After review of the pediatric literature, we report on the prevalence of testicular microlithiasis and its relation with benign and malign entities. We provide a guideline for the management of boys with testicular microlithiasis.The databases searched were Medline, Web of Science, Embase and the Cochrane Library. Data on the rates of testicular microlithiasis were collected and from each study information was extracted on the study population according to country, study design, diagnostic method, type of patient, number of patients, age, associated anomalies, additional diagnostic methods and follow-up information. From the 472 articles, we selected 126 articles as potentially relevant, of which 57 were included.In asymptomatic boys, the prevalence of testicular microlithiasis is 4.2% and in symptomatic referrals it is 1.6%. The development of a testicular malignancy is occasionally reported after diagnosis of testicular microlithiasis. The management of boys with testicular microlithiasis varies widely. Most authors recommend regular self-examination, and some perform testicular ultrasound and/or screen tumor markers.The prevalence of testicular microlithiasis in boys varies between 1.1% and 4.2%. For follow-up, regular self-examination is advised from the age of 15 years.

Background/Aims: We obtained reference data for testicular volume measured by ultrasound in asymptomatic boys aged 0.5–18 years. In addition, we assessed the validity of the Prader orchidometer per age group by correlating it with the volume measurement by ultrasound. Methods: The study only included healthy boys with two scrotal testes at birth and at the time of the examination. For each boy the testicular volume of both testes was measured by ultrasound and the Prader orchidometer. Testicular volumes were measured for boys aged from 1 to 18 years. The boys’ ages were rounded down to the last birthday if it had occurred less than 6 months previously or rounded up to the next birthday if it was going to be within 6 months. Results: The volume measurement by the Prader orchidometer according to reference curves showed a statistically significant correlation. Moreover, the testicular volumes measured by the Prader orchidometer showed an accurate goodness of fit with US measurements (R2 = 0.956). Conclusion: Normative values are provided for testicular volume measured by ultrasound in boys aged 0.5–18 years. An accurate correlation was found between volume measurements by ultrasound and by the Prader orchidometer (R2 = 0.956). Therefore, volume measurement by the Prader orchidometer, as generally used in the practice by doctors, can be used as a valid parameter for monitoring testicular growth.

Purpose: We used ultrasound to determine the volume of retractile testes in boys and compared these volumes with normative testicular volume values.Materials and Methods: A total of 171 boys were enrolled in the study, of whom 14 were excluded from analysis. The 157 boys included (age 0.8 to 11.5 years) were recruited from 2 different populations. The first subgroup comprised 92 boys previously excluded from a study aimed at obtaining normative values of ultra-sonographically scanned testes. The second group included 65 boys who had been referred to our outpatient clinic for nonscrotal testis and who were diagnosed with retractile testis. Testicular volume was measured by ultrasound in a scrotal position or in an inguinal position. Three separate transverse and longitudinal images of each testis were recorded. Length, width and height were measured, and the volume was calculated with the formula for an ellipsoid, pi/6 x length x width x height. The highest value of the 3 testicular volumes was determined and taken as the volume measurement.Results: The volumes measured by ultrasound for the 157 boys with 276 retractile testes ranged from 0.18 to 1.49 ml (mean 0.50). The volumes of the retractile testes were significantly smaller than normative values (p < 0.001). Furthermore, the testicular volumes of retractile testes measured in an inguinal position were significantly smaller than those measured in a scrotal position (p < 0.001).Conclusions: The volumes of retractile testes are significantly smaller than recently determined normative values.

PURPOSE:We assessed the prevalence of testicular microlithiasis via ultrasound in asymptomatic males 0 to 19 years old.MATERIALS AND METHODS:We studied only patients with 2 scrotal testes at birth and at examination. We excluded boys with a history of undescended testis, hydrocele, varicocele and syndromes associated with testicular microlithiasis. To assess for testicular microlithiasis, we scanned the scrotum ultrasonographically by recording transverse and longitudinal images of each testis. Classic testicular microlithiasis was defined as 5 or more echogenic foci in either or both testes. Boys with fewer than 5 microliths (but with at least 1) were deemed to have limited testicular microlithiasis.RESULTS:We examined 694 asymptomatic boys between October 2007 and July 2008, of whom 670 participated in the study. Classic testicular microlithiasis was present in 16 boys (2.4%) and limited testicular microlithiasis in 12 (1.8%), yielding a total prevalence of 4.2%. Classic testicular microlithiasis was found in 1 patient younger than 6 years, 8 boys 6 to 12 years old and 7 boys older than 12 years. There was a significant difference in prevalence among the 3 age groups (p = 0.032). Testicular malignancies were not found in any patient. Of the 24 boys excluded from the study testicular microlithiasis was seen in 4.CONCLUSIONS:The prevalence of classic testicular microlithiasis in asymptomatic boys is 2.4% and increases with age.

