ABSTRACT
BACKGROUND: n Germany, it is recommended that the surgical treatment of an undescended testis should be carried out between the ages of 6 months and 1 year to lower the risks of subfertility and testicular carcinoma. Although this recommendation has appeared in the German guidelines from 2007 onward, orchidopexy is still frequently performed at later ages. METHOD: We retrospectively analyzed data from seven pediatric surgical services in the German state of Baden-Württemberg on all boys who underwent orchidopexy from 2009 to 2012. We classified the timing of surgery as Age Group I (before the first birthday), Age Group II (between the first and second birthdays), and Age Group III (after the second birthday). We determined whether preoperative hormonal treatment was given and distinguished primary from secondary undescended testis. RESULTS: Among 2213 boys who underwent orchidopexy, 1850 had primary and 363 had secondary undescended testis. Of those with primary undescended testis, the percentages of boys who underwent surgery in Age Groups I, II, and III were (respectively, with 95% confidence intervals): 18.7% (17-20.6%), 24.4% (22.5-26.5%), and 57% (54.6-59.2%). A small percentage of boys in each group also received preoperative hormonal treatment. From 2009 to 2012, there was a secular trend favoring earlier orchidopexy. In 2012, 28 boys (14.2% [9.7-20.0%]) had orchidopexy in outpatient pediatric surgery practices before their first birthday, while 68 did on hospital inpatient services (40.7% [33.2-48.6%]). CONCLUSION: Most of the patients studied had surgery at a later age than recommended. Adherence to the guidelines in this respect is nonetheless relatively good in Germany compared to other countries, as studies from abroad have yielded findings that are just as bad or worse.
Subject(s)
Cryptorchidism/epidemiology , Cryptorchidism/surgery , Infertility, Male/epidemiology , Infertility, Male/prevention & control , Orchiopexy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Causality , Child, Preschool , Comorbidity , Cryptorchidism/diagnosis , Germany/epidemiology , Humans , Infant , Infertility, Male/diagnosis , Male , Preoperative Period , Retrospective Studies , Treatment OutcomeABSTRACT
The authors present a case of an aneurysm of the inferior vena cava in a 5-year-old boy. The boy suffered from acute pulmonary and paradoxical cerebral embolism after a minor abdominal trauma. Magnetic resonance angiography was the key for correct diagnosis of the retroperitoneal process and helped develop a strategy for surgery. The boy underwent resection of the aneurysm and a prosthetic replacement of the distal inferior vena cava. Aneurysms of the inferior vena cava are very rare conditions. The diagnosis is difficult because they may mimic a retroperitoneal tumor. Thrombosis and embolism are common complications of aneurysms of the vena cava.
