Patient and family experiences toward fertility, self-esteem, and sexual function in adolescents with varicoceles: A qualitative study
Catherine Nguyen, MD, Denisse Leza-Rincon, MD, Nicolette Janzen, MD, Albert Lee, DO.
Texas Children's Hospital, Houston, TX, USA.
Histopathologic results of intra-abdominal testicles of post-pubertal pediatric malesCatherine Nguyen, Denisse Leza-Rincon, Nicolette Janzen, Albert Lee
Background: Undescended testicle (UDT), is a common condition, affecting about 3-5% of full-term and 30% of premature male infants. It is estimated that 5% of all UDTs are intra-abdominal. The American Urological Association recommends removal of UDTs in post-pubertal males given its low contribution to fertility and known association with an increased risk for germ cell malignancy. Evidence that leads to opinions on management of UDT mostly comes from studies in adult populations. We report on the first series of histopathological results of intra-abdominal testes in the post-pubertal pediatric population.
Method: We retrospectively reviewed patients who underwent laparoscopic orchiectomy for a unilateral intra-abdominal testicle at a single large tertiary academic center from January 2010 to December 2022. Demographics data were collected as well as physical exam, radiographic data, peri-operative clinical data and histopathology information were abstracted by a single pediatric urologist. We included patients nine to 18 years old at the time of surgery. The tanner stage was not always well documented, thus age of 9 was selected as the cutoff to capture all post pubertal boy as most literature cite age 9-14 as the beginning of puberty in boy. Any patients with disorder of sexual differentiation were excluded.
Result: A total of 25 patients with intra-abdominal testicles who underwent laparoscopic orchiectomy were identified. The median age at surgery was 14 years (range 9-18) with 19 patients being 13 years or older. Four patients previously underwent a first stage Fowler-Stephens orchiopexy. No patient had developmental delay. 11 testes were on the right and 14 were on the left. Two patients had compensatory hypertrophy of the contralateral testis per physical exam documentation. The average size of surgical specimen 3.78cm3 (range 0.02 - 8.7). On histopathology exam, 13 (52%) patients had no germ cells, 23 (92%) had no evidence of spermatogenesis, 20 (80%) had evidence of seminiferous tubules, 18 (72%) had Sertoli cells, 16 (52%) had Leydig cells, and 19 (76%) had fibrosis.
Conclusion: In our study, 52% of pediatric intra-abdominal testis lack germ cells and 92% did not have spermatogenesis. Given the accepted age for the start of puberty in boys is between 9-14 years, this finding supports the belief that intra-abdominal testicles in post-pubertal boy have low contribution to fertility potential. Of note, while malignancy was not detected in our cohort, this could be due to the small number of patients and their young age as most germ cell tumors are found in men between the ages of 20-40 years. The results of our study support the current AUA recommendation and would help guide the decision to perform orchiectomy in older boys with intra-abdominal testicles.
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