Diagnostik und Therapie des Maldeszensus testis – ein Update unter Berücksichtigung der Leitlinien

P. Rubenwolf; R. Stein

doi:10.1055/s-0033-1356343

TumorDiagnostik & Therapie, Table of Contents

TumorDiagnostik & Therapie 2014; 35(1): 36-42
DOI: 10.1055/s-0033-1356343

Thieme Onkologie aktuell

Diagnostik und Therapie des Maldeszensus testis – ein Update unter Berücksichtigung der Leitlinien

Diagnosis and Management of the Undescended Testis – An Update in the Light of the Current Guidelines

Authors

P. Rubenwolf
R. Stein

Abstract

Zusammenfassung

Hodenhochstände gehören mit einer Prävalenz von mindestens 1 % zu den häufigsten Anomalien des äußeren Genitales. Ein Spontandeszensus des Hodens ist innerhalb der ersten 6 Monate möglich, sodass im ersten Lebenshalbjahr Verlaufskontrollen indiziert sind. Unbehandelt birgt ein Hodenhochstand das Risiko eines verminderten Fertilitätspotenzials sowie einer erhöhten malignen Entartung (RR 2,5 – 8). Eine vor der Pubertät durchgeführte Orchidopexie hat das Potenzial, das erhöhte Malignitätsrisiko des MDT auf den Faktor 2 – 3 zu reduzieren. Eine neoadjuvante Hormontherapie mit GnRH-Analoga ab dem 6. Lebensmonat kann den Fertilitätsindex des betroffenen Hodens verbessern und sollte insofern ein integraler Bestandteil des Therapiekonzeptes sein. Der Einsatz von HCG sowie eine Hormontherapie nach dem 1. Lebensjahr sollte jedoch aufgrund möglicher Hodenparenchymschäden kritisch hinterfragt werden. Bei nicht-tastbaren und sonografisch nicht-darstellbaren Gonaden ist die laparoskopische Exploration und Therapie Mittel der Wahl. Die operative Lagekorrektur sollte idealerweise mit dem 1. Geburtstag abgeschlossen sein.

Abstract

Cryptorchidism, or undescended testis (UDT), occurs in 1 – 3 % of male term infant births. At least two-thirds of UDTs will descend spontaneously, typically during the first 6 months of life. UDTs are associated with loss of spermatogenic potential and testicular malignancy in the long term. Orchiopexy performed prior to puberty may significantly reduce the malignant potential by up to 4-fold. Neoadjuvant hormonal therapy starting at 6 months of life has been shown to potentially improve the testicle’s fertility index and should be part of the therapeutic concept. However, the use of hormonal treatment and HCG beyond the first year of life is to be challenged given a potentially negative impact on testicular function. Laparoscopic exploration and therapy is the method of choice for non-palpable testes. Ideally, surgical repair of the UDT should be completed by the age of 1 year.

Schlüsselwörter

Maldeszensus testis - Krytorchismus - Diagnostik - Therapie - Chirurgie - Hormontherapie

Key words

undescended testis (UDT) - cryptorchidism - diagnosis - management - surgery - hormonal therapy

Full Text

References

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