Kriptorhizam u djece

Anko Antabak, Mario Koporčić, Dino Papeš, Stanko Ćavar, Miran Pasini, Krešimir Bulić, Tomislav Luetić, Ivan Jelčić

Kriptorhizam (nespušten testis), izostanak jednog ili obaju testisa u normalnom skrotalnom položaju, može biti kongenitalan ili stečen. Kongenitalni, primjetljiv već pri rođenju, nastao je zastojem (intraabdominalno, ingvinalno ili visoko skrotalno) testisa na njegovom normalnom putu spuštanja. Kongenitalni kriptorhizam jedna je od najčešćih kongenitalnih anomalija (4% zdrave terminske novorođenčadi i oko 45% nedonoščadi). Kriptorhični testisi, ako dugo ostanu u abnormalnom položaju, prolaze kroz određene histološke promjene, a koje dovode do smanjene plodnosti i povećanog rizika za razvoj malignih tumora testisa. Stoga je preporuka kirurško liječenje završiti do navršenih 12, najkasnije 18 mjeseci života. Cilj ovog rada bio je utvrditi pratimo li mi te smjernice. Proučavali smo razdoblje od 2011. do 2020. godine. U istraživanje je uključeno 598 djece, a koja su u vrijeme operacije bila u dobi od 0 do 18 godina života. Jednostrano nespušteni testis imalo je 413 (69,1%) djece, od čega 245 desno, a 168 lijevo. Bilateralni kriptorhizam je imalo 158 (26,4%) djece koja su operirana u istom aktu i još 27 (4,5%) djece, kod kojih je prvo operirana jedna strana, a naknadno i druga. U prvih 16 mjeseci života operirano je 110 (18,4 %) sve djece koja su analizirana u ovom radu. U prve tri godine života operirano je 279 (46,7%), a do polaska u školu 431 (72%) djece. Prosječna dob djece pri obavljanju orhidopeksije bila je 57,8 mjeseci. Nema značajne razlike bilo da se radilo o jednostranom ili obostranom kriptorhizmu. Kroz čitavo razdoblje praćenja (deset godina) nema razlike prosječne starosti djece, niti se zamjećuje tendencija pada. Valja zaključiti kako se tek mali broj djece operira unutar prvih 18 mjeseci života, a zabrinjava izostanak tendencije smanjenja životne dobi u vrijeme zahvata u promatranom razdoblju.

Cryptorchidism (undescended testicle), the absence of one or both testicles in the normal scrotal position, can be congenital or acquired. Congenital, noticeable already at birth, is caused by the stagnation (intraabdominal, inguinal or high scrotal) of the testis on its normal path of descent. Congenital cryptorchidism is one of the most common congenital anomalies, occurring in 4% of healthy term newborns and about 45% of premature babies. Cryptorchid testicles, if they remain in an abnormal position for a long time, go through certain histological changes, which lead to reduced fertility and an increased risk for the development of malignant testicular
tumors. Therefore, it is recommended to complete the surgical treatment by 12, at the latest 18 months of age. The aim of this paper was to determine whether we follow these guidelines. We studied the period from 2011 to 2020. A total of 598 children were included in this study, who were between 0 and 18 years old at the time of the operation. Out of the total number of children, 413 (69.1%) had unilateral undescended testicles, of which 245 were on the right and 168 on the left side. Bilateral cryptorchidism was present in 158 (26.4%) children who were operated on in the same act and another 27 (4.5%) children who were operated on one side first and then
on the other., One hundred and ten(18.4%) children analyzed in this paper were operated in the first 16 months of life. In the first three years of life, 279 (46.7 %) children were operated , and by the time they started school, 431 (72 %) children. The average age of the children when orchidopexy was performed was 57.8 months. There is no significant difference considering whether it was unilateral or bilateral cryptorchidism. Throughout the entire monitoring period (ten years), there was no difference in the average age of the children, nor was there a tendency of decline. It can be concluded that only a small number of children are operated on within the first 18 months of life, and the absence of a tendency to decrease the age at the time of surgery in the observed period is worrying.