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Transitional Urology for Male Adolescents: What Adult Urologists Should Know

  • Men’s Health (A Dabaja, Section Editor)
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Abstract

In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Eswara JR, Kielb S, Koyle MA, Wood D, Wood HM. The recommendations of the 2015 American Urological Association Working Group on Genitourinary Congenitalism. Urology. 2016;88:1–7.

    Article  PubMed  Google Scholar 

  2. Guven A, Kogan BA. Undescended testis in older boys: further evidence that ascending testes are common. J Pediatr Surg. 2008;43(9):1700–4.

    Article  PubMed  Google Scholar 

  3. Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337–45. This guideline provides an excellent algorithm for the management of undescended testes, as well as a good review of the reasoning behind the recommendations.

  4. Parson JK, Hsieh TC. Chapter 23, Integrated men’s health: androgen deficiency, cardiovascular risk, and metabolic syndrome. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. Philadelphia: Elsevier; 2016. p. 538–55.

    Google Scholar 

  5. Lee PA, Coughlin MT. Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery. J Urol. 2002;167(4):1824–7.

  6. Gudeman SR, Townsend B, Fischer K, Walters RC, Crain D. Etiology of azoospermia in a military population. J Urol. 2015;193(4):1318–21. This manuscript reveals the common causes of azoospermia in a population with complete data because of military health care delivery.

  7. Kollin C, Stukenborg JB, Nurmio M, Sundqvist E, Gustafsson T, Söder O, et al. Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol Metab. 2012;97(12):4588–95.

    Article  CAS  PubMed  Google Scholar 

  8. Bilius V, Verkauskas G, Dasevicius D, Kazlauskas V, Malcius D, Hadziselimovic F. Incidence of high infertility risk among unilateral cryptorchid boys. Urol Int. 2015;95(2):142–5.

    Article  PubMed  Google Scholar 

  9. van Brakel J, Kranse R, de Muinck Keizer-Schrama SM, Hendriks AE, de Jong FH, Bangma CH, et al. Fertility potential in men with a history of congenital undescended testes: a long-term follow-up study. Andrology. 2013;1(1):100–8.

    Article  PubMed  Google Scholar 

  10. Hart RJ, Doherty DA, McLachlan RI, Walls ML, Keelan JA, Dickinson JE, et al. Testicular function in a birth cohort of young men. Hum Reprod. 2015;30(12):2713–24.

    CAS  PubMed  Google Scholar 

  11. Lin YM, Hsu CC, Wu MH, Lin JS. Successful testicular sperm extraction and paternity in an azoospermic man after bilateral postpubertal orchiopexy. Urology. 2001;57(2):365.

    Article  CAS  PubMed  Google Scholar 

  12. Banks K, Tuazon E, Berhane K, Koh CJ, De Filippo RE, Chang A, et al. Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics. Front Endocrinol. 2013;18(3):182.

    Google Scholar 

  13. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. 2007;356(18):1835–41.

    Article  CAS  PubMed  Google Scholar 

  14. Lip SZ, Murchison LE, Cullis PS, Govan L, Carachi R. A meta-analysis of the risk of boys with isolated cryptorchidism developing testicular cancer in later life. Arch Dis Child. 2013;98(1):20–6.

    Article  PubMed  Google Scholar 

  15. Akre O, Pettersson A, Richiardi L. Risk of contralateral testicular cancer among men with unilaterally undescended testis: a meta analysis. Int J Cancer. 2009;124(3):687–9.

    Article  CAS  PubMed  Google Scholar 

  16. Coupland CA, Chilvers CE, Davey G, Pike MC, Oliver RT, Forman D. Risk factors for testicular germ cell tumours by histological tumour type. United Kingdom Testicular Cancer Study Group. Br J Cancer. 1999;80(11):1859–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Klaassen Z, Reinstatler L, Wilson SN, Ellington C, Li Q, Terris MK, Moses KA. Clinical disparities for minorities and foreign-born men with undescended versus descended testicular germ cell tumors. Clin Genitourin Cancer. 2015. epub ahead of print.

