Leydig cell tumors (LCTs) of the testis are rare in children. Although testis-sparing surgery (TSS) is increasingly accepted as the preferred treatment, large-scale studies with long-term follow-up remain limited. This study compared the clinical characteristics of LCTs with those of testicular teratomas and endodermal sinus tumors and evaluated the long-term outcomes of TSS in children to enhance urologists’ understanding of this condition. Patients diagnosed with LCTs between January 2015 and December 2024 at three tertiary medical centers were enrolled, along with equal numbers of patients with testicular endodermal sinus tumors and testicular teratomas as control groups. Clinical data were collected and analyzed using SPSS 22.0 software. This study enrolled 14 patients with testicular LCTs, 14 with testicular endodermal sinus tumors, and 14 with testicular teratomas. Patients with LCTs exhibited a significantly older age at presentation (P = 0.003). Precocious puberty was more prevalent in LCT patients (P < 0.001), and elevated serum testosterone levels were identified in 9 of 14 patients (64.3

Wilms tumor (WT) is the most common primary malignant renal tumor in children. Currently, there is no unified consensus regarding surgical management of WT. This is particularly so in complex cases where tumors are large, where there is invasion of adjacent organs, for nephron-sparing procedures, and for lymph node biopsy. Non-standardized surgical procedures can lead to tumor recurrence and progression; this is of increasing clinical concern. Standardizing the surgical approach and protocols for WT is therefore of great importance to improving treatment outcomes and patient prognosis. To better guide clinical practice, the Oncology Surgery Group and Urology Surgery Group of Pediatric Surgery Branch of the Chinese Medical Associationhave formulated this expert consensus. Based on previous clinical research findings and existing guidelines, the consensus provides specific recommendations for surgical approach and for decision-making.

This study aimed to describe HRQoL of both children and parents in a Chinese DSD cohort, evaluate caregiver burden, and employ the latent profile analysis (LPA) to identify distinct parental HRQoL profiles and their associated determinants. This study included 147 parents of children with DSD and 519 parents of healthy controls. Group differences in HRQoL were analyzed using t-tests or one-way analysis of variance (ANOVA). Multivariate regression identified predictors of parental HRQoL, and LPA classified parental HRQoL profiles with multinomial logistic regression used to assess their associated factors. Children with DSD had similar HRQoL scores to healthy controls (p > 0.05), but their caregivers showed significant impairments across all domains (p < 0.05). In multivariate analysis, caregiver burden and child HRQoL were significantly associated with parental HRQoL (p < 0.05), with caregiver burden mediating 60.8

Background:Loss-of-function variants in protein phosphatase 1 regulatory subunit 12A (PPP1R12A) can lead to urogenital and/or brain malformation syndrome (UBMS). When UBMS individuals exhibit genital abnormalities, it is combined with disorders of sex development (DSD). To report a PPP1R12A de novo variation in a case of 46,XY twins exhibiting different phenotypes of genital development. Case Description:Twin A exhibited more feminine external genitalia (Prader III), while Twin B showed severe hypospadias (Prader IV) along with left cryptorchidism and right hernia. Endocrine evaluation and ultrasonography revealed that Twin A had bilateral gonadal dysgenesis, confirmed by gonadal pathology, while Twin B had well-functioning testes. Both twins were identical with a 46,XY karyotype. Genetic sequencing identified a novel heterozygous de novo mutation (c.1551-2A>G) in the PPP1R12A gene. Following a discussion with the multidisciplinary team (MDT) and the parents, Twin A was assigned female and underwent feminization surgery, while Twin B continued to be raised as male and received hypospadias repair. The Pre-School Activities Inventory scale was applied to assess their psychosexual development at 3.5 years old: Twin A scored 55.95 (neutral, slightly inclined to male), while Twin B scored 84.55 (male). Conclusions:This is the first instance of identical twins with a heterozygous mutation (c.1551-2A>G) in the PPP1R12A gene, associated with UBMS and DSD. The same variation resulted in identical twins exhibiting different genital phenotypes and choosing to live as different genders.

