Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt.
Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt.
J Pediatr Urol. 2021 Aug;17(4):515.e1-515.e8. doi: 10.1016/j.jpurol.2021.02.014. Epub 2021 Feb 20.
Scrotal hypoplasia or agenesis may posses difficulty during orchidopexy or end with social anxiety around excessively small scrotal size when compared to peers, and where there may be concerns regarding the future sexual life.
Any conservative modality applicable to ameliorate scrotal underdevelopment partially or completely will be useful either solely or before reconstructive surgery.
Seventeen child (3-8 years) were diagnosed with bilateral scrotal hypoplasia (SH) in 5 unilateral in 7, bilateral scrotal agenesis (SA) diagnosed in 4 cases, and unilateral in one. Testicles are either undescended, ectopic, or normal. All cases managed by Testogel 1% topical testosterone for 4 weeks. Clinical assessment by measurements of the scrotal skin surface area (scrotal length multiplied by width) and scrotal corrugations counting. Inguinal and renal ultrasound done for all cases and karyotyping for cases of agenesis and cases with bilateral undescended testicles. Total and free testosterone, LH, FSH and AMH hormones were assisted before treatment, weekly and one week after therapy. Data analyzed and evaluated, difference of means used to test for statistically significant differences between scores of scrotal development.
Free and total testosterone elevated in the 1st week of treatment, but restored to normal or higher levels in 60% of cases at the 2nd week. Satisfactory response (Increasing numbers of scrotal rugae or scrotal surface area by 30-50% above the pretreatment status) obtained in 85% and 60% of unilateral and bilateral SH, but only a partial response (10-20% increase) was gained in 40% of cases with agenesis. No major adverse effect was appreciated.
Response of some cases of SH to topical testosterone indicates presence of remnants of labioscrotal folds with testosterone receptors (Bell et al., 1971) [1]. Testosterone replacement therapy can improve the signs and well-being of a hypogonadal male by restoring serum testosterone concentrations to physiologic levels. In this study the mean average testosterone concentration one week after application of testogel was 13.47 ± 2.45 and 12.12 ± 2.5 within 2nd, 4th week, and after cessation of treatment. Anti-Mullerian hormone is significantly low in 12 cases; mainly in cases of SA (P-value <0.001).
Short term topical testosterone proved to be effective in a considerable percentage of cases of either bilateral or unilateral scrotal hypoplasia; with a subsequent increase in scrotal surface area and number of rugae, it may substitutes the indication for surgical reconstruction. Long term follow up is a limitation of this study.
与同龄人相比，阴囊发育不良或缺失可能会导致在进行睾丸固定术时出现困难，或者由于阴囊过小而导致社交焦虑，并且可能会对未来的性生活产生担忧。
任何适用于改善部分或完全阴囊发育不良的保守治疗方法都将是有用的，无论是单独使用还是在重建手术之前使用。
17 名儿童（3-8 岁）被诊断为双侧阴囊发育不良（SH），5 名单侧，7 名双侧阴囊缺失（SA），1 名单侧。睾丸要么未下降，要么异位，要么正常。所有病例均接受 1%Testogel 局部睾酮治疗 4 周。通过测量阴囊皮肤表面积（阴囊长度乘以宽度）和阴囊皱襞计数进行临床评估。所有病例均进行腹股沟和肾脏超声检查，并对缺失和双侧未下降睾丸的病例进行核型分析。在治疗前、每周和治疗后一周检查总睾酮、游离睾酮、LH、FSH 和 AMH 激素。分析和评估数据，使用均值差异检验来测试阴囊发育评分的统计学差异。
游离睾酮和总睾酮在治疗第 1 周升高，但在第 2 周恢复正常或高于正常水平。85%和 60%的单侧和双侧 SH 获得满意的反应（治疗后阴囊皱襞或阴囊表面积比治疗前增加 30-50%），但 40%的缺失病例仅获得部分反应（增加 10-20%）。未观察到严重不良反应。
一些 SH 病例对局部睾酮的反应表明存在带有睾酮受体的阴唇阴囊褶皱（Bell 等人，1971 年）[1]。睾酮替代治疗通过将血清睾酮浓度恢复到生理水平，可以改善低促性腺激素男性的体征和健康状况。在这项研究中，应用 Testogel 后第 1 周和第 2 周的平均平均睾酮浓度分别为 13.47±2.45 和 12.12±2.5，第 4 周和停止治疗后。12 例抗苗勒管激素明显降低，主要在缺失病例中（P 值<0.001）。
短期局部睾酮治疗在双侧或单侧阴囊发育不良的相当一部分病例中证明是有效的；随着阴囊表面积和皱襞数量的增加，它可能替代手术重建的指征。长期随访是这项研究的一个局限性。
