Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review |
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| Affiliation: | 1. University of South Carolina School of Medicine – Greenville, Greenville, SC, United States;2. University of Iowa, Stead Family Children''s Hospital, Iowa City, IA, United States;3. Ohio State University, Nationwide Children''s Hospital, Columbus, OH, United States;4. University of Michigan, C.S. Mott Children''s Hospital, Ann Arbor, MI, United States;5. Children''s Mercy Hospital, Kansas City, MO, United States;6. Alpert Medical School of Brown University, Hasbro Children''s Hospital, Providence, RI, United States;7. Comer Children''s Hospital, The University of Chicago Medicine, Chicago, IL, United States;8. Children''s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States;9. Pediatric Surgical Associates, Children''s Minnesota, Minneapolis, MN, United States;10. Nemours Children''s Specialty Care, Jacksonville, FL, United States;11. Providence Pediatric Surgery, Sacred Heart Children''s Hospital, Spokane, WA, United States;12. University of California, Davis, Sacramento CA, United States;13. Loma Linda University Children''s Hospital, Loma Linda, CA, United States;14. Children''s Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States;15. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States;p. Ann & Robert H. Lurie Children''s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States;q. Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children''s Center, Roseville, CA, United States;r. Division of Pediatric Surgery, BC Children''s Hospital, University of British Columbia, Vancouver, BC, United States |
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| Abstract: | PurposeManagement of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children.MethodsA comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020.ResultsA total of 825 articles were identified in the initial search, and 260 were included in the final review.ConclusionsPre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy. |
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