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Praxisrelevantes aus der S2k-Leitlinie Hodenhochstand – Malsdescensus testis

German guideline on undescended testis—what is relevant in daily routine?

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Zusammenfassung

Der Hodenhochstand stellt mit einer Inzidenz von 0,7–3 % bei reif geborenen männlichen Säuglingen eine der häufigsten kongenitalen Anomalien dar. In den ersten 6 Lebensmonaten kann es bei bis zu 70 % zu einem spontanen Deszensus kommen. Liegt der Hoden danach nicht in einer skrotalen Position, kann es langsam zu einer Einschränkung der Fertilität und zu einer Risikoerhöhung für einen Hodentumor kommen. Deshalb empfiehlt die aktuelle deutsche Leitlinie zum Maldescensus testis, dass die Therapie zwischen dem 6. und 12. Lebensmonat erfolgen sollte. Nach ausführlicher Aufklärung über Vor- und Nachteile kann beim Gleithoden eine Hormontherapie mit dem Ziel des Deszensus bzw. beim bilateralen Befund mit dem Ziel der Verbesserung des Keimzellpools angeboten werden. Nach dem 1. Lebensjahr ist die Hormontherapie obsolet. Ansonsten stellt die chirurgische Intervention die Therapie der Wahl dar. Beim Gleit- bzw. tiefen Leistenhoden über einen skrotalen oder auch inguinalen Zugang, beim nicht tastbaren und sonographisch nicht detektierbaren Hoden erfolgt die Laparoskopie zur Diagnostik und gleichzeitigen Therapie. Im 1. postoperativen Jahr sollte eine adäquate Nachsorge erfolgen, um einen Reaszensus und/oder ein insuffizientes Wachstum zu detektieren. Die regelmäßige Selbstuntersuchung ab dem 15. Lebensjahr dient der frühzeitigen Detektion eines nur sehr selten auftretenden Hodentumors (ca. 0,003 %).

Abstract

With an incidence of 0.7–3% in male infants, undescended testicles is one of the most common congenital anomalies. In the first 6 months of life, the testicles may spontaneously descend in up to 70% of individuals. If the testicle is not in a scrotal position afterwards, fertility can gradually be reduced and the risk of a testicular tumor increases. Therefore, the current German guideline for undescended testis recommends that therapy should be take place between 6 and 12 months of life. After extensive information on the advantages and disadvantages, hormone therapy with the aim of a descensus or in those with bilateral anomaly with the aim of improving the germ cell pool can be offered. After the first year of life, hormone therapy is obsolete. Otherwise, surgical intervention is the treatment of choice. In the case of gliding or deep inguinal testis via scrotal or inguinal access, in the case of nonpalpable and sonographically undetectable testis, laparoscopy is carried out for diagnosis and simultaneous therapy. In the first postoperative year, adequate follow-up should be done to detect a re-ascensus and/or insufficient growth. Regular self-examinations from the age of 15 serve for the early detection of a testicular tumor that occurs only very rarely (approximately 0.003%).

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Authors and Affiliations

  1. Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    R. Stein & N. Younsi

  2. Kinderarztpraxis, Schwanenstraße 25, 68259, Mannheim, Deutschland

    F. Loersch

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R. Stein, F. Loersch und N. Younsi geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stein, R., Loersch, F. & Younsi, N. Praxisrelevantes aus der S2k-Leitlinie Hodenhochstand – Malsdescensus testis. Urologe 59, 559–564 (2020). https://doi.org/10.1007/s00120-020-01183-z

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