Eijsbouts S W, de Muinck Keizer-Schrama S M P F, Hazebroek F W J
Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
J Urol. 2007 Oct;178(4 Pt 2):1726-9. doi: 10.1016/j.juro.2007.03.184. Epub 2007 Aug 17.
It is still controversial whether acquired undescended testis can best be managed by orchiopexy or by the wait and see method. We prospectively evaluated spontaneous descent of acquired undescended testes and possible predictive factors in prepubertal boys.
From 1982 to 2004 spontaneous descent was awaited until at least Tanner stage P2G2 in 109 boys with a total of 83 unilateral and 52 bilateral acquired undescended testes. Annually we established testis position and size. After Tanner stage P2G2 orchiopexy was done for all testes in an unstable scrotal position.
Two boys (3 acquired undescended testes) were excluded from analysis. Of 132 acquired undescended testes 75 descended spontaneously (57%, 95% CI 48-65), including 40 of 75 (57%) in early puberty or before puberty and 32 of 75 (43%) in mid puberty. Orchiopexy was performed in 57 of 132 acquired undescended testes (43%). Acquired undescended testes showed an increasing chance of descending spontaneously with increasing age (p trend = 0.002). In 63 of 82 unilateral undescended testes we were able to compare testis volume at the onset of puberty with that of the healthy contralateral side. Of 17 testes that needed orchiopexy 12 (71%) had a volume that was more than 1 ml smaller than the healthy testis. This was noted in only 18 of 46 spontaneously descended acquired undescended testes (39%, p = 0.053). Other factors, such as the most caudal testicular position at referral or the frequency of confirmed descended testicular position before referral, were not predictive of spontaneous descent.
A conservative wait and see approach to acquired undescended testis until puberty could prevent more than half of the boys from undergoing orchiopexy and it does not seem detrimental in terms of testicular volume.
后天性隐睾最佳的治疗方法是睾丸固定术还是观察等待法仍存在争议。我们对青春期前男孩后天性隐睾的自然下降情况及可能的预测因素进行了前瞻性评估。
从1982年至2004年，对109名男孩共83例单侧和52例双侧后天性隐睾患者，等待其自然下降，直至至少达到坦纳分期P2G2。我们每年确定睾丸的位置和大小。在坦纳分期P2G2之后，对所有阴囊位置不稳定的睾丸进行睾丸固定术。
两名男孩（3个后天性隐睾）被排除在分析之外。132个后天性隐睾中有75个自然下降（57%，95%可信区间48 - 65），其中75个中有40个（57%）在青春期早期或青春期前下降，75个中有32个（43%）在青春期中期下降。132个后天性隐睾中有57个（43%）进行了睾丸固定术。后天性隐睾自然下降的几率随年龄增长而增加（p趋势 = 0.002）。在82例单侧隐睾中的63例中，我们能够比较青春期开始时患侧睾丸体积与健侧睾丸体积。在17个需要进行睾丸固定术的睾丸中，有12个（71%）的体积比健侧睾丸小超过1毫升。在46个自然下降的后天性隐睾中，只有18个（39%）出现这种情况（p = 0.053）。其他因素，如转诊时睾丸最尾端的位置或转诊前确诊的睾丸下降位置的频率，均不能预测自然下降情况。
对后天性隐睾采用保守的观察等待方法直至青春期，可以使超过一半的男孩避免接受睾丸固定术，而且从睾丸体积方面来看似乎并无不利影响。
