PDF(Pubmed)
Abstract：
Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child\'s age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.
摘要：
隐睾的发病率为1-5％，对未来的生育能力和整体健康具有潜在的长期影响。这篇综述集中在手术治疗方式，它们对睾丸发育的影响，和功能，同时解决北欧共识声明以及当前的欧洲泌尿外科协会（EAU）和美国泌尿外科协会（AUA）指南。先天性和获得性隐睾在手术管理中提出了独特的挑战，对生育率有不同的影响。虽然先天性隐睾会给生育带来风险，并需要早期干预，回缩睾丸和获得性隐睾也对生育潜力构成风险，强调评估治疗方案的重要性。睾丸位置和孩子的年龄构成了未降睾丸实用分类系统的基础。通过临床检查早期诊断，可以及时治疗。仅对选定病例保留成像。遵循准则，对于先天性隐睾，建议在6-12个月大之间进行睾丸固定术。越来越多的证据表明，早期手术对促进睾丸健康和生育潜力的益处。目前的手术选择范围从开放到腹腔镜技术，选择很大程度上取决于未降睾丸的位置和可及性。腹腔镜治疗不可触及睾丸的方法的进步强调了外科治疗的不断发展。根据未降睾丸的活动性，可能需要进行顺序手术。需要更多的研究来探索激素疗法的潜力和局限性，这是次要的手术治疗，可以有选择地作为辅助手术的作用。长期随访对于评估生育结果至关重要，睾丸恶性肿瘤的风险，和心理影响。通过将当前指南与最新证据相结合，这项审查旨在促进对隐睾的全面了解，从而优化患者管理和结果。
