Search

As part of a retrospective data analysis over a period of 6 years, the coincidence of undescended testis and hydatid of Morgagni (appendix testis) was examined on the basis of 814 operated testes. The overall prevalence of hydatids after opening of the testicular envelope of undescended testes was 62.66%. In addition, we were able to establish a correlation between patient age and the hydatid size. According to the results of the study, the size of the hydatid-with growth most likely to be influenced by hormones-can be assumed to be associated with the patient's age.Im Rahmen einer retrospektiven Datenanalyse über einen Zeitraum von 6 Jahren wurde an Hand von 814 operierten Hoden die Koinzidenz eines Maldescensus testis mit einer Morgagni-Hydatide untersucht. Dabei ergab sich eine Hydatidengesamtprävalenz bei erfolgter Hodenhülleneröffnung nicht-deszendierter Hoden von 62,66 %. Zusätzlich konnten wir eine Korrelation zwischen Patientenalter und Größenausprägung der Hydatiden feststellen. Entsprechend der Studienergebnisse kann die Vermutung geäußert werden, dass von einer Größenwachstumsdynamik der Hydatiden – am ehesten unter Hormoneinfluss – in Bezug zum Patientenalter ausgegangen werden kann.

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 After the first year of life, hormone therapy is obsolete.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%).

For decades, hormonal therapy was considered an integral part of the treatment regimen for undescended testes, particularly in Europe. However, the available data are controversial. According to many studies and a large meta-analysis, testicular descent can only be achieved in approximately 20 % of cases, whereas a few small studies report better results. Improvement of fertility is also considered significant in some studies, while others even report detrimental effects. Meanwhile, the recommendations for the use of hormonal therapy have been removed from most international guidelines. In Germany, hormonal therapy is only recommended for a limited number of indications. It is widely accepted that hormonal therapy has no particular value in the induction of testicular descent, and even the possible improvement of fertility in cases of bilateral undescended testes is regarded with some caution. In light of the controversial and weak data, it is questionable if hormonal therapy should still be recommended.Die Hormontherapie wurde über Jahrzehnte (zumindest in Europa) als integraler Bestandteil der Behandlung des Hodenhochstandes angesehen. Die Datenlage ist jedoch ausgesprochen kontrovers. Die Induktion des Deszensus gelang in vielen Studien und laut einer großen Metaanalyse nur in ca. 20 % der Fälle, einzelne kleinere Studien beschreiben bessere Ergebnisse. Auch die potenzielle Verbesserung der Fertilität wird in einigen Studien als erwiesen angegeben, andere beschreiben gegenteilige Ergebnisse.Inzwischen wurde die Hormontherapie aus den meisten internationalen Leitlinien vollends entfernt und wird auch in Deutschland nur noch für wenige Indikationen empfohlen. Bez. der Induktion des Deszensus hat die Hormontherapie aufgrund der vielfach dokumentierten unzureichenden Wirksamkeit keinen hohen Stellenwert mehr, lediglich mit dem Ziel der potenziellen Fertilitätsverbesserung bei bilateralem Hodenhochstand wird sie noch mit einer gewissen Zurückhaltung empfohlen.In Anbetracht der widersprüchlichen Datenlage fällt es schwer, die Hormontherapie aktuell noch zu empfehlen.

It has been known for more than 20 years that early treatment of maldescended testicles can have a positive effect on fertility and a negative effect on the development of tumors. In certain circumstances, hormone therapy is still recommended in German-speaking countries. However, its benefit is still controversially discussed. Therapy is usually initiated by the pediatrician, who is usually the first to detect undescended testicles. Since therapy may involve early hormone therapy as well as surgery, acceptance among pediatricians and also the parents may be reduced. The question also arises as to how far the implementation is practicable. In patients with nonpalpable testis, there are many controversies concerning the value of ultrasound investigations. In the following two case studies, the treatment decisions for undescended testes in infancy are exemplified. Furthermore, the available evidence from the literature and guidelines is presented to provide assistance for daily routine care and to critically discuss potential fields of application and limitations of existing guidelines.

