Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Hodenhochstand: aktuelle Therapierichtlinien

Undescended testis: current treatment guidelines

  • 530 Accesses

  • 1 Citations

Zusammenfassung

Hintergrund

Der Hodenhochstand ist die häufigste genitale Fehlbildung, die bei neugeborenen Jungen diagnostiziert wird. In den letzten Jahren haben sich die Empfehlungen zur Diagnostik und Therapie durch die Implementierung neuer wissenschaftlicher Erkenntnisse teils deutlich verändert.

Ziele der Arbeit

Diese Arbeit soll einen Überblick über die aktuellen Empfehlungen der nationalen und internationalen Leitlinien zur Behandlung des Hodenhochstands geben. Die wesentlichen kontroversiellen Punkte werden im Licht der aktuellen Literatur diskutiert.

Material und Methoden

Die Leitlinien der „European Association of Urology“ (EAU)/„European Society for Pediatric Urology“ (ESPU), der „American Association of Urology“ (AUA), des Arbeitskreises Kinderurologie der Österreichischen Gesellschaft für Urologie (ÖGU), der „International Consultation on Urological Disease“ (ICUD) und der Deutschen Gesellschaft für Urologie (DGU)/der Deutschen Gesellschaft für Kinderchirurgie (DGKCh) wurden hinsichtlich der wesentlich erscheinenden Punkte in Diagnose und Therapie verglichen.

Ergebnisse

Bezüglich der meisten wesentlichen Schritte und Entscheidungen in der Behandlung des Hodenhochstands besteht weitgehend Konsensus. Aspekte der bildgebenden Diagnostik, die neoadjuvante Hormontherapie und der chirurgische Zugang bei nicht tastbaren Hoden sind die Themen, bei denen sich teils wesentliche Änderungen ergaben und größtenteils geringe Diskrepanzen bestehen.

Abstract

Background

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.

Objectives

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.

Materials and methods

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.

Results

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.

This is a preview of subscription content, log in to check access.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. 1.

    United Kingdom Testicular Cancer Study Group (1994) Aetiology of testicular cancer: Association with congenital abnormalities, age at puberty, infertility, and exercise. BMJ 308:1393–1399

  2. 2.

    Charles JC (2004) The fate of the retractile testis. J Urol 171:1237

  3. 3.

    Copp H, Bogaert G, Braga L, Lorenzo A, Tasian G (2014) Cryptorchidism, hernia and hydrocele. in: congenital anomalies in children: a joint SIU-ICUD international consultation. Société Internationale d’Urologie (SIU), Vancouver, S 21–51

  4. 4.

    Dunkel L, Taskinen S, Hovatta O, Tilly JL, Wikström S (1997) Germ cell apoptosis after treatment of cryptorchidism with human chorionic gonadotropin is associated with impaired reproductive function in the adult. J Clin Invest 100:2341–2346

  5. 5.

    Fowler R, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 29:92–106

  6. 6.

    Guven A, Kogan BA (2008) Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg 43:1700–1704

  7. 7.

    Hadziselimovic F (2012) The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: A review of the literature by B. Ludwikowski and R. González. Eur J Pediatr 171(8):1281

  8. 8.

    Hadziselimovic F, Hocht B, Herzog B, Buser MW (2007) Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy. Horm Res 68:46–52

  9. 9.

    Hadziselimovic F, Zivkovic D, Bica DT, Emmons LR (2005) The importance of mini-puberty for fertility in cryptorchidism. J Urol 174:1536–1539

  10. 10.

    Koff SA, Sethi PS (1996) Treatment of high undescended testes by low spermatic vessel ligation: An alternative to the fowler-stephens technique. J Urol 156:799–803

  11. 11.

    Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, Diaz M, Lee PA, Seashore CJ, Tasian GE, Barthold JS, American Urological Assocation (2014) Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 192:337–345

  12. 12.

    Körner I, Neissner C, Steckermeier J, Rösch WH (2009) Late diagnosis of cryptorchidism. Urologe A 48:1032–1037

  13. 13.

    Körner I, Rübben H (2010) Undescended testis : aspects of treatment. Urologe A 49(9):1199–1205

  14. 14.

