Treatment of Congenital and Acquired Undescended Testes: Why How WhenClinical studies in adult men

J. van Brakel

Undescended testis (UDT) is one of the most frequent urogenital abnormalities, and can be of congenital or acquired origin. The problem with most literature is that since acquired UDT was only recently accepted as a distinct entity, it does not discriminate between congenital and acquired UDT. For congenital UDT much is known on the aetiology, natural course, and treatment, however, these matters are less clear for acquired UDT and are still debated. Congenital UDT are not likely to descent spontaneously after 12 months of age and are associated with an increased risk of fertility problems and testicular malignancies. Over 50% of acquired UDT descend spontaneously before or during puberty. For acquired UDT the chance of fertility problems and risks for testicular malignancies are unknown. It is hypothesized that early treatment in congenital UDT can contribute to less problems in adulthood based on histological parameters in childhood, however this needs to be verified in adulthood. For acquired UDT there is no consensus on treatment protocols and although less fertility problems are expected than in congenital UDT, this needs to be confirmed. This thesis analyses outcomes after different treatments for congenital and acquired UDT and elucidates differences between congenital and acquired UDT regarding natural course, fertility, endocrinology and ultrasound anomalies. Men from the congenital group are participants from a historical cohort in which boys were operated upon at several ages during childhood. Men from the acquired group were men with a history of acquired UDT who, during childhood, were either followed annually until puberty to await spontaneous descent with orchiopexy in case of non-descent or were operated upon immediate after diagnosis. At inclusion of the initial studies great effort was put into ascertaining previous testis position to differentiate congenital from acquired UDT.

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