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Long-term results of surgical treatment of cryptorchid boys. Part I: Testicular volume and risk of malignant transformation
Article published in Urologia Polska 2004/57/4.

authors

Wojciech Kuzański, Jerzy Niedzielski
Klinika Chirurgii i Onkologii Dziecięcej Instytutu Pediatrii Uniwersytetu Medycznego w Łodzi
Kierownik kliniki: dr hab. Ewa Andrzejewska

keywords

cryptorchidism, inguinal testis, intraabdominal testis, nonpalpable testis, testicular volume, testicular atrophy index, human chorionic gonadotropin

summary

goal of the study
To examine the influence of the cryptorchid boy's age at the operation, position of the gonad before and after orchiopexy, and the treatment of the testicle development and risk of the neoplasmatic transformation.
patients and methods
44 males (mean age 31 year ±4,4) operated on in childhood due to cryptorchismus; group I - 30 patients with unilateral, group II - 10 with bilateral defect, group III - 4 men after resection of atrophic testicle at the time of orchiopexy. Testicular volume (TV), testicular atrophy index (TAI), and total testicular volume (TTV) were calculated for all patients. In 6 men with TAI >40% needle biopsy was taken for evaluation of presence of the testicle fetal spermatogenic cells (CIS).
results
Mean TV of the operated gonad in group I was 12,12 ±5,79 ml and was significantly lower than mean TV of the contralateral testicle: 21,47 ±6,25 ml (p<0,001). Mean TV in group II was 7,87 ±4,15 ml and was significantly lower than both, mean population TV (p<0,001) and mean TV of operated gonad in group I (p<0,001). Mean TV of the only testicle in group III was 28,81 ±5,07 ml and was significantly greater than mean of the population TV (p<0,05). TAI value of 37,53 ±24,5% in group I was significantly lower than TAI value in group II: 60,11 ±23,95% (p<0,001). Statistically significant difference (p<0,001) between TAI values of inguinal and abdominal undescended testicles was found (39 ±25,2% vs. 67 ±20,8%). Bifocal neoplasm of operated testicle (seminoma) was detected in patient of group I. In remaining 5 men after needle biopsy of atrophic gonad (TAI >40%), major degree atrophy of spermatogonias without CIS features was found.
conclusions
Bilateral cryptorchidism and primary abdominal position of the undescended testicle proved to be factors having significant deteriorating influence on growth of the cryptorchid gonad, and their coexistence in one patient caused amplification of this effect. Incidence of neoplasmatic transformation in presented group being 2% was significantly lower than one given in the literature.

references

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correspondence

Wojciech Kuzański
Klinika Chirurgii i Onkologii Dziecięcej
91-738 Łódź
ul. Sporna 36/50
tel. (0 42) 617 77 11, fax 617 77 05