İnmemiş Testis
Özet
Çocuklarda en sık görülen ürolojik problemdir. İlk 3-6 aylık süre içinde spontan inebilmektedir. Testisin lokalizasyonuna göre sınıflandırılır. Tanıda fizik muayene yeterli olmaktadır. Fertilitenin korunması, kanser gelişimi ve torsiyon riskinin önlenmesi amacı ile 6 ay- 12 ay arasında opere edilmesi gereklidir. Tedavide hormonal yöntemin başarısı düşük ve yan etkisi olabileceğinden cerrahi yöntem önerilir. Bu amaçla geleneksel cerrahi ve laparoskopi tercih edilen yöntemlerdir. Laparoskopi hem tanı hem de tedavi amacı ile kullanılmaktadır. İki taraflı inmemiş testis ya da eşlik eden mikropenis, hipospadias gibi ek anomali varlığında endokrin değerlendirme gereklidir.
Referanslar
Virtanen HE, Toppari J. Embryology and physiology of testicular development and descent. Pediatric Endocrinology Reviews. 2014;11 (Suppl. 2): 206–13.
Hack WW, Meijer RW, Van Der Voort-Doedens LM, et al. Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma? BJU International 2003 Aug;92(3):293-6. doi: 10.1046/j.1464-410x.2003.04317.
Braga LH, Lorenzo AJ. Cryptorchidism: A practical review for all community healthcare providers. Canadian Urological Association Journal. 2017 Jan-Feb;11(1-2Suppl1):S26-S32. doi: 10.5489/cuaj.4343. PMID: 28265313; PMCID: PMC5332229.
Lee MM. Moleculer genetic control of sex differentiation. In: Pestovitz Oh, Eugster EA (Eds). Pediatric Endocrinology, Lippincott Williams&Wilkins, Philadelpia, 2004:231-304.
Rajfer J, Handelsman DJ, Swerdloff RS, et al. Hormonal therapy of cryptorchidism. A randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin-releasing hormone. The New England Journal of Mediciine. 1986;314(8):466-470. doi:10.1056/NEJM198602203140802
Nation TR, Balic A, Southwell BR, Newgreen DF, Hutson JM. The hormonal control of testicular descent. Pediatr Endocrinol Rev. 2009;7(1):22-31.
7.Henna MR, Del Nero RG, Sampaio CZ, et al. Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials. Pediatric Surgery International. 2004;20(5):357-359. doi:10.1007/s00383-004-1198-3
Ashley RA, Barthold JS, Kolon TF. Cryptorchidism: pathogenesis, diagnosis, treatment and prognosis. Urologic Clinics of North America, 37:183, 2010
Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. Journal of Urology. 2014;192:337-45.
British Association of Pediatric Surgeons. Commissioning guide: paediatric orchidopexy for undescended testis. London: Royal College of Surgeons of England (RCS); British Association of Urological Surgeons (BAUS), 2015.
Radmayr C, Bogaert G, Dogan HS, Kočvara R, Nijman JM, Stein R, et al. EAU Guidelines on Paediatric Urology 2018. Arnhem (The Netherlands): European Association of Urology; European Society for Paediatric Urology, 2018.
Houk CP, Levitsky LL. Evaluation of the infants with ambiguous
genitalia. 2011 UpToDate, www.uptodate.com
Abacı A, Çatı G, Anık A, Böber E. Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? Journal of Clinical Research in Pediatric Endocrinology 2013;5(2):65-72.
14.Meijer RW, Hak WW, van der Voort-Doedens LM, Haasnoot K, Bos SD. Surgical findings in acquired undescended testis. Journal of Pediatric Surgery. 2004;39(8):1835.
Pyorala S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. Journal of Clinic Endocrinology Metabolism. (1995) 80:2795–9. 10.1210/jcem.80.9.7673426.
Henna MR, Del Nero RG, Sampaio CZ, Atallah AN, Schettini ST, Castro AA, et al. Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials. Pediatric Surgery International. (2004) 20:357–9. 10.1007/s00383-004-1198-3.
