- Email: [email protected]
European Society for Paediatric Urology Guidelines’
Accepted Manuscript Commentary on ‘Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines’ Nicolas Kalfa PII:
S1477-5131(16)30282-0
DOI:
10.1016/j.jpurol.2016.08.019
Reference:
JPUROL 2331
To appear in:
Journal of Pediatric Urology
Received Date: 4 August 2016 Accepted Date: 13 August 2016
Please cite this article as: Kalfa N, Commentary on ‘Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines’, Journal of Pediatric Urology (2016), doi: 10.1016/j.jpurol.2016.08.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT COMMENTARY Commentary on ‘Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines’
Nicolas Kalfa
Giraud, Montpellier, 34295, France E-mail address: [email protected]
RI PT
Service de Chirurgie Viscerale et Urologique Pediatrique Hopital Lapeyronie, 171 avenue
SC
As orchiopexy is one the most common surgical procedures in children [1], we would expect that the etiology of undescended testis (UDT) would be very well known and its treatment would be perfectly codified with a massive amount of evidence-based literature available to
M AN U
justify the recommendations. Unfortunately this is not the case. Fewer than 75 papers have been selected by Radmayr et al. to update the ESPU/EAU 2016 recommendations [2]. Whereas an early surgical approach to preserve the germinal cells appears to be consensual, many questions are left open. Have the previous recommendations for UDT been implemented in our daily practice in recent years [3,4]? Are the potential consequences of an
TE D
early general anesthesia before 1 year of age taken into account for the timing of surgery [5]? Are the beneficial effects of hormonal treatment limited to specific subgroups of patients, for example bilateral cases, or should such treatment be avoided to limit potential secondary effects? Biopsies may help to better evaluate the future fertility potential and the subsequent
EP
risk of cancer for each patient, but should reassuring results prevent surgeons from giving information to parents and recommendations for auto-examination to patients? In a postpubertal adolescent, is a 2% risk of intratubular germ cell neoplasia enough to justify an
AC C
orchiectomy rather than an orchiopexy? Radmayr et al. [2] collect objective data and try to provide at best answers, at worst simple points of view to homogenize the management of the most common genital and endocrine disease of the male newborn. Undescended testis should not be underestimated and considered as a simple and
isolated defect of migration of the gonad [6]. It is probably a symptom of a more general disease of the testis altering the function of the Leydig cells. The concomitant increased incidence of undescended testis, hypospadias, testicular cancer, and fertility troubles, as well as the geographic correlation of these conditions throughout the world, are puzzling [7]. Dissection of the causes of UDT (genetic, endocrine, and environmental factors) is needed. A
ACCEPTED MANUSCRIPT better understanding of its pathophysiology would help in treatment and follow-up, and would allow for a better, individualized prediction of fertility issues and cancer. Despite all the information provided by Radmayr et al. [2], the gray zones remain large and should be the basis for future collaborative and evidence-based research protocols. References
RI PT
[1] Schneuer FJ, Holland AJ, Pereira G, Jamieson S, Bower C, Nassar N. Age at Surgery and Outcomes of an Undescended Testis. Pediatrics 2016;137(2):e20152768.
[2] Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Stein R, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric
SC
Urology Guidelines. J Pediatr Urol 2016;XX:XXX-XXX.
[3] Bradshaw CJ, Corbet-Burcher G, Hitchcock R. Age at orchidopexy in the UK: Has new evidence changed practice? J Pediatr Urol 2014;10(4):758–62.
M AN U
[4] Hensel KO, Caspers T, Jenke AC, Schuler E, Wirth S. Operative management of cryptorchidism: guidelines and reality - a 10-year observational analysis of 3587 cases. BMC Pediatrics 2015; http://www.biomedcentral.com/1471-2431/15/116. [5] Beers SR, Rofey DL, McIntyre KA. Neurodevelopmental assessment after anesthesia in childhood: review of the literature and recommendations. Anesth Analg 2014;119(3):661–9.
TE D
[6] Skakkebaek NE, Rajpert-De Meyts E, Buck Louis GM, Toppari J, Andersson A-M, Eisenberg ML, et al. Male Reproductive Disorders and Fertility Trends: Influences of Environment and Genetic Susceptibility. Physiol Rev 2016;96(1):55-97. [7] Serrano T, Chevrier C, Multigner L, Cordier S, Jegou B. International geographic
EP
correlation study of the prevalence of disorders of male reproductive health. Hum Reprod
AC C
2013;28(7):1974–86.
