Treatment of undescended testes – time for a change in approach and methods of surgical treatment

Abstract

Undescended testis is one of the most common congenital abnormalities of the genitourinary tract. Outcomes of orchidopexy include the existance of a viable, palpabale testis in the scrotum, fertility, measured by parentity rate or by analyzing semen in adulthood, as well as the risk of testicular cancer. Many operative techniques have been described, with varying success rates. Over the past decade the success rate of orchidopexy for inguinal testes has been 95%. For abdominal testes it was 85 – 90% in most of clinical trials for single or two-stage Fowler- Stephens’ orchidopexy, whether performed laparoscopically or classically. Nevertheless, the presence of a testis in the scrotum does not insure fertility, as iatrogenic factors may negatively influence the outcome. This review is a summation of current guidelines for the treatment of undescended testes. The recommendation to abandon hormonal treatment remains controversial, although based on clinical evidence. We agree with the current consensus that orchidopexy should be performed under the age of 12 months in a centre, experienced both in pediatric surgery and in pediatric anaesthesiology. Based on this review we recommend the following algorythm: when an undescended testis is suspected at neonatal age and if it has not descended by the age of 5 – 6 months, the child should be appointed to a pediatric surgeon. If both testes are unpalpable or there are uncertainties during the clinical examination, the child should immediately be referred to a pediatric surgeon after birth. When an undescended testis has been diagnosed, the operation should be performed between the age of 6 and 12 months, certainly before the age of 18 months.