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PEDIATRIC
UROLOGY
Testicular
Growth from Birth to Two Years of Age, and the Effect of Orchidopexy at
Age Nine Months: A Randomized, Controlled Study
Kollin C, Hesser U, Ritzen EM, Karpe B
Department of Woman and Child Health, Karolinska Institut, Stockholm,
Sweden
Acta Paediatr. 2006; 95: 318-24
- Aim:
To
study whether surgical treatment at age 9 mo in boys with congenital
unilaterally palpable undescended testes (cryptorchidism) is followed
by improved growth of the previously retained testes compared to non-treatment.
-
Methods:
At the age of 6 mo, 70 boys were randomized to surgical treatment at
9 mo and 79 boys to treatment at 3 y of age. The boys were then followed
at 12 and 24 mo. Ultrasonography was used to determine testicular volume.
-
Results:
After orchidopexy, the previously retained testes resumed growth and
were significantly larger than the non-operated testes at 2 y (0.49
ml vs 0.36 ml, p < 0.001). Testicular growth after orchidopexy was
also demonstrated by a higher mean ratio between the previously retained
and the scrotal testes of the individual boys at 2 y: 0.84 for the surgically
treated group, compared to 0.63 for the untreated group (p < 0.001).
-
Conclusion:
Surgery at 9 mo has a beneficial effect on the growth of previously
undescended testes.
- Editorial
Comment
The authors performed an excellent, randomized study of surgery at 9
months vs. delayed surgery (planned for 3 years of age) for undescended
testes. They report that 1) undescended testes are slightly smaller
than their descended contralateral matches are shortly after birth;
2) these testes lose considerable ground during the first 6 months of
life; 3) those operated on grow much better than those non-operated
on during the first 24 months of life.
This is the first randomized trial of early surgery in these patients
and demonstrated a clear benefit in terms of testicular size. It is
extremely important from that standpoint and it is rewarding for most
surgeons in that it supports early surgery. On the other hand, there
are a number of questions that the study raises. First, the size measurements
were difficult to blind. Those still undescended clearly were notable
at the time of the ultrasound and there might well be observer bias.
Second, one has to wonder if the increased size is at all related to
lymphatic obstruction. Doing a proper orchiopexy may well require damaging
most lymphatics, resulting in a large testis in the first year or 2
postoperatively. This type of enlargement might not be discernable on
ultrasound. Third, the study results are reported after 24 months, so
we do not know if those children operated on later might have the same
increase in growth and therefore, there may not be any benefit to early
surgery. Fourth, we do not know if the larger testis is any better functionally.
Indeed, most studies suggest that the undescended testis contributes
little to ultimate fertility. This is an early report of a much larger
study and we can expect that the answers to some of these questions
will be forthcoming.
Overall, the authors are to be congratulated on a careful randomized
study of this complex problem. We eagerly look forward to further reports
from this study.
Dr.
Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA |