Press Benjamin H, Olawoyin Olamide, Arlen Angela M, Silva Cicero T, Weiss Robert M
Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA.
Department of Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA.
J Pediatr Urol. 2024 Feb;20(1):106-111. doi: 10.1016/j.jpurol.2023.08.032. Epub 2023 Sep 9.
AUA Guidelines do not support the routine use of ultrasound (US) in evaluation of boys with an undescended testicle (UDT) prior to urology referral. Multiple studies have demonstrated that real time US is inferior to a physical examination by a pediatric urologist in detecting an UDT. However, improved US technology, which now permits detection of the non-palpable testis located just proximal to the internal ring, may aid in guiding the surgical approach to the non-palpable testis. We evaluated US findings of boys deemed to have a non-palpable UDT and compared them to surgical findings.
To assess the role of pre-operative ultrasonography in guiding surgical management in boys deemed to have a non-palpable testis by a pediatric urologist.
US of boys with a non-palpable UDT, as reported by a pediatric urologist on physical exam, during a 3-year period, were reviewed. All US were performed jointly by a technician and pediatric radiologist. Patient demographics, laterality, and intra-operative findings were assessed.
Thirty-one boys with a non-palpable testicle on physical exam underwent scrotal/inguinal/pelvis US at a median age of 7.5 months (IQR 2.5-12.3 months). Two patients had bilateral non-palpable testicles, 21 had a non-palpable left sided testicle and 8 had a non-palpable right sided testicle. Of the 33 non-palpable testes, 5 (15.2%) were identified in the inguinal canal. Sixteen (48.5%) were visualized in the lower pelvis just proximal to the internal ring and graded as intra-abdominal. Four (12.1%) nubbins or very atrophic testes were identified in the inguinal region or scrotum and 5 (15.2%) testes were not identified on US. Three (9.1%) testes were observed to be mobile between the lower pelvis just proximal to the internal ring and the inguinal canal. Of the 8 patients with testes that were identified in the inguinal canal, or mobile between the lower pelvis and inguinal canal, 7 avoided a diagnostic laparoscopy and underwent an inguinal orchiopexy. Of the 16 testicles located in the lower pelvis proximal to the internal ring, only 2 underwent laparoscopy/laparoscopic orchiopexy.
In cases of a non-palpable testicle following a physical examination by a urologist, an ultrasound can impact the operative plan, and allow for patients to avoid laparoscopy. In our cohort, 87.5% of non-palpable testes avoided laparoscopic surgery after ultrasound identification of a viable testis.
US in the evaluation of cryptorchidism can guide surgical management in select cases in which a testis is non-palpable following careful examination by a urologist.
美国泌尿外科学会（AUA）指南不支持在将患有隐睾症（UDT）的男孩转诊至泌尿外科之前，常规使用超声（US）进行评估。多项研究表明，在检测隐睾症方面，实时超声不如小儿泌尿外科医生的体格检查。然而，如今改进后的超声技术能够检测出位于内环口近端的不可触及睾丸，这可能有助于指导针对不可触及睾丸的手术方法。我们评估了被认为患有不可触及隐睾症男孩的超声检查结果，并将其与手术结果进行比较。
评估术前超声检查在指导小儿泌尿外科医生认为患有不可触及睾丸男孩的手术管理中的作用。
回顾了小儿泌尿外科医生在体格检查中报告的、在3年期间患有不可触及隐睾症男孩的超声检查情况。所有超声检查均由技术人员和小儿放射科医生共同完成。评估了患者的人口统计学特征、患侧以及术中发现。
31名体格检查时睾丸不可触及的男孩接受了阴囊/腹股沟/盆腔超声检查，中位年龄为7.5个月（四分位间距2.5 - 12.3个月）。2例患者双侧睾丸不可触及，21例左侧睾丸不可触及，8例右侧睾丸不可触及。在33个不可触及的睾丸中，5个（15.2%）在腹股沟管内被发现。16个（48.5%）在紧邻内环口的下盆腔被观察到，并被分级为腹内型。4个（12.1%）小结节或极度萎缩的睾丸在腹股沟区或阴囊内被发现，5个（15.2%）睾丸在超声检查中未被发现。3个（9.1%）睾丸被观察到在紧邻内环口的下盆腔和腹股沟管之间可移动。在8例睾丸在腹股沟管内被发现或在下盆腔和腹股沟管之间可移动的患者中，7例避免了诊断性腹腔镜检查，接受了腹股沟睾丸固定术。在紧邻内环口的下盆腔中的16个睾丸中，只有2个接受了腹腔镜检查/腹腔镜睾丸固定术。
在泌尿外科医生体格检查后睾丸不可触及的病例中，超声检查可影响手术方案，并使患者避免进行腹腔镜检查。在我们的队列中，在超声检查发现有活力的睾丸后，87.5%的不可触及睾丸避免了腹腔镜手术。
在评估隐睾症时，超声检查可在某些病例中指导手术管理，即在泌尿外科医生仔细检查后睾丸不可触及的情况下。
