The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis

Undescended Testes Growth Potential in Relation to Testis Position from Diagnosis until Puberty

Background: Testicular volume (TV) and testicular atrophy index (TAI) were used to determine criteria for normal, hypotrophic and atrophic undescended testes (UDT). Objectives: This study aimed to determine changes in TV and TAI in patients with different types of UDT. Materials and Methods: 182 boys (aged 0.3-14.0 years) with 212 UDTs were assessed twice 24 months apart. Testes were unilateral (UCT) or bilateral canalicular (BCT) and intra-abdominal (IAT). Results: At the beginning of the observation, the highest TAI was observed in IAT and the lowest in the BCT group (38.1 vs. 12.5%, p < 0.05). After 2 years, the highest TAI was observed in the BCT and IAT groups (20.5 and 19.1%), while the lowest was in the UCT group (12.0%, p < 0.05). At the beginning and after 2 years, the highest TAI was observed in boys aged < 6 years (25.0%, 18.2%) and the lowest in pubertal boys aged 12-14 years (5.9%, 7.3%, p < 0.05). A total of 78.3% of patients at the beginning and 86.8% at the end of the observation had TAI < 30%. Furthermore, 7% of boys at the beginning and 3% at the end of the observation had TAI > 50%. IATs have the highest testicular growth potential (TGP), while BCTs have the lowest (120.0 vs. 28.6%, p < 0.05). The highest TGP was in boys aged < 3 years (100%, p < 0.05) and boys aged 12-14 years (98.1%, p < 0.05), while the lowest was in boys aged 9-10.9 years (19.5%, p < 0.05). Conclusions: We revealed the continuous growth of UDTs until puberty independently of their position. IATs revealed high growth potential.

Outcomes of Early vs. Late Surgical Intervention in Children With Undescended Testis

Background Undescended testis (UDT) is one of the most common urogenital abnormalities. International guidelines recommend performing orchidopexy no later than 18 months to decrease the risk of complications associated with UDT such as infertility and testicular malignancy. The aim of the study is to evaluate the outcomes of early versus late surgical intervention of UDT and to assess if the optimal age of orchidopexy is met. Methods This is a retrospective cross-sectional study that included 258 pediatric patients' testes with no prior UDT intervention from January 2016 to December 2020. A chart review was used to collect the patients' data. Children included were categorized into two groups based on their age at the time of surgery (group A ≤ 18 months and group B > 18 months). Statistical differences were explored using Pearson's chi-squared test or Fisher's exact test for categorical variables or a Wilcoxon rank sum test for numerical variables. A p-value of <0.05 indicated statistical significance. Results The median age at the presentation among the overall cohort was 14 months. The median age at the presentation for group A was six months and group B was 35 months. Group A included 109 children and group B included 149 children. At the time of the surgery, the median age of patients was 23 months. The median age at orchidopexy for group A was 12 months and the median age for group B was 38 months. The time between diagnosis and surgery was significantly shorter among older children with a median duration of one month versus a median of five months among patients in the ≤18 months group (p = 0.003). The follow-up interval was at three and 12 months. The change in testicular size before and after surgeries was statistically significant, as most small testicles before surgeries had become normal in size after surgeries among the overall cohort (76.6%), patients aged ≤18 months (72.4%), and those aged >18 months (79.2%) (p < 0.001). Conclusion Most of the patients included in this study did not undergo orchidopexy at the optimal age recommended by the international guidelines. However, there was a statistically significant improvement in testicular size following orchidopexy in children with small UDT regardless of age at the time of surgery.

Factors affecting testicular volume after orchiopexy for undescended testes

PURPOSE

Children with undescended testes (UDTs) undergoing orchiopexy at a later age reportedly experience more negative effects on post-orchiopexy testicular volume (TV). This study aimed to investigate the effect of orchiopexy according to the age at operation.

METHODS

We included 93 patients (127 testes) who underwent orchiopexy between 2008 and 2020. According to their age at orchiopexy, they were divided into Group 1 (< 24 months; n = 36, median follow-up: 17 [14-39] months) and Group 2 (≥ 24 months; n = 57, median follow-up: 16 [13-34] months). TV was measured with ultrasonography preoperatively and postoperatively. In unilateral UDTs, the testicular volume rates (TVR) were calculated as diseased-side TV/intact-side TV × 100%. A TVR < 50% indicated preoperative testicular atrophy (pre-op TA), whereas volume loss ≥ 50% from baseline indicated postoperative testicular atrophy (post-op TA).

