Orchidopexy Timing and Follow Up: From Guidelines to Clinical Practice

Area of Science:

• Pediatric Surgery
• Urology
• Developmental Biology

Background:

• Undescended testis (UDT) is a common pediatric genital anomaly, particularly in premature neonates.
• Delayed diagnosis and treatment of UDT can lead to infertility, malignancy, and psychological distress.
• Current guidelines recommend early surgical intervention, yet significant delays persist in clinical practice.

Purpose of the Study:

• To evaluate clinical management of UDT at a tertiary pediatric center over ten years.
• To identify risk factors for postoperative testicular atrophy (TA) following orchidopexy.
• To analyze trends in surgical timing and outcomes.

Main Methods:

• Retrospective analysis of 1082 pediatric UDT cases undergoing orchidopexy (2014-2023).
• Data collected included UDT location, age at surgery, laterality, comorbidities, family history, and surgical approach.
• Multivariate logistic regression used to identify predictors of postoperative testicular atrophy.

Main Results:

• Median age at surgery was 5.07 years, exceeding guideline recommendations.
• Testicular atrophy (TA) occurred in 24.8% of cases.
• Independent risk factors for TA included non-palpable testes, intra-abdominal position, comorbidities, positive family history, and delayed surgery.

Conclusions:

• Significant delays in UDT diagnosis and treatment persist despite established guidelines.
• Testicular atrophy is a notable postoperative complication, especially in cases with non-palpable testes, high testicular position, comorbidities, and late intervention.
• Optimizing management strategies and adherence to early surgical intervention are critical for improving long-term outcomes in UDT patients.