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

    CAS  PubMed  Google Scholar 

  19. Kucheria R, Sahai A, Sami TA, Challacombe B, Godbole H, Khan MS, et al. Laparoscopic management of cryptorchidism in adults. Eur Urol. 2005;48(3):453–7.

    Article  CAS  PubMed  Google Scholar 

  20. Patel RP, Kolon TF, Huff DS, Carr MC, Zderic SA, Canning DA, et al. Testicular microlithiasis and antisperm antibodies following testicular biopsy in boys with cryptorchidism. J Urol. 2005;174(5):2008–10.

    Article  PubMed  Google Scholar 

  21. Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, McDermott TE, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol. 1998;159(3):851–4.

    Article  CAS  PubMed  Google Scholar 

  22. Koni A, Ozseker HS, Arpali E, Kilinc E, Dogan HS, Akyol A, et al. Histopathological evaluation of orchiectomy specimens in 51 late postpubertal men with unilateral cryptorchidism. J Urol. 2014;192(4):1183–8.

    Article  PubMed  Google Scholar 

  23. Ryang SH, Jung JH, Eom M, Song JM, Chung HC, Chae Y, et al. The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis. Korean J Urol. 2015;56(7):515–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Oh J, Landman J, Evers A, Yan Y, Kibel AS. Management of the postpubertal patient with cryptorchidism: an updated analysis. J Urol. 2002;167(3):1329–33.

    Article  PubMed  Google Scholar 

  25. Stec AA, Thomas JC, DeMarco RT, Pope 4th JC, Brock 3rd JW, Adams MC. Incidence of testicular ascent in boys with retractile testes. J Urol. 2007;178(4 Pt 2):1722–4.

    Article  PubMed  Google Scholar 

  26. Agarwal PK, Diaz M, Elder JS. Retractile testis—is it really a normal variant? J Urol. 2006;175(4):1496–9.

    Article  PubMed  Google Scholar 

  27. van Brakel J, Kranse R, de Muinck Keizer-Schrama SM, Hendriks AE, de Jong FH, Hack WW, et al. Fertility potential in a cohort of 65 men with previously acquired undescended testes. J Pediatr Surg. 2014;49(4):599–605.

    Article  PubMed  Google Scholar 

  28. Kolon TF. Evaluation and management of the adolescent varicocele. J Urol. 2015;194(5):1194–201. This is an excellent review that includes a handy algorithm for the management of adolescent varicocele.

  29. Christman MS, Zderic SA, Kolon TF. Comparison of semen analyses in youths with a history of cryptorchidism or varicocele. J Urol. 2013;190(4 Suppl):1561–5.

    Article  PubMed  Google Scholar 

  30. Coutinho K, McLeod D, Stensland K, Stock JA. Variations in the management of asymptomatic adolescent grade 2 or 3 left varicoceles: a survey of practitioners. J Pediatr Urol. 2014;10(3):430–4.

    Article  PubMed  Google Scholar 

  31. Pastuszak AW, Kumar V, Shah A, Roth DR. Diagnostic and management approaches to pediatric and adolescent varicocele: a survey of pediatric urologists. Urology. 2014;84(2):450–5.

    Article  PubMed  Google Scholar 

  32. Alukal JP, Zurakowski D, Atala A, Bauer SB, Borer JG, Cilento Jr BG, et al. Testicular hypotrophy does not correlate with grade of adolescent varicocele. J Urol. 2005;174(6):2367–70.

    Article  PubMed  Google Scholar 

  33. Diamond DA, Zurakowski D, Bauer SB, Borer JG, Peters CA, Cilento Jr BG, et al. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol. 2007;178(4 Pt 2):1584–8.

    Article  PubMed  Google Scholar 

  34. Kolon TF, Clement MR, Cartwright L, Bellah R, Carr MC, Canning DA, et al. Transient asynchronous testicular growth in adolescent males with a varicocele. J Urol. 2008;180(3):1111–4.

