Edinsel İnmemiş Testis: Hemen Cerrahi mi? Takip mi?

Öz

İnmemiş testis erkek çocuklarda sık görülen bir ürolojik patolojidir. Muayene bulgularına göre palpabl, non-palpabl, ortaya çıkış zamanına göre konjenital, edinsel gibi kategorilere ayrılmaktadır. Konjenital inmemiş testiste 6 aydan itibaren en geç 18 aya kadar orşiopeksi yapılması önerilmektedir. Edinsel inmemiş testisin hem ortaya çıkış zamanı belirsizdir hem de büyük bir kısmı spontan olarak kendiliğinden skrotuma inebilmektedir. Bu sebeple edinsel inmemiş testis farkedildiğinde hemen orşiopeksi mi yapılmalı yoksa takip bir seçenek mi sorusu önem kazanmaktadır. Bu çalışmamızda bu soruya cevap bulmak için güncel literatür eşliğinde edinsel inmemiş testis ile ilgili yapılmış çalışmaları incelemeyi amaçladık.

Anahtar Kelimeler

• İnmemiş testis
• Edinsel inmemiş testis
• Orşiopeksi

Acquired Undescended Testes: Immediate Surgery or Wait and See?

Abstract

Undescended testes are a common urological pathology in boys. This condition is categorized according to the examination findings, palpable or non-palpable, and according to the time of diagnosis, congenital or acquired. Orchiopexy is recommended for congenital undescended testes as early as 6 months and up to 18 months at the latest. It is not certain when cases of acquired undescended testes first occur, and most will descend spontaneously into the scrotum. For this reason, when an acquired undescended testis is noticed, the question of whether orchiopexy should be performed immediately or if follow-up is an option becomes important. In this study, we aimed to examine studies on acquired undescended testes in light of the current literature in order to find an answer to this question.

Keywords

• Undescended testis
• acquired undescended testis
• orchiopexy

Kaynakça

1. 1. Sijstermans K, Hack WWM, Meijer RW, et al. The frequency of undescended testis from birth to adulthood: a review. Int J Androl 2008; 31: 1–11.
2. 2. Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol 2004; 171: 849–851.
3. 3. Trussell JC, Lee PA. The relationship of cryptorchidism to fertility. Curr Urol Rep 2004; 5: 142–148.
4. 4. Hadziselimovic F, Herzog B. The importance of both an early orchidopexy and germ cell maturation for fertility. Lancet 2001; 358: 1156–1157.
5. 5. Lee PA. Fertility after cryptorchidism: epidemiology and other outcome studies. Urology 2005; 66: 427–431.
6. 6. Swerdlow AJ, Higgins CD, Pike MC. Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ 1997; 314: 1507–1511.
7. 7. Dieckmann K-P, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol 2004; 22: 2–14.
8. 8. Pettersson A, Richiardi L, Nordenskjold A, et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007; 356: 1835–1841.

