Boehm Katharina, Fischer Nikita Dhruva, Qwaider Mohammad, Haferkamp Axel, Schröder Annette
Department of Urology, University Medical Center, Carl-Gustav-Carus University, Dresden.
Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
J Pediatr Urol. 2023 Apr;19(2):214.e1-214.e6. doi: 10.1016/j.jpurol.2022.11.006. Epub 2022 Nov 13.
The objective of our study is to examine the impact of monorchism on contralateral testicular size in children with non-palpable testis (NPT). Enhanced contralateral testicular volume or longitudinal diameter (length) serves as a predictor of monorchism. In the present study, we assessed the ability of ultrasound measured enlarged contralateral testicular length for predicting monorchism (and hence a testicular nubbin) in children with NPT. Furthermore, we evaluated the general prevalence of viable versus non-viable testes in patients referred to our institution with unilateral undescended testis between 2005 and 2020.
We analysed the records of 54 patients who underwent diagnostic laparoscopy for NPT between 2005 and 2020 in a European tertiary care centre. Testicular lengths (longitudinal diameter) and testicular volume of the contralateral testis, as well as surgeon (surgeon 1 vs surgeon 2 vs others) and age at surgery (months) were assessed and stratified according to intraoperative findings (presence or absence of a testicular nubbin). Testicular length and volume were evaluated by ultrasound examination in office prior to surgery. Chi-square and t-test for descriptive analyses as well as uni- and multivariable logistic regression analyses were performed using R Version 3.1.0 (R Project for Statistical Computing, www.R-project.org).
A total of 15 children presented with viable testes and 39 patients with testicular nubbin. Mean age was 20.5 months in the overall cohort and 22.6 vs 19.7 months in children with viable testis vs testicular nubbin (p = 0.4). In patients with presence of a testicular nubbin, the contralateral testis was larger (median length 17 mm (16-19.2)) as compared to patients with a viable testis (median length 15 mm (14-17), p = 0.001). Similarly, contralateral testicular volume was lower in patients with a present viable testis (0.6 ccm vs 0.8 ccm; p < 0-001). This effect remained statistically significant when logistic regression analyses were adjusted for age and weight at surgery, year of surgery, surgeon, and laterality. OR (odds ratio) for presence of a testicular nubbin was 1.6 (per mm) [95% CI (confidence interval) 1.13-2.17; p = 0.007].
Patients with preoperative increased length and volume of the contralateral testis in the ultrasound examination are at significantly higher risk of monorchism than their counterparts with lower testicular length. This should be emphasized during counselling of the parents prior to surgery. In our experience parents cope more easily with the diagnosis of monorchism, once this has already been discussed and explained thoroughly prior to surgery.
我们研究的目的是探讨单侧隐睾对不可触及睾丸（NPT）患儿对侧睾丸大小的影响。对侧睾丸体积增大或纵径（长度）增加是单侧隐睾的一个预测指标。在本研究中，我们评估了超声测量的对侧睾丸增大长度对预测NPT患儿单侧隐睾（进而预测睾丸残端）的能力。此外，我们评估了2005年至2020年间转诊至我院的单侧隐睾患者中，存活睾丸与非存活睾丸的总体患病率。
我们分析了2005年至2020年间在一家欧洲三级医疗中心因NPT接受诊断性腹腔镜检查的54例患者的记录。评估对侧睾丸的长度（纵径）和体积，以及手术医生（医生1、医生2或其他医生）和手术年龄（月龄），并根据术中发现（有无睾丸残端）进行分层。术前在门诊通过超声检查评估睾丸长度和体积。使用R 3.1.0版本（R统计计算项目，www.R-project.org）进行卡方检验和t检验用于描述性分析，以及单变量和多变量逻辑回归分析。
共有15例患儿睾丸存活，39例患者有睾丸残端。整个队列的平均年龄为20.5个月，睾丸存活患儿与有睾丸残端患儿的平均年龄分别为22.6个月和19.7个月（p = 0.4）。有睾丸残端的患者，其对侧睾丸比睾丸存活的患者更大（中位长度17mm（16 - 19.2））（睾丸存活患者中位长度15mm（14 - 17），p = 0.001）。同样，睾丸存活的患者对侧睾丸体积较低（0.6立方厘米对0.8立方厘米；p < 0.001）。当对手术年龄和体重、手术年份、手术医生和侧别进行逻辑回归分析调整后，这种效应仍具有统计学意义。有睾丸残端的比值比（OR）为1.6（每毫米）[95%置信区间（CI）1.13 - 2.17；p = 0.007]。
超声检查显示术前对侧睾丸长度和体积增加的患者，单侧隐睾的风险显著高于对侧睾丸长度较短的患者。在术前向家长咨询时应强调这一点。根据我们的经验，一旦在手术前已经充分讨论和解释，家长更容易接受单侧隐睾的诊断。
