog B (2001) The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 358(9288):1156–1157PubMedCrossRef

24.

Chua M, Mendoza J, Gaston M (2014) Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review. J Ped Surg 49:1659–1667CrossRef

25.

Buzzard JJ, Loveland KL, O’Bryan MK et al (2004) Changes in circulating and testicular levels of inhibin A and B and activin A during postnatal development in the rat. Endocrinology 145(7):3532–3541PubMedCrossRef

26.

Miles DC, Wakeling SI, Stringer JM et al (2013) Signaling through the TGF beta-activan receptors ALK4/5/7 regulated testis formation and male germ cell development. PLoS One 8(1):e54606PubMedPubMedCentralCrossRef

27.

Kolling C, Stukenborg JB, Nurmio M et al (2012) Boys with undescended testes: endocrine volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol-Metabol 97(12):4588–4595CrossRef

28.

Thorup J, Kvist K, Clasen-Linde E, Petersen BL, Cortes D (2013) The relation between adult dark spermatogonia and other parameters of fertility potential in cryptorchid testes. J Urol 190:1566–1571PubMedCrossRef

29.

Thorup J, Kvist K, Clasen-Linde E, Petersen BL, Cortes D (2012) Bilateral undescended testes classified according to preoperative and postoperative status of gonadotropins and inhibin B in relation to testicular histopathology at bilateral orchiopexy in infant boys. J Urol 188(suppl 4):1436–1442PubMedCrossRef

30.

Cortes D, Thorup J, Visfeldt J (2000) Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism. J Urol 163:1290–1292PubMedCrossRef

31.

Bianchi A, Squire BR (1989) Transscrotal orchidopexy: orchidopexy revised. Pediatr Surg In 4(1):189–192

32.

Na SW, Kim SO, Hwang EC, Oh KJ, Jeong SI, Kang TW, Kwon DD, Park K, Ryu SB (2011) Single scrotal incision orchiopexy for children with palpable low-lying undescended testis: early outcome of a prospective randomized controlled study. Korean J Urol 52(9):637–641PubMedPubMedCentralCrossRef

33.

Young C, Walker A, Weber B, Spencer A (2020) Quality improvement assessment of a Bianchi-technique pediatric orchiopexy preoperative pain management pathway. J Ped Urol 16:e1-461.e9CrossRef

34.

Hinmann F (2010) Atlas of Urologic Surgery. 2nd edn, pp 308–337

35.

Spitz L, Coran A (2013) Pediatric Surgery. 7th edn, pp 891–900

36.

Ziylan O, Oktar T, Korgali E, Nane I, Ander H (2004) Failed orchiopexy. Urol Int 73(4):313–315PubMedCrossRef

37.

Sfoungaris D, Mouravas V, Petropoulos A, Filippopoulos A (2012) Prentiss orchiopexy applied in younger age group. J Pediatr Urol 8(5):488–492PubMedCrossRef

38.

Prentiss RJ, Weickgenant C, Moses J, Frazier D (1960) Undescended testis: surgical anatomy of spermatic vessels, spermatic surgical triangles and lateral spermatic ligament. J Urol 83:686–692PubMedCrossRef

39.

Novaes HF, Carneiro Neto JA, Macedo A Jr, Barroso Júnior U (2013) Single scrotal incision orchiopexy—a systematic review. Int Braz J Urol 39(3):305–311PubMedCrossRef

40.

Kozminski DJ, Kraft K, Bloom D (2015) Orchiopexy without transparenquimal fixation suturing: a 29-year experience. J Urol 194:1743PubMedCrossRef

41.

Almoutaz A, Eltaye B (2014) Single high scrotal incision orchidopexy for unilateral palpable testis: a randomize controlled study. Afr J Ped Surg 11(2):143–146CrossRef

42.

Feng S, Yang H, Li X, Yang J, Zhang J, Wang A, Lai XH, Qiu Y (2016) Single scrotal incision orchiopexy versus the inguinal approach in children with palpable undescended testis: a systematic review and meta-analysis. Pediatr Surg Int 32(10):989–995PubMedCrossRef

43.

