Send letter to journal:
Re: This is the first study

Dear Dr Hack and colleagues,

I read your paper with great interest as it confirms my own findings, which were published on line in July,2006, and in print in the October issue of the Journal of Pediatric Urology,2006.

I and my editor, David Frank, are aware that you probably did not know about my article, but when I e-mailed him that your "What this study adds" comments are not strictly true he thought I should inform the Editor of the Archives.

My paper will, I trust, be forwarded to you by Professor Bauchner. I should like you to read it for your opinion, as recent guidelines in this country will clearly not pick up the acquired UDTs, as they have done in the past, allbeit not realising the natural history, which has been made clear by your work.

David Frank suggested that a letter might be printed in the Archives in recognition of my Herefordshire study.

I hope this is not too much trouble.

Yours sincerely

Send letter to journal:
Re: Response

24 January 2007

Dear Editor,

The important and excellent study by Martin 1 showed that many orchidopexies (ORPs) for undescended testis (UDT) are performed later in childhood on previously fully descended testes. Other studies have shown similar results.2,3 These late ORPs can mainly be attributed to surgery on acquired UDT, although late referral, surgery on retractile testes and misdiagnosis cannot be ruled out in individual cases. The results of these studies prompted us to initiate a prospective study in unselected groups of boys to investigate the frequency of acquired UDT. Already, in selected groups of boys there were indications that acquired UDT might outnumber congenital UDT by a factor two to three. The results of our study showed that acquired UDT is seen in 1,2% of 6-year olds, in 2,2% of 9-year olds and in 1,1% of 13-year olds. These figures closely correspond with the 1- 2% late ORP-rate. Therefore, acquired UDT seems to be a plausible cause of the high late ORP-rate. Furthermore, as suggested by Martin,1 we also recommended that Youth Health Care Institutions should become familiar with the phenomenon of acquired UDT and testis position should be routinely determined in elderly boys as well. Whether prepubertal surgery is needed in the treatment of acquired UDT is now heavily under debate since 3 out of 4 acquired UDT will descend spontaneously at (early) puberty.4

Yours sincerely,

W.W.M. Hack
K. Sijstermans
J. van Dijk
L.M. van der Voort-Doedens
M.E. de Kok
M.J. Hobbelt-Stoker

References:

1. Martin JDC. Further evidence for acquired undescended testicle in the UK and its incompatibility with current recommendations in the Hall Report. J Ped Urol 2006;2 (5):392-7.

2. Thayyil S, Shenoy M, Agrawal K. Delayed orchidopexy: failure of screening or ascending testis. Arch Dis Child 2004;89:890-1.

3. Hack WWM, van der Voort-Doedens LM, de Kok ME, Meijer RW, Bos SD, Hobbelt-Stoker JM. Previous testicular position in boys who underwent orchidopexy due to undescended testis at the Alkmaar Medical Centre, the Netherlands (1986-1999). Ned Tijdschr Geneeskd 2002;146;563-6.