Cryptorchism is one of the most frequent diagnoses in early childhood with an incidence of up to 3 - 8 %. The goal of any treatment is scrotal positioning of the testis until the end of the first year of life to prevent degenerative changes of the testis. This often requires a surgical procedure. The surgical treatment for a palpable testis in the inguinal area is orchidopexy, combined with laparoscopy in case of a non-palpable testis. Orchidopexy can be done via inguinal or scrotal access with inguinal access being the gold standard.Der Hodenhochstand stellt eine der häufigsten Erkrankungen im Kindesalter dar und wird bei 3 – 8 % der männlichen Patienten diagnostiziert. Das Ziel der Therapie des Hodenhochstandes ist der Deszensus in den Hodensack innerhalb des ersten Lebensjahres, um anhaltende degenerative Veränderungen des Hodens zu vermeiden. Oft ist dazu eine operative Behandlung notwendig.Die chirurgische Therapie des tastbaren Hodens im Bereich der Leiste ist die Orchidopexie und bei nicht tastbaren Hoden ein laparoskopischer Ansatz mit ggf. inguinaler Freilegung. Die Orchidopexie für einen tastbaren Hoden kann durch einen traditionellen Leistenschnitt (inguinal) oder transskrotal behandelt werden. Der inguinale Zugangsweg gilt für die Orchidopexie als operative Methode der Wahl.

The prevalence of varicocele in children is less than 1% and in 11- to 19-year-old boys 8-14%. Up to 15% of patients with varicocele have impaired fertility. The indication for therapy of varicocele is still controversially discussed. In clinical trials testicular volume, volume difference, semen quality, fertility, hormones and pain have been investigated. The results are very heterogeneous for all parameters, so that the evidence level of recommendations for therapy of varicocele is very low. Nevertheless, the EAU guidelines recommend therapy of varicocele in children and young adults in case of small testis (volume difference2 ml or 20%), additional cryptorchism, bilateral palpable varicoceles, symptomatic varicoceles and in case of pathological semen (in older boys). Microsurgical inguinal and laparoscopic procedures with preservation of lymph vessels have the best success and lowest complication rates.

Undescended testes are a very common congenital problem of the urogenital tract. Altered spermatogenesis and fertility as well as an elevated risk for oncologic degeneration are known facts associated with testicular malposition. There is broad international consensus among the various disciplines that the treatment of undescended testes should be completed by the age of 12 months. Following the guideline of the German Working Group of Scientific Medical Societies (AWMF), hormonal treatment should be offered to patients with bilateral undescended testicles. This article reviews the literature and disputes the reasoning of the recommendation to treat undescended testes hormonally.Der Hodenhochstand stellt eine sehr häufige angeborene Normvariante des Urogenitaltrakts dar. Dabei ist bekannt, dass infolge der Fehllage des Hodens seine normale Entwicklung eingeschränkt sein kann. Eine Folge daraus ist ein erhöhtes Entartungsrisiko sowie eine verminderte Spermiogenese und Fertilität. Zwischen den verschiedenen Fachrichtungen besteht internationaler Konsens darüber, dass die Behandlung des maldeszendierten Hodens spätestens zum ersten Geburtstag abgeschlossen sein sollte. Gemäß der deutschen AWMF-Leitlinie soll die hormonelle Therapie Patienten mit beidseitigem Hodenhochstand angeboten werden. Der nachfolgende Artikel wird die Rationale hinter dieser Empfehlung unter Einbezug der aktuellen Literatur erörtern.

Undescended testis is the most common genitourinary disorder during childhood. The traditional inguinal approach still represents the standard technique to correct undescended testis. However, over the last decades a large number of studies have shown that the scrotal approach has a lower morbidity rate and significantly shorter operation times and offers a good cosmetic result as well as an equal surgical treatment result, which makes it a good alternative to the traditional inguinal approach in gliding and low palpable testis.Der Hodenhochstand ist die häufigste urogenitale Erkrankung im Kindesalter. Weiterhin gilt der inguinale Zugangsweg für die Orchidofunikolyse als operative Methode der Wahl. Eine Vielzahl von Studien konnten in den letzten zwei Jahrzehnten zeigen, dass die skrotale Orchidofunikolyse aufgrund der geringen Invasivität und einer damit verbundenen reduzierten Morbidität bei deutlich kürzerer Operationszeit und einem guten kosmetischen Ergebnis bei gleichem operativen Behandlungsergebnis eine gute Alternative beim Gleit- und tiefen Leistenhoden darstellt.

