Alchoikani Nasib, Ashour Khaled
Oxford University Hospitals NHS Foundation Trust: John Radcliffe Hospital, Department of Paediatric Surgery, UK.
Oxford University Hospitals NHS Foundation Trust: John Radcliffe Hospital, Department of Paediatric Surgery, UK; Alexandria University Hospital, Department of Paediatric Surgery, Egypt.
J Pediatr Urol. 2021 Apr;17(2):192.e1-192.e3. doi: 10.1016/j.jpurol.2020.12.016. Epub 2020 Dec 20.
About 0.8% of boys have undescended testes at 1 year of age. However, the overall rate of orchidopexy is 2.5 times that expected. While studies have shown ascending testes accounting for a proportion of such discrepancy, the aetiology of this ascent remains controversial. In this study, intra-operative findings of patients underwent orchidopexy for ascending testes are evaluated to infer aetiology.
Patients with confirmed ascending testes from a single paediatric surgery unit over a four-year period from June 2015 till June 2019 were included in this observational study. During orchidopexy procedure, intra-operative findings in terms of gubernacular attachment, and the degree of epididymal attachment to the upper pole of the testicle were primarily evaluated. Secondary findings including the presence and length of patent processus vaginalis (PPV), and the presence of any long looping vas or hydatid of morgangi were also noted.
Eighty-three children (median age = 79 months [range 38-149]) were included in this study. Two boys had bilateral ascending testes leading to a total of 85 orchidopexy cases performed. All patients were found to have a gubernacular attachment proximal to the junction between the upper lateral wall of scrotum and the medial part of the thigh. PPV was present in all cases, with its length measured from the deep inguinal ring after retracting the conjoint tendon ranging from 4 to 15 mm 84 cases (98.8%) demonstrated complete or partial separation between the head of epididymis and the upper pole of the testicle. Hydatid of morgagni was present in 82 cases (96.4%), and none of the operated testicles demonstrated looping vas.
The varying degrees of PPV length demonstrated during orchiodpexy for ascending testes in this study casts a doubt on the role of processus vaginalis in such ascent. Also, there is considerably a wide-range of reported incidence (13-78%) in literature for PPV in ascending testes. In this study, intra-operative findings demonstrated an abnormal gubernaculum attachment in all ascending testes in keeping with previous reports, and support the hypothesis that ascending testis has always been undescended, yet acquired more apparent undescended position with child age and growth.
Patients with ascending testes seem to share similar intra-operative findings with patients who have true undescended testes. The universal abnormal attachment of the gubernaculum and the omnipresent testicular-epididymal fusion anomalies may indicate that ascending testis is a congenital predetermined condition, and that these testes have always been congenitally undescended, yet obtained a more noticeable position with the child growth.
约0.8%的男孩在1岁时存在隐睾。然而，总体睾丸固定术的发生率是预期的2.5倍。虽然研究表明睾丸上升占这种差异的一定比例，但这种上升的病因仍存在争议。在本研究中，对因睾丸上升而接受睾丸固定术的患者的术中发现进行评估，以推断病因。
本观察性研究纳入了2015年6月至2019年6月期间来自单一儿科手术单元的确诊为睾丸上升的患者。在睾丸固定术过程中，主要评估精索附着情况以及附睾与睾丸上极的附着程度等术中发现。还记录了包括鞘状突未闭（PPV）的存在及长度，以及是否存在任何长襻状输精管或 Morgagni 囊肿等次要发现。
本研究纳入了83名儿童（中位年龄 = 79个月[范围38 - 149]）。两名男孩为双侧睾丸上升，共进行了85例睾丸固定术。所有患者的精索附着均位于阴囊上外侧壁与大腿内侧交界处的近端。所有病例均存在PPV，在牵开联合腱后从腹股沟深环测量其长度，84例（98.8%）显示附睾头与睾丸上极之间存在完全或部分分离。82例（96.4%）存在 Morgagni 囊肿，且所有手术的睾丸均未显示有襻状输精管。
本研究中在睾丸上升的睾丸固定术中所显示的不同程度的PPV长度，对鞘状突在这种上升中的作用提出了质疑。此外，文献中报道的睾丸上升患者中PPV的发生率范围相当广泛（13 - 78%）。在本研究中，术中发现所有上升的睾丸均存在异常的精索附着，这与先前的报道一致，并支持这样的假说，即上升的睾丸一直是未降的，但随着儿童年龄和生长而获得了更明显的未降位置。
睾丸上升的患者似乎与真正隐睾的患者具有相似的术中发现。精索普遍的异常附着以及普遍存在的睾丸 - 附睾融合异常可能表明上升的睾丸是一种先天性预先确定的情况，并且这些睾丸一直是先天性未降的，但随着儿童生长而获得了更明显的位置。
