Department of Urology, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kyoto City, Kyoto, 602-8566, Japan.
J Med Ultrason (2001). 2023 Oct;50(4):493-499. doi: 10.1007/s10396-023-01329-4. Epub 2023 Jun 12.
Children with undescended testes (UDTs) undergoing orchiopexy at a later age reportedly experience more negative effects on post-orchiopexy testicular volume (TV). This study aimed to investigate the effect of orchiopexy according to the age at operation.
We included 93 patients (127 testes) who underwent orchiopexy between 2008 and 2020. According to their age at orchiopexy, they were divided into Group 1 (< 24 months; n = 36, median follow-up: 17 [14-39] months) and Group 2 (≥ 24 months; n = 57, median follow-up: 16 [13-34] months). TV was measured with ultrasonography preoperatively and postoperatively. In unilateral UDTs, the testicular volume rates (TVR) were calculated as diseased-side TV/intact-side TV × 100%. A TVR < 50% indicated preoperative testicular atrophy (pre-op TA), whereas volume loss ≥ 50% from baseline indicated postoperative testicular atrophy (post-op TA).
Only seven patients experienced pre-op TA. The TV of these 14 atrophic testes improved after orchiopexy (TVR: 100% (7/7) in Group 1 and 85% (6/7) in Group 2). Furthermore, the median TVR significantly improved after orchiectomy, from 27 to 58% (p < 0.01) and from 32 to 61% in Groups 1 and 2 (p < 0.05), respectively. Post-op TA was found in four testes (8%) in Group 1 and three testes (4%) in Group 2. Multivariate analysis showed that only preoperative testicular location predicted post-op TA.
Post-orchiopexy TA may occur regardless of the patient's age at orchiopexy, and orchiopexy is recommended irrespective of age at diagnosis.
据报道，接受隐睾固定术（orchiopexy）的年龄较大的儿童术后睾丸体积（testicular volume，TV）下降的负面影响更大。本研究旨在探讨根据手术年龄对隐睾固定术的影响。
我们纳入了 2008 年至 2020 年期间接受隐睾固定术的 93 名患者（127 个睾丸）。根据手术年龄，他们分为 1 组（<24 个月；n=36，中位随访时间：17 [14-39] 个月）和 2 组（≥24 个月；n=57，中位随访时间：16 [13-34] 个月）。术前和术后均通过超声测量 TV。在单侧隐睾中，计算睾丸体积率（testicular volume rate，TVR）为患侧睾丸体积/健侧睾丸体积×100%。TVR<50%表示术前睾丸萎缩（pre-operative testicular atrophy，pre-op TA），而与基线相比体积损失≥50%表示术后睾丸萎缩（post-operative testicular atrophy，post-op TA）。
仅有 7 例患者术前存在 pre-op TA。这些 14 个萎缩睾丸在隐睾固定术后的 TV 得到了改善（1 组的 TVR 为 100%（7/7），2 组为 85%（6/7））。此外，睾丸切除术（orchiectomy）后，中位 TVR 分别从 27%显著改善至 58%（p<0.01）和从 32%改善至 61%，1 组和 2 组分别改善（p<0.05）。1 组中 4 个睾丸（8%）和 2 组中 3 个睾丸（4%）发现存在 post-op TA。多变量分析表明，只有术前睾丸位置预测了 post-op TA。
无论隐睾固定术的年龄如何，术后都可能发生睾丸萎缩，且无论诊断年龄如何，都建议进行隐睾固定术。
