The impact of age at orchiopexy on testicular cancer outcomes

Testicular ectopia: A case report

This paper mainly describes three cases of children with ectopic testis, of which two patients with transverse testicular ectopia (TTE) and one with perineal ectopic testis (PET). All patients who underwent orchidopexy at the same pediatric surgical unit in the Affiliated Hospital of Jining Medical University (Jining, China) between June 2010 and February 2021 were retrospectively evaluated (age range, 14-34 months). A total of two patients (67%) was admitted with asymptomatic unilateral inguinal masses and the contralateral testis missing; the first patient was diagnosed with TTE intraoperatively, whereas the other patient was diagnosed with TTE through physical examination and ultrasound preoperatively. The third patient (33%) was admitted with the right testis missing and a left perineal mass, which was confirmed using PET by physical and ultrasound examination before the operation. The first two patients underwent transseptal orchidopexy, whereas the third patient underwent simple orchidopexy. Postoperative complications were not observed (follow-up, 10-24 months). The low incidence and poor understanding of ectopic testis compels us to report our findings and further discuss this particular disease of testicular ectopia, including its pathogenesis, diagnostic and treatment options.

Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review

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.

Case Report: Orchiopexy in Two Poodle Dogs and Its Effect on Their Sperm Quality Parameters

Cryptorchidism is a common congenital abnormality encountered in veterinary clinics. The treatment of choice for this condition is a surgical procedure named orchiectomy or orchidectomy, where the retained testicle is removed. Surgical placement and fixation of the cryptorchid testicle into the scrotum, referred to as orchiopexy, is used in humans. However, due to the hereditary nature of cryptorchidism in dogs, this treatment option has not been proposed in veterinary clinics. Two adult Poodle dogs were referred to our research facility for a sperm parameter evaluation check. The two dogs were unilateral cryptorchid dogs treated with orchiopexy before the age of 6 months. Their sperm kinematics and morphology were within normal ranges, and their libido and testicles sizes were normal. Treatment of unilateral cryptorchidism by orchiopexy in dogs before the age of 6 months successfully restored spermatogenic function and sperm quality-related parameters. However, due to the nature of this condition, orchiectomy remains the treatment of choice.

Testicular Surveillance Post-Orchidopexy and its Impact on Early Diagnosis of Testicular Cancer

Paediatric surgeons are expected to counsel patients about the potential risk of cancer post-orchidopexy and the need to self-examine in adulthood. The study objectives were to examine if such advice is being given and identify the stage of cancer at presentation in adult patients with history of orchidopexy. This was a 5-year observational, retrospective collaborative study between a tertiary paediatric surgical unit and its regional adult testicular cancer service, examining the nature of counselling given by paediatric surgeons to orchidopexy patients and their carers and estimating the local incidence of testicular cancer in adults with previous orchidopexy during the same period. Orchidopexy was performed in 228 patients with a mean follow-up of 11.9 months. Twenty-two patients had documented advice to self-examine from puberty onwards. The advice was not influenced whether the surgery was staged or single (p = 0.39). During the 5 years, 133 adults were diagnosed with testicular cancer, 6 (4.5%) were cases of previous cryptorchidism, seminoma (n = 5) and non-seminoma germ cell tumour (n = 1). In our study, the incidence of cryptorchidism in testicular cancer was 4.5%, with all cancer patients presenting with early disease despite documented advice to self-examine being low (9.7%).

Transverse testicular ectopia: two rare adult cases and a review of literature

The first case is a 45-year-old man who presented with complaints of right-sided indirect hernia. On examination the left hemiscrotum was empty. Open hernioplasty and mesh fixation with orchiopexy of both testes were done in the same hemiscrotum, followed by MRI for further evaluation. The second case is a 26-year-old man who presented with penoscrotal hypospadias and empty left hemiscrotum, with the left testis not palpable in the scrotum or the inguinal region. MRI, karyotyping and laparoscopic orchidectomy were performed, followed by endocrinology work-up. From our experience, preoperative diagnosis with ultrasonography and/or MRI prior to diagnostic laproscopy is benifical when there is a strong suspicion of mullerian duct remnants. In other cases, diagnostic laparoscopy can be useful in diagnosis and management. Placement of both testes in the same hemiscrotum can be considered safe, although not ideal. Also, in cases with partial gonadal dysgenesis, laparoscopic orchidectomy along with excision of the mullerian remnantsis a better approach than orchiopexy.

Performance of SOFA, qSOFA and SIRS to predict septic shock after percutaneous nephrolithotomy

OBJECTIVE

The new clinical criteria termed SOFA and qSOFA were demonstrated to be more accurate than SIRS in screening patients at high risk of sepsis. We aim to evaluate the ability of SOFA, qSOFA and SIRS to predict septic shock after PCNL.

PATIENTS AND METHODS

Consecutive patients undergoing PCNL were included to assess the performance of SOFA, qSOFA and SIRS in predicting septic shock, the AUC of ROC curve and decision curve analysis were used, and the optimal cutoff values and their achieving time were calculated.

RESULTS

Of the 431 included patients, 12 (2.7%) cases developed septic shock. Compared with non-septic shock patients, patients with septic shock were more likely to be female, have positive history of urine culture and higher urine leukocyte count, and show increased postoperative serum creatinine, PCT and decreased leukocyte. The optimal cutoff of SOFA, qSOFA and SIRS was > 2, > 0 and > 1, respectively. All of the 12 patients with verified septic shock met SOFA and SIRS criteria, while only 11 cases met qSOFA criterion. SOFA had the identical highest sensitivity (100%) and greater specificity (87% vs. 81%) than SIRS. qSOFA had higher specificity (92%) than both SOFA and SIRS at the expense of lower sensitivity (92%). The AUC of SOFA (0.973) to predict septic shock was greater than that of qSOFA (0.928) and SIRS (0.935). When combined with SIRS, SOFA outperformed qSOFA for discrimination of septic shock (AUC 0.987 vs. 0.978). Decision curve analysis indicated SOFA was clearly superior to both qSOFA and SIRS with a higher net benefit and net reduction in intervention. The qSOFA achieved the best time-based predictive efficiency, with the shortest median time to meet its cutoff, followed by SOFA and SIRS.

CONCLUSION

The performance of SOFA in predicting septic shock after PCNL was slightly greater than qSOFA and SIRS. The comprehensive application of various criteria is recommended to assist early detection of septic shock following PCNL.

The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy

PURPOSE

To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC).

METHODS

A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups.

RESULTS

Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P < 0.001) and operative time > 120 min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity.

CONCLUSIONS

In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.