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Journal of Korean Medical Science Mar 2022It is quite difficult to distinguish retractile testis from gliding testis, which requires different treatment planning in the clinic setting. We evaluated practice...
BACKGROUND
It is quite difficult to distinguish retractile testis from gliding testis, which requires different treatment planning in the clinic setting. We evaluated practice patterns of urologists in Korea regarding the diagnosis and management of retractile and gliding testes.
METHODS
We mailed or e-mailed self-completion questionnaires consisting of 20 items to 106 urologists practicing in Korean hospitals concerning the diagnosis and treatment of cryptorchidism. We collected and analyzed the responses statistically.
RESULTS
Responses were received from 62 urologists. The response rate was 58.5%. Thirty-seven urologists (59.7%) actually felt they had difficulty in distinguishing retractile testis from gliding testis in the clinic setting. This rate was higher for non-pediatric urologists (78.1%) than for pediatric urologists (40.0%) ( = 0.006). In cases of infant retractile testis, only five urologists (8.1%) said that they would perform orchiopexy immediately, with 54 (87.1%) urologists saying they would do follow-up. In cases of preschool-age children with retractile testis, 17 urologists (27.4%) said that they would perform orchiopexy immediately with 41 (66.1%) urologists saying they would do follow-up. In cases of infant gliding testis, 37 urologists (59.7%) said that they would perform orchiopexy immediately with 24 (38.7%) urologists saying they would do a follow-up.
CONCLUSION
More than half (59.7%) of Korean urologists revealed it challenging to distinguish retractile testis and gliding testis in the clinical setting. The more it was difficult to diagnose retractile testis with certainty, the more frequent surgical correction was chosen for treatment. Therefore, it is essential to prevent unnecessary surgical treatment by establishing a practical guideline.
Topics: Asian People; Child; Child, Preschool; Comprehension; Cryptorchidism; Humans; Infant; Male; Urologists
PubMed: 35347906
DOI: 10.3346/jkms.2022.37.e98 -
Canadian Family Physician Medecin de... Jun 2017To review the differences between normal, retractile, ectopic, ascended, and undescended testes and to describe the optimal way to perform a testicular examination to... (Review)
Review
OBJECTIVE
To review the differences between normal, retractile, ectopic, ascended, and undescended testes and to describe the optimal way to perform a testicular examination to distinguish one from the other, as well as to demonstrate that ultrasound imaging is not necessary and to clarify when to consider specialist referral.
SOURCES OF INFORMATION
This paper is based on selected findings from a MEDLINE search on undescended testes and orchiopexy referrals, and on our experience at the Urology Clinic at the Children's Hospital of Eastern Ontario in Ottawa, including review of referrals to our clinic for undescended testes and the resultant findings of normal variants versus surgical cases. The MeSH headings used in our MEDLINE search included and .
MAIN MESSAGE
An is defined as the true absence of one testis (or both testes) from normal scrotal position. Ectopic and ascended testes will likewise be absent from the scrotum, the latter having been present at one point in development. Differentiating among testicular examination findings is important, as descended and retractile testes are managed conservatively, while prompt surgical intervention should be offered for ascended, ectopic, and undescended testes. Uncertainty surrounding the diagnosis of an undescended testis causes anxiety, might lead to unwarranted imaging, and might increase the wait list for specialty assessment. For this reason, avoidance of ultrasound in the evaluation of undescended testes was included in the recent Choosing Wisely Canada campaign. We seek to clarify the physical examination findings in the evaluation of possible undescended testes, the suggested referral parameters, and the subsequent management.
CONCLUSION
Undescended testes and their variants are common. As decision for referral is based on the primary care physician's physical examination findings, we clarify distinguishing between normal and abnormal findings on testicular examination to aid in appropriate referral for subspecialist evaluation. Consultation, if needed, should be sought at 6 months' corrected gestational age, or at detection if later than 6 months, without delay for ultrasound imaging, as surgical management is recommended for those patients with undescended, ectopic, or ascended testes.
Topics: Child; Child, Preschool; Cryptorchidism; Humans; Infant; Male; Orchitis; Physical Examination; Primary Health Care; Referral and Consultation; Scrotum; Testis; Ultrasonography
PubMed: 28615391
DOI: No ID Found -
International Braz J Urol : Official... 2016To assess the incidence of anatomical anomalies in patients with retractile testis.
