**5. Management**

The proper management of acquired UDT remains controversial mainly due to a lack of longitudinal follow up data ((Hack WW et al 2010). Currently two main polices have been proposed : a) the policy of prompt surgical correction (Taghizadeh AK & Thomas DF 2008, Bonney T et al 2008) and b) consrvative policy either of "wait and see"(Meij-de Vries A et al 2010) or hormonal treatment (Meijer RW et al 2001). The target of the first policy is to achieve normal or at least improved fertility, and to prevent malignancy (Hack WW et al 2010). However, it is still unknown whether the risks of infertility and cancer migh benefit at all from surgery as in congenital UDT (Hack WW et al 2010). In addition, it must be noted that there is no evidence that the ascended testis has a higher malignancy rate compared with the normal descended testis (Ong C et al 2005). Τhe second policy is based on studies which showed a spontaneous descent of acquired UDTs at the beginning of puberty in 57% to 77.5% of the cases, with normal testicular growth ( Hack WW et al 2010, Acerini CL et al 2009). This policy is supported by the following: 1) surgery itself can lead to complications such as direct injury to the vas deferens or testicular vessels (Mouriquand PDE 2008), 2) Meijer et al (Meijer RW et al 2001) treated successfully with human chorionic gonadotropin (HCG) 14/ 15 acquired UDTs (93.3%) (54). In addition, Hutson et al (Hutson JM & Basley SW 1991 ) predicted acquired UDTs to respond well to HCG therapy. These findings suggest that surgery should be reserved for those testes which fail to respond to hormonal therapy and those with anatomical abnormalities; 3) there is no strong evidence that early operation in boys 4-14 years has any effect on subsequent fertility (Chilvers C et al 1986). Although these results seem promising of a conservative approach to acquired UDTs, more long term follow-up studies are necessary to determine the consequences in fertility potential of boys with a history of acquired UDTs.

### **6. Conclusions**

This study showed, that there is an ongoing interest for the exact pathogenesis and the optimal mode of treatment of acquired UDTs. However, the data are inconclusive, as there are no available studies reaching a worldwide consensus. Large series, randomizedcontrolled studies and close follow-up beyond the puberty are recommended to further elucidate acquired UDT.

#### **7. References**

38 Complementary Pediatrics

However, early forms, even in boys less than 1 year, have also been recognized (Hack WW 2007b). Wright (Wright JE 1989) proposed the following criteria that have to be satisfied for the diagnosis of acquired UDT: a) it must be recorded by an experienced observer that the testis once had reached the bottom of the scrotum, b) the same or an equally experienced observer must later be unable to manipulate it into the scrotum, and the testis must remain above the scrotum when the child squats or sits bolt upright with the thighs abducted. c) there must have been no surgery or inflammatory episode to have caused the ascent, and d) the testis must remain above the scrotum when the child is

Potential impediments that may interfere in the correct diagnosis an ascending testis include: a) obesity, b) a small contracted scrotum, and c) an uncooperative or fretful patient (Redman JF 2005). The contractions of the cramasteric muscles, hydroceles, thick walled hernia sacs, and long looping vasa are further possible factors to a correct diagnosis

The proper management of acquired UDT remains controversial mainly due to a lack of longitudinal follow up data ((Hack WW et al 2010). Currently two main polices have been proposed : a) the policy of prompt surgical correction (Taghizadeh AK & Thomas DF 2008, Bonney T et al 2008) and b) consrvative policy either of "wait and see"(Meij-de Vries A et al 2010) or hormonal treatment (Meijer RW et al 2001). The target of the first policy is to achieve normal or at least improved fertility, and to prevent malignancy (Hack WW et al 2010). However, it is still unknown whether the risks of infertility and cancer migh benefit at all from surgery as in congenital UDT (Hack WW et al 2010). In addition, it must be noted that there is no evidence that the ascended testis has a higher malignancy rate compared with the normal descended testis (Ong C et al 2005). Τhe second policy is based on studies which showed a spontaneous descent of acquired UDTs at the beginning of puberty in 57% to 77.5% of the cases, with normal testicular growth ( Hack WW et al 2010, Acerini CL et al 2009). This policy is supported by the following: 1) surgery itself can lead to complications such as direct injury to the vas deferens or testicular vessels (Mouriquand PDE 2008), 2) Meijer et al (Meijer RW et al 2001) treated successfully with human chorionic gonadotropin (HCG) 14/ 15 acquired UDTs (93.3%) (54). In addition, Hutson et al (Hutson JM & Basley SW 1991 ) predicted acquired UDTs to respond well to HCG therapy. These findings suggest that surgery should be reserved for those testes which fail to respond to hormonal therapy and those with anatomical abnormalities; 3) there is no strong evidence that early operation in boys 4-14 years has any effect on subsequent fertility (Chilvers C et al 1986). Although these results seem promising of a conservative approach to acquired UDTs, more long term follow-up studies are necessary to determine the consequences in fertility

This study showed, that there is an ongoing interest for the exact pathogenesis and the optimal mode of treatment of acquired UDTs. However, the data are inconclusive, as there

anesthetized.

(Redman JF 2005)

**5. Management** 

**6. Conclusions** 

potential of boys with a history of acquired UDTs.


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**1. Introduction** 

after circumcision and relation to STDs or UTI.

**2. History of circumcision** 

**3** 

*Egypt* 

**Merits and Arguments** 

Hosni Khairy Salem *Kasr Al Ainy Hospital, Cairo University, Cairo,* 

**Related to Circumcision** 

Christians and no believers perform Circumcision for health and hygienic reasons especially in U.S.A. and some countries of the Middle East. It is uncommon in Northern Europe, Central and South America and Asia (Leitch, 1970). It is one of the" oldest operations but it has not received enough consideration or progress in the Middle East. It is always regarded as a minor outpatient procedure often performed by primitive clamps by barbers, Mohels, medical students and house officers (Kaplan, 1977).In hospitals, male circumcision is performed by junior gynecologists, urologists, or surgeons. The objective of this article is to perform a review of the literature regarding the different aspects of male circumcision and discussing the following points; history of circumcision, urgent indications of circumcision, merits and arguments related to circumcision, religious factors, contraindications of circumcision, timing of circumcision, different techniques of circumcision , complications

Circumcision is one of the oldest operation in the history and the first unequivocal description of circumcision is found in the forth dynasty Egyptian toombs (3000 BC). According to Herodotus, it was practiced at puberty. It is carved on portraits in the Karnak temple of Mount Saini Statues of Pharaohs. Its technique is seen in a bas brief on Mastaba of Sakkarah in the fifty dynasty (Bistschai& Brodnay, 1956; Arnaout et al., 1962 and Badr, 1963). Whether it had a religious or hygienic in purpose in Ancient Egypt, it is unknown. According to Herodotus, the Egyptians taught the procedure to Jews, Syrians and Phoenicians. Later, the custom spread to Ethiopians but Herodotus did not know that Columbus would find the natives of the West Indias circumcised. Captain Cook found the practice used by natives of Australia, Fijt, New Caledonia, New Hebrides and Madagascar (Blandy, 1968).It is a religious ritual practiced by Jews and Muslims. Jews practice it on the eighth day after birth. From Jews, it passes to the Christians who performed it for hygienic purposes then passed to Muslims as an important ritual of cleanliness for males. It was introduced to the western cultures by Biblical injunctions (Arnaout et al., 1962).Circumcision has also been practiced in other locations and for various reasons throughout the world e.g.,

