Unsuspected urological anomalies in asymptomatic cryptorchid boys.
Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα), Athínai, Attica, GreecePediatric Radiology (Impact Factor: 1.57). 02/1988; 18(1):51-3. DOI: 10.1007/BF02395760
In a period of 6 years 144 asymptomatic boys with cryptorchidism, of mean age 7 +/- SD 3.5 years, underwent orchiopexy. None of these boys referred to a history of a known urological anomaly, urinary tract infection, haematuria, palpable mass in the renal region, bladder extrophy, epispadias, hypospadias or anorectal malformation. On the third day after orchiopexy and intravenous pyelography was done in every boy following testicular protection against irradiation. Ultrasonic investigation was not available at that time. There were minor urological abnormalities in 36 (25%) boys and major ones in 8 (5.5%) boys. A major anomaly is defined as one resulting in significant loss of renal substance (one case of single kidney and three cases of unilateral renal hypoplasia), or requiring surgical correction for conservation of the renal substance (one case of ureterocele, two cases of pelviureteric stenosis and one case of vesicoureteric stenosis with ipsilateral hydronephrosis). The unsuspected major urological abnormalities are usually ipsilateral to the more undescended testis. They may be associated with a hernia and are more frequent in bilateral cryptorchidism. In conclusion we encourage the routine use of IVP, or ultrasonic investigation or dynamic renal scanning (99mTc-DTPA), if it is possible, in all patients undergoing orchiopexy for the detection of an unsuspected major renal anomaly.
Article: UNDESCENDED TESTIS
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ABSTRACT: The prevalence of 54 minor morphological aberrations (MMAs) (mild malformations, dysplasias, deformities and phenogenetic variants) was determined in 138 children with isolated malformations of the urinary tract and in 32 patients with multiple major birth defects including renal malformations. Children with infectious diseases matched to each patient by sex, age and ethnic origin served as controls. The overall prevalence of MMAs--expressed as MMA/subject ratio--proved to be significantly higher in patients with multiple malformations (2.50) than in those with isolated renal abnormalities (0.80) and in controls (0.76). The difference between the latter two groups was not significant. Apart from characteristic patterns of well-defined syndromes, the only specific association found was the higher prevalence of supernumerary nipples in patients with isolated (and hidden) urinary tract abnormalities of various types (9.4% versus 1.8% in controls; P less than 0.005).
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ABSTRACT: Cryptorchidism is the absence of at least one testis in the scrotum. The incidence of cryptorchidism is high and almost 3% of boys in the western countries are operated on for this condition. Abnormalities in the hypothalamo-pituitary-testicular axis may result in cryptorchidism, and cryptorchidism is nearly almost present in individuals with a testis and abnormal sexual differentiation. We characterized an association of cryptorchidism and T10-S5 vertebral, renal and ureteral malformations and dysplasias. Cryptorchidism was ipsilateral to renal and ureteral malformations and dysplasias in more than 90% of cases. The association was proved with increasing frequency in: 4-10% of cryptorchid boys who had undergone laparoscopy for impalpable testes or were expected to be without additional abnormalities; 18% of cryptorchid boys in a material from a department of pediatric surgery; 34% of cryptorchid individuals who had died between week 28 and 40 of gestation; 65% of cryptorchid boys operated on for imperforate anus; all individuals with tritonmelia who are always cryptorchid. As the association was demonstrated with increasing frequency the higher the degree of abnormal differentiation of the caudal developmental field, cryptorchidism may be interpreted as a feature of such an abnormal differentiation. The general significance of our hypothesis is supported by the fact that both position and histology of the undescended testes were independent of a possible presence of the malformations and dysplasias encompassed by the association. Intra-abdominal testes were associated with persisting diaphragmatic ligaments which again were associated with an abnormal differentiation of the midline. Consequently we consider cryptorchidism a feature of abnormalities in the hypothalamo-pituitary-testicular axis and of an abnormal differentiation of the male sexual organs, the midline, and/or the caudal developmental field. The recommended age at surgery for cryptorchidism has gradually been lowered. The recommendations are mainly based on analyses of number of spermatogonia per tubular transverse section in normal and undescended testes. In 1984 when we started our investigations, the biological value of this variable was unclarified.
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