    Article  PubMed  Google Scholar 

  35. Spinelli C, Di Giacomo M, Lo Piccolo R, Martin A, Messineo A. The role of testicular volume in adolescents with varicocele: the better way and time of surgical treatment. J Urol. 2010;184(4 Suppl):1722–6.

    Article  PubMed  Google Scholar 

  36. Van Batavia JP, Woldu SL, Raimondi PM, Spencer BA, Insel BJ, Poon SA, et al. Adolescent varicocele: influence of Tanner stage at presentation on the presence, development, worsening and/or improvement of testicular hypotrophy without surgical intervention. J Urol. 2010;184(4 Suppl):1727–32.

    Article  PubMed  Google Scholar 

  37. Korets R, Woldu SL, Nees SN, Spencer BA, Glassberg KI. Testicular symmetry and adolescent varicocele—does it need followup? J Urol. 2011;186(4 Suppl):1614–8.

    Article  PubMed  Google Scholar 

  38. Thomas JC, Elder JS. Testicular growth arrest and adolescent varicocele: does varicocele size make a difference? J Urol. 2002;168(4 Pt 2):1689–91.

    Article  PubMed  Google Scholar 

  39. Chen JJ, Ahn HJ, Junewick J, Posey ZQ, Rambhatla A, Steinhardt GF. Is the comparison of a left varicocele testis to its contralateral normal testis sufficient in determining its well-being? Urology. 2011;78(5):1167–72.

    Article  PubMed  Google Scholar 

  40. Christman MS, Zderic SA, Canning DA, Kolon TF. Active surveillance of the adolescent with varicocele: predicting semen outcomes from ultrasound. J Urol. 2014;191(5):1401–6.

    Article  PubMed  Google Scholar 

  41. Verim S, Uguz S, Celikkanat S, Guragac A, Turker T, Topuz B, Demirci R, Alp BF, Irkilata HC, Sağlam M. Prognostic predictors of fertility in young adult patients with varicocele: peak retrograde flow velocity and reflux grade. J Ultrasound Med. 2016. Epub ahead of print.

  42. Del Giudice PT, Belardin LB, Camargo M, Zylbersztejn DS, Carvalho VM, Cardozo KH, et al. Determination of testicular function in adolescents with varicocoele—a proteomics approach. Andrology. 2016;4(3):447–55.

    Article  PubMed  Google Scholar 

  43. Christman MS, Kraft KH, Tasian GE, Zderic SA, Kolon TF. Reproducibility and reliability of semen analysis in youths at risk for infertility. J Urol. 2013;190(2):683–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fine RG, Gitlin J, Reda EF, Palmer LS. Barriers to use of semen analysis in the adolescent with a varicocele: survey of patient, parental, and practitioner attitudes. J Pediatr Urol. 2016;12(1):41.e1–6.

    Article  Google Scholar 

  45. Kurtz MP, Zurakowski D, Rosoklija I, Bauer SB, Borer JG, Johnson KL, et al. Semen parameters in adolescents with varicocele: association with testis volume differential and total testis volume. J Urol. 2015;193(5 Suppl):1843–7.

    Article  PubMed  Google Scholar 

  46. Diamond DA, Gargollo PC, Caldamone AA. Current management principles for adolescent varicocele. Fertil Steril. 2011;96(6):1294–8. This review nicely summarizes the various surgical options and their outcomes.

  47. Nees SN, Glassberg KI. Observations on hydroceles following adolescent varicocelectomy. J Urol. 2011;186(6):2402–7.

    Article  PubMed  Google Scholar 

  48. Harel M, Herbst KW, Nelson E. Practice patterns in the surgical approach for adolescent varicocelectomy. Springerplus. 2015;4:772.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Fast AM, Deibert CM, Van Batavia JP, Nees SN, Glassberg KI. Adolescent varicocelectomy: does artery sparing influence recurrence rate and/or catch-up growth? Andrology. 2014;2(2):159–64.