INTRODUCTION:The gonadal genetics and germ cell tumor (GCT) risk in SRY-negative 46,XX testicular and ovotesticular disorders of sex development (DSD) are poorly understood and debated. This study aimed to investigate the gonadal genetic etiology and evaluate GCT risk in an independent cohort. METHODS:We conducted a retrospective analysis of SRY-negative 46,XX testicular and ovotesticular DSD patients who underwent gonadal biopsy or gonadectomy. Routine next-generation sequencing was performed on peripheral blood samples. In gonadal tissues, quantitative PCR was utilized for SRY gene detection, while whole exome sequencing and whole genome sequencing provided comprehensive genetic analysis. Gonadal histopathological features were assessed through HE staining and immunohistochemical markers. RESULTS:Thirty-five individuals with SRY-negative 46,XX testicular or ovotesticular DSD were included, comprising 26 ovotesticular and 9 testicular cases. Two pathogenic NR5A1 variants and one SOX3 gene duplication were identified in peripheral blood of 3 out of 34 patients (8.82%). XX/XY chimerism was detected in gonadal tissue of 1 out of 32 patients (3.13%). Notably, no precursor lesions (GCNIS, gonadoblastoma, or undifferentiated gonadal tissue) or GCTs were found. OCT 3/4 positivity was observed in testicular parenchyma of 7 patients (7/35), with these positive germ cells primarily located at the center of the seminiferous cords and showing negative SCF staining. CONCLUSION:The risk of GCTs in individuals with SRY-negative 46,XX testicular and ovotesticular DSD remains contentious. This study underscores the importance of comprehensive genetic and histological evaluations of gonadal tissues. Immunohistochemical findings suggest a relatively low GCT risk; however, long-term follow-up is essential for effective patient monitoring.

Objective This study aimed to evaluate the medium and long-term outcomes of tunneled labial mucosa tube graft urethroplasty in the treatment of primary severe hypospadias and failed hypospadias.Methods We retrospectively reviewed the medical records of the patients who underwent tunneled labial mucosa tube graft urethroplasty at a single center between 2007 and 2020. Data collected included patient demographic, operative and post-operative characteristics. The surgical procedure was performed in two stages. Binary logistic regression model was used to identify risk factors for postoperative complication.Results A total of 82 patients who were followed for at least 12 months were included in this study. Among these, 56 patients received primary repair, while 26 had previously undergone failed reconstruction. The mean age at surgery was 5.0 years. Postoperative urinary fistula occurred in 36 patients, with 24 requiring surgical repair and 12 resolving spontaneously. Urethral stricture developed in 26 patients, with 20 undergoing surgical intervention and 6 managed with urethral dilation. Preoperative surgical history was identified as an independent risk factor for postoperative complications (p=0.015).Conclusions Although the complication rate associated with tunneled labial mucosa tube graft urethroplasty is relatively high compared with other techniques, it remains a viable option for patients with insufficient replacement materials, particularly for primary severe hypospadias. For cases of failed hypospadias repair, this procedure should be considered selectively based on patient-specific factors.

>Testicular torsion is a urological emergency that requires prompt diagnosis and treatment,accounting for10%–15%of cases of acute scrotum. [1] It occurs most frequently during the perinatal period and adolescence and can occur at any age. [2] The incidence of testicular torsion is 1/4,000 in males under 25 years of age and1/160 in males over 25 years of age. [3] Unilateral torsion is relatively common,with a higher incidence on the left side.Testicular torsion is typically managed through surgical exploration.Necrotic testes,identified by a black appearance,require orchiectomy. [4]

Background To analyze the clinical characteristics of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CV) in infants and young children. Methods A retrospective analysis was performed on children with UPJO who underwent primary surgery. Patients were classified into laparoscopic pyeloplasty (LP) and open pyeloplasty (OP) groups and classified as ≤3 or >3 (years old) groups. Children with CV-caused UPJO were identified. Results A total of 747 patients were included. Ninety cases of CV were identified. The CV discovery rate was higher in the LP group (78/457, 17.1%) than in the OP group (12/290, 4.1%) (P<0.001). In the ≤3 group, the CV discovery rate in the LP group (27/144, 18.8%) was higher than that in the OP group (11/274, 4.0%) (P<0.001). In the LP group, there was no significant difference between ≤3 (27/144, 18.8%) and >3 (51/313, 16.3%) groups in the CV discovery rate. The rate in children with UPJO was not significantly different at any age (P>0.05). Progressive aggravation of hydronephrosis (21/27, 77.8%) and symptomatic hydronephrosis (44/51, 86.3%) were the main surgical indications in the ≤3 and >3 groups, respectively. There were no preoperatively confirmed cases of CV in the ≤3 group. In the OP group, five patients underwent reoperation, three of whom were due to failure to detect CV during the initial operation. Conclusions The CV distribution is similar in children with UPJO across all ages; CV in infants and young children are not rare. LP should be considered as CV are prone to being missed during OP. Levels of Evidence III.