Aim: We aimed to investigate long-term testicular growth and the position of congenital undescended testes (UDT) after orchidopexy (ORP), taking into account that nowadays UDT has to be divided into congenital and acquired forms. Methods: This study included 181 patients with 199 congenital UDT (91 right-sided, 72 left-sided, 18 bilateral), in whom ORP had been carried out (1986–2006). Long-term testicular position and growth were assessed by clinical examination and ultrasound (US). Results: In 44.5% (65/146), testicular volume of the unilaterally operated congenital UDT was >50th percentile for age. In 55.5% (81/146), the volume was ≤50th percentile, and 13.0% (19/146) of these were ≤10th percentile. In 7 of 34 (20.6%) bilaterally operated congenital UDT, testicular volume was ≤10th percentile. The difference in size between the operated congenital UDT and the contralateral non-operated testes measured by both Prader orchidometer (p = 0.00) and US (p = 0.00) was statistically significant. There was a strong correlation between the orchidometer and US. On examination, 87.9% (175/199) of the operated testes were located in the lower scrotum. Conclusion: The findings of this study suggest that ORP for congenital UDT is safe, and even when performed later than current recommendations did not result in severe growth retardation.

We performed a systematic review and critique of the literature on the frequency of undescended testis (UDT) among boys from birth to adolescence. Special attention was given to whether previous testicular position was taken into account to distinguish between congenital and acquired UDT. We searched Medline, Embase, Cinahl and the Cochrane Library. Any study reporting on the frequency of UDT was included. Study population age, number of boys studied, period of examination, primary examiner, area of study, study design, ethnicity, definitions used and previous testicular position were analysed. A total of 46 studies met the inclusion criteria. Twenty-three of the 46 (50%) studies involved newborns. Definitions were described in half of the studies; however, the definitions used were heterogeneous. Previous testis position was described in 11% (5/46) of the studies. At birth, in term and/or birth weight >2.5 kg infants, the UDT rate ranged from 1.0 to 4.6%, and in premature and/or birth weight <2.5 kg infants from 1.1 to 45.3%. At the age of 1 year UDT in term and/or birth weight >2.5 kg infants was seen in 1.0-1.5%, at 6 years in 0.0-2.6%, at 11 years in 0.0-6.6% and at 15 years in 1.6-2.2% of boys. The frequency of UDT shows variable figures in the literature. The actual frequency of acquired UDT essentially remains unclear because of the shortage of studies performed at an older age, and of studies reporting on previous testicular position.

Een 8-jarig meisje werd verwezen in verband met een acuut ontstaan, pijnlijk exantheem op de billen en gewrichtszwellingen. Bij huidbiopsie werd een perivasculair, dicht ontstekingsinfiltraat met granulocyten gezien passende bij het syndroom van Sweet. Het betreft een neutrofiele dermatose die in hoofdzaak bij volwassenen wordt gezien. Slechts in 8% van de gevallen betreft het kinderen. De pathogenese is grotendeels onbekend, maar lijkt multifactorieel bepaald. De aandoening is geassocieerd met infecties (bacterieel, viraal, parasitair), immunologische aandoeningen (o.a. reumatoïde artritis, dermatomyositis, inflammatoire darmaandoeningen) of zwangerschap en wordt dan de klassieke of idiopathisch vorm genoemd.Verder is er een vorm geassocieerd met medicijngebruik (o.a. granulocyte colony-stimulating factor, orale anticonceptie, trimethoprimsulfamethoxazol, furosemide) en is de aandoening beschreven bij maligniteiten van vooral hemato-oncologische aard zoals acute myeloïde leukemie en non- Hodgkin-lymfomen. Systemisch corticosteroïden is de gouden standaard in de behandeling, naast ondersteunende maatregelen. De prognose wordt in hoofdzaak bepaald door de eventueel geassocieerde aandoeningen.