OBJECTIVES
To assess the incidence of anatomical anomalies in patients with retractile testis.
MATERIALS AND METHODS
We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p<0.05).
RESULTS
The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116).
CONCLUSIONS
Retractile testis is not a normal variant with a significant risk of patent processos vaginalis and epididymal anomalies.
Topics: Child; Child, Preschool; Cryptorchidism; Epididymis; Fetus; Gestational Age; Humans; Infant; Male; Prospective Studies; Testicular Hydrocele; Testis
PubMed: 27564294
DOI: 10.1590/S1677-5538.IBJU.2015.0538 -
Advances in Urology 2023Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study...
OBJECTIVES
Ascending testis or acquired undescended testis develops in approximately 30% of cases of retractile testis, and orchiopexy is recommended for these cases. This study aimed at assessing the intraoperative anatomical findings of ascending testis and acquired undescended testis in search of better management for retractile testis.
METHODS
We retrospectively collected data of patients with confirmed diagnosis of retractile testis between February 2012 and November 2021. Orchiopexy was performed for cases with ascending testis and for patients with increasing difference of right and left testicular volume. The site of gubernaculum attachment and patent processus vaginalis were evaluated during surgery.
RESULTS
A total of 119 testes in 71 patients with retractile testis were included in this study. Sixteen retractile testes in 12 patients (17%) underwent orchiopexy. The weight at birth was significantly higher, and bilateral retractile testes were significantly more common in the follow-up group than in the surgical intervention group. In the surgical intervention group, the abnormal site of gubernaculum attachment was found in 12 out of 16 testes (75%), and patent PV was found in nine out of sixteen testes (56%). Sites of gubernaculum attachment in testes with patent PV were significantly higher than in sites with closed processus vaginalis, and all testes with patent processus vaginalis had abnormal site of gubernaculum attachment.
CONCLUSION
Patients with ascending testis and acquired undescended testis have clinical features and intraoperative abnormal findings similar to a cryptorchidism. Therefore, our surgical indication for retractile testis is considered appropriate.
PubMed: 37720542
DOI: 10.1155/2023/8764631 -
Canadian Urological Association Journal... 2017Cryptorchidism is one of the most common congenital anomalies of the male genitalia, occurring in 1% of boys by the age of one year. Even though the etiology of... (Review)
Review
Cryptorchidism is one of the most common congenital anomalies of the male genitalia, occurring in 1% of boys by the age of one year. Even though the etiology of cryptorchidism is multifactorial, management has evolved with the clear recognition that hormonal treatment is not effective and surgery between 6-18 months of age leads to better testicular outcomes. Diagnostic laparoscopy is considered the standard approach for management of non-palpable testes, and can be combined with one or two-stage orchidopexy, with up to 80-90% success rates. This review discusses the natural history of retractile testicles, indications for hormonal treatment and orchidectomy, ultrasound's role as a diagnostic tool, risks of infertility and testicular cancer, and surgical techniques for inguinal and intra-abdominal testes.
PubMed: 28265313
DOI: 10.5489/cuaj.4343 -
Frontiers in Endocrinology 2024Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment... (Review)
Review
Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child's age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.
Topics: Male; Child; Humans; Cryptorchidism; Testicular Neoplasms; Fertility; Research Design
PubMed: 38495791
DOI: 10.3389/fendo.2024.1327957 -
Australian Journal of General Practice Feb 2019Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. Management in a timely fashion may reduce the risk of...
BACKGROUND
Undescended testis (UDT) is a common condition, and parents often primarily present to general practitioners. Management in a timely fashion may reduce the risk of malignancy and infertility
OBJECTIVES
The aim of this article is to summarise the key points of assessment and management of UDT in the primary care setting. By reviewing key definitions, such as undescended, retractile, ectopic and ascending testes, we aim to provide updated information for the ongoing management of these conditions.
DISCUSSION
The exact pathophysiology of UDT is still an area of ongoing research, and there remains much controversy regarding the exact mechanisms leading to congenital and acquired UDT. Current evidence does not support the use of ultrasonography prior to referral. Hormone therapy has shown no significant benefit, and surgery remains the treatment of choice.
Topics: Cryptorchidism; Education, Medical, Continuing; General Practitioners; Humans; Male; Testis
PubMed: 31117161
DOI: 10.31128/AJGP-07-18-4633 -
Urologia Internationalis 2021The evaluation of the testicular position in newborns is important to ensure timely initiation of therapy. The aim of our study was to assess the reliability of a...
