Cancian Madeline, Ellsworth Pamela, Caldamone Anthony
Department of Urology, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Division of Urology, Nemours Children's Hospital, Orlando, FL, USA.
J Pediatr Urol. 2017 Oct;13(5):504.e1-504.e5. doi: 10.1016/j.jpurol.2017.03.011. Epub 2017 Mar 28.
Metachronous undescended testis (mcUDT), an acquired UDT after contralateral orchiopexy, can occur in some boys. If one were able to predict its occurrence, one might consider a proactive approach or at least one would be able to counsel the parents accordingly. Our hypothesis was there may be characteristics evident at the time of initial orchiopexy which could predict the development of contralateral mcUDT.
The aim was to Identify factors present at initial orchiopexy that predict development of subsequent mcUDT.
Subjects were identified using the Current Procedural Terminology code for inguinal orchiopexy (54640). We included patients from January 1997 to October 2015. We included patients who underwent orchiopexy for unilateral UDT (uUDT). The study population consisted of patients who had undergone metachronous orchiopexies; controls were patients who were 17 years at time of data collection with a single orchiopexy. Cox proportional hazard regression was used to model the relationship between possible predictors of subsequent UDT using PROC PHREG with SAS Software 9.4.
From 1035 eligible patients we identified 38 with mcUDT and 207 controls (uUDT). Median age at the first orchiopexy of mcUDT patients was 2.5 years (min/max, 0.50/10.4 years) and 8.2 years (min/max 0.70/12.8 years) for uUDT, p < 0.0001. Subjects with a contralateral retractile testis on preoperative exam had a 4.2 times higher rate of subsequent UDT than patients with a contralateral descended testis (95% CI 2.077-8.353). The rate of mcUDT was 6.7 times higher if the testis was a retractile testis under anesthesia (95% CI 2.7-16.5) (Table).
Contralateral retractile UDT was a significant predictor of mcUDT. We believe patients with a contralateral retractile testis at time of orchiopexy should be counseled on bilateral orchiopexy. The risks of complications with orchiopexy should be weighed against risks of a subsequent surgery and anesthesia event.
A discussion of risks and benefits regarding bilateral orchiopexies should be undertaken with the parents prior to surgery in the setting of an UDT with contralateral retractile testis.
异时性隐睾（mcUDT）是对侧睾丸固定术后出现的后天性隐睾，部分男孩可能会发生。如果能够预测其发生，或许可以考虑采取积极的方法，或者至少能够据此向家长提供咨询建议。我们的假设是，在初次睾丸固定术时可能存在一些特征，这些特征能够预测对侧mcUDT的发生。
旨在确定初次睾丸固定术时存在的可预测后续mcUDT发生的因素。
使用腹股沟睾丸固定术的当前程序编码（54640）来识别研究对象。我们纳入了1997年1月至2015年10月期间的患者。我们纳入了因单侧隐睾（uUDT）接受睾丸固定术的患者。研究人群包括接受过异时性睾丸固定术的患者；对照组为在数据收集时年龄为17岁且仅接受过一次睾丸固定术的患者。使用SAS软件9.4中的PROC PHREG程序，通过Cox比例风险回归模型来分析后续隐睾可能的预测因素之间的关系。
在1035例符合条件的患者中，我们识别出38例mcUDT患者和2名对照组（uUDT）。mcUDT患者初次睾丸固定术时的中位年龄为2.5岁（最小/最大，0.50/10.4岁），uUDT患者为8.2岁（最小/最大0.70/12.8岁），p<0.0001。术前检查发现对侧睾丸可回缩的患者，其后续隐睾的发生率是对侧睾丸已下降患者的4.2倍（95%可信区间2.077 - 8.353）。如果睾丸在麻醉下为可回缩睾丸，mcUDT的发生率则高出6.7倍（95%可信区间2.7 - 至16.5）（表）。
对侧可回缩性隐睾是mcUDT的一个重要预测因素。我们认为，对于睾丸固定术时对侧睾丸可回缩的患者，应就双侧睾丸固定术进行咨询。应权衡睾丸固定术的并发症风险与后续手术及麻醉事件的风险。
对于存在对侧可回缩睾丸的单侧隐睾患者，术前应与家长讨论双侧睾丸固定术的风险和益处。
