Orchidopexy for bilateral undescended testes: A multicentre study on its effects on fertility and comparison of two fixation techniques

Abstract

| INTRODUC TI ONBilateral undescended testes (BUDT) are associated with subfertility, which orchidopexy in early childhood aims to prevent. According to the literature, not treating BUDT results in azoospermia in 80% of men, whilst treatment reduces this to 7%-43% (Bellinger, 1989;Cendron, 1989;Cortes, 2001;Dadfar, 2007;Hoseinpour, 2015;Werder, 1976). Men with BUDT are less likely to father children. Only 62% will succeed within 12 months compared to 94% in healthy agematched controls (Lee, 1997). This lower fertility potential is also reflected in a decreased sperm concentration of 5.2 × 10 6 /ml in men with BUDT versus 82.4 × 10 6 /ml in controls (Lee, 1997).The technique for the preparation of the testis and the way to perform the fixation in the scrotum in relation to later fertility potential has not been thoroughly investigated. Animal studies have shown the presence of spermatogenesis in 71% of cases when using a suture through the tunica albuginea as fixation compared to 94% when using a tunica dartos pouch. Also, increased tubular atrophy was seen in 58% versus 23% respectively (Bellinger, 1989). The two techniques were evaluated for an effect on testicular volume in 69 AbstractTo evaluate fertility potential after orchidopexy for bilateral undescended testis and compare two surgical fixation techniques for effect on fertility. Men older than 22 years who had either tunica albuginea orchidopexy (TAO) or "no-touch" technique (NTO) in childhood for bilateral undescended testis (BUDT) were selected.Participants filled out a questionnaire followed by physical examination, had testicular ultrasound, blood sample and semen analysis. Statistical testing was performed using general linear modelling. Sixty-seven out of 166 individuals responded. Fortynine completed the questionnaire, and nine (18.3%) reported having fathered children. Thirty-six showed up for further examination, 26 had TAO and 10 NTO. Impaired hormonal spermatogenesis regulation (34.6% vs. 20%), higher subfertility rate (46% vs. 20%) and lower means of motile spermatozoa (58.1 × 10 6 spz vs.177.9 × 10 6 spz) were observed in the TAO versus the NTO group; none of these were statistically significant. Four (15.4%) of the TAO and two (20%) of the NTO group have azoospermia. Although the operation technique did not have a significant impact on fertility, unfavourable outcomes were more common after surgery involving the tunica albuginea of the testis. Larger sample sizes are needed to ascertain whether the trends favouring the NTO technique are of any significance. K E Y W O R D Sbilateral undescended testes, fertility, fixation technique, orchidopexy, semen analysis

The Importance of Surgical Timing in Inguinoscrotal Surgical Pathologies

“…Due to the fact that these disorders occurred after 5 years of age in light microscopy studies; until the 1980s, it was believed that the surgery should be done at the age of 5 years. However, in the ultrastructural investigations possible by the use of electron microscopy; in fact, it shows that spermatogenesis disorders began to appear much earlier, around 2 years of age (7)(8)(9). According to our current study; only 46 (25.0%) patients who performed orchiopexy operation were <2 years of age.…”