- Sepulveda JA (2013) Orquidopexia videoasistida (OVA): ¿es la técnica de elección para una criptorquidia palpable difícil? Revista chilena de urología, volumen 78 , número 2 año.

44.

Ceccanti S, Sani A, Mele E, Cozzi DA (2014) Orchidopexy without ligation of the processus vaginalis is not associated with an increased risk of inguinal hernia. Hernia 18(3):339–342PubMedCrossRef

45.

Smedberg SG, Broome AE, Gullmo A (1984) Ligation of the hernial sac? Surg Clin North Am 64(2):299–306PubMedCrossRef

46.

Othman H, Hady A (2014) Hernia sac of indirect inguinal hernia: invagination, excision, or ligation? Hernia 18:199–204PubMedCrossRef

47.

Blackburn SC, Adams SD, Moahomed AA (2012) Risk of hernia occurrence where division of an indirect inguinal sac without ligation is undertaken. J Laparoendosc Adv Surg Tech A 22(7):713–714PubMedCrossRef

48.

Kao CY, Li CL, Lin CC, Su CM, Chen CC, Tam KW (2015) Sac ligation in inguinal hernia repair: a meta-analysis of randomized controlled trials. Int J Surg 19:55–60PubMedCrossRef

49.

Koh YH, Granger J, Cundy TP, Boucaut HA, Goh DW (2019) Sutured point-fixation versus Jaboulay fixation for salvaged testicular torsion in children. J Pediatr Surg 54(12):2631–2635PubMedCrossRef

50.

Anand S, Singh A, Bajpai M (2020) Transparenchymal testicular suture: a systematic review and meta-analysis highlighting the impact of additional fixation suture during routine orchiopexy. J Pediatr Urol S1477–5131(20):30733–30736

51.

Dixon TK, Ritchey ML, Boykin W, Harper B, Zeidman E, Thompson IM (1993) Transparenchymal suture fixation and testicular histology in a prepubertal rat model. J Urol 149(5):1116–1118PubMedCrossRef

52.

Coughlin MT, Bellinger MF, LaPorte RE, Lee PA (1998) Testicular suture: a significant risk factor for infertility among formerly cryptorchid men. J Ped Surg 33:1790–1793CrossRef

53.

Uijldert M, Meiβner A, Kuijper CF, Repping S et al (2019) Orchiopexy for bilateral undescended testes: a multicentre study on its effects on fertility and comparison of two fixation techniques. Andrologia 51:13194CrossRef

54.

Hoseinpour M, Memarzadeh M, Sadeqi A (2015) Comparative investigation of two surgical techniques of orchiopexy in the post-operative recurrence rate and testicular size in children in clinical trial study. Adv Biomed Res 4:171PubMedPubMedCentralCrossRef

55.

Chandrasekharam V (2005) Laparoscopy vs inguinal exploration for nonpalpable undescended testis. Ind J Pediatra 72:1021CrossRef

56.

López PJ, Angel L, Rodríguez J (2009) Abordaje Laparoscópico en el testículo no palpable. Rev Chil Pediatr 80(3):225–230CrossRef

57.

Frimberger D, Malm-Buatsi E, Kropp BP, Aston CE, Godiwalla SY, Palmer BW (2015) Reliance of preoperative scrotal examination versus final operative findings in the evaluation of non-palpable testes. J Pediatr Urol 11(5):255PubMedCrossRef

58.

Sturm R, Kurzrock E, Amend G, Shannon R, Gong E, Cheng E (2017) Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present? J Pediatr Urol 13(4):392.e1-392.e6CrossRef

59.

Woodford E, Eliezer D, Deshpande A, Kumar R (2018) Is excision of testicular nubbin necessary in vanishing testis syndrome? J Pediatr Surg 53(12):2495–2497PubMedCrossRef

60.