9. 9. Bonney T, Hutson J, Southwell B, et al. Update on congenital versus acquired undescended testes: incidence, diagnosis and management. ANZ J Surg 2008; 78: 1010–1013.
10. 10. Virtanen HE, Toppari J. Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 2008; 14: 49–58.
11. 11. Gracia J, Navarro E, Guirado F, et al. Spontaneous ascent of the testis. Br J Urol 1997; 79: 113–115.
12. 12. Hadziselimović F, Hecker E, Herzog B. The value of testicular biopsy in cryptorchidism. Urol Res 1984; 12: 171–174.
13. 13. Hutson J, Goh D. Can undescended testes be acquired? The Lancet 1993; 341: 504.
14. 14. Wohlfahrt-Veje C, Boisen KA, Boas M, et al. Acquired cryptorchidism is frequent in infancy and childhood. Int J Androl 2009; 32: 423–428.
15. 15. Acerini CL, Miles HL, Dunger DB, et al. The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort. Arch Dis Child 2009; 94: 868–872.
16. 16. Eijsbouts SW, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ. Further evidence for spontaneous descent of acquired undescended testes. J Urol 2007; 178: 1726–1729.
17. 17. Sijstermans K, Hack WWM, van der Voort-Doedens LM, et al. Puberty stage and spontaneous descent of acquired undescended testis: implications for therapy? Int J Androl 2006; 29: 597–602.
18. 18. Barthold JS, González R. The epidemiology of congenital cryptorchidism, testicular ascent and orchiopexy. J Urol 2003; 170: 2396–2401.
19. 19. Atwell JD. Ascent of the testis: fact or fiction. Br J Urol 1985; 57: 474–477.
20. 20. Clarnette TD, Hutson JM. Is the ascending testis actually ‘stationary’? Normal elongation of the spermatic cord is prevented by a fibrous remnant of the processus vaginalis. Pediatr Surg Int 1997; 12: 155–157.
21. 21. Hutson JM, Thorup J. Evaluation and management of the infant with cryptorchidism. Curr Opin Pediatr 2015; 27: 520–524.
22. 22. van Brakel J, de Muinck Keizer-Schrama SMPF, van Casteren NJ, et al. Scrotal ultrasound findings in previously congenital and acquired unilateral undescended testes and their contralateral normally descended testis. Andrology 2015; 3: 888–894.
23. 23. van Brakel J, de Muinck Keizer-Schrama SMPF, Hazebroek FWJ, et al. INSL3 and AMH in patients with previously congenital or acquired undescended testes. J Pediatr Surg 2017; 52: 1327–1331.
24. 24. Haid B, Silay MS, Radford A, et al. Late ascended testes: is non-orthotopic gubernacular insertion a confirmation of an alternative embryological etiology? J Pediatr Urol 2019; 15: 71.e1-71.e6.
25. 25. Barthold J, Hagerty J. Etiology, diagnosis, and management of the undescended testis. Campbell-Walsh Urology 2016; 4: 3430–52.
26. 26. Favorito LA, Anderson KM, Costa SF, et al. Structural study of the cremaster muscle in patients with retractile testis. J Pediatr Surg 2018; 53: 780–783.
27. 27. Agarwal PK, Diaz M, Elder JS. Retractile testis--is it really a normal variant? J Urol 2006; 175: 1496–1499.
28. 28. Kolon TF, Herndon CA, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. The Journal of urology 2014; 192: 337–345.
29. 29. La Scala GC, Ein SH. Retractile testes: an outcome analysis on 150 patients. J Pediatr Surg 2004; 39: 1014–1017.
30. 30. Stec AA, Thomas JC, DeMarco RT, et al. Incidence of testicular ascent in boys with retractile testes. J Urol 2007; 178: 1722–1724; discussion 1724-1725.
31. 31. Tasian GE, Zaid H, Cabana MD, et al. Proximal hypospadias and risk of acquired cryptorchidism. J Urol 2010; 184: 715–720.
32. 32. Promm M, Schröder A, Neissner C, et al. Acquired cryptorchidism: More harm than thought? J Pediatr Urol 2016; 12: 236.e1–6.
33. 33. Radmayr C, Bogaert G, Dogan H, et al. EAU guidelines on paediatric urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona. EAU, 2019.
34. 34. Dinkelbach L, Lehnick D, Shavit S, et al. Acquired undescended testis: When does the ascent occur? J Pediatr Surg 2021; 56: 2027–2031.
35. 35. Hack WWM, Sijstermans K, van Dijk J, et al. Prevalence of acquired undescended testis in 6-year, 9-year and 13-year-old Dutch schoolboys. Arch Dis Child 2007; 92: 17–20.
36. 36. Ritzén EM, Bergh A, Bjerknes R, et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007; 96: 638–643.
37. 37. Cortes D, Thorup JM, Visfeldt J. Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1,335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res 2001; 55: 21–27.
38. 38. Hutson JM. Undescended testis: the underlying mechanisms and the effects on germ cells that cause infertility and cancer. Journal of pediatric surgery 2013; 48: 903–908.
39. 39. van der Plas EM, van Brakel J, Meij-de Vries A, et al. Acquired undescended testes and fertility potential: is orchiopexy at diagnosis better than awaiting spontaneous descent? Andrology 2015; 3: 677–684.
40. 40. van der Plas EM, Zijp GW, Froeling FMJA, et al. Long-term testicular volume after orchiopexy at diagnosis of acquired undescended testis. J Urol 2013; 190: 257–262.
41. 41. Meij-de Vries A, Goede J, van der Voort L, et al. Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy. J Pediatr Surg 2012; 47: 727–735.
42. 42. van Brakel J, Kranse R, de Muinck Keizer-Schrama SMPF, et al. Fertility potential in a cohort of 65 men with previously acquired undescended testes. J Pediatr Surg 2014; 49: 599–605.
43. 43. Boehme P, Degener S, Wirth S, et al. Multicenter Analysis of Acquired Undescended Testis and Its Impact on the Timing of Orchidopexy. J Pediatr 2020; 223: 170-177.e3.
44. 44. Hack WWM, Goede J, van der Voort-Doedens LM, et al. Acquired undescended testis: putting the pieces together. Int J Androl 2012; 35: 41–45.
45. 45. van Brakel J, Dohle GR, de Muinck Keizer-Schrama SMPF, et al. Different surgical findings in congenital and acquired undescended testes. BJU Int 2012; 110: E387-391.
46. 46. Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976; 8: 33–34.
47. 47. Jordan GH, Winslow BH. Laparoscopic single stage and staged orchiopexy. J Urol 1994; 152: 1249–1252.