Department of Paediatrics, Medical Centre Alkmaar, Alkmaar, the Netherlands.
BJU Int. 2010 Oct;106(7):1052-9. doi: 10.1111/j.1464-410X.2010.09226.x. Epub 2010 Feb 11.
To assess prospectively the natural history and long-term testicular growth of acquired undescended testis (UDT) after spontaneous descent or pubertal orchidopexy in case of nondescent.
From 1996 until 2008, 391 boys with 464 acquired UDT were included in the study. In accordance with Dutch consensus on non-scrotal testes, spontaneous descent at puberty was awaited; if this did not take place, orchidopexy was performed at puberty. Acquired UDT was defined as a testis previously residing in the scrotum that can no longer be manipulated into a stable scrotal (high scrotal) or nonscrotal (inguinal, impalpable) position. After referral, testis position, testis volume and puberty stage were monitored annually until adolescence. Testis volume was assessed using an orchidometer and compared with the Dutch standard. All investigations were carried out by the same physician (W.H.). Of these boys, 84 (mean age 12.9 years, range 6.4-21.3) were also clinically assessed by a second physician (J.G.), unaware of the results of the first examination. In addition, these boys were assessed with testicular ultrasonography, carried out by both physicians.
Currently the mean (range) follow-up is 4.7 (0.1-12.0) years, and 253 acquired UDT have reached the scrotum. In 196 of these 253 cases (77.5%), there was spontaneous descent at puberty (mean age at descent 12.9 years, range 9.8-16.9); in the other 57 cases (22.5%), pubertal orchidopexy was required due to nondescent; five cases required orchidectomy. Of the 494 testis volume measurements after spontaneous descent, 458 (92.7%) were at ≥10th centile for age, of which 311 (63.0%) were ≥50th centile, and 107 (21.7%) ≥90th centile. After pubertal orchidopexy for nondescent, of the 85 measurements, 79 (92.9%) were at ≥10th centile, 53 (62.4%) ≥50th centile and 12 (14.1%) ≥90th centile. In unilateral cases, after spontaneous descent 174 of the 294 (59.2%) retained testes were found to be smaller than their counterpart and 90 of 294 (30.6%) were equal in size. After pubertal orchidopexy in unilateral cases, 40 of the 51 (78.4%) testes were smaller, and nine (17.6%) were equal in size. There was a strong correlation between both investigators for the measurement of testicular volume by orchidometer, and for the main investigator (W.H.) between his measurements by ultrasonography and the Prader orchidometer.
Acquired UDT has a 77.5% tendency of spontaneous descent at puberty. In nearly all cases, after spontaneous descent as well as after pubertal orchidopexy, long-term testicular growth is within the normal range.
前瞻性评估获得性未降睾丸（UDT）在自发性下降或青春期隐睾固定术后的自然史和长期睾丸生长情况。
1996 年至 2008 年，研究纳入了 391 名患有 464 例获得性 UDT 的男孩。根据荷兰非阴囊睾丸的共识，等待青春期自发性下降；如果未发生下降，则在青春期进行隐睾固定术。获得性 UDT 定义为曾经位于阴囊内但不能再被操纵到稳定的阴囊（高位阴囊）或非阴囊（腹股沟、不可触及）位置的睾丸。转诊后，每年监测睾丸位置、睾丸体积和青春期阶段，直到青春期。使用睾丸测量计评估睾丸体积，并与荷兰标准进行比较。所有检查均由同一位医生（W.H.）进行。这些男孩中有 84 名（平均年龄 12.9 岁，范围 6.4-21.3）也由第二位医生（J.G.）进行了临床评估，第二位医生并不知道第一次检查的结果。此外，这 84 名男孩还接受了两位医生进行的睾丸超声检查。
目前的平均（范围）随访时间为 4.7（0.1-12.0）年，253 例获得性 UDT 已降至阴囊。在这 253 例中，196 例（77.5%）在青春期自发性下降（下降时的平均年龄为 12.9 岁，范围为 9.8-16.9）；在其余 57 例（22.5%）中，由于未下降，需要进行青春期隐睾固定术；5 例需要进行睾丸切除术。在自发性下降后进行的 494 次睾丸体积测量中，458 次（92.7%）处于年龄第 10 百分位数以上，其中 311 次（63.0%）处于第 50 百分位数以上，107 次（21.7%）处于第 90 百分位数以上。在青春期隐睾固定术治疗未下降的 85 次测量中，79 次（92.9%）处于第 10 百分位数以上，53 次（62.4%）处于第 50 百分位数以上，12 次（14.1%）处于第 90 百分位数以上。在单侧病例中，在自发性下降后，294 例中 174 例（59.2%）保留的睾丸被发现较小，294 例中有 90 例（30.6%）大小相等。在单侧病例中，青春期隐睾固定术后，40 例（78.4%）睾丸较小，9 例（17.6%）睾丸大小相等。两位研究者在睾丸体积测量方面具有很强的相关性，主要研究者（W.H.）在超声检查和 Prader 睾丸测量计测量方面也具有很强的相关性。
获得性 UDT 在青春期有 77.5%的自发性下降趋势。在几乎所有情况下，无论是在自发性下降后还是青春期隐睾固定术后，长期睾丸生长都在正常范围内。