Aim: The present study aimed to assess the diagnostic efficacy of contrast-enhanced voiding urosonography (ceVUS) using SonoVue for evaluating duplex kidneys, and to compare it with fluoroscopic voiding cystourethrography (VCUG). Material and methods: Forty-six children with duplex kidneys confirmed by surgical intervention or cystoscopy were included in the study, resulting in a total of 46 duplex kidneys and 46 normal kidneys (138 pyeloureteral units). Results: The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RBUS for diagnosing duplex kidney disease were 73.91%, 80.43%, 79.07%, and 75.51%, respectively. The diagnostic performance of RBUS and ceVUS in detecting duplex kidney yielded an overall sensitivity, specificity, PPV, and NPV of 89.13%, 84.78%, 85.42%, and 88.64%, respectively. The sensitivity, specificity, PPV, and NPV of VCUG in diagnosing duplex kidney disease were 17.31%, 86.96%, 57.14%, and 51.23%, respectively. For the 42 pyeloureteral units with VUR, Cohen’s weighted kappa value for the agreement between ceVUS and VCUG in grading VUR was 0.702 (95% CI, 0.551 ~ 0.854; p <0.05). Conclusions: RBUS effectively diagnoses duplex kidneys with renal pelvic dilation, while ceVUS can further elucidate whether reflux occurs in the upper or lower moiety in cases of duplex kidneys with VUR. Compared to VCUG, both RBUS and ceVUS provide more intuitive diagnoses for duplex kidneys with VUR and ureterocele. Additionally, there is good consistency between ceVUS and VCUG in grading VUR. CeVUS is recommended as an initial evaluation method for patients suspected of having duplex kidneys associated with urinary tract infections.

Ectopic scrotum is an infrequent congenital scrotal anomaly. Different surgical methods of correcting ectopic scrotum have been used, but none have produced optimal cosmetic results for all types. We describe a case of left ectopic suprainguinal scrotum in a 14-month-old boy who had an undescended left testicle and a left-sided scrotal skin tag. Single-stage rotational flap scrotoplasty and unilateral orchiopexy were performed; however, we modified the surgical technique of scrotal rotation by excising the intervening longitudinal skin. Eight months after surgery, the repositioned scrotum had a better appearance, and the affected testicle was similar in size to the contralateral one. In comparison with other surgical methods, pedicle flap rotation of the ectopic scrotal skin with excision of the intervening longitudinal skin may produce a better cosmetic outcome.

With no obvious clinical symptoms, testicular microlithiasis (TM) is frequently detected during routine physical examination or consultations of other diseases.Adult TM is correlated with testicular tumors and male infertility.And it appears in a growing number of children, especially those with cryptorchidism.This review summarized the latest researches on the correlation between TM and cryptorchidism in children to provide references for clinical practices.

Objective: To compare the characteristics of conventional laparoscopic pyeloplasty (LP) and robotic -assisted laparoscopic pyeloplasty (RALP) in infants and young children with ureteropelvic junction obstruction (UPJO).Methods: We performed a retrospective study of patients (age: 0-36 months) who underwent dismembered pyeloplasty (Anderson-Hynes) with the fourth-generation RALP or traditional LP between April 2020 and December 2020.Results: A total of 33 patients with UPJO were enrolled: 12 underwent RALP (9 left side; 3 right side) and 21 underwent LP (18 left side; 3 right side). In the RALP group, the median patient age was 17 months (range: 5-36 months). In the LP group, the median patient age was 9 months (range: 2-36 months) (P = 0.182). The mean operation times were 120.25 +/- 37.54 min (RALP) and 156.10 +/- 51.11 min (LP) (P = 0.042), and the mean lengths of hospital stay were 6.42 +/- 1.62 days (RALP) and 8.19 +/- 2.25 days (LP) (P = 0.023). Removal of the drainage tube was performed after 3.08 +/- 0.69 days (RALP) and after 4.76 +/- 1.81 days (LP) (P = 0.001). The postoperative pain showed no significant difference. The mean hospitalization costs were 61464.75 +/- 2800.53 yuan (RALP) and 22169.52 +/- 3442.15 yuan (LP) (P < 0.001). The mean follow-up time was 10-18 months. Significant improvements in the ante-roposterior diameter and parenchymal thickness were observed after surgery. Conversion to laparotomy was not performed. No short-term complications occurred during postoperative hospitalization and follow-up.Conclusion: RALP has the advantages of less trauma and faster recovery. It can be safely and effectively performed in infants and young children, and its effectiveness is similar to that of traditional LP.(c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

