Nonpalpable Testis Syndrome: History and Current State of the Issue. Literature Review.
- Authors: Ekimov M.N.1, Tsap N.A.1, Komarova S.Y.1
-
Affiliations:
- Ural State Medical University, Ekaterinburg, Russia
- Section: REVIEWS
- Submitted: 12.10.2024
- Accepted: 11.02.2025
- Published: 26.02.2025
- URL: https://jps-nmp.ru/jour/article/view/840
- DOI: https://doi.org/10.17816/ps840
- ID: 840
Cite item
Abstract
According to domestic and foreign literature, nonpalpable testes (NPT) are found in 20% of children with cryptorchidism. Approximately 50% of them are located in the abdominal cavity, and 50% are atrophied or vanished testes. The aim of our review is to systematize the scientific literature data on nonpalpable testis syndrome in children. Materials and Methods. The review is composed of original articles found in scientific databases such as eLibrary, PubMed, Scopus. Results and Discussions. In literature, nonpalpable testes are often classified into three types: intra-abdominal, extra-abdominal, and non-viable. Extra-abdominal gonads are more often of normal volume compared to intra-abdominal ones, which are mostly hypoplastic. There are many controversial issues regarding diagnostic methods and treatment strategies for different types of NPT in children. Conclusions. The problem of diagnosing and treating nonpalpable testes in children, especially in cases of high intra-abdominal localization of the gonad, remains highly relevant and requires further scientific research and observations.
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About the authors
Mikhail Nikolaevich Ekimov
Ural State Medical University, Ekaterinburg, Russia
Author for correspondence.
Email: malaj777@mail.ru
ORCID iD: 0000-0003-1802-6105
Россия
Natalia Aleksandrovna Tsap
Email: tsapna-ekat@rambler.ru
Svetlana Yuryevna Komarova
Email: urokom@yandex.ru
References
- Leslie SW, Sajjad H, Villanueva CA. Cryptorchidism. 2024 May 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.– PMID: 29261861
- Razumovskiy A.Yu., editor. Detskaya khirurgiya: National guidelines. 2-nd ed., reprint. and add. Moscow: GEOTAR-Media; 2021. (In Russ.)
- Xia Q, et al. Testicular Tumor Arising From an Intra-abdominal Undescended Testis in a 1-year-old Child: a Case Report and Literature Review. Front Pediatr. 2023;11:1142157. PubMed PMID: 37266534
- Shepard CL, Kraft KH. The Nonpalpable Testis: a Narrative Review. J Urol. 2017;198(6):1410-1417. PubMed PMID: 28434984.
- Zhou, Wei, et al. "Ultrasound Manifestations and Clinical Features of Nonpalpable Testis in Children." Scientific Reports, vol. 12, no. 1, 2022, p. 12245.
- Mamoulakis, Charalampos, et al. "Testicular Descent." Hormones (Athens, Greece), vol. 14, no. 4, 2015, pp. 515-30.
- Hutson JM, et al. Regulation of Testicular Descent. Pediatr Surg Int. 2015;31(4):317-25. PubMed PMID: 25690562.
- Hadziselimovic F. Involvement of Fibroblast Growth Factors and Their Receptors in Epididymo-Testicular Descent and Maldescent. Mol Syndromol. 2016;6(6):261-7. PubMed PMID: 27022326
- Hadziselimovic Basic and Clinical Andrology (Hadziselimovic F. On the Descent of the Epididymo-testicular Unit, Cryptorchidism, and Prevention of Infertility. Basic Clin Androl. 2017;27:21. PubMed PMID: 29163975
- Rey, Rodolfo A., and Romina P. Grinspon. "Anti-Müllerian Hormone, Testicular Descent and Cryptorchidism." Frontiers in Endocrinology, vol. 15, 2024, p. 1361032
- Sepúlveda X, Egaña PL. Current Management of Non-palpable Testes: a Literature Review and Clinical Results. Transl Pediatr. 2016;5(4):233-239. PubMed PMID: 27867845
- Elderwy AA, et al. Laparoscopic Versus Open Orchiopexy in the Management of Peeping Testis: a Multi-institutional Prospective Randomized Study. J Pediatr Urol. 2014;10(4):605-9. PubMed PMID: 25042877
- Punwani VV, et al. Testicular Ectopia: Why Does It Happen and what Do We Do. J Pediatr Surg. 2017;52(11):1842-1847. PubMed PMID: 28024737
- Alaqeel SM, Hakeem AH, Almaary JO. Testicular Ectopia in a Child's Anterior Abdominal Wall: a Case Report and Literature Review. Am J Case Rep. 2020 Dec 7;21:e927495. PubMed PMID: 33284787
- Iliodromiti, Zoi, et al. "Bilateral Ectopic Femoral Testes: a Rare Cause of Empty Scrotum." Urology Case Reports, vol. 33, 2020, p. 101348
- Ngowi BN, et al. Perineal Ectopic Testis in Adult: Experience From Tertiary Hospital, Northern Tanzania. Int J Surg Case Rep. 2022;92:106817. PubMed PMID: 35183004.