Emir H, Ayik B, Eliçevik M, Büyükünal C, Danişmend N, Dervişoğlu S, Söylet Y (2007) Histological evaluation of the testicular nubbins in patients with nonpalpable testis: assessment of etiology and surgical approach. Pediatr Surg Int 23(1):41–44PubMedCrossRef

61.

Banieghbal B, Davies M (2003) Laparoscopic evaluation of testicular mobility as a guide to management of intra-abdominal testes. World J Urol 20(6):343–345PubMedCrossRef

62.

Alagaratnam S, Nathaniel C, Cuckow P, Duffy P, Mushtaq I et al (2014) Testicular outcome following laparoscopic second stage Fowler Stephens orchidopexy. J Ped Urol 10:186–192CrossRef

63.

Braga LH, Farrokhyar F, McGrath M, Lorenzo AJ (2019) Gubernaculum testis and cremasteric vessel preservation during laparoscopic orchiopexy for intra-abdominal testes: effect on testicular atrophy rates. J Urol 201(2):378–385PubMedCrossRef

64.

Roy C, Cullis PS, Clark C, Munro FD (2020) Retrospective analysis of testicular outcomes following laparoscopic two-stage Fowler Stephens orchidopexy. J Pediatr Surg 55(2):300–303PubMedCrossRef

65.

Elderwy AA, Kurkar A, Abdel-Kader MS, Abolyosr A, Al-Hazmi H, Neel KF, Hammouda HM, Elanany FG (2014) Laparoscopic versus open orchiopexy in the management of peeping testis: a multi-institutional prospective randomized study. J Pediatr Urol 10(4):605–609PubMedCrossRef

66.

Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A (2016) Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg 51(2):211–215PubMedCrossRef

67.

Abouheba M, Youis W, El-Sokkary A et al (2019) Early clinical outcome of staged laparoscopic traction orchidopexy for abdominal testes. J Laparoendosc Adv Sure Tech 29:N4

68.

Elsherbeny M, Abdallah A, Abouzeid A et al (2018) Staged laparoscopic traction orchiopexy for intrabdominal testis: is it always feasible? J Ped Urol 14(3):267.e1-267.e4CrossRef

69.

Youssef A, Marei M, Abouelfadl M, Yassin T (2020) Unsatisfactory testicular position after inguinal orchidopexy: is there a role for upfront laparoscopy? Arab J Urol 18(N1):48–53PubMedCrossRef

70.

Lopes RI, Naoum NK, Chua ME, Canil T, Dos Santos J, Farhat WA (2016) Outcome analysis of redo orchiopexy: scrotal vs inguinal. J Urol 196(3):869–874PubMedCrossRef

71.

Dudley AG, Sweeney DD, Docimo SG (2011) Orchiopexy after prior inguinal surgery: a distal approach. J Urol 185(6):2340–2343PubMedCrossRef

72.

Marret JB, Ravasse P, Guleryuz K et al (2017) Experience of the single scrotal approach for recurrent undescended testis after primary orchiopexy or inguinal surgery. Prog Urol 27:93–97PubMedCrossRef

73.

Tong Q, Zheng L, Tang S, Mao Y, Wang Y, Liu Y, Cai J, Ruan Q (2009) Laparoscopy-assisted orchiopexy for recurrent undescended testes in children. J Pediatr Surg 44(4):806–810PubMedCrossRef

74.

Ryang SH, Jung JH, Eom M, Song JM, Chung HC, Chae Y, Lee CM, Kim KJ (2015) The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis. Korean J Urol 56(7):515–518. https://doi.org/10.4111/kju.2015.56.7.515CrossRefPubMedPubMedCentral

75.

Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181(2):452–461PubMedCrossRef

76.

Guías de Urología Pediátrica Hospital Exequiel González Cortés; Junio 2020. www.urologiahegc.cl.

Titel: The undescended testis in children and adolescents part 2: evaluation and therapeutic approach
verfasst von: María Pilar Echeverría Sepúlveda
Francisca Yankovic Barceló
Pedro-Jose López Egaña
Publikationsdatum: 21.03.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 6/2022
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05111-4

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