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The usefulness of testicular

atrophy index in the assessment


of undescended testicle
- Preliminary report

Niedzielski J, Pisarska K, Przewratil P


Department of Pediatric Surgery & Oncology, University School of Medicine in Lodz

In Annales Academiae Medicae Bialostocensis, vol. 48, 2003


INTRODUCTION
• Cryptorchidism : serious and one of most frequent GU
tract anomalies in boys
• Affect : 2 - 8 % male newborn, first year : 0.5 – 1 %
• Can cause : impaired fertility and germ cells neoplasia
• Th/ : early hormonal and surgical
• D/ : clinical examination, ultrasound imaging
• Ultrasound : follow up treatment result, can assess
accurately
• The aim of this study : determine clinical usefulness of TAI
(Testicular Atrophy Index)
MATERIAL AND METHODS

• 1999-2000, 105 cryptorchid boys, aged 1 to 15 – unilateral


orchiopexy
• Prior surgery – hormonal th/ -- not satisfactory result
• Parameters that analysed : age, side, dimensions, volume,
and position of the testicle before and 1 year after surgery
• US : Toshiba unit, linear array 7.5 and 10 MHz, experienced
sonographers
• TV (Lamberts formula)
TV (ml) = 0.71x (width x length x height)
1000

• Testicular Atrophy Index (TAI)


TAI (%) = [contralateral testis vol – affected testis vol] x 100
contralateral testis volume

• Paired Student’s t-test :


meassuring mean differences pre and post op. TAI
RESULT
• 58 (55,2 %) right side and 47 (44,8%) Left side
• There were 35 boys analyzed pre and post operative
scrotal US
• Age divided into 5 groups
• TAI range from 27,1% - 52,8%
• Biggest lost was found in boys aged 4-10 years
• TAI post op. Lower than pre op
• Difference TAI pre - post op. ranged 18,16% - 36,43% were
found in age 2 – 10 years (p<0,001)
• In the youngest (0 – 2 yrs) and oldest boys (>10yrs) the
differences was not statistically significant
Table 1 . Result of scrotal US before orchiopexy (N = 35)

Mean
Mean volume
No of volume of
Age Range of contralateral TAI (%)
Patients affected
testis (ml)
testis (ml)
0-2 5 0.44 0.63 27.10
2-4 10 0.56 1.09 35.40
4-6 8 0.57 1.20 44.20
6-10 6 0.66 1.17 52.80
>10 6 0.76 1.25 28.90

Table 2. Result of scrotal US after orchiopexy (N = 35)

Mean
Mean volume
No of volume of
Age Range of contralateral TAI (%)
Patients affected
testis (ml)
testis (ml)
0-2 5 0.88 1.10 20.00
2-4 10 0.86 1.00 17.24
4-6 8 0.96 1.28 21.04
6-10 6 0.96 1.15 16.37
>10 6 0.81 0.85 22.40
Table 3. Comparison of testicular atrophy index (TAI) before
and after orchiopexy (N = 35 ))

TAI TAI
Age
No of before after Student t-
Range Difference
Patients surgery surgery test
(yrs)
(%) (%)
0-2 5 27.10 20.00 7.10 NS
2-4 10 35.40 17.24 18.16 p<0.001
4-6 8 44.20 21.04 23.16 p<0.001
6-10 6 52.80 16.37 36.43 p<0.001
>10 6 28.90 22.40 6.50 NS
DISCUSSION
• Important : accurate assessment of position and the volume
affected testis compare with normal contralateral
• Scrotal US : greatest accuracy to determine testicular
volume
• At this age fertility is undefined, so only impaired affected
testis growth compare to normal contralateral can be assess
as indication for surgery
• Still controversy indication for surgery in retactile/wandering
testicle
• Recommendation : watchful waiting, repeated US scrotal
every 12 months, if significant volume decrease → surgery

• According to Niedzielski, TAI ≥ 20% → surgery
• Sayfan et al → 20% - 25%
• This study TAI ranged from 27.1% - 52.8% at initial
diagnosis
• Testicular atrophy approx. 5 - 10% of testis in long-term
outcome after orchiopexy, but impossible to determine
it’s caused by blood vessel injury during op. or
preexistent primary damage (testicular dyplasia)
• In this study : repair undescent testis : growth (+)
• Postoperative TAI decreased from 18.16% to 36.43%
depending on patient’s age
• The smallest difference TAI (no growth of affected testis)
found in youngest and oldest
• This indicates that the best result of surgical treatment
should be expected in boys aged 2 - 10 years
CONCLUSIONS

• US assessment is important in detecting TV differential in


cryptorchid boys
• Should be used routinely
• TAI proved as a valuable and objective tool, to determine
indication for surgery and follow up result of treatment
• TAI ≥ 20% consider as indication for surgery in boys with
retractile testes.