Assmus M, Svechnikov K, von Euler M, et al. Single subcutaneous administration of chorionic gonadotropin to rats induces a rapid and transient increase in testicular expression of pro-inflammatory cytokines. PediatricResearch.2005;57(6):89601.doi:10.1203/01.PDR.0000161410.30145.15.
Dunkel L, Taskinen S, Hovatta O, et al. Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. Journal of Clinical Investigation. 1997;100(9):2341-2346. doi:10.1172/JCI119773.
19. Liu J, Xiu W, Sui B, et al. Open controversies on the treatment of undescended testis: An update. Frontiers in Pediatrics. 2022 Jul 27;10:874995. doi: 10.3389/fped.2022.874995. PMID: 35967583; PMCID: PMC9363670.
Başaklar C. Bebek ve Çocukların cerrahi ve ürolojik hastalıkları. editör: Can basaklar Cilt 2. Palme yayıncılık, Ankara, 2006; 1717-52.
Omling E, Bergbrant S, Persson A,et al. How boys and testicles wander to surgery: A nationwide cohort study of surgical delay in Sweden. BMJ Paediatrics Open. 2020;4(1):e000741. Published 2020 Sep 22. doi:10.1136/bmjpo-2020-000741.
Ritzén EM. Undescended testes: a consensus on management. European Journal of Endocrinology. 2008;159 Suppl 1:S87-S90. doi:10.1530/EJE-08-0181.
Kaygısız O , Pişkin MM, Dogan HS, et al. İnmemiş testis ve güncel tedavisi. Hasan Serkan Doğan (ed.) Ürolojik Cerrahi Derneği Güncelleme Serileri; Ocak 2012;1(1).
Chung E, Brock GB. Cryptorchidism and its impact on male fertility: a state of art review of current literature. Canadian Urological Association Journal. 2011;5(3):210-214. doi:10.5489/cuaj.10106
Tackett LD, Wacksman J, Billmire D, et al. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. Journal of Endourology. 2002;16(6):359-361. doi:10.1089/089277902760261383.
Koff SA, Sethi PS. Treatment of high undescended testes by low spermatic vessel ligation: an alternative to the Fowler-Stephens technique. Journal of Urology. 1996;156(2 Pt 2):799-803. doi:10.1097/00005392-199608001-00067.
Referanslar
Virtanen HE, Toppari J. Embryology and physiology of testicular development and descent. Pediatric Endocrinology Reviews. 2014;11 (Suppl. 2): 206–13.
Hack WW, Meijer RW, Van Der Voort-Doedens LM, et al. Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma? BJU International 2003 Aug;92(3):293-6. doi: 10.1046/j.1464-410x.2003.04317.
Braga LH, Lorenzo AJ. Cryptorchidism: A practical review for all community healthcare providers. Canadian Urological Association Journal. 2017 Jan-Feb;11(1-2Suppl1):S26-S32. doi: 10.5489/cuaj.4343. PMID: 28265313; PMCID: PMC5332229.
Lee MM. Moleculer genetic control of sex differentiation. In: Pestovitz Oh, Eugster EA (Eds). Pediatric Endocrinology, Lippincott Williams&Wilkins, Philadelpia, 2004:231-304.
Rajfer J, Handelsman DJ, Swerdloff RS, et al. Hormonal therapy of cryptorchidism. A randomized, double-blind study comparing human chorionic gonadotropin and gonadotropin-releasing hormone. The New England Journal of Mediciine. 1986;314(8):466-470. doi:10.1056/NEJM198602203140802
Nation TR, Balic A, Southwell BR, Newgreen DF, Hutson JM. The hormonal control of testicular descent. Pediatr Endocrinol Rev. 2009;7(1):22-31.
7.Henna MR, Del Nero RG, Sampaio CZ, et al. Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials. Pediatric Surgery International. 2004;20(5):357-359. doi:10.1007/s00383-004-1198-3
Ashley RA, Barthold JS, Kolon TF. Cryptorchidism: pathogenesis, diagnosis, treatment and prognosis. Urologic Clinics of North America, 37:183, 2010
Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. Journal of Urology. 2014;192:337-45.
