Testicules impalpables. Place de la cœlioscopie

Testicular Regression Syndrome: Two Case Studies

Testicular agenesis, also called testicular regression syndrome (TRS), is a rare disease. It is defined by the complete absence of testicular tissue associated with a 46,XY karyotype. The phenotype is variable depending on when gonadal regression occurs in utero. Several etiologies have been identified. Here, we report two cases of TRS with an initial diagnosis of cryptorchidism and bilateral impalpable testes. The hormonal assessment showed an undetectable anti-Müllerian hormone (AMH) level and high gonadotropins. Also, radiological exploration did not show the testicles in a normal position, which was confirmed by a negative laparoscopy, establishing the diagnosis of TRS. Androgen replacement therapy along with psychological support to the patient is recommended is such cases.

[Embryonic testicular regression syndrome: report of 6 cases]

Le syndrome de régression embryonnaire des testicules ou anorchidie bilatérale congénitale (ABC) est un syndrome très rare défini par l'absence complète de tissu testiculaire chez un patient présentant un caryotype masculin normal. Le phénotype est variable en fonction du moment où la régression gonadique survient in utero. Actuellement, son déterminisme reste encore mystérieux mais sa survenue familiale est un argument pour suggérer une étiologie génétique. Nous en rapportons six cas, illustrant la variabilité phénotypique et décrivant la démarche et les nouveaux marqueurs diagnostiques ainsi que la conduite à tenir thérapeutique.

Ultrasonography is unnecessary and misleading in evaluating boys with a nonpalpable testis and can be a cause of a legal process

A 2-year-old boy came to our attention for a left non-palpable testis (NPT). The parents asked us to perform a laparoscopy to pull down a left intrabdominal testis (IAT), identified ultrasonographically before surgery. The ultrasonography (US) performed in another institution showed a right intrascrotal testis of normal size and a left IAT of 0.85 × 0.78 mm(2) located near the internal inguinal ring. We performed a laparoscopy that showed a blind-ending vas deferens and blind-ending inner spermatic vessels as in case of vanishing testis and a large lymphnode located near the internal inguinal ring that was closed. Parents were disappointed after laparoscopic diagnosis because the US performed before surgery showed them an IAT; for this reason they undertook a legal challenge against the pediatrician and the radiologist who had given them false information. In conclusion, we believe that in cases of NPT, laparoscopy is the gold standard for diagnosis and US is unnecessary and misleading.

Management of boys with nonpalpable undescended testis

Cryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys with palpable testis is standardized, there are no formal guidelines for the management of boys with nonpalpable testis. In this Review we look at the current trends in the diagnosis and treatment of this disorder, as well as the indications for therapy and surgical procedures. On the basis of current evidence, we find that there is no optimum orchidopexy technique for the treatment of intra-abdominal testis, although it is preferable to adopt techniques that preserve the spermatic vessels. We also briefly examine the follow-up of patients with this disorder and its common complications. As yet, there are no data that assess the potential of laparoscopic orchidopexy being a risk factor for impaired fertility later in life.