Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14 032, Caen cedex 9, France; Caen University Hospital, Avenue de la Côte de Nacre, 14 000, Caen, France.
Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14 032, Caen cedex 9, France; Caen University Hospital, Avenue de la Côte de Nacre, 14 000, Caen, France.
J Pediatr Urol. 2019 Aug;15(4):377.e1-377.e6. doi: 10.1016/j.jpurol.2019.03.019. Epub 2019 Mar 29.
Surgery for undescended testis is now commonly recommended before the age of one year. However, the risk of testicular atrophy or miss location after surgery at a young age has not been clearly evaluated.
The objective of this study is to evaluate the rate of testicular atrophy after surgery for non-palpable testis before the age of one year.
Fifty-five patients operated between 2005 and 2014 for non-palpable testes were reviewed for clinical and ultrasound (US) evaluation. Median follow-up after surgery was of 68.5 months (range 26-130 months). The median age at surgery was of months (5-12 months). Eight patients (14.5%) had bilateral non-palpable testis; thus, 63 testes were evaluated. At surgery, 38 (60%) testes were located in the high inguinal canal; 25 (40%), in the abdominal cavity. Orchiopexy was performed with preservation of the testicular vessels for 58 testes. Fowler-Stephens (FS) procedure was performed for 5 testes. Testicular location was clinically evaluated, and testicular volume was measured using a standard sonogram technique in our pediatric radiology department. Ratio comparing the volume of the descended testis to the spontaneously scrotal located testis was calculated in unilateral forms.
After surgery, testes had scrotal location in 62 cases and inguinal location in one case. Seven cases of atrophy were confirmed after US control (11%), more frequently (odds ratio, OR 11.68 [1.9-72.5]) in abdominal testis (24%) than in inguinal testis (2.6%). Atrophy testicular was more frequent with FS technique (OR 7.1 [1.3-40.1]), but the population was weak (N = 5). Median volume ratio for unilateral form was 0.88 [0-1.8]; 14 patients presented a ratio greater than 1.
The influence of the young age at surgery and the risk of post operative testicular atrophy had not been clearly evaluated. The term of 'no palpable testis' supports an heterogeneous group mixing abdominal and extra-abdominal testis sharing a uniform clinical presentation. Our rate of atrophy in the group of abdominal testes (24%) and inguinal testes (2.6%) is similar to the literature, which concerns older patients. The long-term sonogram assessment demonstrated a good development of the testis after surgery, especially in inguinal cases.
Surgery for no palpable testis before the age of one year does not lead to a superior risk of testicular atrophy compared with surgery at an older age and allows a good development of the testis.
目前普遍建议在一岁之前对未降睾丸进行手术治疗。然而，对于幼儿期手术后睾丸萎缩或缺失的风险尚未得到明确评估。
本研究旨在评估一岁以下非可触及睾丸手术后睾丸萎缩的发生率。
对 2005 年至 2014 年间因非可触及睾丸而行手术的 55 例患者进行了临床和超声（US）评估。术后中位随访时间为 68.5 个月（26-130 个月）。手术时中位年龄为 个月（5-12 个月）。8 例（14.5%）患者双侧睾丸均不可触及，因此共评估了 63 个睾丸。手术时，38 个（60%）睾丸位于高位腹股沟管；25 个（40%）位于腹腔内。对 58 个睾丸行保留睾丸血管的睾丸固定术，对 5 个睾丸行 Fowler-Stephens（FS）手术。临床评估睾丸位置，在我院儿科放射科采用标准超声技术测量睾丸体积。单侧形式计算下降睾丸体积与自发下降至阴囊睾丸体积的比值。
术后 62 例睾丸位于阴囊，1 例位于腹股沟。超声检查证实 7 例（11%）发生萎缩，其中腹腔内睾丸（24%）较腹股沟内睾丸（2.6%）更常见（优势比，OR 11.68 [1.9-72.5]）。FS 技术的萎缩睾丸更常见（OR 7.1 [1.3-40.1]），但人群较弱（N=5）。单侧形式的中位体积比为 0.88 [0-1.8]；14 例患者的比值大于 1。
手术年龄较小和术后睾丸萎缩风险的影响尚未得到明确评估。“无触诊睾丸”这一术语支持一个混合了腹腔和腹腔外睾丸的异质群体，它们具有相同的临床表现。我们在腹腔内睾丸（24%）和腹股沟内睾丸（2.6%）中的萎缩发生率与文献报道的老年患者相似。长期的超声评估显示手术后睾丸发育良好，尤其是在腹股沟病例中。
一岁以下非可触及睾丸的手术并不比老年手术导致更高的睾丸萎缩风险，且能使睾丸良好发育。
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