RESUMEN

BACKGROUND: There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables. METHODS: We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018. RESULTS: A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851. CONCLUSIONS: In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.

RESUMEN

BACKGROUND: Polyorchidism is a congenital anomaly of the urogenital system and means more than two testes. It is a rare phenomenon, where there are no more than 200 reported cases in the literature. In this case, we report a 13-month year's old case with five testicles. CASE PRESENTATION: We report a rare five testicles in the genital area of a 13-month-old baby. The initial diagnosis was undescended testis (UDT) based on ultrasound findings where a testis in the abdomen and a testis in the inguinal canal were detected. Surgery with general anaesthesia was performed to diagnose and treat this case. Before surgery, four HCG 1200u injections were administered. During the operation, it was determined that the case had had five testicles. Testicles were on the left in the proximal inguinal canal, and the sac hernia was ligated parallel to the inner ring. The patient was followed up several times after surgery by a urologist, and the results showed that there were no problems, and the intervention was uncomplicated. CONCLUSION: Based on the result, it is not possible to diagnose such cases only by examination or ultrasound in infant patients, as the patient often presents with undescended testis (UDT), so the disease is diagnosed only through surgery.

Asunto(s)

RESUMEN

BACKGROUND: To investigate whether management of undescended testis (UDT) may be improved with educational updates and new transferring model among referring providers (RPs). METHODS: The 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. RESULTS: A 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. CONCLUSIONS: The management of undescended testis may be improved with educational updates and new transferring model among primary healthcare practitioners.

Asunto(s)

RESUMEN

PURPOSE: The purpose of this chapter is to review hormonal therapy in cryptorchidism in boys to improve fertility. METHODS: Multiple searches, primarily in PubMed, were performed using various combinations of the terms: cryptorchidism, undescended testis (UDT), hormonal therapy, fertility, infertility, germ cell numbers, spermatogonia and semen analyses. In additions the pertinent articles from the reference lists in these papers were also obtained and reviewed. RESULTS: Data on fertility in unilateral cryptorchidism does not reveal a significant risk for infertility. Testes biopsies in childhood do not correlate with fertility parameters in adulthood. In bilateral cryptorchidism there is a significant risk of infertility. Results of hormonal treatment were not reported separately for bilateral cryptorchidism. Current data is insufficient to know if hormonal therapy is efficacious in bilateral UDT. CONCLUSIONS: Hormonal therapy should not be used in childhood to improve fertility in cases of unilateral cryptorchidism. Testes biopsies in childhood to identify those at risk for infertility should not be performed in unilateral cryptorchidism. More data are needed to answer whether hormonal therapy is beneficial in bilateral UDT. There is insufficient data to establish that testis biopsies are helpful in bilateral cryptorchidism in identifying the subgroup with risk for infertility. They should not be performed in the routine clinical setting but may have a role in a research protocol.