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Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence
Robert L Gates1, Julia Shelton2, Karen A Diefenbach3
1University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
Insights
Optimal management of undescended testes (UDT) involves performing orchiopexy before age one for improved testicular growth and fertility. Pre-operative imaging and hormonal therapy are generally not recommended for UDT treatment.
Area of Science:
- Pediatric Urology
- Surgical Oncology
Background:
- Management of undescended testes (UDT) varies among North American pediatric surgeons despite existing guidelines.
- This systematic review addresses the evolving landscape of UDT treatment.
Purpose of the Study:
- To systematically evaluate published evidence on the treatment of undescended testes (UDT) in children.
- To provide evidence-based recommendations for UDT management.
Main Methods:
- A comprehensive literature search adhering to PRISMA guidelines was conducted from 2005 to 2020.
- Focused on five key areas: imaging, medical treatment, surgical technique, timing, and outcomes for UDT.
Main Results:
- 260 articles were included from an initial search of 825.
- Pre-operative imaging and hormonal therapy are typically not indicated for UDT.
- Orchiopexy before one year of age improves testicular growth and fertility potential.
Conclusions:
- Single-incision orchiopexy is preferred for palpable testes.
- Laparoscopic orchiopexy shows lower atrophy but higher retraction rates.
- Pre-pubertal orchiopexy may reduce the elevated risk of testicular cancer in UDT patients.
Purpose:
Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children.
Methods:
A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020.
Results:
A total of 825 articles were identified in the initial search, and 260 were included in the final review.
Conclusions:
Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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