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Contralateral metachronous undescended testis: Is it predictable?

Madeline Cancian1, Pamela Ellsworth2, Anthony Caldamone1

  • 1Department of Urology, Warren Alpert Medical School, Brown University, Providence, RI, USA.

Journal of Pediatric Urology
|April 25, 2017
PubMed
Summary
This summary is machine-generated.

Boys with a retractile testis on one side are at higher risk for developing a metachronous undescended testis (mcUDT) on the other side. This finding can help guide discussions about potential bilateral orchiopexy.

Keywords:
Acquired undescended testisRetractile testisUndescended testis

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Area of Science:

  • Pediatric Urology
  • Andrology
  • Surgical Outcomes

Background:

  • Metachronous undescended testis (mcUDT) is an acquired condition where a testis becomes undescended after an initial orchiopexy.
  • Predicting mcUDT could allow for proactive management or informed parental counseling.
  • This study investigated potential predictors of mcUDT present at the time of the first orchiopexy.

Purpose of the Study:

  • To identify factors present during the initial orchiopexy that predict the subsequent development of metachronous undescended testis (mcUDT).

Main Methods:

  • Retrospective review of patients who underwent inguinal orchiopexy (CPT code 54640) between January 1997 and October 2015.
  • Study population included patients with unilateral undescended testis (uUDT) who later developed mcUDT.
  • Cox proportional hazard regression analysis was used to model predictors of subsequent UDT.

Main Results:

  • Of 1035 eligible patients, 38 had mcUDT and 207 served as controls (uUDT).
  • Patients who developed mcUDT were significantly younger at their first orchiopexy (median 2.5 years) compared to controls (median 8.2 years).
  • A contralateral retractile testis pre-operatively increased the rate of subsequent UDT by 4.2 times; a retractile testis under anesthesia increased the rate by 6.7 times.

Conclusions:

  • A contralateral retractile testis identified during the initial orchiopexy is a significant predictor of metachronous undescended testis (mcUDT).
  • Consideration of bilateral orchiopexy may be warranted in cases of unilateral UDT with a contralateral retractile testis.
  • Discussions with parents should weigh the risks of bilateral orchiopexy against the risks of subsequent surgery and anesthesia.