WOFAPS 2025 8th World Congress of Pediatric Surgery

Alvaro Mayordomo Ruiz, Paulina Vargova, Reyes Delgado Alvira, Yurema Gonzalez Ruiz, Marina Gonzalez Herrero, Carolina Corona Bellostas, Ricardo Escartin Villacampa, Andrea Santino Tenorio, Paolo Bragagnini Rodriguez

Hospital Universitario Miguel Servet

Aim:

Cryptorchidism is a common congenital anomaly of the male genital tract, with true non-palpable testes (NPTs) accounting for approximately 30% of cases. Although surgery is a standard treatment, there is no universally accepted technique. This study aims to compare the risk of testicular atrophy between one-stage (1S) and two-stage laparoscopic (2S) orchiopexy.

Material and Methods:

We retrospectively reviewed 42 NPTs that remained non-palpable under anesthesia and were managed with either 1S or 2S laparoscopic orchiopexy. Atrophy was defined based on clinical follow-up and confirmed histologically when orchiectomy was required.

Results:

Thirty-nine patients were included, 31 with unilateral and 8 with bilateral NPTs. Among the bilateral cases, three underwent laparoscopic surgery on both sides. Of the 42 testes, 23 were left-sided. Ultrasound was performed in 34 cases; 15 testes were not visualized. Among the visible ones, 57.9% were in the inguinal canal.

Laparoscopic 1S orchiopexy was performed on 22 testes, with two cases of atrophy (9.1%). Among the 20 testes treated with 2S orchiopexy, three became atrophic (15.0%). The difference was not statistically significant (p = 0.554). No significant association was found between the surgical technique and intraoperative testicular location (p = 0.118).

Neither the presence of a non-palpable testis at birth, nor its unilateral or bilateral presentation, showed a statistically significant association with atrophy. However, smaller or non-visualized testes on ultrasound were linked to higher recurrence (p = 0.0127), and more proximal ultrasound locations correlated with smaller intraoperative testicular size (p = 0.0504).

Atrophy was diagnosed after an average of 35 months; four cases required reoperation, confirming complete atrophy and severe hypospermatogenesis histologically.

Conclusions:

While the type of surgical technique was not significantly associated with testicular atrophy, ultrasound parameters such as testicular size and location were correlated with relevant surgical outcomes such as cryptorchidism recurrence and intraoperative testicular dimensions.