Undescended testes

Abstract

Primary aims in diagnosis and treatment of undescended testes (UDT): 1. Improve fertility. 2. Preserve testosterone production. 3. Reduce cancer risk. Secondary aims: 1. Repositioning the testis into the dependent scrotum without atrophy. 2. Normal scrotal appearance. 3. Distinction between UDT versus retractile testes. Summary of evidence for these goals: Limited available data suggest paternity rates in men with former unilateral UDT are similar to those of normal men, whereas paternity rates are diminished with formerly bilateral UDT. One RCT reported preoperative intranasal GNRH improved the fertility index (adult spermatogonia/tubule) over patients undergoing orchiopexy alone. The overall risk that an operated UDT will develop cancer is <0.5 %; risk for nonoperated UDT is unknown. While cancer risk doubles if orchiopexy is done after age 13 versus before, 69 patients have to be operated before that age to prevent one tumor in males between ages 13 and 55 years. Surgical reports on orchiopexy rarely state final testicular position or objectively assess testicular size. Based on intra-scrotal position, a RCT reported 94 % success with both tradition inguinal and scrotal orchiopexy for palpable UDT. Meta-analysis found no difference between open versus laparoscopic orchiopexy for nonpalpable testis. A systematic review found a 5 % benefit to two-stage versus single-stage Fowler-Stephens orchiopexy, but cautioned data quality was poor. Our review found a single study using a parent questionnaire that reported no difference in satisfaction between inguinal versus scrotal orchiopexy. Surgeons perform approximately two times more orchiopexies than the rate of UDT, suggesting confusion between UDT versus retractile testes.