目的 探究产前影像学检查(产前超声和胎儿MRI)诊断胎儿尿道下裂的准确性.方法 本研究为回顾性研究.以2012年3月至2021年3月浙江省产前诊断中心经产前多学科会诊存在胎儿尿道下裂的31名孕妇为研究对象,收集31名孕妇年龄、孕周、产前超声检查结果,以及胎儿MRI影像学特征.结果 31名孕妇产前超声诊断均存在胎儿尿道下裂,孕妇年龄(29.8±4.4)岁,孕周(30.1±3.2)周.孕中期诊断4例,孕晚期诊断27例.31例产前疑似尿道下裂胎儿中,出生后确诊尿道下裂22例,诊断准确率为71.0％.胎儿尿道下裂的产前超声影像学特征如下:①外生殖器"郁金香"征19例(19/31,61.3％);②外生殖器短小4例(4/31,12.9％);③外生殖器形态模糊8例(8/31,25.8％).外生殖器"郁金香"征诊断胎儿尿道下裂的准确率为84.2％(16/19),灵敏度72.7％,特异度66.7％.15名孕妇进一步行胎儿MRI,影像学特征如下:①外生殖器短小10例;②外生殖器"郁金香"征6例;③阴囊分裂4例;④阴茎头部圆钝3例;⑤阴茎腹侧弯曲2例;⑥阴茎阴囊转位1例;⑦性别可辨(女性)1例.胎儿MRI诊断尿道下裂准确率为85.7％(12/14).1例羊水穿刺提示46,XY,雄激素不敏感综合征,引产后确诊为重度尿道下裂.结论 产前超声是诊断胎儿尿道下裂的常用方法,外生殖器"郁金香"征是常用且准确性较高的超声诊断标准.对于产前超声提示胎儿尿道下裂者,进一步行胎儿MRI可增加产前诊断的准确性.

Objective To explore the characteristics and mechanism of sirtuin 1 (SIRT1) in lipopolysaccharide (LPS)-activated pyroptosis in the renal tissue of children with congenital hydronephrosis (CHn).Methods We detected the expression characteristics and clinical significance of SIRT1 and pyroptosis pathway proteins in CHn renal tissues by immunohistochemistry. The degree of renal fibrosis was detected by Masson staining. The human renal tubular epithelial cell line (HK-2) was cultured in vitro and treated with LPS (1 µg/mL), the SIRT1-specific agonist SRT1720 (2.5 µmol/L) and small interfering RNA (siRNA)-SIRT1 for 48 hours. After 48 hours, Cell Counting Kit-8 was used to detect the changes in cell proliferation ability, and ELISA was used to detect the changes in the expression of interleukin (IL)-1β and IL-18 in the cell supernatant. Real-time PCR (quantitative RT-PCR) and western blot analysis were used to detect the expression of SIRT1, caspase-1, caspase-4, NOD-like receptor thermal protein domain associated protein 3(NLRP3), and cleaved gasdermin D (GSDMD) in each group.Results Serum inflammatory cytokines were significantly elevated in 13 children with CHn with urinary tract infection, mainly caused by Gram-negative bacteria. Severe renal fibrosis occurred in children with CHn. Compared with the control group, the expression of SIRT1 in CHn kidney tissues was decreased, and the expression of caspase-4 and GSDMD was increased. LPS inhibited the expression of SIRT1 in HK-2 cells, promoted the expression of caspase-1, caspase-4, NLRP3, cleaved GSDMD, promoted the expression of IL-1β and IL-18 in the supernatant, and promoted pyroptosis in HK-2 cells. SRT1720 can inhibit LPS-activated pyroptosis by promoting SIRT1 expression, while siRNA-SIRT1 can further aggravate LPS-activated pyroptosis after inhibiting SIRT1 expression.Conclusions LPS can promote the inflammatory response in children with CHn by activating non-canonical pyroptosis and inhibiting SIRT1 expression. Promoting SIRT1 expression can inhibit pyroptosis of renal tubular epithelial cells, reduce the release of IL-18 and IL-1β, and alleviate the progression of renal fibrosis in children with CHn.

