Mostafa Ibrahim A, Shalaby Mohamed S, Woodward Mark N
Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK.
Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, UK; Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt.
J Pediatr Surg. 2019 Feb;54(2):310-312. doi: 10.1016/j.jpedsurg.2018.10.088. Epub 2018 Nov 6.
BACKGROUND/AIM: Approximately 20% of undescended testes (UDT) are bilateral. It is unclear whether bilateral orchidopexy (BO) should be undertaken synchronously (SBO) or metachronously (MBO). Our aim was to investigate current UK practice and the complications of SBO vs MBO.
MATERIALS & METHODS: Following approval of BAPS and BAPU ethics committee, a survey was circulated to UK consultant pediatric surgeons and urologists regarding practice. A departmental retrospective review was additionally carried out for patients undergoing BO between 2005 and 2017.
Forty-three consultant surgeons from 20 centres completed the survey. Overall, SBO was preferred by 70% for bilateral palpable UDT versus 30% for bilateral impalpable UDT. When one side was palpable and the other impalpable, 70% preferred SBO. Pediatric urologists were significantly more likely to undertake SBO than pediatric general surgeons. One hundred eighty-eight patients (376 testicular units) were identified who had undergone BO with a median follow up of 9 months. 144/188 (76.6%) underwent SBO, while 44 had MBO. There was no statistical difference in the complication rate between the two groups (7.6% in SBO vs 9.1% in MBO; p = 0.66).
The majority of the responding UK consultants, in particular pediatric urologists, favor SBO. This potentially offers a reduction in cost, more rapid completion of treatment, and is not associated with additional complications by comparison to MBO. We recommend SBO to be standard practice for bilateral UDT whenever possible.
Level III, Retrospective Comparative Study.
背景/目的：约20%的隐睾为双侧性。目前尚不清楚双侧睾丸固定术（BO）应同期（SBO）还是分期（MBO）进行。我们的目的是调查英国目前的做法以及SBO与MBO的并发症情况。
经英国小儿外科医师协会（BAPS）和英国小儿泌尿外科医师协会（BAPU）伦理委员会批准后，向英国小儿外科和泌尿外科顾问医师发放了一份关于该做法的调查问卷。此外，还对2005年至2017年间接受BO手术的患者进行了科室回顾性研究。
来自20个中心的43名顾问外科医师完成了调查。总体而言，对于双侧可触及的隐睾，70%的人倾向于SBO，而对于双侧不可触及的隐睾，这一比例为30%。当一侧可触及而另一侧不可触及时，70%的人倾向于SBO。小儿泌尿外科医师比小儿普通外科医师更倾向于进行SBO。共确定了188例接受BO手术的患者（376个睾丸单位），中位随访时间为9个月。144/188（76.6%）接受了SBO，44例接受了MBO。两组并发症发生率无统计学差异（SBO组为7.6%，MBO组为9.1%；p = 0.66）。
大多数参与调查的英国顾问医师，尤其是小儿泌尿外科医师，倾向于SBO。与MBO相比，这可能降低成本、更快完成治疗，且不会增加并发症。我们建议只要有可能，SBO应作为双侧隐睾的标准治疗方法。
III级，回顾性比较研究。
