Guven Ahmet, Kogan Barry A
Department of Pediatric Surgery, Gulhane Military Medical Academy, Etlik, Ankara 06018, Turkey.
J Pediatr Surg. 2008 Sep;43(9):1700-4. doi: 10.1016/j.jpedsurg.2008.03.029.
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.
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.
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%).
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.
出于手术、睾丸及心理方面的原因，我们建议在9至18个月大时进行睾丸固定术。然而，在实际操作中，我们观察到许多患者在较晚的年龄才来进行睾丸固定术。为了更好地理解这种差异，我们回顾了我们对接受晚期睾丸固定术患者的经验。
我们回顾性地查阅了1997年7月至2006年4月间所有接受睾丸固定术男孩的门诊病历。我们将“晚期”睾丸固定术定义为在4岁及以后进行的手术。每位男孩均由小儿泌尿科医生进行仔细检查，并对术前、术中和术后的检查结果进行了回顾。
177例患者共进行了191例晚期睾丸固定术（在552例患者总共587例睾丸固定术中）。手术时的中位年龄为7.2岁（范围为4.0 - 16.2岁）。术前，140例（72%）睾丸可触及，51例（28%）不可触及。晚期睾丸固定术的明显原因是睾丸上升（先前已下降）85例（45%），家长延误41例（22%），转诊延迟39例（20%），医源性隐睾18例（9%）。上升的睾丸更有可能有可回缩病史（85%对30%），有鞘状突未闭（78%对54%），且位于腹股沟浅环区域（87%对50%）。
对初级保健提供者和家长进行早期睾丸固定术益处的教育很重要，但此外，睾丸上升比以前认为的要常见得多。对可回缩睾丸患者应定期随访。