OBJECTIVES:To report a novel corporoplasty technique with a urethral plate flap in hypospadias repair and evaluate its safety and efficacy for ventral lengthening.METHODS:Data were retrospectively collected from consecutive patients with hypospadias who underwent urethral plate flap corporoplasty between July 2021 and March 2022. All patients underwent hypospadias repair using the Duckett technique. The corporoplasty procedure involved the following key steps: the half-spongiosum of the urethral plate was harvested as a flap (with a pedicle attached to the corpus cavernosum); a transverse incision of the tunica albuginea was made adjacent to the pedicle; and the flap was patched onto the corporal defect.RESULTS:The study included 10 patients, with a median age of 20 months. The initial meatal location was penile in two patients, penoscrotal in four patients, and scrotal in four patients. The median ventral curvature was 45° after degloving and urethral plate transection. The median ventral lengthening distance proportional to penis length was 0.21. During the median follow-up of 13.8 months, complications occurred in three cases, including two cases of fistula and one case of urethral stricture with secondary diverticulum. No cases of recurrent ventral curvature, meatal stenosis, or urethral dehiscence were noted. Postoperative ultrasonography showed a good continuation of the tunica albuginea and integrity of the stratum spongiosum at the corporoplasty site.CONCLUSIONS:Urethral plate flap corporoplasty is a simple and effective ventral lengthening procedure. The novel corporoplasty technique allows for anatomical and architectural repair of corporal disproportion.

Persistent Müllerian duct syndrome (PMDS) is a rare clinically and genetically overlapping disorder caused by mutations in the anti-Müllerian hormone (AMH) gene or the anti-Müllerian hormone receptor type 2 (AMHR2) gene. Affected individuals present uterus and tubes in normally virilized males and are discovered unexpectedly during other surgeries. Since it is rare and complex, a definitive clinical diagnosis can be missed, and there are no guidelines regarding how to deal with the uterus. In the present study, exome sequencing and Sanger verification were performed for causal variants in 12 PMDS patients. Preoperative diagnoses were made by positive exome sequencing in 8 patients. Of them, 7 patients evoked on the basis of ultrasound indicating bilateral testes on the same side of the body. Twelve different AMH variants (2 frameshift/nonsense, 1 deletion, 8 missense, and 1 in-frame) in 9 patients and 6 different AMHR2 variants (5 missense and 1 splicing) in 3 patients were identified. Seven variants were classified as “pathogenic” or “likely pathogenic”, and 4 of them were novel. All but two patients with AMH defects showed low serum AMH concentrations, but all patients with AMHR2 defects showed elevated AMH levels. During surgery, an abnormal vas deferens was observed in half of the patients. Eight patients underwent orchidopexy with uterine preservation. Of them, 2 patients presented complications including irreducible cryptorchidism, and 3 patients developed Müllerian remnant cysts. Three patients underwent subtotal hysterectomy. Of them, one patient had complication of injury to the vas deferens, and one had hemorrhage after operation. This is the first report of PMDS involving a large Chinese population. The present study not only expands the variation spectrum but also provides clinical experience about the management of the uterus.

