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Aktuelle Urol 2015; 46(05): 373-377
DOI: 10.1055/s-0035-1555801
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle Defizite in der Therapie des Maldeszensus testis – Analyse eines Pädiaters

Current Shortcomings in the Treatment of Cryptorchidism – Analysis Performed by a Paediatrician
K. O. Hensel
1   Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Wuppertal, Universität Witten/Herdecke
,
S. Wirth
1   Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Wuppertal, Universität Witten/Herdecke
› Author Affiliations
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Publication History

Publication Date:
17 September 2015 (online)

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Zusammenfassung

Maldeszensus testis (MT) stellt das häufigste kinderchirurgische Krankheitsbild der westlichen Welt und einen der größten Risikofaktoren für maligne Entartung und Subfertilität dar. 2009 wurde die Empfehlung bzgl. des Zeitpunktes, zu dem die Therapie bei MT spätestens abgeschlossen sein soll, vom zweiten auf den ersten Geburtstag abgesenkt. Der Anteil von im ersten Lebensjahr durchgeführten Orchidopexien bei MT ist nach Änderung der AWMF-Leitlinie nur gering angestiegen. Sowohl in Deutschland als auch international werden zu wenige Kinder im ersten Lebensjahr operiert. Einem Großteil der Kinder behandelnden Ärzte scheint diese Diskrepanz zwischen Leitlinienempfehlung und tatsächlichem Alter zum Operationszeitpunkt nicht bewusst zu sein. Außerdem scheint ein nicht unerheblicher Teil der Fälle von Hodenhochstand durch sekundären Hodenhochstand bedingt zu sein, der oft erst im Schulkindesalter auftritt. Schlussfolgernd müssen eine Optimierung des Operationszeitpunktes bei kongenitalem MT und regelmäßige Untersuchungen des Hodens auch jenseits des Kleinkindesalters konsequenter angestrebt werden. Eine kontinuierliche Aufklärung für Kinder behandelnde Ärzte, Eltern und Patienten ist erforderlich, um die Prognose bei Hodenhochstand hinsichtlich Subfertilität und maligner Entartung zu verbessern. Die hohe Anzahl später Operationen bedarf weiterer Aufklärung.

Abstract

Cryptorchidism is the most common disorder in paediatric surgery in the Western world and a major risk factor for subfertility and malignancy. In 2009, German national guidelines were changed to recommend that treatment for undescended testes should be completed by the age of 1 instead of 2. However, the share of boys undergoing orchidopexy for cryptorchidism within the first year of life has only marginally increased in response to the guideline of the Association of the Scientific Medical Societies in Germany (AWMF). The number of orchidopexies performed in children below the age of 1 is too low both in Germany as well as internationally. The majority of primary care physicians treating children do not seem to be aware of this discrepancy between guideline recommendations and average actual age at orchidopexy. Moreover, a considerable number of cryptorchidism cases seem to be due to secondary ascent of the testis – an underappreciated condition that usually occurs at school age. Consequently, the timing of orchidopexy in primary undescended testes must be optimised. Therefore, education of parents and primary care physicians regarding the necessity of early orchidopexy and frequent testicular examinations even beyond infancy is mandatory to improve the prognosis of cryptorchidism regarding subfertility and malignancy. Further studies are needed to clarify the reasons for the large number of late orchidopexies.

Schlüsselwörter

Hodenhochstand - Kryptorchismus - Leitlinien - Orchidopexie - Versorgungsforschung

Key words

undescended testis - cryptorchidism - guidelines - orchidopexy - health services research

Editorial Comment

 

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