Testicular Tumors in Patients with Exstrophy-Epispadias Complex

Abstract

The observation of comorbid testicular tumor in males with exstrophy-epispadias complex should prompt a preventive health examination after puberty, which gives these patients the opportunity for further appropriate diagnostics and treatment if necessary. Biopsy is recommended for sonographically detected intratesticular lesions. Organ sparing procedures are worth considering, especially when stromal tumors with favorable outcome are discovered. However, current oncologic principles must be strictly followed. Although the etiology and true incidence of testicular tumors in exstrophy-epispadias complex are still unclear, our findings highlight the importance of long-term followup in patients with exstrophy-epispadias complex.

This Month in Pediatric Urology

“…Ebert et al (page 1300) from Germany recruited 22 adults previously treated for exstrophy or epispadias who presented for andrology evaluation including testicular ultrasound, which revealed intratesticular problems in 23%. 2 The most common finding was testicular microlithiasis which is not unexpected given the high prevalence in the general population. However, 3 patients had lesions suspicious for malignancy and underwent testicular biopsy, which confirmed intraepithelial neoplasia in 1 and 2 testicular stromal tumors in 2 cases.…”

Experiencia en el abordaje de pacientes con complejo extrofia-epispadias en un centro de alto nivel de complejidad en Colombia, 10 años

“…El 50% de los hombres con epispadias son incontinentes, pero hasta el 80% recuperan la continencia urinaria posterior a la intervención quirúrgica; 30 aquellos que permanecen incontinentes podrían requerir posteriormente reconstrucción del cuello vesical. 37 En la EVC y en la extrofia cloacal el predictor más importante de crecimiento vesical y continencia a largo plazo es un cierre primario exitoso. 38,39 La continencia en pacientes con EVC después de un cierre primario es del 80 al 100%, disminuye al 60% después de un cierre primario fallido y hasta el 40% después de un segundo procedimiento no exitoso.…”

New insights on testicular cancer prevalence with novel diagnostic biomarkers and therapeutic approaches

“…This bias arises from the fact that the latter group consists of a certain proportion of boys who may have undergone unnecessary treatment for conditions such as retractile testis. These conditions typically resolve spontaneously and have a weaker or no association with testicular cancer 53,78 . Hence, a potential disturbance in a prevalent regulatory pathway, such as the androgen signaling mechanism, could potentially serve as an underlying causative factor for the correlation between cryptorchidism and TC 79,80 .…”

“…These conditions typically resolve spontaneously and have a weaker or no association with testicular cancer. 53 , 78 Hence, a potential disturbance in a prevalent regulatory pathway, such as the androgen signaling mechanism, could potentially serve as an underlying causative factor for the correlation between cryptorchidism and TC. 79 , 80 An alternative hypothesis posits that the anomalous positioning of the testis is the primary factor contributing to both infertility and the development of germ cell tumors.…”