BACKGROUND: Intra-abdominal testes (IAT) are at a 200-fold higher risk of malignant transformation. With the advent of laparoscopy, laparoscopic orchiopexy is now the gold standard for the management of IAT. Current literature notes the risk of testicular atrophy is <10%. However, bilateral IAT management is associated with anorchia risk if bilateral testes atrophy. Due to the rarity of bilateral IAT, outcomes of laparoscopic bilateral orchiopexy are not well described. We report the feasibility and outcome of bilateral laparoscopic orchiopexy in a large cohort of patients with bilateral IAT. METHODS: A retrospective review of a single pediatric tertiary care academic center from 2012 to 2021 was performed for all patients < 18 who underwent laparoscopic orchiopexy for bilateral IAT. Demographic and clinical information were abstracted from the electronic medical record. Data was analyzed using demographic data, comorbidities, procedure, and follow-up results.
RESULTS: A total of 37 patients were identified. 4 were excluded due to incomplete data. A total of 33 patients with 66 testicle units were included. The median age at first surgery was 1.79 years, with a median follow-up of 8.6 months after patient’s last stage orchiopexy. 42.4% (14) patients with comorbidities. 29 underwent 2-stage, 3 underwent 3 stages, and 1 underwent a single stage laparoscopic orchiopexy. At follow-up, 77.3% (51) testes were in the scrotum, 34.8% (23) testes were non-palpable or atrophic, and 9.1% (3) developed bilateral atrophy. Patients with comorbidities had a non-statistically significant higher rate of atrophy (42.9% vs 31.6%, p=0.35). 30.3% (10) patients had non-atrophic and palpable bilateral testes in the scrotum at follow-up. CONCLUSIONS: We report one of the largest series on the outcome of bilateral laparoscopic orchiopexy for bilateral IAT. While bilateral laparoscopic orchiopexy is feasible and the gold standard, it does carry significant risks of testicular atrophy and anorchia. Our data provides valuable information that can aid in counseling families about the potential risks.
