Puberty stage and spontaneous descent of acquired undescended testis: implications for therapy?

Abstract

We assessed spontaneous descent of acquired undescended testis (UDT) at puberty. 299 Boys (aged 1.2-16.5 years, mean 9.4) with 350 acquired-UDT were examined annually during a 12.6-year period (mean 3.1). An acquired-UDT was defined as a previously intrascrotal testis which can no longer be manipulated into a stable scrotal position. Each year, position of the testis and pubertal development according to Tanner's stages were assessed. Early puberty was defined as puberty stage G2 (testicular volume 4-9 mL), mid-puberty as puberty stages G3 (testicular volume 10 mL) and G4 (testicular volume 11-15 mL), and late puberty as puberty stage G5 (testicular volume >15 mL). Follow-up was completed if spontaneous descent had occurred, if mid-pubertal orchidopexy (ORP) had to be performed, if the boy was lost for follow-up, or if pre-pubertal ORP was performed in another hospital. In 139 boys with 164 acquired-UDT follow-up was meanwhile completed. Twelve boys with 14 UDT were lost for follow-up. In an additional 16 boys with 21 UDT, ORP was performed in another hospital. In 98 of the remaining 129 (76.0%) acquired-UDT spontaneous descent at puberty occurred. Mean follow-up was 2.5 years (range 0.2-8.5). In 70 of 98 testes (71.4%) descent occurred in early puberty, in 26 of 98 testes (26.5%) in mid-puberty, and in two testes in late puberty. In 31 of 129 testes (24.0%) ORP had to be performed at mid (30 cases) or late (one case) puberty. In this series, 98 of 129 acquired-UDT (76.0%) descended spontaneously at puberty, whereas in 31 of 129 (24.0%) pubertal ORP was performed. If ORP is postponed until puberty stage G3 (testicular volume of 10 mL) three of four acquired-UDT will descend spontaneously.

Undescended testis in older boys: further evidence that ascending testes are common

“…For example, if the prevalence of ascending testes increases and then decreases over time, then some must resolve spontaneously. Sijstermans et al [22] have recently described spontaneous descent of ascending testis. This report shows that the ascending testis has a high tendency to descend spontaneously during puberty [22].…”

“…Sijstermans et al [22] have recently described spontaneous descent of ascending testis. This report shows that the ascending testis has a high tendency to descend spontaneously during puberty [22]. Recognizing that the physical examination for testicular position is an inexact science, if these data are substantiated, surgical intervention in 9-year-olds might not be warranted, and surgery should be deferred until the diagnosis of an ascended testis is confirmed during puberty.…”

Long-Term Testicular Growth and Position after Orchidopexy for Congenital Undescended Testis

“…Nevertheless, evidence regarding the effectiveness of early treatment has not yet been presented. Treatment of acquired UDT, on the other hand, might be postponed until mid or late puberty, since this form has a strong tendency towards spontaneous peripubertal descent [4,5] .…”

Acquired Cryptorchidism: What Should We Know? The Results of a Systematic Review

“…They found that a 77.7% has a tendency of spontaneous descent at puberty, and in nearly all cases, after spontaneous descent or after pubertal orchidopexy, with long-term testicular volumes appropriate for age. Pubertal surges in luteinizing hormone and testosterone, as also is seen in the first 3 months after birth (Hamza AF et al 2001) when spontaneous descent of congenital UDT can still occur, are hypothesized to be responsible for pubertal spontaneous descent (Sijsterman K et al 2006).…”

“…They noted that acquired UDT showed an increasing chance of descending spontaneously with increasing age, and an appropriate for the age testicle volume. Sijsterman et al (Sijsterman K et al 2006) reported that among 129 acquired UDTs, (mean follow-up 2.5 years, range: 0.2-8.5 years), 98 (76%) descended spontaneously at puberty with appropriate testicular growth; in the remaining 31 (24%) orchidopexy was performed at puberty, due to non-descent. Hack et al assessed prospectively the natural history and long-term testicular growth of acquired UDT after spontaneous descent or pubertal orchidopexy in case of non-descent, in 391 boys with 464 acquired UDT.…”