European urology supplements vol:37 issue:2 pages:5-5
EAU edition:15 location:Brussels date:12-15 April 2000
INTRODUCTION & OBJECTIVES: Using the histological classification of Nistal for the evaluation of testis biopsies we aimed to find a cut-off value for age in order to perform an orchidopexy at a moment in which only minor histological changes have occurred.
MATERIAL & METHODS: Between Dec 1992 and Dec 1998 an orchidopexy was performed on 115 patients (aged between 4 month and 16 years) for a total of 146 testes. During the procedure a testes biopsy was taken for histological evaluation. Nistal 1: tubular fertility index (by Mack et al) reduction <30%, mean tubular diameter reduction <10%, normal sertoli cell index (NR. of S.C. per tubular section), after puberty normal spermatogenesis. Nistal 2: TFI between 30% and 50% reduction, MTD between 10% and 30% reduction, SCI normal, after puberty hypospermatogenesis and maturation arrest. Nistal 3: TFl more than 50% reduced, MTD more than 30% reduced, SCI more than one-third below the normal count or one-third above the normal count. After puberty exclusively SCO or immature Sertoli cells (the germinal cell line does not reach adult development).
CONCLUSION: Many studies have been reported on the optimal age for an operation. Currently before the age of 2 years is the recommended age for an orchidopexy. Our study clearly demonstrated that if one wants to stay on the safe side, orchidopexy should be performed before the first anniversary of the boy. On the other hand even in older age categories one finds a significant number of patients with normal testicular development. Counselling should take this fact into account.