RESULTS

Only seven patients experienced pre-op TA. The TV of these 14 atrophic testes improved after orchiopexy (TVR: 100% (7/7) in Group 1 and 85% (6/7) in Group 2). Furthermore, the median TVR significantly improved after orchiectomy, from 27 to 58% (p < 0.01) and from 32 to 61% in Groups 1 and 2 (p < 0.05), respectively. Post-op TA was found in four testes (8%) in Group 1 and three testes (4%) in Group 2. Multivariate analysis showed that only preoperative testicular location predicted post-op TA.

CONCLUSION

Post-orchiopexy TA may occur regardless of the patient's age at orchiopexy, and orchiopexy is recommended irrespective of age at diagnosis.

Comparison of clinical outcomes between laparoscopic orchiopexy and open orchiopexy in the treatment of palpable undescended testes

Objective

To compare the clinical effects of laparoscopic orchiopexy (LO) and open orchiopexy (OO) in the treatment of palpable undescended testes.

Methods

Seventy-six children with palpable undescended testes treated in Zaozhuang Municipal Hospital from June 2019 to January 2021 were selected in this observational retrospective study. Patients were grouped according to their different surgical methods, 33 patients received OO (Open-group) and 43 patients received LO (Laparoscopic-group). The clinical outcomes of the two groups were compared, including surgical-related indicators, near and long-term surgical complications and postoperative testicular growth.

Results

Operation time, intraoperative bleeding, first ambulation time and hospitalization time in the Laparoscopic-group were lower than those in the Open-group (p<0.05). The short-term complication rate in the Laparoscopic-group was lower than that in the Open-group (2.27% vs 15.15%; p<0.05), but the long-term complication rate in the Laparoscopic-group was not significantly different from the Open-group (4.65% vs 3.03%; p>0.05). Follow-up was up to 18 months post-operation, with the rate of testicular growth (97.67% vs 96.97%; p>0.05) and testicular volume (0.59 ± 0.14ml vs 0.58 ± 0.12ml p>0.05) not significantly different between the Laparoscopic-group or Open-group respectively.

Conclusion

LO is as clinically effective as OO in the treatment of palpable undescended testes, however, shorter operation time, less intraoperative bleeding and rapid recovery time have been noted with LO.

The role of the resistive index in predicting testicular atrophy after orchiopexy in unilateral undescended testis

PURPOSE

One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT.

METHODS

The data of 215 patients aged < 15 years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded.

RESULTS

TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy.

CONCLUSION

Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.

Ultrasound manifestations and clinical features of nonpalpable testis in children

To explore the value of ultrasound in the preoperative diagnosis of nonpalpable testis (NPT) in children. A retrospective study of 254 cases with NPT from May 2017 to December 2021. The preoperative ultrasound examination results were compared with the surgical exploration and pathological results. There were 254 cases (312 testes) NPT has got surgery in our centre. The surgical age were from 6 month to 12 years old, the median age was 2.33 years. There were 103 cases (136 testes) diagnosed as intra-abdominal testis (IAT) by preoperative ultrasound, and 80 cases (103 testes) of extra-abdominal testis (EAT), 71 cases (73 testes) of non-viable testis (NVT). There were 102 cases (135 testes) consistented as IAT by the diagnostic laparoscopy, the preoperative ultrasound's coincidence of IAT was 99.02%. There were 80 cases (103 testes) consistented as EAT by the diagnostic laparoscopy, the preoperative ultrasound's coincidence rate was100%. There were 62 cases (62 testes) consistented as NVT by the diagnostic laparoscopy, there were 9 cases (11 testes) misdiagnosed, the preoperative ultrasound's coincidence rate was 84.9%. Ultrasound can provide valuable information for the preoperative diagnosis of children with nonpalpable testicles, and especially good at identifying the EAT and IAT with normal testicular morphology.

Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review

PURPOSE

Management 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.

METHODS

A 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.

RESULTS

A total of 825 articles were identified in the initial search, and 260 were included in the final review.

CONCLUSIONS

Pre-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.

