Early Orchiopexy in Undescended Testis – Outcome of Surgical Management in a Tertiary Care Center

Abstract

I n 1786, John Hunter was the first to observe that the testis was located in the abdomen of the fetus. Undescended testis (UDT) is a common congenital problem encountered in pediatric age group. Cryptorchid testis, literally meaning hidden or obscure testis, refers to the absence of testis in the scrotal position and is most commonly undescended or maldescended. Overall, up to 4% of full-term male newborns may present with UDT. The prevalence is around 33% in premature male newborns and it reaches 60-70% if the birth weight is <1500 g [1]. In majority, the testis descends within the subsequent 3 months, resulting in an incidence of 1% UDT at 1 year. The testis is unlikely to descend after this time. However, testicular descent after 3 months of age is also possible; especially, in preterm infants [4]. About 10% of the cases are bilateral and are commonly associated with complex syndromes or other congenital malformations such as abdominal wall defects or neural tube defects [2].Factors that predispose to UDT include prematurity, low birth weight, small for gestational age, twins, genetic predisposition, endocrine disorders (e.g. disruption of hypothalamic-pituitarygonadal axis), and environmental factors such as nicotine, alcohol, pesticides, and maternal exposure to estrogen during the first trimester [2]. Since 80-90% of a testis is composed of seminiferous tubules, the volume of the testis is significantly related to the semen profile and testicular function, hence testicular volume is an indicator of development of the testis [3]. Since boys with UDT may have an increased incidence of testicular hypoplasia, atrophy, infertility, torsion of testis, trauma, and testicular malignancy, there is a need for locating testis and placement in the scrotum at an early age.Principles of surgical management of palpable UDT are well established. Management of non-palpable testis is challenging and laparoscopy is an ideal tool for diagnosis and management in this scenario. There is a need for spreading the awareness regarding current concepts of management of UDT; especially, among pediatricians, general surgeons, and referral doctors. Children who undergo early orchiopexy need to be followed up, to evaluate outcomes of UDT with respect to growth potential [4].