The Timing of Surgery for Undescended Testis

Hrivatakis, Georg; W, Astfalk; Schmidt, Andreas; Hartwig, Andreas; Kugler, Thomas; Heim, Thomas M.; Clausner, A; Frunder, Albrecht; Weber, H; Loff, Steffan; Fuchs, Joerg; Ellerkamp, Verena

doi:10.3238/arztebl.2014.0649

Cited by 16 publications

(11 citation statements)

References 84 publications

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“…In childhood age does not limit the application of laparoscopy because now it has opticians, trocars and surgical material from 1.7 mm in diameter and can be performed even in neonates. In the pediatric use of laparoscopy as an exploratory procedure it is highly profitable and in some cases irreplaceable [6,10].…”

Section: Discussionmentioning

confidence: 99%

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Testicle Evanescent in Pediatric Urology: Laparoscopic Management

P¹

2016

OAJUN

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Testicular regression syndrome or evanescent testis is a clinical condition that arises from atrophy and disappearance of normal testis in the fetal period. Anatomically it is characterized by a spermatic cord with no identifiable macroscopically testicular tissue. The absence of a testicle in a man 46XY is usually unilateral and arises from a twist or an intrauterine or perinatal stroke. The clinical case of male 2 years 6 months old, a product of the second pregnancy, which comes to evaluation, is presented cryptorchidism left. On physical examination, genital according to age and sex, good gonadal development, normal penis and foreskin, right testicle in scrotal sac, about 12 mm, left no palpable. It inguino-escrotal ultrasound with left empty scrotal sac, no left testicle, right scrotal sac with normal testicle is identified. MRI was performed showing only right testicle in the scrotum. Diagnostic laparoscopy was performed, finding in the groin area on the right side the path of vas deferens normally and gonadal vessels of good caliber in the inguinal ring, on the left side, vas deferens was found dead-end and absence of gonadal vessels and the inguinal ring closed. Laparoscopy is the most effective and most widely accepted for non-palpable testicle therapeutic diagnostic method because it provides access to the abdominal cavity and high visibility, with the known advantages of laparoscopy in terms of postoperative recovery, also applicable to pediatric patients.

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Section: Discussionmentioning

confidence: 99%

“…Clinically unilateral non-palpable testes can be associated with evanescent testicles, cryptorchidism, retractile testes with testicular agenesis or. Laparoscopy has been widely used to distinguish these conditions over open surgery [10].…”

Section: Discussionmentioning

confidence: 99%

Testicle Evanescent in Pediatric Urology: Laparoscopic Management

P¹

2016

OAJUN

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“…The main issues associated with undescended testis are decreased fertility and an in-creased risk for developing testicular cancer. This is due to the body's core temperature, which is not optimal for further development and functioning of the testis, whose optimal temperature is 33 degrees Celsius, such as in the normal scrotal position [2,4].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the age at orchiopexy

Januzović¹,

Jokić²,

Antić³

et al. 2019

Med pregl

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Introduction. Undescended testis is the most common congenital anomaly of the male urogenital tract. The main issues associated with this condition are decreased fertility and an increased risk for testicular cancer, which are minimized if early orchiopexy is performed. The objective of this study is to evaluate the age at orchiopexy at the Institute of Child and Youth Health Care of Vojvodina and to compare it to international guidelines (American Urological Association, Canadian Urological Association and European Association of Urology). Material and Methods. A retrospective study included 457 patients operated on between 2010 and 2015. The recorded data were analyzed by Microsoft Excel Office 365 using means, medians, minimums, maximums and standard deviations where appropriate. The patient age and current recommendations for timing of orchiopexy were analyzed as well. Results. The mean age at orchiopexy was 69.47 months, and the median age was 64 months. Considering each year separately, no significant differences between mean and median age at orchiopexy were found. The percentage of orchiopexies performed before 24 months was 29% and 5% were performed before 12 months of age. The mean age at orchiopexy was 51.47 months later than recommended by current international guidelines. Conclusion. This study confirmed that the age at orchiopexy in our sample was significantly delayed than recommended. It is necessary for all medical practitioners involved in child health care to share new information, trends and diagnostic-therapeutic algorithms about undescended testis and consequences of late treatment.

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“… 5 , 6 Patients’ treatment outcomes may also be adversely affected by pro-longed waiting. 7 – 9 Moreover, long wait times carry economic consequences: a study carried out by the Fraser Institute revealed that waiting for medically necessary interventions cost the Canadian economy $2.1 billion in lost wages in 2018 alone. 10…”

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confidence: 99%

The burden of waiting: wait times for pediatric surgical procedures in Quebec and compliance with national benchmarks

Arulanandam

Dorais

et al. 2021

cjs

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Background: Wait time information and compliance with national guidelines are limited to a few adult conditions in the province of Quebec. We aimed to assess compliance with Paediatric Canadian Access Targets for Surgery (P-CATS) guidelines and determine the burden incurred due to waiting for 3 common elective surgical conditions (inguinal hernia, cryptorchidism and hypospadias) in a pediatric population. Methods: We carried out a population-based retrospective cohort study of randomly selected children residing in Quebec without complex chronic medical conditions, using administrative databases belonging to the Régie de l’assurance maladie du Québec for the period 2010–2013. Disability-adjusted life years (DALYs) were calculated to measure the burden due to waiting. Multivariate forward regression identified risk factors for compliance with national guidelines. Results: Surgical wait time information was assessed for 1515 patients, and specialist referral wait time was assessed for 1389 patients. Compliance with P-CATS benchmarks was 76.6% for seeing a specialist and 60.7% for receiving surgery. Regression analysis identified older age (p < 0.0001) and referring physician specialty (p = 0.001) as risk factors affecting specialist referral wait time target compliance, whereas older age (p = 0.040), referring physician specialty (p = 0.043) and surgeon specialty (p = 0.002) were significant determinants in surgical wait time compliance. The total burden accrued due to waiting beyond benchmarks was 35 DALYs. Conclusion: Our results show that provincial compliance rates with wait time benchmarks are still inadequate and need improvement. Patient age and physician specialty were both found to have significant effects on wait time target compliance.

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The Timing of Surgery for Undescended Testis

Abstract: Most of the patients studied had surgery at a later age than recommended. Adherence to the guidelines in this respect is nonetheless relatively good in Germany compared to other countries, as studies from abroad have yielded findings that are just as bad or worse.

Cited by 16 publications

References 84 publications

Testicle Evanescent in Pediatric Urology: Laparoscopic Management

Testicle Evanescent in Pediatric Urology: Laparoscopic Management

Evaluation of the age at orchiopexy

The burden of waiting: wait times for pediatric surgical procedures in Quebec and compliance with national benchmarks

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