Die vorliegende Arbeit untersucht den Hodenabstieg beim Hengstfohlen ab dem Zeitpunkt der Geburt in den ersten Lebenswochen. Hierbei stehen die Palpation und Sonografie der Inguinal- bzw. Skrotalregion im Vordergrund der Methodik. Es sollten Daten zum zeitlichen Verlauf des Hodenabstiegs, zur Lokalisation der Hoden, zum Vergleich der Palpation und Sonografie, zur Hodengröße, zum Abwehrverhalten der Fohlen und zu den Unterschieden zwischen den Rassen gesammelt werden. Außerdem sollte die Praktikabilität und diagnostische Relevanz der Methoden festgestellt werden. Es handelt sich um eine Feldstudie, in der 25 Hengstfohlen verschiedener Rassen unter unterschiedlichen Bedingungen ab dem Zeitpunkt der Geburt bis zu einem Alter von 240 Tagen in verschiedenen Intervallen palpatorisch und sonografisch untersucht wurden. Zu den wesentlichen Ergebnissen dieser Arbeit gehört, dass der Hodenabstieg in den meisten Fällen in den ersten Lebenstagen vollständig erfolgt. Weiterhin konnte festgestellt werden, dass der Hodenabstieg auf der linken Seite etwas früher als auf der rechten Seite abgeschlossen ist, was im Gegensatz zur vorhandenen Literatur steht. Eine weitere Erkenntnis dieser Arbeit ist, dass die Sonografie in Bezug auf die Darstellung der skrotalen bzw. inguinalen Strukturen eine deutlich geringere diagnostische Sensitivität hat als die Palpation. Somit wird der Schluss gezogen, dass die Sonografie bei der Diagnostik des Hodenabstiegs beim Hengstfohlen keine geeignete Methode ist. Bezüglich der Hodengröße konnte keine statistisch signifikante Abhängigkeit vom Alter, von der betrachteten Körperseite oder von der Lokalisation des Hodens festgestellt werden. Das Abwehrverhalten der Hengstfohlen hatte auf die Ergebnisse der palpatorischen Untersuchung keinen Einfluss, jedoch auf die sonografische Darstellung. Hier wurde abgeleitet, dass eine gute sonografische Darstellbarkeit mit einem stärkeren Abwehrverhalten in Verbindung gebracht werden kann. Der Vergleich der Daten zwischen den Ponyfohlen und den Warmblutfohlen ergab keine signifikanten Unterschiede. Während der Datensammlung für diese Arbeit konnten viele exemplarische Ultraschallbilder der Skrotal- und Inguinalregion beim Hengstfohlen zu unterschiedlichen Zeitpunkten gesammelt werden. Die Einzelfälle verdeutlichen eine breite physiologische Spanne anzunehmender palpatorischer und sonografischer Befunde. Kritisch zu sehen sind bei der Interpretation dieser Ergebnisse vor allem die nicht standardisierbaren Bedingungen einer Feldstudie, die relativ geringe Anzahl an Hengstfohlen, die unterschiedlichen Untersuchungsintervalle und die Einteilung der durchgeführten Untersuchungen in nur zwei Zeitgruppen für die Auswertung. Hervorzuheben ist, dass die vorliegende Arbeit die erste ist, die sich mit der ultrasonografischen Diagnostik des Hodenabstiegs beim Hengstfohlen kurz nach der Geburt beschäftigt hat., The present study examines testis descend in the colt from the date of birth and in the first weeks of life. Especially palpation and ultrasonography of the scrotum and inguinal region are the main part of the methodology. Data was to be collected of the time course of testicular descent, the localization of the testes, comparison of palpation and ultrasound, testicular size, the defensive behavior of foals and about the differences between races. In addition, the practicability and diagnostic relevance of the methods were to be established. This is a field study in which 25 colts of different breeds were examined under different conditions from the moment of birth to the age of 240 days at various intervals by palpation and ultrasonography. The main results of this work entail that testes descend completely takes place in the first days of life in most of the cases. Furthermore, it was found that testes descend on the left side is completed earlier than on the right side, which is in contrast to the existing literature. Another finding of this study is that sonography concerning scrotal or inguinal structures has a significantly lower diagnostic sensitivity than palpation. Thus, it is concluded that sonography is not a suitable method for the diagnosis of testicular descent in colts. Regarding the size of the testicles it was no statistically significant relation to age, considered side of body or localization of the testicle found. The defensive behavior of the colt does not have any effect on the results of the palpation examination, however, it does on the sonographic presentation. Here it can be concluded that a good sonographic presentability can be associated with a stronger defensive behavior. There were no observed differences between Warmblood foals and pony foals. During data collection for this study many exemplary ultrasound images of the scrotal and inguinal region of the colt at different times could be assembled. The individual cases illustrate a broad physiological range of assumable palpatoric and sonographic findings. Points of criticism are mainly the not standardized conditions of a field study, the relatively small number of colts, the different intervals of examinations and the division of the investigations in only two time groups for evaluation when interpreting these results. Finally it should be emphasized that the present work is the first to have dealt with sonographic diagnosis of testicular descent in colts shortly after birth.

