Elsevier

Urology

Volume 70, Issue 6, December 2007, Pages 1204-1206
Urology

Pediatric urology
Histologic Evaluation of the Testicular Remnant Associated with the Vanishing Testes Syndrome: Is Surgical Management Necessary?

https://doi.org/10.1016/j.urology.2007.08.020Get rights and content

Objectives

There is controversy surrounding the optimal management of the testicular remnant associated with the vanishing testes syndrome. Some urologists advocate the need for surgical exploration, whereas others believe this is unnecessary. These differing opinions are based on the variable reports of viable germ cell elements found within the testicular remnants. To better understand the pathology associated with this syndrome and the need for surgical management, we reviewed our experience regarding the incidence of viable germ cell elements within the testicular remnant.

Methods

An institutional review board-approved, retrospective review was performed of all consecutive patients undergoing exploration for a nonpalpable testis at Eastern Virginia Medical School and Geisinger Medical Center between 1994 and 2006. Patients who were found to have spermatic vessels and a vas deferens exiting a closed internal inguinal ring were included in this analysis.

Results

Fifty-six patients underwent removal of the testicular remnant. Patient age ranged from 11 to 216 months. In 8 of the specimens (14%), we identified viable germ cell elements. In an additional 4 patients (7%), we identified seminiferous tubules without germ cell elements.

Conclusions

In our review, we identified that a significant number of testicular remnants associated with the vanishing testes syndrome can harbor viable germ cell elements or seminiferous tubules. The exact fate of these residual elements remains unknown; however, there may exist the potential for malignant transformation. Given the potential for malignant degeneration, we believe that these remnants should be removed.

Section snippets

Materials and Methods

A retrospective review was performed of all consecutive patients undergoing diagnostic laparoscopy for a nonpalpable testis at Eastern Virginia Medical School and Geisinger Medical Center between 1994 and 2006. In our practice, if a testes is found to be nonpalpable on an initial examination performed during an office visit, then after receiving informed consent, all patients are scheduled for an examination under anesthesia. Provided that the examination under anesthesia confirms that the

Results

Between 1994 and 2006, 56 patients underwent laparoscopic removal of the testicular remnant associated with the vanishing testes syndrome. Patient age ranged from 11 to 216 months (median age 44.5 months). In no instance was a normal undescended testes encountered when the examination under anesthesia confirmed the nonpalpable nature of the testes. In 8 of the specimens (14%), we identified viable germ cell elements (Fig. 1). In an additional 4 patients (7%), we identified seminiferous tubules

Comment

Cryptorchidism is known to affect 3% of full-term male newborn infants and 0.8% of these male infants at 1 year of age. Twenty percent of all undescended testes are found to be nonpalpable.9 Elder further identified that 58% of nonpalpable testes are associated with spermatic vessels and a vas deferens exiting a closed internal inguinal ring. An additional 4% of nonpalpable testes were found to have blind ending spermatic vessels.4 Thus, 62% of nonpalpable testes may be associated with the

Conclusion

In our review, we identified that a significant number of testicular remnants associated with the vanishing testes syndrome can harbor viable germ cell elements or seminiferous tubules. The exact fate of these residual germ cells remains unknown; however, there is the potential for malignant transformation of these cells within the remnant. We believe that these remnants should be removed and this procedure may be accomplished with minimal morbidity via a minimally invasive approach.

Cited by (0)

View full text