    Ludiwikowsi LB (2013) S2kHodenhochstand-Maldescensus testis. AWMF Register 006/022. http://www.awmf.org/uploads/tx_szleitlinien/006-022l_SS2k_Hodenhochstand_Maldescensus_testis_2013-04.pdf

  15. 15.

    Ludwikowski B, González R (2012) The controversy regarding the need for hormonal treatment in boys with unilateral cryptorchidism goes on: a review of the literature. Eur J Pediatr 172(1):5–8

  16. 16.

    Neissner C, Ebert AK, Rösch WH (2011) Analysis of laparoscopic orchidopexy in intra-abdominal testis. Urologe A 50:573–578

  17. 17.

    Oswald J, Becker T (2012) Leitlinien Kinderurologie. J Urol Urogynaekol 19(1):35–42

  18. 18.

    Patel SR, Caldamone AA (2010) Sir denis browne: Contributions to pediatric urology. J Pediatr Urol 6:496–500

  19. 19.

    Prakash J, Dalela D, Goel A, Dalela D, Kumar M, Sankhwar SN, Kureel SN (2014) Testicular rerouting by modified prentiss maneuver: Usefulness in bilateral synchronous orchidopexy for high inguinal undescended testes. J Pediatr Surg 49:1311–1314

  20. 20.

    Raivio T, Toppari J, Kaleva M, Virtanen H, Haavisto AM, Dunkel L, Jänne OA (2003) Serum androgen bioactivity in cryptorchid and noncryptorchid boys during the postnatal reproductive hormone surge. J Clin Endocrinol Metab 88:2597–2599

  21. 21.

    Rusnack SL, Wu HY, Huff DS, Snyder HM, Zderic SA, Carr MC, Canning DA (2002) The ascending testis and the testis undescended since birth share the same histopathology. J Urol 168:2590–2591

  22. 22.

    Schwentner C, Oswald J, Kreczy A, Lunacek A, Bartsch G, Deibl M, Radmayr C (2005) Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol 173:974–977

  23. 23.

    Shibata Y, Kojima Y, Mizuno K, Nakane A, Kato T, Kamisawa H, Kohri K, Hayashi Y (2010) Optimal cutoff value of contralateral testicular size for prediction of absent testis in japanese boys with nonpalpable testis. Urology 76:78–81

  24. 24.

    Sijstermans K, Hack WW, Meijer RW, van der Voort-Doedens LM (2008) The frequency of undescended testis from birth to adulthood: a review. Int J Androl 31:1–11

  25. 25.

    Sijstermans K, Hack WW, van der Voort-Doedens LM, Meijer RW, Haasnoot K (2006) Puberty stage and spontaneous descent of acquired undescended testis: Implications for therapy? Int J Androl 29:597–602

  26. 26.

    Tasian GE, Copp HL, Baskin LS (2011) Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness. J Pediatr Surg 46:2406–2413

  27. 27.

    Tekgül S, Dogan H, Hoebeke P, Radmayr C, Kocvara R, Nijman E et al (2015) EAU guidelines on paediatric urology. http://uroweb.org/wp-content/uploads/23-Paediatric-Urology_LR_full.pdf

  28. 28.

    Vos A, Vries AM, Smets A, Verbeke J, Heij H, van der Steeg A (2014) The value of ultrasonography in boys with a non-palpable testis. J Pediatr Surg 49:1153–1155

  29. 29.

    Wayne C, Chan E, Nasr A, The Canadian Association of Paediatric Surgeons Evidence-Based Resource (2015) What is the ideal surgical approach for intra-abdominal testes? a systematic review. Pediatr Surg Int 31(4):327–338

  30. 30.

    Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: Separating fact from fiction. J Urol 181:452–461

Download references

Author information

Correspondence to Dr. B. Haid.

Ethics declarations

Interessenkonflikt

B. Haid gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Haid, B. Hodenhochstand: aktuelle Therapierichtlinien. Urologe 55, 10–18 (2016). https://doi.org/10.1007/s00120-015-0002-4

Download citation

Schlüsselwörter

  • Kryptorchismus
  • Leitlinien
  • Hormontherapie
  • Laparoskopie
  • Fehlbildung, genitale

Keywords

  • Cryptorchism
  • Guidelines
  • Hormonal therapy
  • Laparoscopy
  • Urogenital abnormalities