Cryptorchidism is the most common genital malformation in male newborns. In recent years, guidelines concerning diagnosis and therapy have undergone considerable evolution with the implementation of recent knowledge in pathophysiology, diagnosis, and therapy.The aim of this publication is to provide an overview of the current national and international guideline recommendations concerning diagnosis and treatment of cryptorchidism. Critical points are discussed in light of current scientific literature.The current guidelines of the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU), the American Association of Urology (AUA), the pediatric urologic task force of the Austrian Society of Urology (ÖGU), the international consultation on urological disease (ICUD) and the German Society of Urology (DGU)/German Association of Pediatric Surgery (DGKCh) have been analyzed concerning the most important aspects of treatment and diagnosis.There is broad consensus concerning most steps and decisions for the treatment of cryptorchidism. However, some aspects of diagnostic imaging, the use of hormonal therapy, and surgical access in nonpalpable testis warrant further discussion and are the fields of considerable changes.

Cryptorchidism is the most common disorder in paediatric surgery in the Western world and a major risk factor for subfertility and malignancy. In 2009, German national guidelines were changed to recommend that treatment for undescended testes should be completed by the age of 1 instead of 2. However, the share of boys undergoing orchidopexy for cryptorchidism within the first year of life has only marginally increased in response to the guideline of the Association of the Scientific Medical Societies in Germany (AWMF). The number of orchidopexies performed in children below the age of 1 is too low both in Germany as well as internationally. The majority of primary care physicians treating children do not seem to be aware of this discrepancy between guideline recommendations and average actual age at orchidopexy. Moreover, a considerable number of cryptorchidism cases seem to be due to secondary ascent of the testis - an underappreciated condition that usually occurs at school age. Consequently, the timing of orchidopexy in primary undescended testes must be optimised. Therefore, education of parents and primary care physicians regarding the necessity of early orchidopexy and frequent testicular examinations even beyond infancy is mandatory to improve the prognosis of cryptorchidism regarding subfertility and malignancy. Further studies are needed to clarify the reasons for the large number of late orchidopexies.

Cryptorchidism, or undescended testis (UDT), occurs in 1-3% of male term infant births. At least two-thirds of UDTs will descend spontaneously, typically during the first 6 months of life. UDTs are associated with loss of spermatogenic potential and testicular malignancy in the long term. Orchiopexy performed prior to puberty may significantly reduce the malignant potential by up to 4-fold. Neoadjuvant hormonal therapy starting at 6 months of life has been shown to potentially improve the testicle's fertility index and should be part of the therapeutic concept. However, the use of hormonal treatment and HCG beyond the first year of life is to be challenged given a potentially negative impact on testicular function. Laparoscopic exploration and therapy is the method of choice for non-palpable testes. Ideally, surgical repair of the UDT should be completed by the age of 1 year.