--Undescended testis (UDT) is one of the most common urogenital abnormalities in boys. --UDT is defined as a testis which cannot be brought into a stable scrotal position. --At present, congenital and acquired forms of UDT are recognised. Congenital UDT is defined as a UDT which has never descended from birth. Acquired UDT is defined as a UDT which has been fully descended in the past. --Congenital UDT should be treated surgically between 6 to 12 months of age. --The treatment of acquired UDT is still disputed. As yet, awaiting spontaneous descent at early puberty seems to be the most rational treatment. --In the Netherlands, the high number of late orchidopexies is due to surgery for acquired UDT. To reduce this high number, the guidelines of the first development conference on 'non-scrotal testis' dating back to 1986 should be revised on several points

Bij drie jongens van respectievelijk 15, 9 en 10 jaar werd door middel van echografie de diagnose testiculaire microlithiasis (TM) gesteld. Twee van hen hadden geen klachten, één klaagde over pijn in de testis. TM wordt gekenmerkt door meerdere echorijke foci in de tubuli seminiferi zonder slagschaduw. De oorzaak is grotendeels onbekend. Bij volwassenen bedraagt de prevalentie tussen de 0,2 en 29%, bij jongens tussen de 0,1 en 11,7%. Er zijn aanwijzingen dat TM geassocieerd is met maligne aandoeningen van de testis. Alhoewel er bij volwassenen geen eensluidende richtlijn voor follow-up bestaat, wordt veelal jaarlijkse follow-up geadviseerd. Voor jongens bestaan vrijwel geen richtlijnen. Een driemaandelijks zelfonderzoek gecombineerd met jaarlijks lichamelijk onderzoek en echografie is raadzaam, vooral bij jongens met een al verhoogd risico op testismaligniteiten zoals jongens met een niet-scrotale testis. De prognose, evenzeer ten aanzien van de fertiliteit, is grotendeels onbekend.

Niet-scrotale testis (NST) is een van de meest voorkomende urogenitale aandoeningen bij jongens. Men spreekt van NST indien de testikel niet in een stabiele ligging in het scrotum kan worden gebracht. Tegenwoordig worden aangeboren en verworven vormen van NST onderscheiden. De aangeboren NST is vanaf de geboorte nooit ingedaald geweest, terwijl een verworven NST aanvankelijk wel volledig ingedaald is geweest, maar na verloop van tijd niet meer in een stabiele ligging in het scrotum kan worden gebracht. De aangeboren NST wordt bij voorkeur rond de leeftijd van 6-12 maanden operatief behandeld. Over de behandeling van de verworven NST kan nog geen eensluidend advies worden gegeven. Vooralsnog lijkt afwachten tot in de puberteit het meest voor de hand te liggen. Operatieve behandeling van de verworven NST is de oorzaak van het hoge aantal orchidopexie-ingrepen in ons land. Om dit hoge aantal terug te dringen is het wenselijk om de bestaande richtlijnen voor het beleid bij niet-scrotale testis uit 1986 op verschillende punten te herzien.

Background: Since the mid-1990s, acquired undescended testis has gradually been recognised as a separate entity for which the efficacy of prepubertal surgery has not been univocally been demonstrated. Therefore, in our hospital, orchidopexy was no longer routinely performed for acquired undescended testis.Aim: To investigate the effect of expectative policy in our hospital on the number of orchidopexies.Methods: Two 5-year periods were compared. Period A (1991-1995), in which undescended testis was treated surgically, and period B (2000-2004), in which prepubertal orchidopexy in our hospital was no longer performed for acquired undescended testis. In addition, a comparison was made between the percentage reduction in hospital and national figures.Results: In period B, the number of orchidopexies in our hospital was reduced by 61.8% (from 387 to 148), mainly in the age group > 6 years. Nationally, during the same period, the number of orchidopexies decreased only by 2.4% (from 18 024 to 17 591).Conclusion: The results of this study confirm that recognition of acquired undescended testis is crucial for reducing the high number of (late) orchidopexies.

