BILATERAL CRYPTORCHIDISM IN PEDIATRIC SURGEON’S PRACTICE: CURRENT TACTICS OF PATIENT MANAGEMENT

Abstract

The aim: To provide best practices of disease management to improve treatment outcomes for this group of patients. Materials and methods: The paper is based on first-hand experience in observing and treating 117 children aged from 6 months to 13 years with bilateral congenital cryptorchidism during a ten-year follow-up period, who were referred for surgical treatment, and 3 newborn boys with undescended testicles and testicular torsion. A complex of clinical and laboratory, instrumental, endocrinological, and genetic research methods was used for the survey of all patients. Results: Recognizing the action of a common causative factor for bilateral cryptorchidism, which is a consequence of primary endocrine disorders, makes it possible to predict bilateral identity of the location of testicles in this pathology, which we observed in 81 patients: bilateral inguinal cryptorchidism was registered in 49 (41.88%) children, bilateral abdominal cryptorchidism – in 32 (27.35%) children, a combination of inguinal and abdominal cryptorchidism – in 24 (20.51%) children. The following types of treatment were used in the studied group of children: 1 – primary surgical intervention – 4 children, representing 3.42%. 2 – observation and non-surgical treatment by an endocrinologist – 113 (96.58%) children. 3 – comprehensive treatment (surgical correction after hormone treatment) – 67 (59.29%) children. According to the research, hormone therapy had a positive effect on descent of the testicles in 89 (78.76%) patients: the testicles descended into the scrotum – in 22 (24.72%) children; the testicles descended in the inguinal canal – in 32 (35.95%) children; the testicles descended to the level of the opening to the inguinal canal – in 35 (39.33%) children. Conclusions: 1. All doctors, starting from the maternity hospital, polyclinic, children’s unit, should identify children with bilateral cryptorchidism. All children diagnosed with bilateral cryptorchidism are referred to a surgeon or endocrinologist. The parents of a child with bilateral cryptorchidism should immediately consult a doctor. The study of the reasons for late admission of children to the surgical hospital revealed that 76.92% of patients sought medical advice late, after 1 year of life. 2. At the stage of diagnosis and determination of treatment tactics, an examination by an endocrinologist and a geneticist is necessary; ignoring them is considered an error in diagnostic and therapeutic tactics, since the process of descent of the testicles into the scrotum is hormone-dependent. 3. The indications for primary surgical treatment of a child with bilateral cryptorchidism involve a combination of cryptorchidism with inguinal hernia and pain syndrome, which might be caused by testicular torsion. 4. Hormone therapy provides better results of surgical intervention in bilateral cryptorchidism. The ineffectiveness of two courses of hormone therapy necessitates surgical treatment. 5. Comprehensive treatment of children with bilateral cryptorchidism (non-surgical hormone therapy and surgical correction) has led to good postoperative results in 71.64% of patients, satisfactory results – in 22.39% of children, recurrences – in 5.97% of patients. 7. A long-term follow-up observation should be carried out by a surgeon and endocrinologist until patients reach their reproductive years.