- Priam A, et al. Scrotal Orchidopexy for Perineal Ectopic Testis. Arch Pediatr. 2022;29(5):404-406. PubMed PMID: 35644718
- Piplani R. A Rare Presentation of Transverse Testicular Ectopia and Role of Laparoscopy. Afr J Paediatr Surg. 2023 Jan-Mar;20(1):74-76. PubMed PMID: 36722574
- Sipani M, Bhat A, Prabhakar G. Transverse Testicular Ectopia: a Report of Five Cases and Review of Literature. J Indian Assoc Pediatr Surg. 2020 Nov-Dec;25(6):404-407. PubMed PMID: 33487947
- Rajesh A, Farooq M. A Rare Case of Male Pseudohermaphroditism-persistent Mullerian Duct Syndrome With Transverse Testicular Ectopia - Case Report and Review of Literature. Int J Surg Case Rep. 2017;37:72-75. PubMed PMID: 28645010
- Mao CK, Yuan-Fang , Cao YS. Management of Pediatric Vanishing Testes Syndrome Based On Pathological Diagnosis: a Single-center Retrospective Study. Sci Rep. 2024 04 24;14(1):9437. PubMed PMID: 38658594
- Heksch Ra, Et Al. Testicular Regression Syndrome: Practice Variation In Diagnosis And Management. Endocr Pract. 2019;25(8):779-786. Pubmed PMID: 31013155
- Elamo HP, Virtanen HE, Toppari J. Genetics of Cryptorchidism and Testicular Regression. Best Pract Res Clin Endocrinol Metab. 2022;36(1):101619. PubMed PMID: 35193821
- Kolon TF, et al. Evaluation and Treatment of Cryptorchidism: AUA Guideline. J Urol. 2014;192(2):337-45. PubMed PMID: 24857650
- Bajaj M, Upadhyay V. Age at Referral for Undescended Testes: Has Anything Changed in a Decade. N Z Med J. 2017 Jun 16;130(1457):45-49. PubMed PMID: 28617788
- Smith SC, Nguyen HT. Barriers to Implementation of Guidelines for the Diagnosis and Management of Undescended Testis. F1000Res. 2019;8 PubMed PMID: 30984373
- Niedzielski JK, Oszukowska E, Słowikowska-Hilczer J. Undescended Testis - Current Trends and Guidelines: a Review of the Literature. Arch Med Sci. 2016 Jun 1;12(3):667-77. PubMed PMID: 27279862
- Ulubay M. Perineal Ectopic Testis: a Rare Congenital Anomaly. Urol Case Rep. 2019;24:100853. PubMed PMID: 31211064
- Liu J, et al. Open Controversies On the Treatment of Undescended Testis: an Update. Front Pediatr. 2022;10:874995. PubMed PMID: 35967583
- Vikraman J, Donath S, Hutson Ao JM. Undescended Testes: Diagnosis and Timely Treatment in Australia (1995-2014). Aust Fam Physician. 2017;46(3):152-158. PubMed PMID: 28260279
- Zhou W, et al. Ultrasound Manifestations and Clinical Features of Nonpalpable Testis in Children. Sci Rep. 2022 07 18;12(1):12245. PubMed PMID: 35851046
- Braga LH, et al. Is There an Optimal Contralateral Testicular Cut-off Size That Predicts Monorchism in Boys With Nonpalpable Testicles. J Pediatr Urol. 2014;10(4):693-8. PubMed PMID: 25008806
- Vos A, et al. The Value of Ultrasonography in Boys With a Non-palpable Testis. J Pediatr Surg. 2014;49(7):1153-5. PubMed PMID: 24952806
- Iqbal N, et al. Laparoscopic Orchiopexy for Management of Bilateral Non-Palpable Testes. J Ayub Med Coll Abbottabad. 2020 Oct-Dec;32(4):445-449. PubMed PMID: 33225641
- Wang SQ, et al. Diagnostic Value of Multislice Spiral Computed Tomography (CT) Combined With CT Angiography for Intra-abdominal Undescended Testis Secondary Seminomas. Cancer Imaging. 2019 May 16;19(1):24. PubMed PMID: 31097025
- Shehata SM, Baky Fahmy M. The Intra-abdominal Testis: Lessons From the Past, and Ideas for the Future. Pediatr Surg Int. 2013;29(10):1039-45. PubMed PMID: 23995239
- Aggarwal H, Kogan BA. The Role of Laparoscopy in Children With Groin Problems. Transl Androl Urol. 2014;3(4):418-28. PubMed PMID: 26816798
- Mah LW, Durbin-Johnson B, Kurzrock EA. Non-palpable Testis: Is Management Consistent and Objective. J Pediatr Urol. 2020;16(1):62-68. PubMed PMID: 31917156
