Management of cryptorchidism and gastroschisis

Cryptorchidism is commonly associated with gastroschisis. Management of the undescended testes varies with regard to technique and timing of orchidopexy. To evaluate the appropriate timing of and procedure for orchidopexy in patients with gastroschisis, we reviewed our experience.

Male neonates admitted between January 1999 and September 2010 with gastroschisis were reviewed. This retrospective study was conducted after institutional review board approval. Testis location at birth was recorded, and outcomes for those with undescended testes were analyzed.

Sixty-two males with gastroschisis were identified, and 24 had cryptorchidism (38.7%) affecting 31 testes. All babies had an initial watch-and-wait approach without any attempt at orchidopexy during gastroschisis closure. Those with extraabdominal testes at birth had the testicle repositioned in the abdomen before gastroschisis closure. Mean follow-up was 27.3 months. At follow-up, 54.8% of the testes relocated without intervention and 38.7% required orchidopexy. Laparoscopy was used in 5 patients to perform the orchidopexy. A total of 3 testes required orchiectomy secondary to atrophy, one of which had previously undergone an orchidopexy. Two of the orchiectomies were performed laparoscopically.

The watch-and-wait approach for cryptorchidism in gastroschisis is safe and appropriate, with a high rate of spontaneous migration during the first year of life and greater than 90% testes viable at follow-up. Laparoscopy is a safe and feasible option for management of undescended testes that remain intraabdominal at follow-up.