An updated mortality risk analysis of the post-pubertal undescended testis

Shah, Amit G.; Feustel, Paul J.; Knuth, Jennifer; Welliver, Charles

doi:10.5489/cuaj.5296

Cited by 5 publications

(5 citation statements)

References 29 publications

(22 reference statements)

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“…Patients with ASA class 3 or above should always undergo observation. 20 Based on these studies, we propose an algorithm regarding the recommendation of post-pubertal UDT management (Figure 2). had bilateral UDT and underwent bilateral inguinal exploration and a left orchidopexy at the age of 18.…”

Section: Discussionmentioning

confidence: 99%

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

Tendi,

Raharja,

Wahyudi

et al. 2023

F1000Res

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Background: 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. On the other hand, in post-pubertal UDT, the current guideline recommends orchiectomy; however, 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. Methods: 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. Results: 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 in situ of the testes. In addition, this study was able to propose an algorithm for post-pubertal UDT treatment strategy. Conclusions: 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.

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Section: Discussionmentioning

confidence: 99%

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

Tendi,

Raharja,

Wahyudi

et al. 2023

F1000Res

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“…Chances for fertility among men presenting with abdominal bUDT are exceedingly low. Although this may prompt some to universally advocate for bilateral orchiectomy in these men, a recent review found that for healthy men > 50 years old, the risk of death from complications following orchiectomy is higher than that from a germ cell tumor 53 . For men younger than 50 with abdominal bUDT, considerations include surveillance, orchidopexy, or orchiectomy.…”

Section: Discussionmentioning

confidence: 99%

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

et al. 2021

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Objective Reports of adult orchidopexy for bilateral undescended testicles (bUDT) are sparse, and fertility outcomes are not well established. Our aim was to determine prognosis for restoration of spermatogenesis among adult men (≥18 years) undergoing orchidopexy for bUDT. Methods A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/MEDLINE and EMBASE databases through March 2020 using search terms "adult” AND “bilateral orchidopexy" OR "bilateral cryptorchidism.” Relevant referenced articles from non‐indexed journal were identified by Google Scholar search and additionally included. Results Fifty‐seven publications including adult men with uncorrected bilateral UDTs were identified. Baseline semen analysis was reported in 157 men, all of whom demonstrated azoospermia. Testosterone values were reported in 82 cases and were normal in 89%. Germ cells could not be identified in 72.6% of histologic specimens from 62 testicles. Abdominal testicles more frequently lacked germ cells (90%, p = 0.038) on univariate analysis. Eleven cases identified ejaculated spermatozoa following adult bilateral orchidopexy (8 publications). Sperm extraction (TESE) during orchidopexy or orchiectomy was reported in 13 men without success. Delayed TESE (median 10 months) was performed in 22 persistently azoospermic men with success in 10 (45.5%), none of whom had abdominal testicles prior to orchidopexy. Six men experienced successful paternity via natural conception (3) or assisted reproduction (3). Conclusion Fertility is possible in adult men with inguinal bUDT following orchidopexy. Subsequent sperm retrieval may involve ejaculated specimens or delayed TESE. TESE performed prior to or at time of orchidopexy is unlikely to be of benefit.

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“…Older studies about patients with undescended testis indicate an age cut-off of 50 years for post-pubertal orchiectomy [8]. In addition, a recent study about risk of post-pubertal orchiectomies for undescended testes has found that prophylactic orchiectomy should be done in males under 50 years if their ASA score is 1, while those with ASA score 2 should undergo surgery only if they are younger than 35 years of age [9]. In a very comprehensive study by Cools et al, the authors have stated that the data regarding older patients were not clear, and have concluded malignant transformation in androgen insensitivity is a rare event.…”

Section: Discussionmentioning

confidence: 99%

Partial androgen insensitivity syndrome in a 68-year-old patient

Sezgin¹,

Dönmez²,

Dirican

et al. 2019

Endocr J

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Partial androgen insensitivity syndrome (PAIS) is a form of disorders of sexual development. Besides the issues of gender assignment, the fate of gonads in these patients poses a challenging problem. Debate still remains on the need and/or timing of gonadectomy in either complete or partial androgen insensitivity syndromes. In this case report, we present a 68year-old patient who was raised as a woman, stayed married for 45 years and admitted to our endocrinology department with complaint of male type hair distribution after initial examination following move to a nursing home. Physical examination revealed no breast development, a phallus of 6 cm, labia majoras that include testes and a blind ending vagina. Chromosomal analysis confirmed 46,XY with intact SRY and AZF regions. Pelvic ultrasonography and magnetic resonance imaging results indicated testicular tissue in labia majoras in addition to a rudimentary prostate. Gonadectomy was not offered to the patient due to lacking evidence of benefit in this age group and considering possible hormonal side effects. Our patient might be the oldest patient to be diagnosed with PAIS. Treatment and follow-up protocols for adults with PAIS are not standardized and therefore these patients should be individually evaluated and treated. Risks and benefits of surgery should be kept in mind when suggesting gonadectomy.

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An updated mortality risk analysis of the post-pubertal undescended testis

Cited by 5 publications

References 29 publications

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review

Fertility potential in adult men treated for uncorrected bilateral cryptorchidism: A systematic literature review and analysis of case reports

Partial androgen insensitivity syndrome in a 68-year-old patient

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