- Elgaili Salah SE, Elssayed Ahmed EO. The Role of Laparoscopy in Non-palpable Undescended Testicle: Analysis and Review of the Experience From Two Cities in Sudan. Afr J Paediatr Surg. 2022 Jul-Sep;19(3):127-132. PubMed PMID: 35775511
- Gonzalez KW, et al. The Anatomic Findings During Operative Exploration for Non-palpable Testes: a Prospective Evaluation. J Pediatr Surg. 2016;51(1):128-30. PubMed PMID: 26563527
- Haid B, Rein P, Oswald J. Undescended Testes: Diagnostic Algorithm and Treatment. Eur Urol Focus. 2017;3(2-3):155-157. PubMed PMID: 28753808
- Orlov VM, et al. [The Volume of the Contralateral Testis in Unilateral Non-palpable Cryptorchidism a Diagnostic Criterion to Optimize Surgical Strategy]. Urologiia. 2018;(2)89-93. PubMed PMID: 29901300
- Radmayr C, et al. Corrigendum to "Management of Undescended Testes: European Association of Urology/European Society for Paediatric Urology Guidelines" [J Pediatr Urol 12 (2016) 335-343]. J Pediatr Urol. 2017;13(2):239. PubMed PMID: 28341426
- Gates RL, et al. Management of the Undescended Testis in Children: an American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg. 2022;57(7):1293-1308. PubMed PMID: 35151498
- Wei Y, et al. Efficacy and Safety of Human Chorionic Gonadotropin for Treatment of Cryptorchidism: a Meta-analysis of Randomised Controlled Trials. J Paediatr Child Health. 2018;54(8):900-906. PubMed PMID: 29655188
- Shehata S, et al. The Management of Intraabdominal Testis: a Survey of the World Federation of Associations of Pediatric Surgeons (WOFAPS) Practices. Front Pediatr. 2022;10:928069. PubMed PMID: 35844765
- Chan E, et al. Ideal Timing of Orchiopexy: a Systematic Review. Pediatr Surg Int. 2014;30(1):87-97. PubMed PMID: 24232174
- Suskind A, et al. Fibrosis Correlates With Detailed Histological Analysis of Human Undescended Testes. BJU Int. 2008;101(11):1441-5. PubMed PMID: 18218059
- Krishna, O.H & Kotaiah, Mandakini & K., Geetha & G., Santosh & P., Srinivas & Kota, Ramesh. (2019). Cryptorchidism and its Effects on Histomorphology of Testis in Paediatric Age Group. Journal of Evolution of Medical and Dental Sciences. 8. 2480-2484. 10.14260/jemds/2019/540
- Loebenstein M, et al. Cryptorchidism, Gonocyte Development, and the Risks of Germ Cell Malignancy and Infertility: a Systematic Review. J Pediatr Surg. 2020;55(7):1201-1210. PubMed PMID: 31327540
- Hadziselimovic F. Temperature Is Not a Major Factor in the Differentiation of Gonocytes Into Ad Spermatogonia and Fertility Outcome in Congenitally Cryptorchid Boys. Basic Clin Androl. 2022 Jan 10;32(1):2. PubMed PMID: 35000579
- Huff DS, et al. Abnormal Germ Cell Development in Cryptorchidism. Horm Res. 2001;55(1):11-7. PubMed PMID: 11423736
- Verkauskas G, et al. Histopathology of Unilateral Cryptorchidism. Pediatr Dev Pathol. 2019 Jan-Feb;22(1):53-58. PubMed PMID: 30012073
- Mechlin CW, Kogan BA. What Lessons Can Be Learned From Testicular Histology in Undescended Testes. Transl Androl Urol. 2014;3(4):365-9. PubMed PMID: 26816792
- Wayne C, et al. What Is the Ideal Surgical Approach for Intra-abdominal Testes? a Systematic Review. Pediatr Surg Int. 2015;31(4):327-38. PubMed PMID: 25663531
- Neheman A, et al. Standardized Single-stage Laparoscopic Fowler-Stephens Orchiopexy Regardless of Testis Position: Modification of Technique Eliminates the Need for Intra-operative Decision-making. J Minim Access Surg. 2022 Oct-Dec;18(4):591-595. PubMed PMID: 36204939
- Narayanan SK, et al. Does the Internal Inguinal Ring Need Closure During Laparoscopic Orchiopexy With Prentiss Manoeuvre. Int Urol Nephrol. 2017;49(1):13-15. PubMed PMID: 27770240
- Alagaratnam S, et al. Testicular Outcome Following Laparoscopic Second Stage Fowler-Stephens Orchidopexy. J Pediatr Urol. 2014;10(1):186-92. PubMed PMID: 24045121
