Aubert Ophelia, Zaidan Hind, Garnier Hanna, Saxena Amulya K, Cascio Salvatore
Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany.
Department of Pediatric Surgery, King Hamad University Hospital, Busaiteen, Bahrain.
Eur J Pediatr Surg. 2024 Oct;34(5):452-457. doi: 10.1055/s-0043-1777338. Epub 2023 Nov 28.
The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT).
An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA).
Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role.
Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.
本研究的目的是评估在隐睾（UDT）管理中对欧洲泌尿外科学会（EAU）/欧洲小儿泌尿外科学会（ESPU）2016年指南的遵循情况。
2023年向欧洲小儿外科医生协会（EUPSA）成员发送了一份在线问卷。
在157名成员中，分别有46%和44%的人在12个月和18个月之前进行睾丸固定术。总体而言，92%的人建议对回缩性睾丸进行保守管理，58%的人提供密切随访。对于不可触及的睾丸，78%的人倾向于腹腔镜检查，18%的人倾向于超声检查。如果在腹腔镜检查中发现一个可窥视的睾丸，76%的人进行一期睾丸固定术。对于高位睾丸，更倾向于采用分期手术（84%）。盲端精索血管的处理方法各异，大多数人选择结束手术，其次是探查腹股沟管并切除睾丸残端，可选择固定对侧睾丸。只有少数人建议采用激素疗法来提高双侧UDT患者的生育潜力。大多数人（59%）讨论了青春期后男孩UDT患者的睾丸切除问题。此外，77%的人宣称遵循EAU/ESPU指南。未了解指南是最常被提及的不遵循的原因。国际指南对临床实践的影响最大；然而，个人经验和机构实践似乎也起着重要作用。
EUPSA成员大多遵循EAU/ESPU指南的建议；然而，个人和机构实践会影响决策。双侧UDT的激素治疗、消失睾丸的处理以及青春期后男孩的UDT管理有待改进。