British Association of Pediatric Surgeons. Commissioning guide: paediatric orchidopexy for undescended testis. London: Royal College of Surgeons of England (RCS); British Association of Urological Surgeons (BAUS), 2015.
Radmayr C, Bogaert G, Dogan HS, Kočvara R, Nijman JM, Stein R, et al. EAU Guidelines on Paediatric Urology 2018. Arnhem (The Netherlands): European Association of Urology; European Society for Paediatric Urology, 2018.
Houk CP, Levitsky LL. Evaluation of the infants with ambiguous
genitalia. 2011 UpToDate, www.uptodate.com
Abacı A, Çatı G, Anık A, Böber E. Epidemiology, Classification and Management of Undescended Testes: Does Medication Have Value in its Treatment? Journal of Clinical Research in Pediatric Endocrinology 2013;5(2):65-72.
14.Meijer RW, Hak WW, van der Voort-Doedens LM, Haasnoot K, Bos SD. Surgical findings in acquired undescended testis. Journal of Pediatric Surgery. 2004;39(8):1835.
Pyorala S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. Journal of Clinic Endocrinology Metabolism. (1995) 80:2795–9. 10.1210/jcem.80.9.7673426.
Henna MR, Del Nero RG, Sampaio CZ, Atallah AN, Schettini ST, Castro AA, et al. Hormonal cryptorchidism therapy: systematic review with metanalysis of randomized clinical trials. Pediatric Surgery International. (2004) 20:357–9. 10.1007/s00383-004-1198-3.
Assmus M, Svechnikov K, von Euler M, et al. Single subcutaneous administration of chorionic gonadotropin to rats induces a rapid and transient increase in testicular expression of pro-inflammatory cytokines. PediatricResearch.2005;57(6):89601.doi:10.1203/01.PDR.0000161410.30145.15.
Dunkel L, Taskinen S, Hovatta O, et al. Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. Journal of Clinical Investigation. 1997;100(9):2341-2346. doi:10.1172/JCI119773.
19. Liu J, Xiu W, Sui B, et al. Open controversies on the treatment of undescended testis: An update. Frontiers in Pediatrics. 2022 Jul 27;10:874995. doi: 10.3389/fped.2022.874995. PMID: 35967583; PMCID: PMC9363670.
Başaklar C. Bebek ve Çocukların cerrahi ve ürolojik hastalıkları. editör: Can basaklar Cilt 2. Palme yayıncılık, Ankara, 2006; 1717-52.
Omling E, Bergbrant S, Persson A,et al. How boys and testicles wander to surgery: A nationwide cohort study of surgical delay in Sweden. BMJ Paediatrics Open. 2020;4(1):e000741. Published 2020 Sep 22. doi:10.1136/bmjpo-2020-000741.
Ritzén EM. Undescended testes: a consensus on management. European Journal of Endocrinology. 2008;159 Suppl 1:S87-S90. doi:10.1530/EJE-08-0181.
Kaygısız O , Pişkin MM, Dogan HS, et al. İnmemiş testis ve güncel tedavisi. Hasan Serkan Doğan (ed.) Ürolojik Cerrahi Derneği Güncelleme Serileri; Ocak 2012;1(1).
Chung E, Brock GB. Cryptorchidism and its impact on male fertility: a state of art review of current literature. Canadian Urological Association Journal. 2011;5(3):210-214. doi:10.5489/cuaj.10106
Tackett LD, Wacksman J, Billmire D, et al. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. Journal of Endourology. 2002;16(6):359-361. doi:10.1089/089277902760261383.
Koff SA, Sethi PS. Treatment of high undescended testes by low spermatic vessel ligation: an alternative to the Fowler-Stephens technique. Journal of Urology. 1996;156(2 Pt 2):799-803. doi:10.1097/00005392-199608001-00067.