INTRODUCTION
The evaluation of the testicular position in newborns is important to ensure timely initiation of therapy. The aim of our study was to assess the reliability of a routinely performed screening examination.
PATIENTS AND METHODS
Newborns were examined by a pediatrician between 48 and 72 h after birth. Boys with suspected cryptorchidism were double-checked by a pediatric urologist within 24 h.
RESULTS
1,181/2,353 children included in the study between June 2015 and December 2017 were male. Eight hundred sixty-one boys could be included in this analysis; 5.8% (n = 50) were diagnosed with undescended testis (UDT) by the pediatrician. 30/50 boys were double-checked at the Department of Pediatric Urology. Forty percent (20/50) were lost to follow-up. In 43% (13/30), the diagnosis could be confirmed. Three former studies had shown a relevant discrepancy in the results of the diagnosis of UDT made by health care providers and urologists/pediatric surgeons. To our knowledge, this is the first study evaluating the testicular position in male newborns in such a large prospective birth cohort study by physicians with ranging expertise within 1 day.
CONCLUSION
Further treatment for UDT is based on clinical examination. Ours and previous studies can clearly show the various findings in boys suspected having UDT. Therefore, it is essential that the diagnosis is confirmed by a specialist before a therapy is initiated.
Topics: Cryptorchidism; Germany; Humans; Infant, Newborn; Male; Neonatal Screening; Observer Variation; Physical Examination; Predictive Value of Tests; Prognosis; Prospective Studies; Referral and Consultation; Reproducibility of Results; Testis
PubMed: 34237748
DOI: 10.1159/000517268 -
Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study.Canadian Urological Association Journal... 2015Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed...
INTRODUCTION
Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists.
METHODS
We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed.
RESULTS
Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes.
CONCLUSION
Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.
PubMed: 26788226
DOI: 10.5489/cuaj.3242 -
Frontiers in Endocrinology 2018Cryptorchidism is reported in 40-50% of small case series of cerebral palsy (CP) and attributed to hypothalamic-pituitary-gonadal axis abnormalities, intellectual...
BACKGROUND
Cryptorchidism is reported in 40-50% of small case series of cerebral palsy (CP) and attributed to hypothalamic-pituitary-gonadal axis abnormalities, intellectual disability (ID), or cremaster spasticity. We collected demographic and clinical data to define the frequency of cryptorchidism and clinical comorbidities in a large CP population.
METHODS
Electronic health record data were collected for all male patients ≥7 years of age seen in a large, multidisciplinary CP clinic between 2000 and 2016. Variables including age, testicular position, surgical findings, CP severity, birth history, and comorbidities were tested for association using univariable and stepwise backward logistic regression analyses.
RESULTS
Of 839 established patients, testis position was scrotal in 553, undescended in 185 (24%), retractile in 38 (5%), and undocumented in 63 cases. Cryptorchidism were diagnosed at a mean age of 5.8 years, with 20% documented as acquired, and testes were most commonly in the superficial inguinal pouch (41%) and associated with an inguinal hernia (56%). Severity was bilateral in 114/166 (69%) undescended and 24/36 (66%) retractile cases, respectively. Mean birth weight and the frequency of prematurity (55, 58, and 54%) and multiple birth (14, 13, and 9%) were not significantly different among the three groups. We observed a strong ordinal trend in the frequency of comorbidities, including quadriplegia, syndromic features/known genetic disease, intrauterine growth restriction (IUGR), death, brain malformations, seizures, gastrostomy, absent continence, ID and hearing, speech or visual impairment, with the retractile group holding the intermediate position for the majority. The stepwise multivariable analysis showed independent positive associations of cryptorchidism with quadriplegia, syndromic features/known genetic disease, hearing loss, and absent continence, and inverse associations with gestational age and multiple birth.
CONCLUSION
These data suggest that cryptorchidism is less common than previously reported in CP cases, but most strongly associated with quadriplegia. Delayed diagnosis may be related to an acquired condition or to the multiple additional functional deficits that occur in this population. Our data suggest that UDT and CP may both be components of malformation syndromes occurring in singleton births whose clinical features are more likely to include earlier delivery, IUGR, hearing loss, and/or global spasticity.
PubMed: 29713311
DOI: 10.3389/fendo.2018.00151