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PEDIATRIC
UROLOGY
Undescended
testis in older boys: further evidence that ascending testes are common
Guven A, Kogan BA
Department of Pediatric Surgery, Gulhane Military Medical Academy, Etlik,
Ankara, Turkey
J Pediatr Surg. 2008; 43: 1700-4
- Introduction:
We recommend orchiopexy between 9 and 18 months of age for surgical,
testicular, and psychological reasons. However, in practice, we observed
many patients coming to orchiopexy at a later age. To understand this
difference better, we reviewed our experience with patients undergoing
late orchiopexy.
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Methods: We
reviewed retrospectively the office medical records of all boys who
had undergone an orchiopexy between July 1997 and April 2006. We defined
a “late” orchiopexy as that performed at 4 years of age
or later. Each boy was examined carefully by a pediatric urologist,
and preoperative, intraoperative, and postoperative findings were reviewed.
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Results: There
were 191 late orchiopexies in 177 patients (from a total of 587 orchiopexies
in 552 patients). Median age at the operation was 7.2 years (range,
4.0-16.2). Preoperatively, the testes were palpable in 140 (72%) and
nonpalpable in 51 (28%). The apparent reason for the late orchiopexy
was an ascending testis (previously descended) in 85 (45%), parental
delay in 41 (22%), late referral in 39 (20%), and iatrogenic cryptorchidism
in 18 (9%). Ascended testes were more likely to have a history of being
retractile (85% vs. 30%), to have a patent processus vaginalis (78%
vs. 54%), and to be localized to the superficial inguinal area (87%
vs. 50%).
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Conclusions:
Primary care provider and parent education on the benefits of early
orchiopexy is important, but in addition, ascending testes are much
more common than previously thought. Patients with retractile testes
should be followed regularly.
- Editorial
Comment
This manuscript explores orchiopexies in boys over four and compares
them to patients who were under four years of age. 552 had 587 orchiopexies.
177 of these boys had 191 orchiopexies over the age of four. The stated
reasons were ascending testicles in 45%, parental delay in 22%, referral
or insurance problems in 20%, entrapped testes in 9%, with the remaining
cases uncertain. 85% of the ascending testis group and 30% of the others
had a history of retractile testes. Palpable testes were found in 93%
of the ascending testes and only 58% of the other patients. The ascending
testes were more likely to be found in the superficial inguinal pouch
(87%) while only 50% of the other categories had the testicles in the
superficial inguinal pouch with a statistical difference of p < 0.001.
The processus vaginalis was more likely to be patent in the ascending
testis group (78%) than the other group (54%) with a p-value of <
0.001. Excluding the iatrogenic group where the testes were stuck with
scar tissue, the p-values were still significant.
It is becoming better understood that some testes that were found in
the scrotum ascend and become fixed in a non-scrotal position. It is
interesting to note that the ascending testes are more likely to be
in the superficial inguinal pouch and more likely to have a patent processus
vaginalis than the other delayed orchiopexy patients. It is still important
for urologists to recognize that early orchiopexy before the second
year of life has significant benefit. Educating primary care physicians
and referring physicians about early referral is still the best policy.
Dr.
Brent W. Snow
Division of Urology
University of Utah Health Sci Ctr
Salt Lake City, Utah, USA
E-mail: brent.snow@hsc.utah.edu |