Testicular regression syndrome: A retrospective analysis of clinical and histopathological features in 570 cases

Abstract

This study aimed to analyze the clinical features and pathological findings of the largest reported case series of testicular regression syndrome (TRS). Data, including age, affected side, color Doppler ultrasound results, surgical methods, intraoperative conditions, and pathological examinations, of children with unilateral TRS who were treated in our center from December 2012 to November 2021 were retrospectively analyzed. A total of 570 patients were included in this study. The mean age at surgery was 38 (range, 5–193) months. There were 457 cases (80.2%) of left TRS. Preoperative color Doppler ultrasonography found nubbins in 172 cases (30.2%). The long diameter of the contralateral testis was 17.11 (±4.22) mm, and the volume was 0.81 (±1.15) ml. The long diameter was ≥1.6 cm in 62.0% of the patients (240/387) aged ≤3 years. Laparoscopy was performed as the initial surgical step in 513 cases, of which 96.7% of the children had closed internal rings. One or more lesions of fibrosis, hemosiderin, and calcification were found in 92.4% (474/513) of the excised remnants. Germ cells were present in 16 cases (3.1%). In conclusion, TRS is more common on the left side and is usually accompanied by a closed internal ring and compensatory hypertrophy of the contralateral testis. Germ cells are only present in cases where the spermatic vessels enters the internal ring. We recommend that further exploration and excision of the remnants may not be applicable in cases where only the vas deferens has entered the internal ring.

Management of pediatric vanishing testes syndrome based on pathological diagnosis: a single-center retrospective study

“…However, recent studies strongly support the theories of vascular accidents and prenatal torsion, rather than endocrine diseases 14 . Our study consistently observes and supports this theory, as fibrosis, malnutrition-induced calcification, hemosiderin deposition, and the presence of macrophages in the excised residual tissues indicate vascular accidents 4 , 15 , 16 . Additionally, VTS is more common on the left side, as reported in previous studies 3 – 6 , 16 .…”

“…Our study consistently observes and supports this theory, as fibrosis, malnutrition-induced calcification, hemosiderin deposition, and the presence of macrophages in the excised residual tissues indicate vascular accidents 4 , 15 , 16 . Additionally, VTS is more common on the left side, as reported in previous studies 3 – 6 , 16 . He et al 16 suggest that it is challenging to explain this significant lateralization with endocrine factors.…”

“…Additionally, VTS is more common on the left side, as reported in previous studies 3 – 6 , 16 . He et al 16 suggest that it is challenging to explain this significant lateralization with endocrine factors. The potential reasons include anatomical relationships between the left testicular vein and the left renal vein, leading to vascular occlusion secondary to abnormal renal activity 5 .…”

“…The potential reasons include anatomical relationships between the left testicular vein and the left renal vein, leading to vascular occlusion secondary to abnormal renal activity 5 . Furthermore, the earlier descent of the left testis during fetal development may be another contributing factor 15 , 16 .…”

“…Unlike measuring tools such as calipers, ultrasound can exclude interference from the epididymis, scrotal skin, and adjacent soft tissues during the measurement, making it considered the best tool for assessing testicular size in the pediatric population 20 . Although CTH often indicates ipsilateral testicular atrophy, ultrasound is often challenging in determining the location of atrophic nodules 16 . Therefore, CTH has no impact on the decision-making for NPT management, consistent with the results of Wei et al 21 .…”