Department for Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
Division of Paediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
J Pediatr Urol. 2019 Feb;15(1):71.e1-71.e6. doi: 10.1016/j.jpurol.2018.10.013. Epub 2018 Oct 25.
Re-ascended testes account for a proportion of all undescended testes (UDTs); one main hypothesis relating to their etiology relates to a patent processus vaginalis peritonei. The aim was to investigate gubernacular insertion points in boys with late ascended testis as a possible guide to an alternative embryological etiology.
Patients with proven ascended testes were recruited from four different pediatric urology centers between May 2016 and September 2017. All patients were evaluated regarding their gubernacular insertion during orchidopexy. The presence of accompanying patent processus vaginalis and the association between the epididymis and testis were also documented.
Seventy-seven children (mean age = 73.1 ± 41.2 months [range 18-176]) were enrolled into the study. A non-orthotopic gubernacular insertion point was found in 96.1% (n = 74); 34.2% (n = 26) of these were located in the groin and 63.2% (n = 48), high within the scrotum. Figure A. An open processus vaginalis peritonei was found in 35.1%. Twelve patients (15.6%) had small, dysplastic appearing testis with testis-epididymis dissociation. Boys with a higher insertion of the non-orthotopic gubernaculum (n = 48, groin) were operated earlier (mean age at surgery, 62.3 months) compared with those with a gubernacular insertion at a high scrotal site (mean age at surgery, 90.5 months; p = 0.004). Figure B.
This study revealed that non-orthotopic gubernacular insertion is found in the vast majority of the ascending testis cases. Patent processus vaginalis was accompanying only 35.1% of all children and might be the cause of the ascending testis in this small subgroup of patients in line with the earlier reports [1]. In boys with ascending testes, in this population, the gubernaculum was very likely to insert non-orthotopically. In concordance with previous reports [2] and regarding the finding of a an earlier age at surgery in boys with higher inserting gubernacula, this could provide a logical explanation as to how these testes are initially palpable in the scrotum and then, during body growth are retracted to the groin.
In 96.1% of the patients, a non-orthotopic gubernacular insertion was found. This points to embryologic etiology, complying well with earlier reports and further underlining the critical importance of timely diagnosis and treatment for this group of patients.
复发性睾丸占未降睾丸（UDT）的一部分；与病因相关的一个主要假设与开放的鞘状突腹膜有关。目的是研究晚期上升睾丸的精索插入点，作为可能的替代胚胎发生病因的指导。
2016 年 5 月至 2017 年 9 月期间，我们从四个不同的小儿泌尿科中心招募了患有已证明上升睾丸的患者。所有患者在进行睾丸固定术期间均对精索插入点进行评估。还记录了伴随的开放鞘状突腹膜的存在以及附睾和睾丸之间的关联。
研究纳入了 77 名儿童（平均年龄 73.1 ± 41.2 个月[范围 18-176]）。96.1%（n=74）的儿童发现精索非正位插入点；34.2%（n=26）位于腹股沟，63.2%（n=48）位于阴囊高位。图 A. 发现开放的鞘状突腹膜 35.1%。12 名患者（15.6%）的睾丸小，外观发育不良，睾丸-附睾分离。非正位精索插入点较高的男孩（n=48，腹股沟）的手术年龄较早（平均手术年龄 62.3 个月），而精索插入点位于阴囊高位的男孩（平均手术年龄 90.5 个月；p=0.004）。图 B.
本研究表明，非正位精索插入在绝大多数上升睾丸病例中发现。仅 35.1%的儿童伴随开放的鞘状突腹膜，根据早期报道，这可能是这一小部分患者中上升睾丸的原因[1]。在上升睾丸的男孩中，在这个人群中，精索很可能非正位插入。与之前的报道一致[2]，以及在精索插入较高的男孩中发现手术年龄较早的结果，这可以解释这些睾丸最初在阴囊中触诊，然后在身体生长过程中回缩至腹股沟的原因。
96.1%的患者发现精索非正位插入。这指向胚胎发生病因，与早期报道一致，进一步强调了对这组患者及时诊断和治疗的重要性。
