Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, University of Indonesia, Central Jakarta, Jakarta, 10430, Indonesia.
F1000Res. 2024 Nov 13;12:1226. doi: 10.12688/f1000research.134221.2. eCollection 2023.
Undescended testes (UDT) is a condition where one or both testes is absent in the scrotum. The general age recommendation in which the treatment should be performed is before 18 months old due to the infertility risk and malignancy in later life. In post-pubertal UDT, the current guideline recommends orchiectomy; however, the strength rating of this recommendation is weak. Therefore, this study aimed to provide a systematic review of post-pubertal UDT treatment, focusing on the malignancy risk point of view.
A systematic search was performed using PubMed, Wiley Online Library and the Cochrane Library up to 5 March 2023. Any study with either post-pubertal orchiectomy or orchidopexy in patients with UDT and reporting the testicular malignancy was included. The exclusion criteria were studies with lack of information of UDT correction time, no history of correction and the full text wasn't available. The data collected were the occurrence of testicular malignancy in post-pubertal UDT patients corrected with any method. Quality and bias assessment was assessed with Newcastle-Ottawa scale and Joanna Briggs Institute tools.
Seven articles (three case reports and four observational studies) were reviewed with a total of 42 patients who underwent post-pubertal correction of either unilateral or bilateral UDT. The correction age ranged from 13 to 34 years old, with follow-up of 48.7-252 months. Among those who developed malignancies, the most common were seminoma, teratoma and carcinoma of the testes. In addition, this study was able to propose an algorithm for post-pubertal UDT treatment strategy.
The scarce resource was the main limitation of this study. Nevertheless, this review showed that post-pubertal UDT management should be tailored individually. Several factors that should be considered include the condition of the contralateral descended testis, UDT location, serum testosterone level, patient's age, comorbidities, and interest in fertility.
隐睾症（UDT）是指睾丸未降入阴囊的一种病症。由于生育能力受损和晚年恶性肿瘤的风险，一般建议在 18 个月之前进行治疗。在青春期后 UDT 中，目前的指南建议行睾丸切除术；然而，该建议的推荐强度等级较弱。因此，本研究旨在提供一个青春期后 UDT 治疗的系统综述，重点关注恶性肿瘤风险观点。
我们使用 PubMed、Wiley Online Library 和 Cochrane Library 进行了系统检索，检索时间截至 2023 年 3 月 5 日。纳入任何在 UDT 患者中进行青春期后睾丸切除术或睾丸固定术，并报告睾丸恶性肿瘤的研究。排除标准为缺乏 UDT 矫正时间信息、无矫正史且无法获取全文的研究。收集的数据是任何方法矫正青春期后 UDT 患者的睾丸恶性肿瘤发生情况。使用纽卡斯尔-渥太华量表和 Joanna Briggs 研究所工具评估质量和偏倚。
共回顾了 7 篇文章（3 篇病例报告和 4 篇观察性研究），共 42 例患者接受了单侧或双侧 UDT 的青春期后矫正。矫正年龄为 13-34 岁，随访时间为 48.7-252 个月。在发生恶性肿瘤的患者中，最常见的是精原细胞瘤、畸胎瘤和睾丸癌。此外，本研究还提出了青春期后 UDT 治疗策略的算法。
本研究的主要局限性是资源有限。尽管如此，本综述表明，青春期后 UDT 的管理应因人而异。应考虑的因素包括对侧下降睾丸的状况、UDT 位置、血清睾酮水平、患者年龄、合并症和对生育能力的兴趣。
