Materiały źródłowe

• #1 Cryptorchidism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470270/

  With proper diagnosis and treatment, the prognosis for cryptorchidism is excellent. However, there is a slight increase in the risks of testicular cancer and infertility compared to the general population. A Danish study involving over 6000 men indicated that individuals with a history of cryptorchidism exhibited testicular hypofunction, with a 3.5 mL reduction in testis volume, a 28% reduction in sperm concentration, and diminished Leydig cell function compared to men without cryptorchidism. […] Orchiopexy is associated with 2 major testicular complications: atrophy and testicular ascent. These complications occur in approximately 1% of the time for palpable testes. The rate increases to around 5% for laparoscopic orchiopexies. In FS orchiopexies, whether performed in 1 or 2 stages, the rate of testicular atrophy is around 20% to 30%, with the 1-stage procedure resulting in worse outcomes. Over-skeletonization of the spermatic cord leading to the loss of the testis represents a severe complication of orchiopexy.

• #2 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. […] Successful scrotal relocation of the testis, however, may reduce but does not prevent these potential long-term sequelae in susceptible individuals. […] The purpose of this guideline is to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism. […] In the absence of spontaneous testicular descent by six months (corrected for gestational age), specialists should perform surgery within the next year.

• #3 Evaluation and Treatment of Cryptorchidism (2018) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/cryptorchidism-guideline

  Orchidopexy in the first 18 months of life is recommended to preserve available fertility potential. […] The specific etiology for this compromised fertility remains unclear, but is likely related to germ cell depletion and/or defective germ cell maturation, loss of Leydig cells, and/or an increase in testicular fibrosis. […] There are two major long-term concerns for patients with a history of cryptorchidism: an increased incidence of developing testicular cancer and a heightened risk of subfertility. […] Men with a history of cryptorchidism have an increased risk of testicular cancer. […] Formerly bilateral cryptorchid men have greatly reduced fertility compared with men with a history of unilateral cryptorchidism and the general male population. […] In summary, although there is some suggestion that the examined genomic loci may contribute to cryptorchidism susceptibility, the evidence is weak at this point and likely due to the multifactorial nature of the trait, the heterogeneous phenotypic manifestation of cryptorchidism as well as the lack of simultaneous assessment of potential gene-environment interactions.

• #4 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism

  Undescended testicles may increase the risk of infertility, especially if both testicles are affected. […] However, boys who have one undescended testicle tend to father children at the same rate as those who are not affected by the condition at all. […] Boys who have two undescended testicles a much lower percentage of patients do have a significantly lower fertility rate. […] A child with undescended testicles is slightly more prone to develop testicular cancer, even after corrective surgery. […] However, surgery performed before puberty may reduce the risk of developing cancer. […] Parents should know that cases of cancer related to undescended testicles are rare. […] Having the surgery is important in that the testicle is located where a young man can palpate a mass if it should develop.

• #5 Undescended Testicles (Cryptorchidism) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/undescended-testes-cryptorchidism

  Orchiopexy moves the testicles into the scrotum, where they’re about three to five degrees cooler than they would be if they remained inside the abdominal cavity. […] This improves the chances of fertility later in life. […] Boys born with undescended testicles are slightly more prone to testicular cancer, even after corrective surgery, and at a rate of less than 1 percent. […] However, recent studies suggest that surgical repositioning may help in early detection of a testicular mass prior to the spread of disease, which may reduce the rate of malignancies.

• #6 Comparison of diagnostic and treatment guidelines for undescended testis

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2019.01438

  Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%2% of boys older than 6 months have undescended testes after their early postnatal descent. […] A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates. […] The original location of the testes and the age at orchiopexy are predictive factors for infertility and malignancy later in life. […] The fertility rate is low in patients with bilateral undescended testes, although orchiopexy is successful. The risk of testicular cancer in patients with undescended testis is increased compared to that in the general population. […] Timely referral to a surgical specialist and timely surgical correction may improve fertility and decrease malignancy rates related to undescended testis.

• #7

  https://link.springer.com/article/10.1007/s00383-024-05729-6

  This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. […] The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias. […] This retrospective cohort study of nearly 700 testes which underwent orchidopexy found a total rate of re-ascent of 6%. Patients who were re-operated were significantly younger, more often had congenital UDT, and were more often operated on with an inguinal approach. However, neither of these variables remained significant in adjusted analyses. Atrophy occurred only in one testis.

• #8

  https://link.springer.com/article/10.1007/s00383-024-05729-6

  The rate of re-ascent after surgery for UDT was twice as high after an inguinal approach as compared to a scrotal approach, even if the surgical approach did not fall out as a significant predictor in the multivariate analysis. […] Six percent of all orchidopexied testes needed a re-operation due to re-ascent after primary orchidopexy. The inguinal approach had double the rate of re-ascent compared to the scrotal approach but neither this nor other predictors of re-ascent remained significant in multivariate analyses. Atrophy was very rare. The scrotal approach had as expected significantly shorter operation times.

• #9 A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis – Yang – Translational Pediatrics

  https://tp.amegroups.org/article/view/65821/html

  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. […] 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). […] The model suggested that the risk of TA was higher for patients with deferens and epididymis anomalies, higher testicular location, lower TV ratio, and in two-stage FSO. […] Our study illustrates that the incidence of TA is higher in patients with a lower TV ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage FSO.

• #10 A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis – Yang – Translational Pediatrics

  https://tp.amegroups.org/article/view/65821/html

  The preoperative TV ratio is the most important factor affecting TA. The smaller the testes, the higher the atrophy rate. […] The decision on which surgical procedure to perform is surgeon-dependent. […] This prediction model provides good evidence for surgeons to choose the appropriate surgical procedure in UDT and predict the probability of TA.

Zobacz więcej