- Bae KH, et al. Inguinal Approach for the Management of Unilateral Non-palpable Testis: Is Diagnostic Laparoscopy Necessary. J Pediatr Urol. 2014;10(2):233-6. PubMed PMID: 24206784
- Arena S, et al. Is Inguinal Orchidopexy Still a Current Procedure in the Treatment of Intraabdominal Testis in the Era of Laparoscopic Surgery. J Pediatr Surg. 2017;52(4):650-652. PubMed PMID: 27629799
- Yu C, et al. Evaluation of Fowler-Stephens Orchiopexy for High-level Intra-abdominal Cryptorchidism: a Systematic Review and Meta-analysis. Int J Surg. 2018;60:74-87. PubMed PMID: 30408514
- Elder JS. Surgical Management of the Undescended Testis: Recent Advances and Controversies. Eur J Pediatr Surg. 2016;26(5):418-426. PubMed PMID: 27631723
- Shehata S, et al. Staged Laparoscopic Traction-orchiopexy for Intraabdominal Testis (Shehata Technique): Stretching the Limits for Preservation of Testicular Vasculature. J Pediatr Surg. 2016;51(2):211-5. PubMed PMID: 26655212
- Braga LH, et al. Gubernaculum Testis and Cremasteric Vessel Preservation During Laparoscopic Orchiopexy for Intra-Abdominal Testes: Effect On Testicular Atrophy Rates. J Urol. 2019;201(2):378-385. PubMed PMID: 30053512
- Jawdat JR, Kocherov S, Chertin B. One-Stage Laparoscopic Orchiopexy for the Treatment of Intraabdominal Testis. Isr Med Assoc J. 2016;18(11):669-672. PubMed PMID: 28466616
- Igarashi A, et al. Surgical Exploration for Impalpable Testis: Which Should Be First, Inguinal Exploration or Laparoscopic Abdominal Exploration. J Pediatr Surg. 2018;53(9):1766-1769. PubMed PMID: 29132799
- Liu J, et al. Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: a Retrospective Study From a Single Center. Front Pediatr. 2021;9:677955. PubMed PMID: 34222147
- Abouheba MAS, et al. Early Clinical Outcome of Staged Laparoscopic Traction Orchidopexy for Abdominal Testes. J Laparoendosc Adv Surg Tech A. 2019;29(4):531-537. PubMed PMID: 30807243
- Wang CY, et al. Efficacy of Single-stage and Two-stage Fowler-Stephens Laparoscopic Orchidopexy in the Treatment of Intraabdominal High Testis. Asian J Surg. 2017;40(6):490-494. PubMed PMID: 28410943
- Papparella A, De Rosa L, Noviello C. Laparoscopic Fowler-Stephens Orchidopexy for Intra-abdominal Cryptorchid Testis: a Single Institution Experience. Pediatr Med Chir. 2021 Feb 1;42(2) PubMed PMID: 33522214
- Yang Z, et al. A Prediction Model for Risk Factors of Testicular Atrophy After Orchiopexy in Children With Undescended Testis. Transl Pediatr. 2021;10(4):882-892. PubMed PMID: 34012837
- Silber SJ, Kelly J. Successful Autotransplantation of an Intra-abdominal Testis to the Scrotum By Microvascular Technique. J Urol. 1976;115(4):452-4. PubMed PMID: 4632
- Kelley BP, et al. Combined Laparoscopic and Microsurgical Techniques for Testicular Autotransplantation: Is This Still an Evolving Technique. J Reconstr Microsurg. 2010;26(8):555-8. PubMed PMID: 20640978
- Chao BW, et al. Robotic-Assisted Testicular Autotransplantation. Urology. 2022;159:255. PubMed PMID: 34627870
- Casanova NC, et al. Two-Step Fowler-Stephens Orchiopexy for Intra-abdominal Testes: a 28-year Single Institution Experience. J Urol. 2013;190(4):1371-6. PubMed PMID: 23624208
- Woodford E, et al. Is Excision of Testicular Nubbin Necessary in Vanishing Testis Syndrome. J Pediatr Surg. 2018;53(12):2495-2497. PubMed PMID: 30503248
- Nataraja RM, et al. Presence of Viable Germ Cells in Testicular Regression Syndrome Remnants: Is Routine Excision Indicated? a Systematic Review. Pediatr Surg Int. 2018;34(3):353-361. PubMed PMID: 29124402
- He TQ, et al. Testicular Regression Syndrome: a Retrospective Analysis of Clinical and Histopathological Features in 570 Cases. Front Pediatr. 2022;10:1006880. PubMed PMID: 36389371
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