Objective:To compare the therapeutic efficacy of robot-assisted laparoscopic ureteral reimplantation(RALUR)versus traditional laparoscopic ureteral reimplantation(LUR)for primary obstructive megaureter(POM)in infants.Methods:From January 2020 to April 2021, clinical data were collected from 18 children undergoing RALUR/LUR for POM.There were 11 boys and 7 girls with an operative age from 0 to 36 months.Ten children undergoing RALUR were selected as RALUR group.The average age was 9(4-35)months.And the involved side was left(n=6)and right(n=4); Eight children undergoing LUR were selected as LUR group.The average age was 10(5-25)months.And the involved side was left(n=6)and right(n=2).Results:All operations were successfully completed and there was no conversion to open surgery.The operative duration was(149.0±18.9)min in RALUR group and(194.4±45.0)min in LUR group and the inter-group difference had statistical significance( P=0.01); the hospitalization expenditure was(73 807.0±7 342.2)yuan in RALUR group and(23 126.7±4 497.1)yuan in LUR group and the inter-group difference had statistical significance( P<0.001); the postoperative drainage duration was(4.2±1.7)days in RALUR group and(4.8±2.5)days in LUR group and the inter-group difference had no statistical significance( P=0.59); the postoperative hospital stay was(9.0±2.5)days in RALUR group and(9.6±1.6)days in LUR group and the inter-group difference had no statistical significance( P=0.54). The postoperative follow-up period was 3 to 19 months.Two cases of urinary tract infection in both groups received antibiotics.Excretory cystography at Month 3 postoperatively showed no obvious complications.No short-term postoperative complications requiring rehospitalization occurred. Conclusions:Both RALUR and LUR are safe, effective and rapid in the treatment of POM in infants.With a shorter operative duration, RALUR is a viable surgical option.

Neurogenic bladder (NB) is a dysfunction of bladder and urethra caused by abnormal central or/and peripheral nervous system of regulating urinary function.Vesicoureteral reflux (VUR) is one of the most common complications of NB.Since the underlying etiology of VUR secondary to NB is rather complicated and many pathogenic factors affects each other with the progress of the disease, a proper treatment of the disease has always been a clinical dilemma.This review summarized the overall treatment strategies of secondary VUR in NB and focused upon treatment of primary disease, conservative measures and surgery.Also clinical indications for different tretments, current controversies and counter-measures were discussed.

The purpose of this study is to analyze the histopathological features of resected testicular remnant specimens, ascertain the incidence of the presence of either germ cells (GCs) or seminiferous tubules (SNTs), and assess whether surgical excision of the remnant is necessary. A total of 332 boys with vanishing testis underwent surgical removal of unilateral testicular remnants, with age 7-164 months (median age 25 months). Among the total 332 cases, 212 (63.8%) were younger than 36 months and 143 (66.5%) were found to have hypertrophied contralateral testes larger than 1.6 cm in longitudinal diameter under sonography. SNTs were only present in 21 (6.3%) cases and GCs were present in 7 (2.1%) cases. Compared to the review studies, the very low incidence of SNTs and GCs in which implies extremely low chances of potential malignancy. We propose that surgical removal of vanishing testis remnants in an inguinal or scrotal position may not be necessary.

Objective:To explore the safety and feasibility of surgery for stage Ⅰ testicular malignant germ cell tumors via scrotal incision.Methods:From January 2014 to December 2019, clinical data were retrospectively reviewed for 41 children with testicular malignant germ cell tumor without inguinal or retroperitoneal lymph node enlargement.The median age was 36(4-96) months.According to operative approach, they were divided into scrotal and inguinal groups.Perioperative related parameters and postoperative complications were compared between two groups.Results:Both groups completed operations smoothly.No significant inter-group differences existed in age, body weight, tumor diameter or pathological type ( P>0.05). Operative duration and postoperative hospitalization time of scrotal group were (39.3±9.2) min and (3.6±1.5) d respectively and that of groin group was (42.0±8.6) min and (4.3±2.2) d and the inter-group difference was not statistically significant ( P>0.05). In scrotal group, preoperative value of alpha fetoprotein (AFP) was (7 203.9±16 096.3) ng/mL, (21.2±14.0) ng/mL at Month 1 post-operation and (12.9±9.4) ng/mL at Month 2 post-operation.In inguinal group, AFP value was (5 048.8±8 106.1) ng/mL pre-operation, (32.2±41.3) ng/mL at Month 1 post-operation and (22.4±37.9) ng/mL at Month 2 post-operation.After operation, AFP in both groups was significantly lower than that pre-operation with statistical significance ( P<0.05). No significant inter-group difference existed in AFP value ( P>0.05). In terms of complications, one case of incision dehiscence occurred in scrotal group while no perioperative complication was observed in inguinal group.The postoperative follow-up period of two groups was (6-74)(8-69) months.The overall survival rate was 100% and the event-free survival rate 13/14 and 24/27 without statistical significance ( P>0.05). Conclusion:Surgery via scrotal incision for stage Ⅰ testicular malignant germ cell tumors can achieve the same efficacy and prognosis as traditional inguinal incision.The operation is simple and the complications are controllable.Wider popularization is worthwhile.