Login to Access Video or Poster Abstract: MP66-10
Sources of Funding: None

Introduction

Undescended testis (UDT) is usually congenital, but can be acquired in a boy with a prior documented descended testis. Some boys develop metachronous acquired UDT (mcUDT), requiring two separate orchiopexies. Our hypothesis was there may be characteristics evident at the time of initial orchiopexy which could predict the development of contralateral metachronous UDT.

Methods

By database query using CPT code for inguinal orchiopexy (54640), we identified all patients with UDT between the dates of 1/1997 to 10/2015. We included all patients who underwent orchiopexy for the indication of unilateral UDT. Our study population were patients who had undergone metachronous orchiopexies, while controls were patients who were 17 years old at time of data collection and had a unilateral orchiopexy (uUDT). Statistical analysis was completed with SAS Software 9.4.

Results

From a pool of 1035 eligible patients we identified 38 with mcUDT and 207 controls (uUDT). Comparing mcUDT to uUDT, median age at the first orchiopexy of patients who had a subsequent orchiopexy was 2.5 yrs (min/max, 0.50, 10.4) and 8.2 yrs (min/max 0.70, 12.8) for those who did not, p<0.0001 (Table 1). Contralateral testicular exam was significantly predictive of a subsequent UDT, p<.0001. Specifically, subjects who had a retractile testis on preoperative physical exam had a 4.2 times higher rate of subsequent UDT than patients who had a descended testis (95% CI [2.077, 8.353]). Subjects who had a retractile testis under anesthesia had a 6.7 times higher rate of subsequent UDT than patients who had a descended testis (95% CI [2.7, 16.5]). No relationship was found for side of initial UDT (p=.4947), acquired vs. congenital UDT (p=.40), procedure type (p=.52), ipsilateral testicular position (p=.71), size of ipsilateral UDT (p=.21), and patency of the processus vaginalis (p=.08).

Conclusions

Patients with a contralateral retractile testis at time of orchiopexy have an increased rate of requiring a contralateral orchiopexy in the future. A discussion of risks and benefits regarding about preforming bilateral orchiopexies should be undertaken with the parents prior to surgery.

Funding

None