OBJECTIVE:To investigate the prevalence of acquired undescended testis (UDT) in Dutch schoolboys.DESIGN AND PARTICIPANTS:As a part of routine school medical examinations, during a 2-year period (2001-3), testis position was determined in 6-year, 9-year and 13-year-old schoolboys. Before the examination, a parent questionnaire was sent inquiring both about the position of the testes and whether the child had been admitted earlier to hospital for orchidopexy. In 6-year and 13-year olds, a physical examination was performed by the school medical officer; in 9-year olds, a school nurse interview was held. Each boy for whom there was any doubt of the scrotal position was referred to the hospital for examination of both testes.SETTING:Institution for Youth Health Care "Noordkennemerland" and Medical Centre Alkmaar, Alkmaar, the Netherlands.RESULTS:Testis position was determined in 2042 boys aged 6, 1038 aged 9 and 353 aged 13. Of these, 47, 53 and 8 boys, respectively, were referred to the hospital and seen for further evaluation. The diagnosis of acquired UDT was made in 25 boys aged 6, 23 aged 9 and four aged 13. In 33 boys, a congenital UDT was diagnosed; 32 (97%) had already been diagnosed and treated at an early age.CONCLUSIONS:The prevalence of acquired UDT for 6-year, 9-year and 13-year olds was, respectively, 1.2% (25/2042), 2.2% (23/1038) and 1.1% (4/353). In addition, congenital UDT is treated during the early years of life and, in contrast with popular belief, screening programmes for detecting UDT in the early years are successful.

We assessed spontaneous descent of acquired undescended testis (UDT) at puberty. 299 Boys (aged 1.2-16.5 years, mean 9.4) with 350 acquired-UDT were examined annually during a 12.6-year period (mean 3.1). An acquired-UDT was defined as a previously intrascrotal testis which can no longer be manipulated into a stable scrotal position. Each year, position of the testis and pubertal development according to Tanner's stages were assessed. Early puberty was defined as puberty stage G(2) (testicular volume 4-9 mL), mid-puberty as puberty stages G(3) (testicular volume 10 mL) and G(4) (testicular volume 11-15 mL), and late puberty as puberty stage G(5) (testicular volume > 15 mL). Follow-up was completed if spontaneous descent had occurred, if mid-pubertal orchidopexy (ORP) had to be performed, if the boy was lost for follow-up, or if pre-pubertal ORP was performed in another hospital. In 139 boys with 164 acquired-UDT follow-up was meanwhile completed. Twelve boys with 14 UDT were lost for follow-up. In an additional 16 boys with 21 UDT, ORP was performed in another hospital. In 98 of the remaining 129 (76.0%) acquired-UDT spontaneous descent at puberty occurred. Mean follow-up was 2.5 years (range 0.2-8.5). In 70 of 98 testes (71.4%) descent occurred in early puberty, in 26 of 98 testes (26.5%) in mid-puberty, and in two testes in late puberty. In 31 of 129 testes (24.0%) ORP had to be performed at mid (30 cases) or late (one case) puberty. In this series, 98 of 129 acquired-UDT (76.0%) descended spontaneously at puberty, whereas in 31 of 129 (24.0%) pubertal ORP was performed. If ORP is postponed until puberty stage G(3) (testicular volume of 10 mL) three of four acquired-UDT will descend spontaneously.

Background/Purpose: The aim of this study was to retrospectively review the findings at orchidopexy in acquired undescended testis (UDT).Methods: The authors reviewed a 14-year (1986 through 1999) surgical experience in 360 boys in whom 461 orchidopexies were performed for acquired-UDT. The operative notes were reviewed to determine at operation testis position and volume, persistence of patent processus vaginalis (PV), and attachment of the gubernaculum. Also, testis position after orchidopexy was evaluated.Results: Age at operation ranged from 2 to 19 years (mean, 8.9 years), 205 of the 461 orchidopexies (44.5%) had been performed between 9 and 12 years of age. In 327 of the 461 cases (70.9%), testis position was documented as intraoperative; in 281 of these cases (86.0%), the testis was located in the superficial inguinal pouch (SIP). A note was made regarding the presence or absence of a hernial sac in 207 of the cases: 113 (54.6%) were associated with an open PV, which usually was slightly open. In 122 of the 461 cases (26.5%), the gubernacular attachment was assessed; in 121 of these (99.2%), a normal attachment of the gubernaculum was noted. At the end of orchidopexy, in 438 of the 461 cases (95.0%), testis position was recorded. Three hundred eighty-two of these testes (87.2%) were at the bottom of the scrotum.Conclusions: Acquired UDT usually is characterized by SIP position, closed or (small) open PV, and normal gubernaculum attachment. The results of surgery seem excellent. (C) 2004 Elsevier Inc. All rights reserved.