Anatomical laparoscopic orchiopexy and hybrid transcrotal orchiopexy for high inguinal undescended testis: A novel and interfascial technique

BACKGROUND

In traditional laparoscopic orchiopexy for inguinal undescended testis (UDT) surgery, the testicles are pulled back into the abdominal cavity by grasping and cephalad retracting the testicle and the cord. If this fails, a subsequent open inguinal incision is made to complete orchiopexy. To improve the orchiolysis and avoid extra open inguinal incision, we describe our early experience with and illustrate the surgical procedure of a novel anatomical laparoscopic orchiopexy (ALO) and hybrid transscrotal orchiopexy as required in high palpable UDT.

METHODS

From March 2018 to April 2020, ALO was performed in 140 consecutive patients (158 testes) with high inguinal UDT. After blunt and bloodless dissection of the inter-tunica vaginalis-cremasteric fascia plane, tunica vaginalis enveloping the testis was brought into the abdominal cavity as a whole. When the tunica vaginalis was unable to be brought into the abdominal cavity, given that the orchiolysis had already been partially carried out, the testis could be brought out of the external ring and descended when converting to transscrotal surgery.

RESULTS

The mean age in this study was 1.88 years (SD±1.95). The position of the testis assessed at surgery was peeping (58, 36.7%) and canalicular (100, 63.3%). In 128 testes (81.1%), ALO successfully brought the UDT into the abdominal cavity; the remaining 30 testes (18.9%) required a hybrid transscrotal technique. All testes were successfully descended without conversion to open inguinal procedure. The mean operative time was 43.99.2 minutes. All patients had follow-up within a median of 17.8 months, with satisfactory results in relation to viability and location of the testis.

CONCLUSIONS

ALO was shown to be not only safe, feasible, and effective for high inguinal UDT but also facilitated subsequent hybrid transscrotal orchiopexy; when the testis failed to be pulled into the abdominal cavity, the conversion to open inguinal orchiopexy could be obviated.

Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring

OBJECTIVE

To compare the clinical efficacy and safety of laparoscopic orchiopexy with the modified Prentiss maneuver (LOMPM) and laparoscopic trans-inguinal orchiopexy (LTIO) for the treatment of non-palpable testis (NPT) <1 cm from the internal ring.

METHODS

Children with unilateral NPT who underwent laparoscopic orchiopexy at our center between February 2018 and January 2021 were retrospectively analyzed. According to the surgical method, they were divided into LOMPM and LTIO groups. The operation time, postoperative pain degree, postoperative complications and follow-up results were compared between the two groups.

RESULTS

A total of 98 patients were included in this study, including 41 cases in the LOMPM group and 57 cases in the LTIO group. All patients underwent successful surgery. The LOMPM group was superior to the LTIO group in terms of postoperative testicular position (lower scrotm: 90.2 vs. 71.9%, P = 0.026). There were no significant differences in operation time, postoperative pain score, and complications between the two groups. Preoperative testicular volume, postoperative testicular volume, and testicular growth rate in the LOMPM group were comparable to those in the LTIO group. There were no testicular atrophy, inguinal hernia and hydrocele in both groups after operation.

CONCLUSIONS

LOMPM was comparable in safety to LTIO, but LOMPM had a good post-operative testicular position, and was suitable for the treatment of NPT near the internal ring.

Hormonal therapy is effective and safe for cryptorchidism caused by idiopathic hypogonadotropic hypogonadism in adult males

BACKGROUND

Hormonal therapy is a reasonable treatment for cryptorchidism caused by idiopathic hypogonadotropic hypogonadism (IHH). However, the clinical evidence on whether it is effective and safe for the treatment of cryptorchidism caused by IHH is lacking.

AIM

To evaluate the effect of hormonal therapy in testicular descent, puberty development, and spermatogenesis in adult males with cryptorchidism caused by IHH.

METHODS

This retrospective study included 51 patients with cryptorchidism caused by IHH from the Andrology Clinic of University affiliated teaching hospital. Patients were divided into two groups: group A patients received hormonal therapy; group B patients received surgical treatment for cryptorchidism followed by hormonal therapy.

RESULTS

The rate of successful testicular descent following hormonal therapy (19/32 in group A) or surgical treatment (11/19 in group B) shows no statistically significant difference. There was also no statistically significant difference in penile length, Tanner stage of pubic hair, testicular volume, and success rate of spermatogenesis between the two groups. Testicular atrophy was seen in a single patient in group B.

