Testicular regression syndrome revisited: Insights from a 15-year retrospective study and evolving perspectives on management.
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INTRODUCTION: Testicular Regression Syndrome (TRS) represents a form of cryptorchidism characterised by the absence of testicular tissue with persistence of cord structures. While excision of remnants is routinely advocated due to potential malignant risk from seminiferous tubules (SNTs) or germ cells (GCs), the actual risk remains debated, and no universal consensus exists. MATERIALS AND METHODS: We conducted a retrospective review of 262 children with clinically impalpable testes who underwent diagnostic laparoscopy and/or inguinal exploration at a single tertiary centre between 2008 and 2022. Testicular remnants excised were subjected to detailed histopathological examination for seminiferous tubules (SNTs), germ cells (GCs), and features of regression. RESULTS: The median age at surgery was three years, and 83 % of remnants were left-sided. Intra-abdominal remnants were identified in 5 % of patients. Histology demonstrated vas deferens in 86 % and epididymal tissue in 66 % of specimens. SNTs were identified in 10.3 % of cases, while viable GCs were present in only 1.1 %. Calcifications and hemosiderin deposits were seen in 29 %. Intra-abdominal remnants showed significantly higher incidence of SNTs/GCs (62 %) compared to inguinal (10 %) or scrotal (4 %) sites (p < 0.0001). CONCLUSION: TRS remnants rarely harbour viable GCs, and no invasive malignancy has been reported. Excision is recommended for intra-abdominal remnants, whereas selective management of inguino-scrotal remnants may be appropriate. Larger prospective studies are needed to establish evidence-based guidelines for TRS management.