    Article  CAS  PubMed  Google Scholar 

  50. Kim KS, Lee C, Song SH, Cho SJ, Park S, Moon KH, et al. Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents. J Pediatr Urol. 2014;10(3):435–40.

    Article  CAS  PubMed  Google Scholar 

  51. Yu W, Rao T, Ruan Y, Yuan R, Cheng F. Laparoscopic varicocelectomy in adolescents: artery ligation and artery preservation. Urology. 2016;89:150–4.

    Article  PubMed  Google Scholar 

  52. Rizkala E, Fishman A, Gitlin J, Zelkovic P, Franco I. Long term outcomes of lymphatic sparing laparoscopic varicocelectomy. J Pediatr Urol. 2013;9(4):458–63.

    Article  PubMed  Google Scholar 

  53. Shiraishi K, Oka S, Matsuyama H. Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele. Int J Urol. 2016;23(4):338–42.

    Article  PubMed  Google Scholar 

  54. Moursy EE, ElDahshoury MZ, Hussein MM, Mourad MZ, Badawy AA. Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly. J Pediatr Urol. 2013;9(6 Pt B):1018–22.

    Article  PubMed  Google Scholar 

  55. Guo L, Sun W, Shao G, Song H, Ge N, Zhao S, et al. Outcomes of microscopic subinguinal varicocelectomy with and without the assistance of Doppler ultrasound: a randomized clinical trial. Urology. 2015;86(5):922–8.

    Article  PubMed  Google Scholar 

  56. Halpern J, Mittal S, Pereira K, Bhatia S, Ramasamy R. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications. Asian J Androl. 2016;18(2):234–8.

    Article  PubMed  Google Scholar 

  57. Lurvey R, Durbin-Johnson B, Kurzrock EA. Adolescent varicocele: a large multicenter analysis of complications and recurrence in academic programs. J Pediatr Urol. 2015;11(4):186.e1–6.

    Article  Google Scholar 

  58. Li F, Chiba K, Yamaguchi K, Okada K, Matsushita K, Ando M, et al. Effect of varicocelectomy on testicular volume in children and adolescents: a meta-analysis. Urology. 2012;79(6):1340–5.

    Article  PubMed  Google Scholar 

  59. Nork JJ, Berger JH, Crain DS, Christman MS. Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes. Fertil Steril. 2014;102(2):381–7.

    Article  PubMed  Google Scholar 

  60. Bogaert G, Orye C, De Win G. Pubertal screening and treatment for varicocele do not improve chance of paternity as adult. J Urol. 2013;189(6):2298–303.

    Article  PubMed  Google Scholar 

  61. Aksglaede L, Juul A. Testicular function and fertility in men with Klinefelter syndrome: a review. Eur J Endocrinol. 2013;168(4):R67–76. This article provides a nice review about the main urologic implications to men with Klinefelter syndrome.

  62. Samplaski MK, Lo KC, Grober ED, Millar A, Dimitromanolakis A, Jarvi KA. Phenotypic differences in mosaic Klinefelter patients as compared with non-mosaic Klinefelter patients. Fertil Steril. 2014;101(4):950–5.

    Article  PubMed  Google Scholar 

  63. Gies I, Unuane D, Velkeniers B, De Schepper J. Management of Klinefelter syndrome during transition. Eur J Endocrinol. 2014;171(2):R67–77. This article outlines how to make the transition process go more smoothly for these complicated patients.

  64. Turriff A, Levy HP, Biesecker B. Factors associated with adaptation to Klinefelter syndrome: the experience of adolescents and adults. Patient Educ Couns. 2015;98(1):90–5.

    Article  PubMed  Google Scholar 

  65. Mehta A, Clearman T, Paduch DA. Safety and efficacy of testosterone replacement therapy in adolescents with Klinefelter syndrome. J Urol. 2014;191(5 Suppl):1527–31.