CONCLUSIONS

Hormone therapy in adult males with cryptorchidism caused by IHH is effective and safe regarding testicular descent, puberty development, and spermatogenesis. This study provides new insight into the treatment of cryptorchidism caused by IHH and highlights that hormonal therapy could be an effective, safe, and economic treatment option for cryptorchidism in males caused by IHH.

Erythropoietin Effect on Testicular Germinal Epithelium Cells in Undescended Testis Mice Model

Background:

Undescended testis is an absence of testis in the scrotum, the incidence was 15 cases per 1000 from 1974 to 1996 in Europe. At Saiful Anwar Regional Hospital East Java, from January 2015 to July 2019 there were 60 boys diagnosed with undescended testis. A temperature rise of testis located in the abdominal triggers production of reactive oxygen species, causing impairment of the testicular epithelial germ cells and spermatogenesis, leading to many complications. Erythropoietin is a glycoprotein hormone that circulates in the body and has a positive effect on ischemic injury/gonadal reperfusion.

Objective:

To find out ROS involvement in undescended testis and efficacy of EPO as an additional therapy for undescended testis.

Methods:

This study is an experimental study with a post-test only control group design, using 18 male Wistar mice conditioned to be undescended testis for 7 days and underwent orchidopexy and some are given additional erythropoietin 1000iu/Kg 3 times a week.

Results:

Before and after the intervention, the mean body weight of mice did not experience a significant difference, meanwhile testicular volume showed a significant difference between the orchidopexy and EPO groups (p = 0.005 and 0.001). Johnsen’s score were found significant in the EPO group. Malone dialdehyde level in EPO and orchidopexy group showed significant difference p = 0.01 and 0.009 when compared to undescended testis group.

Conclusion:

There was the involvement of ROS in undescended testis and additional EPO improve impairment of germinal epithelial cells and spermatogenesis process due to undescended testis.

A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis

BACKGROUND

There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables.

METHODS

We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018.

RESULTS

A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851.

CONCLUSIONS

In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.

Testosterone Therapy and Its Monitoring in Adolescent Boys with Hypogonadism: Results of an International Survey from the I-DSD Registry

It is unclear whether testosterone replacement therapy (TRT) in adolescent boys, affected by a range of endocrine diseases that may be associated with hypogonadism, is particularly common. The aim of this study was to assess the contemporary practice of TRT in boys included in the I-DSD Registry. All participating centres in the I-DSD Registry that had boys between 10 and 18 years of age and with a condition that could be associated with hypogonadism were invited to provide further information in 2019. Information on 162 boys was collected from 15 centres that had a median (range) number of 6 boys per centre (1.35). Of these, 30 (19%) from 9 centres were receiving TRT and the median (range) age at the start was 12.6 years (10.8-16.2), with 6 boys (20%) starting at <12 years. Median (range) age of boys not on TRT was 11.7 years (10.7-17.7), and 69 out of 132 (52%) were <12 years. TRT had been initiated in 20 of 71 (28%) boys with a disorder of gonadal development, 3 of 14 (21%) with a disorder of androgen synthesis, and all 7 (100%) boys with hypogonadotropic hypogonadism. The remainder who did not have TRT included 15 boys with partial androgen insensitivity, 52 with non-specific XY DSD, and 3 with persistent Müllerian duct syndrome. Before starting TRT, liver function and blood count were checked in 19 (68%) and 18 boys (64%), respectively, a bone age assessment was performed in 23 (82%) and bone mineral density assessment in 12 boys (43%). This snapshot of contemporary practice reveals that TRT in boys included in the I-DSD Registry is not very common, whilst the variation in starting and monitoring therapy is quite marked. Standardisation of practice may lead to more effective assessment of treatment outcomes.

