[size=20px]A 14-year old boy is found to have a testicle in the left inguinal canal. The right testicle is normal in size and location. On exploration the left testicle is 20% of the contralateral size and has very short vessels.

 

What is the appropriate operative procedure?

 

A Inguinal orchiopexy

 

B Laparoscopic orchiopexy

 

C One stage Fowler-Stevens orchiopexy

 

D Two stage orchiopexy

 

E Orchiectomy[/size]

(Untitled)

 

d

think again my dear

A

B

D

E

E

correct

 

A common clinical scenario for pediatric surgeons is the adolescent who presents with a unilateral undescended testicle. The American Urological Association, the European Association of Urology/European Society for Pediatric Urology, and the Canadian Association of Urologic Surgeons all have recent guidelines for cryptorchidism that address this issue. All three organizations support orchiectomy for postpubertal boys based on increased cancer risks as well as decreased fertility.

 

In the setting of a postpubertal boy with cryptorchididm, the family should be counseled for an orchiectomy if the contralateral testicle is normal. At surgery, if the testicle is atrophic, with short vessels, and dysmorphic an orchiectomy should be performed. If the testicle is normal in appearance, with reasonable length on the vessels and reasonable size a orchiopexy can be considered. The literature discusses biopsy, but is not definitive on this option.

 

While older references describe a risk of testicular cancer in an undescended testicle as being as high as 40 times that of the normal population, more recent studies would put this number at about two to eight times. In addition, while there are multiple reports indicating that a contralateral normal testicle is at higher risk for cancer in the presence of an undescended testicle, the risk is not as high as in the cryptorchid testicle. A review of multiple studies by Wood & Elder suggest that there may not be any increased risk at all.

 

There is now increasing evidence that orchiopexy decreases the risk of cancer. In a large study of the Swedish Cancer Registry and the Swedish Hospital Discharge Register, Pettersson et al. examined the effect of age at orchiopexy on cancer risks in 16,983 men undergoing orchiopexy. Relative risk of cancer was 2.23 before age 13 years and 5.4 after age 13. This study supports the role of orchiopexy in reducing cancer risk as well as the need to perform the surgery at an earlier age.

 

Current recommendations for orchiopexy is between 6-18 months of age.

I thought that the risk of cancer is higher in intraabdominal ectopic testis...thank you for these informations