S1477-5131(16)30282-0
DOI:
10.1016/j.jpurol.2016.08.019
Reference:
JPUROL 2331
To appear in:
Journal of Pediatric Urology
Received Date: 4 August 2016 Accepted Date: 13 August 2016
Please cite this article as: Kalfa N, Commentary on ‘Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines’, Journal of Pediatric Urology (2016), doi: 10.1016/j.jpurol.2016.08.019. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT COMMENTARY Commentary on ‘Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines’
Nicolas Kalfa
Giraud, Montpellier, 34295, France E-mail address: [email protected]
RI PT
Service de Chirurgie Viscerale et Urologique Pediatrique Hopital Lapeyronie, 171 avenue
SC
As orchiopexy is one the most common surgical procedures in children [1], we would expect that the etiology of undescended testis (UDT) would be very well known and its treatment would be perfectly codified with a massive amount of evidence-based literature available to
M AN U
justify the recommendations. Unfortunately this is not the case. Fewer than 75 papers have been selected by Radmayr et al. to update the ESPU/EAU 2016 recommendations [2]. Whereas an early surgical approach to preserve the germinal cells appears to be consensual, many questions are left open. Have the previous recommendations for UDT been implemented in our daily practice in recent years [3,4]? Are the potential consequences of an
TE D
early general anesthesia before 1 year of age taken into account for the timing of surgery [5]? Are the beneficial effects of hormonal treatment limited to specific subgroups of patients, for example bilateral cases, or should such treatment be avoided to limit potential secondary effects? Biopsies may help to better evaluate the future fertility potential and the subsequent
EP
risk of cancer for each patient, but should reassuring results prevent surgeons from giving information to parents and recommendations for auto-examination to patients? In a postpubertal adolescent, is a 2% risk of intratubular germ cell neoplasia enough to justify an
AC C
orchiectomy rather than an orchiopexy? Radmayr et al. [2] collect objective data and try to provide at best answers, at worst simple points of view to homogenize the management of the most common genital and endocrine disease of the male newborn. Undescended testis should not be underestimated and considered as a simple and
isolated defect of migration of the gonad [6]. It is probably a symptom of a more general disease of the testis altering the function of the Leydig cells. The concomitant increased incidence of undescended testis, hypospadias, testicular cancer, and fertility troubles, as well as the geographic correlation of these conditions throughout the world, are puzzling [7]. Dissection of the causes of UDT (genetic, endocrine, and environmental factors) is needed. A
ACCEPTED MANUSCRIPT better understanding of its pathophysiology would help in treatment and follow-up, and would allow for a better, individualized prediction of fertility issues and cancer. Despite all the information provided by Radmayr et al. [2], the gray zones remain large and should be the basis for future collaborative and evidence-based research protocols. References
RI PT
[1] Schneuer FJ, Holland AJ, Pereira G, Jamieson S, Bower C, Nassar N. Age at Surgery and Outcomes of an Undescended Testis. Pediatrics 2016;137(2):e20152768.
[2] Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Stein R, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric
SC
Urology Guidelines. J Pediatr Urol 2016;XX:XXX-XXX.
[3] Bradshaw CJ, Corbet-Burcher G, Hitchcock R. Age at orchidopexy in the UK: Has new evidence changed practice? J Pediatr Urol 2014;10(4):758–62.
M AN U
[4] Hensel KO, Caspers T, Jenke AC, Schuler E, Wirth S. Operative management of cryptorchidism: guidelines and reality - a 10-year observational analysis of 3587 cases. BMC Pediatrics 2015; http://www.biomedcentral.com/1471-2431/15/116. [5] Beers SR, Rofey DL, McIntyre KA. Neurodevelopmental assessment after anesthesia in childhood: review of the literature and recommendations. Anesth Analg 2014;119(3):661–9.
TE D
[6] Skakkebaek NE, Rajpert-De Meyts E, Buck Louis GM, Toppari J, Andersson A-M, Eisenberg ML, et al. Male Reproductive Disorders and Fertility Trends: Influences of Environment and Genetic Susceptibility. Physiol Rev 2016;96(1):55-97. [7] Serrano T, Chevrier C, Multigner L, Cordier S, Jegou B. International geographic
EP
correlation study of the prevalence of disorders of male reproductive health. Hum Reprod
AC C
2013;28(7):1974–86.