Management strategies for bilateral intra-abdominal testes: insights from a tertiary paediatric centre

Abstract

Introduction: cryptorchidism, occurring in 2–4 % of male newborns, necessitates orchidopexy to mitigate associated risks, preferably between ages 3–12 months. While unilateral cases are common, bilateral intra-abdominal testes (BIAT) present unique challenges. This study reviews outcomes following bilateral Fowler-Stephens orchidopexy (FSO) at a paediatric surgical tertiary centre, aiming to enhance preoperative counselling and contribute to management consensus. 

Methods: a retrospective analysis was conducted at a tertiary paediatric centre, identifying BIAT cases between 2005 and 2021. Clinical records of patients undergoing bilateral staged orchidopexy were reviewed. Primary endpoints included testicular size and position, with secondary outcomes examining staged versus non-staged procedures. 

Results: we identified thirty patients who underwent Fowler-Stephens orchidopexy (FSO) for bilateral intra-abdominal testes (BIATs) between 2005 and 2021. The procedures were performed using both open surgery (n = 6) and laparoscopic techniques (n = 24), based on consultant preference. Among these patients, three underwent single-stage procedures, with 2 out of 3 having both sides operated on the same day. For the remaining twenty-seven patients, staged procedures were performed. In 22 out of 27 cases, the first stages were conducted bilaterally during the same operation. The second stages were performed synchronously in 3 out of 27 patients and on a metachronous basis in 24 out of 27 patients. The mean age at the time of the first procedure was 1.7 years, ranging from 3 months to 10 years. Outcomes revealed a success rate of 82 %, with 14 % atrophy and 3.5 % ascent rates. Comorbidities were noted in 50 % of patients, and only eight boys underwent endocrine evaluation. 

Conclusion: management of BIATs requires tailored approaches, with staged FSO offering favourable outcomes. Further research is needed to establish consensus guidelines for optimal management strategies.

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