Management of undescended testis: italian experience of a single center of pediatric surgery

Abstract The undescended testis (UDT) is a common male genital anomaly. Sub fertility and testicular hypotrophy are considered the principal long-term consequences of UDT. There are two modes of treatment of UDT: hormonal and surgical treatment surgical that can be used alone or as complementary methods. Testicular histology, testicular volume (TV) and hormonal evaluation are considered to be the most relevant measure to establish future potential fertility. During follow-up each patient undergoes physical and ultrasound examination after three, twelve months and then five years. Serum level of gonadal hormone (LH, FSH, Inhibin B, LDH, Free Testosterone and DHEA) is evaluated before surgery and six months after orchidopexy. We assumed that testis biopsy is more predictive about future potential fertility than TV. Our patients have been found to have higher levels of LH and FSH and lower levels of inhibin B. To discern the presence of an effect of hormonal treatment we decided to consider the Testicular Atrophy Index (TAI), which is applicable only in unilateral UDT. Due to the necessity to consider also the case of bilateral UDT, we have introduced the normalized Testicular Atrophy Index (TAIn). Through the performed management, it has been possible to provide an estimate of the future fertility of these children. We noted that the degree of reduction in testicular volume does not seem to correlate with the severity of histological findings, nor does it seem to affect future fertility. The patients with a TAIn ≥ 20 % treated with preoperative and post-operative GnRHa therapy have a significant increase in TV after 5 years of follow-up, as shown by the relative reduction of TAIn values. Immediate and delayed post-surgery complications have not occurred. In the cases treated with hormonal therapy, a slight accentuation of secondary sexual characteristics occurs but it is completely regressed after discontinuation of the treatment (one month post-surgery). There have been no recurrences UDT after orchidopexy.