A five years old boy was presented to me, who has been operated on two years ago for undescended testicle. The present condition is as follow – moderate hypoplastic testicle, fixed at the same position at the exit of the inguinal canal as before surgery. I don’t support the idea of hormonal treatment, but in this case I think it is needed to be trained preoperatively. According to other colleagues hormones do not make sense and I should go straight to surgery. What would you suggest?
You are two years down the track. I would have another crack at it. You have nothing to loose as it is hypoplastic, and the other side is presumably normal. I would not use hormones.
I suggest for the child (hopefully the mother too for example and motivation) going vegan in order to decrease exogenous estrogen. Ref: data on dairy and animal product summarized beautifully from NIH and other sources here:
https://www.youtube.com/watch?v=27j7V0N9820
Hormonal treatment will not help and may be harmful. The child needs to be re-operated correctly.
No I would not because it will make no difference in the outcome and will be harmful.
Hormonal treatment after failed orchidopexy is useless because of the already formed adhesions. Hormonal treatment sometimes help increase the size of the testes. If the testis is small in size< I will give a course of hormonal treatment , 5 doses of beta HCG and then do a redo orchidopexy. If the size of the testis is OK, I will do a redo-orchidopexy.
We would like to have more history before surgery,site and place of the udt,what type of surgery done and i thing what happened now is what called ASCENDED TESTIS ,i advice for redo after six month of previous orchidopexy.
go a head for re do orchiopexy as no hope from hormones after this age and also after previous surgery and the only indications for hormones if bilateral inguinal undescended testis before the age of 2 ys only, and no need for hormonal treatment for unilateral undescended testis.
I do also agree with the answers given before:
An already operated testis, unilaterally non descended does most likely not respond to hormonal therapy because of fixation of the operated testis and the unilateral occurrence. Balancing the side effects to the expected outcome is strongly on the side of the side effects. Also the hormonal situation most likely is normal in such cases. Better to think of a redo or wait and see - it seems not sure that the position at the exit of the inguinal canal really is a situation that benefits from redo? This may be a decision by your own depending on the discussion with the patients parents - There is no general rule for it. The risk for the testis to get lost may be the same for redo and when you leave it where it is... the risk of malignancy may not be higher and the early detection if it occurs too.
I do believe that hormones will be useless in terms of testicular size and position. Furthermore they will only make the testis edematous and fragile. This will end up in a more obnoxious surgery with higher risk of damaging the testicle. To conclude, I wouldn't administer hormones but go straight to redo surgery. Finally, in case of further failure or atrophy I do not suggest to fix the other side as simple fixation can harm the testicle more than the likelihood of torsion in a patient without a positive personal history.
Hormonal therapy is useless
what do you call hypoplastic testis !
either the testis is normal in size and echogenecity so you go for surgery
either the testis is abnormal very little you should consider fixing the controlateral testis while making orchidopexy for the undescended testis to preserve at least the leydig cell secretion
Hormonal therapy in redo orchiopexy has the only benefit of giving serenity to the surgeon. Regards
The best option in this case is to rake a parents consent for performing an orchiectomy. Although this may look an aggressive action it may help in maintaining the fertility potential later on!
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