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Post-pubertal management of undescended testes from the malignancy risk point of view: a systematic review
William Tendi1, Putu Angga Risky Raharja1, Irfan Wahyudi1
1Department of Urology, Rumah Sakit Dr Cipto Mangunkusumo, University of Indonesia, Central Jakarta, Jakarta, 10430, Indonesia.
Insights
Undescended testes (UDT) occurring after puberty requires individualized treatment due to potential malignancy risks. This review highlights the need for tailored management strategies considering various patient factors for optimal outcomes.
Area of Science:
- Urology
- Pediatric Surgery
- Oncology
Background:
- Undescended testes (UDT) present a challenge, with standard treatment recommended before 18 months to mitigate infertility and malignancy risks.
- Current guidelines for post-pubertal UDT suggest orchiectomy, but with weak evidence, necessitating further investigation into malignancy risks.
Purpose of the Study:
- To systematically review treatments for post-pubertal undescended testes (UDT).
- To focus on the association between post-pubertal UDT management and the risk of testicular malignancy.
Main Methods:
- A systematic literature search was conducted across PubMed, Wiley Online Library, and Cochrane Library up to March 5, 2023.
- Included studies reported testicular malignancy in post-pubertal UDT patients treated with orchiectomy or orchidopexy.
- Quality and bias were assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools.
Main Results:
- Seven articles involving 42 patients with post-pubertal UDT (age 13-34 years) were reviewed.
- Common malignancies observed included seminoma, teratoma, and carcinoma in situ.
- An algorithm for managing post-pubertal UDT was proposed based on the findings.
Conclusions:
- Management of post-pubertal UDT should be individualized, considering factors like contralateral testis status, UDT location, testosterone levels, age, comorbidities, and fertility desires.
- Limited data underscores the need for personalized treatment approaches in post-pubertal UDT cases.
Background:
Undescended testes (UDT) is a condition where one or both testes is absent in the scrotum. The general age recommendation in which the treatment should be performed is before 18 months old due to the infertility risk and malignancy in later life. In post-pubertal UDT, the current guideline recommends orchiectomy; however, the strength rating of this recommendation is weak. Therefore, this study aimed to provide a systematic review of post-pubertal UDT treatment, focusing on the malignancy risk point of view.
Methods:
A systematic search was performed using PubMed, Wiley Online Library and the Cochrane Library up to 5 March 2023. Any study with either post-pubertal orchiectomy or orchidopexy in patients with UDT and reporting the testicular malignancy was included. The exclusion criteria were studies with lack of information of UDT correction time, no history of correction and the full text wasn't available. The data collected were the occurrence of testicular malignancy in post-pubertal UDT patients corrected with any method. Quality and bias assessment was assessed with Newcastle-Ottawa scale and Joanna Briggs Institute tools.
Results:
Seven articles (three case reports and four observational studies) were reviewed with a total of 42 patients who underwent post-pubertal correction of either unilateral or bilateral UDT. The correction age ranged from 13 to 34 years old, with follow-up of 48.7-252 months. Among those who developed malignancies, the most common were seminoma, teratoma and carcinoma in situ of the testes. In addition, this study was able to propose an algorithm for post-pubertal UDT treatment strategy.
Conclusions:
The scarce resource was the main limitation of this study. Nevertheless, this review showed that post-pubertal UDT management should be tailored individually. Several factors that should be considered include the condition of the contralateral descended testis, UDT location, serum testosterone level, patient's age, comorbidities, and interest in fertility.
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