    Article  CAS  PubMed  Google Scholar 

  66. Rogol AD, Swerdloff RS, Reiter EO, Ross JL, ZumBrunnen TL, Pratt GA, et al. A multicenter, open-label, observational study of testosterone gel (1%) in the treatment of adolescent boys with klinefelter syndrome or anorchia. J Adolesc Health. 2014;54(1):20–5.

    Article  PubMed  Google Scholar 

  67. Moskovic DJ, Freundlich RE, Yazdani P, Lipshultz LI, Khera M. Subcutaneous implantable testosterone pellets overcome noncompliance in adolescents with Klinefelter syndrome. J Androl. 2012;33(4):570–3.

    Article  PubMed  Google Scholar 

  68. Nahata L, Yu RN, Bhasin S, Cohen LE. Management of testosterone therapy in adolescents and young men with hypogonadism: are we following adult clinical practice guidelines? J Pediatr Endocrinol Metab. 2015;28(5–6):635–40.

    CAS  PubMed  Google Scholar 

  69. Gies I, Oates R, De Schepper J, Tournaye H. Testicular biopsy and cryopreservation for fertility preservation of prepubertal boys with Klinefelter syndrome: a pro/con debate. Fertil Steril. 2016;105(2):249–55.

    Article  PubMed  Google Scholar 

  70. Rohayem J, Fricke R, Czeloth K, Mallidis C, Wistuba J, Krallmann C, et al. Age and markers of Leydig cell function, but not of Sertoli cell function predict the success of sperm retrieval in adolescents and adults with Klinefelter’s syndrome. Andrology. 2015;3(5):868–75.

    Article  CAS  PubMed  Google Scholar 

  71. Plotton I, Giscard d’Estaing S, Cuzin B, Brosse A, Benchaib M, Lornage J, et al. Preliminary results of a prospective study of testicular sperm extraction in young versus adult patients with nonmosaic 47, XXY Klinefelter syndrome. J Clin Endocrinol Metab. 2015;100(3):961–7.

    Article  CAS  PubMed  Google Scholar 

  72. Madureira C, Cunha M, Sousa M, Neto AP, Pinho MJ, Viana P, et al. Treatment by testicular sperm extraction and intracytoplasmic sperm injection of 65 azoospermic patients with non-mosaic Klinefelter syndrome with birth of 17 healthy children. Andrology. 2014;2(4):623–31.

    Article  CAS  PubMed  Google Scholar 

  73. Bryson CF, Ramasamy R, Sheehan M, Palermo GD, Rosenwaks Z, Schlegel PN. Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction. J Urol. 2014;191(1):175–8.

    Article  PubMed  Google Scholar 

  74. Fedder J, Gravholt CH, Kristensen SG, Marcussen N, Engvad B, Milton AM, et al. Testicular sperm sampling by subcapsular orchiectomy in Klinefelter patients: a new simplified treatment approach. Urology. 2015;86(4):744–50.

    Article  PubMed  Google Scholar 

  75. Greco E, Scarselli F, Minasi MG, Casciani V, Zavaglia D, Dente D, et al. Birth of 16 healthy children after ICSI in cases of nonmosaic Klinefelter syndrome. Hum Reprod. 2013;28(5):1155–60.

    Article  CAS  PubMed  Google Scholar 

  76. Maiburg MC, Hoppenbrouwers AC, van Stel HF, Giltay JC. Attitudes of Klinefelter men and their relatives towards TESE-ICSI. J Assist Reprod Genet. 2011;28(9):809–14.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Mehta A, Bolyakov A, Roosma J, Schlegel PN, Paduch DA. Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor. Fertil Steril. 2013;100(4):970–4.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Kristina D. Suson.

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Suson, K.D. Transitional Urology for Male Adolescents: What Adult Urologists Should Know. Curr Urol Rep 17, 71 (2016). https://doi.org/10.1007/s11934-016-0630-2

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