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[German guideline on undescended testis-what is relevant in daily routine?]
R Stein1, F Loersch2, N Younsi3
1Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. Raimund.Stein@umm.de.
Insights
Undescended testicles, a common congenital anomaly, require timely treatment between 6-12 months to preserve fertility and reduce tumor risk. Early intervention with hormone therapy or surgery is crucial for optimal outcomes in male infants.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Biology
Background:
- Undescended testicles (cryptorchidism) affect 0.7-3% of male infants, representing a common congenital anomaly.
- Spontaneous testicular descent occurs in up to 70% within the first six months of life.
- Delayed treatment post-six months increases risks of reduced fertility and testicular tumors.
Purpose of the Study:
- To outline the recommended diagnostic and therapeutic guidelines for undescended testicles.
- To emphasize the critical treatment window for optimal outcomes.
- To inform about management options including hormone therapy and surgical interventions.
Main Methods:
- Review of current German guidelines for undescended testis management.
- Description of therapeutic approaches: hormone therapy (6-12 months) and surgical intervention (after 1 year or for non-palpable testes).
- Diagnostic laparoscopy for non-palpable testes with simultaneous therapeutic intervention.
- Postoperative follow-up protocols and recommendations for self-examination.
Main Results:
- Hormone therapy is effective for testicular descent or germ cell pool improvement when initiated between 6 and 12 months.
- Surgical intervention is the primary treatment after the first year of life or for specific presentations.
- Laparoscopy serves as both a diagnostic and therapeutic tool for impalpable testes.
- Postoperative monitoring is essential to track testicular growth and prevent re-ascent.
Conclusions:
- Timely intervention for undescended testicles between 6 and 12 months is critical.
- A combination of hormone therapy and surgical options should be tailored to individual cases.
- Long-term follow-up and self-examination aid in early detection of complications, including rare testicular tumors.
Abstract:
With an incidence of 0.7-3% in male infants, undescended testicles is one of the most common congenital anomalies. In the first 6 months of life, the testicles may spontaneously descend in up to 70% of individuals. If the testicle is not in a scrotal position afterwards, fertility can gradually be reduced and the risk of a testicular tumor increases. Therefore, the current German guideline for undescended testis recommends that therapy should be take place between 6 and 12 months of life. After extensive information on the advantages and disadvantages, hormone therapy with the aim of a descensus or in those with bilateral anomaly with the aim of improving the germ cell pool can be offered. After the first year of life, hormone therapy is obsolete. Otherwise, surgical intervention is the treatment of choice. In the case of gliding or deep inguinal testis via scrotal or inguinal access, in the case of nonpalpable and sonographically undetectable testis, laparoscopy is carried out for diagnosis and simultaneous therapy. In the first postoperative year, adequate follow-up should be done to detect a re-ascensus and/or insufficient growth. Regular self-examinations from the age of 15 serve for the early detection of a testicular tumor that occurs only very rarely (approximately 0.003%).
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