A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis
Zhilin YangShoulin LiJianchun YinJiming BaoHongwu ZengWanhua XuXuan ZhangZhihao XingWeiguang ZhaoCundong Liu
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Abstract:
There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables.We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018.A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851.In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.Keywords:
Orchiopexy
Testicular atrophy
Nomogram
Objective To simulate a laparoscopic F S procedure in young rats and evaluated the morphologic alterations in detail with regard to testicular atrophy.Methods Thirty day old Wistar rats divided into 2 groups underwent laparoscopic sham operation and unilateral laparoscopic F S procedure.Detailed morphological investigations were performed at 7 different postoperative intervals between the 9th day and 18th month.Results Laparoscopic F S procedure induced testicular atrophy in 85% of the operated testes with different degrees of spermatogenic arrest. Mild(blood testis barrier damaged), severe (Sertoli cell only syndrome) and complete (normal testicular structure collapsed) testicular atrophy were used to define atrophy according to the morphologic alterations observed. In mild or severe atrophy, the testicular size of the operated testis was only slightly reduced compared to the age matched controls, whereas the contra lateral testis was not involved. In complete atrophy (49% of the operated testes) a striking size reduction with necrosis of the testicular parenchyma and marked central microlithiasis was observed. The contra lateral testes revealed in all cases mild or severe atrophy beginning as early as the 45th day postoperatively and eventually developed severe atrophy 18 months later. Parallel to the testicular atrophy, Leydig cell (LC) hyperplasia developed in mild or severe atrophic testes and finally reached a typical adenoma size in the operated and the contra lateral atrophic testes. In the complete atrophic testes, LC hyperplasia also developed.Conclusions An animal model for laparoscopic F S procedure could be established in prepubertal Wistar rats. This laparoscopic F S procedure induced a high incidence of testicular atrophy in various severities, which could result in sub or infertility due to impaired spermatogenesis, as well as LC hyperplasia or adenoma formation in the atrophic testes.
Testicular atrophy
Spermatic cord
Testicle
Parenchyma
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This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage (TS) in patients with testicular torsion. The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital (Xi'an, China) between August 2008 and November 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS. Based on multivariate regression coefficients, nomograms to predict possibility of TS were established. The predictive ability of the nomograms was internally validated by receiver operating characteristic (ROC) curves and calibration plots. The duration of symptoms ranged from 2 h to 1 month, with a median of 3.5 days. Thirty (14.7%) patients underwent surgical reduction and contralateral orchiopexy, while the remaining 174 (85.3%) underwent orchiectomy and contralateral orchiopexy. Finally, long symptom duration was an independent risk predictor for TS, while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors. Internal validation showed that the nomograms, which were established by integrating these three predictive factors, had good discrimination ability in predicting the possibility of TS (areas under the ROC curves were 0.851 and 0.828, respectively). The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation. In conclusion, this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.
Nomogram
Orchiopexy
Univariate
Univariate analysis
Orchiectomy
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A retrospective cohort study was conducted at the Children's Hospital of Chongqing Medical University from November 2004 to December 2020 to investigate the long-term follow-up results after testicular torsion (TT) in children. Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group, and the baseline characteristics, ultrasonographic indications, intraoperative findings, testicular volumes, and adverse events during follow-up were compared. A total of 145 cases were included in this study. Approximately 56.6% of patients who underwent salvage orchiopexy had testicular atrophy (TA), and the median testicular volume loss of the testes was 57.4%. Age less than 6 years, delayed surgery, and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy. Most atrophied testes appeared within 3-6 months after surgery. Compared with the corresponding age-matched healthy controls, the contralateral testicular volumes were larger in the orchiopexy (P = 0.001 without TA, and P = 0.042 with TA) and orchiectomy groups (P = 0.033). The adverse events were comparable in patients with orchiectomy or orchiopexy. In summary, follow-up before 3 months after surgery may not offer sufficient clinical value, while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring. The contralateral testes of patients with TT showed compensatory hypertrophy. We suggest performing orchiectomy when torsed testes are surgically assessed as Arda grade III or inviable.
Orchiopexy
Testicular atrophy
Orchiectomy
Spermatic Cord Torsion
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Orchiopexy
Testicular atrophy
Testicle
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There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables.We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018.A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851.In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.
Orchiopexy
Testicular atrophy
Nomogram
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Orchiopexy
Testicular atrophy
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Background: Some of the patients that undergo inguinal hernia repair develop testicular atrophy. Testicular atrophy development also brings about a lot of problems. In our study, we aimed to determine the rate of development of testicular atrophy and predicting factors in patients that undergo inguinal hernia repair in our hospital.Methods: Patients who underwent inguinal hernia repair in our centre from January 2017 to January 2020 were included in our study. Total number of patients was 158 divided into 2 groups i.e. group-1 (those who developed testicular atrophy after inguinal hernia repair) and group-2 (those who did not develop testicular atrophy after inguinal hernia repair). We investigated the relationship between the development of testicular atrophy and age, hernia type and localization, duration of surgery and anesthesia, perioperative non-steroidal anti-inflammatory drugs (NSAID) and antispasmolytic use, diabetes mellitus and rheumatological disease and, perioperative fluid replacement.Results: Testicular atrophy developed in 6 of the patients (3.79%). We found that testicular atrophy was mostly secondary and mostly visible in cases underwent open repair (p=0.0001); and in which left and bilateral inguinal hernia repair was performed (p=0.014); and in cases with DM and rheumatological diseases (p=0.0001). We also found that the use of perioperative antispasmolytic and NSAID was lower in patients with testicular atrophy (p=0.0001).Conclusions: According to the results of our study, advanced age, secondary and open repair, diabetes mellitus, rheumatological disease history, not using antispasmolytic and NSAID increases the risk of testicular atrophy.
Testicular atrophy
Hernia Repair
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Testicular atrophy
Testicular volume
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Testicular atrophy
Orchiopexy
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Cryptorchidism affects 2-8% of male newborns. There is a controversy regarding timing of surgery as well as indications for orchiopexy in boys with retractile testicle. The aim of this study was to evaluate the clinical usefulness of testicular atrophy index (TAI) as a criterion of qualifying patients with undescended testes for surgery as well as of monitoring the results of treatment.In 1999-2000, 105 cryptorchid boys, aged 1 to 15 years (mean 4.8) underwent unilateral orchiopexy. Dimensions and volume of testes were measured by means of scrotal US and TAI was calculated before and 1 year after surgery.Pre- and postoperative scrotal US measurements were analyzed in 35 boys divided into five age dependent groups. The preoperative TAI values ranged from 27.1% to 52.8%. The biggest loss in volume of affected testis was found in boys aged 4 to 10 years (35.4% to 52.8%). The TAI values measured one year after orchiopexy were lower than preoperative ones. Significant difference in TAI values, ranging from 18.16% to 36.43% were observed in boys between 2 and 10 years (p < 0.001). In the youngest (0-2 yrs) and the oldest boys (> 10 yrs) the difference was not statistically significant.The testicular atrophy index (TAI) proved to be a valuable and objective tool for qualifying patients with undescended testes for surgery as well as for monitoring the results of treatment. Its value of 20% and more should be considered an indication for surgery in boys with retractile testes.
Orchiopexy
Testicular atrophy
Testicular volume
Testicle
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