Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines

Radmayr, Christian; Doğan, Hasan Serkan; Hoebeke, Piet; Kočvara, R; Nijman, Rien J.M.; Stein, Raimund; Undre, Shabnam; Tekgül, Serdar

doi:10.1016/j.jpurol.2016.07.014

Cited by 167 publications

(130 citation statements)

References 75 publications

(74 reference statements)

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“…During this process there is also apoptosis of germ cells, and it is postulated that these persistent undifferentiated germ cells may lead to malignancy in the long term13. The latest guidance from several professional associations14, 15, 16, 17, including a recent British Association of Paediatric Urologists (BAPU) consensus statement, recommends performing orchidopexy by 12 months of age.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

et al. 2018

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BackgroundCurrent guidelines recommend orchidopexy for cryptorchidism by 12 months of age, yet this is not universally adhered to. The aim of this systematic review and meta‐analysis was to compare outcomes between orchidopexies performed before and after 1 year of age.MethodsMEDLINE and Embase were searched (September 2015) using terms relating to cryptorchidism, orchidopexy and the outcomes of interest. Studies were eligible for inclusion if they compared orchidopexy at less than 1 year of age (early) with orchidopexy at 1 year or more of age (delayed) and reported the primary outcome (testicular atrophy) or one of the secondary outcomes (fertility potential, postoperative complication, malignancy). Studies were excluded when more than 50 per cent of infants had intra‐abdominal testes, or the population included infants with disorders of sexual differentiation. Additional studies were identified through reference list searching. Unpublished data were sought from the ORCHESTRA study investigators.ResultsFifteen eligible studies were identified from 1387 titles. There was no difference in atrophy rate between early orchidopexy and delayed orchidopexy (risk ratio 0·64, 95 per cent c.i. 0·25 to 1·66; 912 testes). Testicular volume was greater (mean difference 0·06 (95 per cent c.i. 0·01 to 0·10) ml; 346 testes) and there were more spermatogonia per tubule (mean difference 0·47 (0·31 to 0·64); 382 testes) in infants undergoing early orchidopexy, with no difference in complication rate (risk ratio 0·68, 0·27 to 1·68; 426 testes). No study reported malignancy rate.ConclusionAtrophy and complication rates do not appear different between early and delayed orchidopexy, and fertility potential may be better with early orchidopexy. Imprecision of the available data limits the robustness of these conclusions.

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Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

et al. 2018

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“…19 Other hormonal analogues have not shown long-term efficacy in causing descent of the NPT. 14,15 As such, both the AUA and EAU do not recommend endocrine treatment to facilitate testicular descent. 14,15 There is a possibility that hormonal therapy may improve fertility, especially for boys with bilaterally undescended testes.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…14,15 As such, both the AUA and EAU do not recommend endocrine treatment to facilitate testicular descent. 14,15 There is a possibility that hormonal therapy may improve fertility, especially for boys with bilaterally undescended testes. Currently, the EAU does recommend treatment with gonadotrophin-releasing hormone analogues for boys with bilaterally undescended testes for this purpose, 15 but the AUA concluded that while this therapy may be found to be beneficial for further fertility, currently the long-term effect remains unclear.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…The examiner may consider utilizing lubricant on the fingertips to aid with the exam. 15 While true for all patients, this is especially important for obese patients. Office exams are less accurate in this patient population, but an exam under anesthesia has similar accuracy for both obese and non-obese patients.…”

Section: Surgery For the Nonpalpable Testismentioning

confidence: 99%

“…Due to the associated histologic changes and increased risk of malignancy, the EAU recommends surgeons offer orchiectomy to postpubertal patients with an undescended testis and normal contralateral descended testis. 15 The AUA also recommends considering orchiectomy for intra-abdominal testes and contralateral normal descended testis for these males. 15 …”

Section: Special Situationsmentioning

confidence: 99%

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The Nonpalpable Testis: A Narrative Review

Shepard

Kraft

2017

Journal of Urology

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Purpose While the nonpalpable testis represents only a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Many controversies about the best evaluation and management exist. This narrative review serves as an update on what is known about the nonpalpable testis: etiology, pre-operative evaluation, the best surgical management, novel techniques, and ongoing controversies. Materials and Methods A Pubmed® and MEDLINE® search limited to January 2000 to January 2017 was performed using relevant key terms. Of 367 articles, a total of 115 manuscripts were considered for inclusion based on an a priori design. Utilizing a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. Results The nonpalpable testis should be evaluated by physical exam only. Imaging is not indicated for the routine case. The optimal surgical approach and technique remains debated, but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trial and other quality comparisons are difficult. Therefore, several controversies in management remain. Conclusions The evaluation and management of the nonpalpable testis remains difficult and some aspects remain debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.

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