Three‑Dimensional Ultrasonography in Preoperative and Postoperative Volume Assessment of the Undescended Testicle

BACKGROUND Ultrasound (US) is the preferred imaging method for cryptorchidism, but most guidelines indicate that its value is questionable. The aim of this study was to evaluate the clinical value of ultrasonic mobility and testicular atrophy index (TAI) based on three‑dimensional US (3DUS) in preoperative and postoperative assessment of the undescended testis. MATERIAL AND METHODS Data from 158 children with unilateral extraperitoneal cryptorchidism were collected and their diagnoses were surgically confirmed. They were divided into different age groups and into 2 ultrasonic mobility groups: the mobile group (MG) and the restricted group (RG). Differences in sonographic characteristics between different groups were compared. Three-dimensional ultrasound performed with virtual organ computer-aided analysis (VOCAL) was used to determined preoperative and postoperative TAI and the reliability of TAI was analyzed. RESULTS Measurement of testicular volume with the VOCAL method was significantly more reliable than that done with the two-dimensional Lambert method. In all age groups, preoperative testicular volumes were smaller than that in the contralateral scrotal testis and postoperatively, they increased steadily. Both preoperative and postoperative TAI were higher in the RG than in the MG. In the MG, postoperative TAI decreased significantly in all age groups. In the RG, in contrast, effective volume growth was only achieved in patients who had undergone surgery before they reached age 1 year. CONCLUSIONS TAI values determined with 3DUS using the VOCAL technique objectively reflect recovery of testicular volume following surgery for undescended testicle. Ultrasonic mobility evaluation is beneficial for clinical management of the condition.

Role of ultrasound in the follow-up of intra-abdominal testes post Fowler-Stephens orchiopexy

OBJECTIVE

To review the role of various ultrasound (US) modalities in their ability to determine testicular viability in prepubertal testes following Fowler-Stephens orchiopexy (FSO).

MATERIAL & METHODS

Our prospective study included all patients from the year 2012 to 2017 with intra-abdominal testes (IAT) who had one-stage or staged FSO in our tertiary centre. Follow-up was done at 6 months to assess testicular viability and testicular position by clinical examination, and this was correlated with conventional and Doppler US results then.

RESULTS

This study included 28 IAT in total, who had one-stage (n = 16) and staged (n = 12) laparoscopic FSO. Median age was 1.27 years. Testicular atrophy was noted by clinical examination in 6 testes. In these 6 testes, conventional US confirmed an atrophic testicular nubbin and both Color Doppler US (CDU) and Power Doppler US (PDU) failed to show any parenchymal testicular vessels. Spectral Mode Analysis (SMA) also showed no significant arterial waveform. As for the remaining 22 viable testes by clinical examination, conventional US showed normal testicular morphology in all, while CDU and PDU confirmed adequate parenchymal blood flow in only 15 and 20 testes respectively. SMA revealed a normal arterial resistive index in only 21 testes.

CONCLUSION

There is no evident role for US in the follow-up of prepubertal testes post-FSO as US results are strongly correlated to clinical examination findings. Blood flow assessment in prepubertal testes following FSO can be difficult, unclear and undetectable in cases. This can be due to the prepubertal testicular stage, technique or unrecognized testicular atrophy despite normal morphology.

LEVEL OF EVIDENCE

Level IV: Case series with no comparison group.

Unsatisfactory testicular position after inguinal orchidopexy: Is there a role for upfront laparoscopy?

Objectives: To examine the role of laparoscopy in managing unsatisfactory testicular position after an open inguinal orchidopexy. We hypothesised that testes that were originally peeping, where short vessels represented a difficulty and testes that only reached a high scrotal position under tension, especially after an initial surgery performed with the appropriate expertise, are candidates for initial laparoscopic dissection.

Patients and methods: Nineteen boys with an initial open inguinal orchidopexy, with a mean age of 31 months, were considered. Twelve were then treated by a laparoscopic-assisted orchidopexy technique. Standard laparoscopy was established and utilised to mobilise the spermatic cord from above, then completed by an open inguinal mobilisation.

Results: The mean age at surgery was 26 months. The laparoscopic redo surgery took place at a mean interval of 11.9 months after the initial operation. The mean operative time was 72 min. A good position and size of the testis were achieved in all cases, evidenced by ultrasonography at 6 months postoperatively and clinically thereafter.

Conclusion: An upfront combined laparoscopic and inguinal approach to redo orchidopexy for recurrent palpable undescended testes is suitable in selected patients. This study identifies the selection criteria and outlines the operative considerations. This laparoscopic-assisted approach is a safe and feasible way to correct unsatisfactory position of the testis, with diminished risk of injury to the vas and vessels, while gaining the maximum possible length by high retroperitoneal dissection.

Abbreviation: UDT: undescended testis/testes