Bilateral intra-abdominal testes (BIATs) are rare. There is no consensus regarding optimum management. Fowler-Stephens Orchidopexy (FSO) carries a failure rate of 15-35%, and when bilateral, there is a risk of iatrogenic anorchia. Options in the setting of unilateral testicular atrophy include delaying procedures on the second testis to promote natural puberty.
Aim of the Study
We aimed to evaluate management strategy and cosmetic testicular outcome in boys undergoing FSO for BIATs.
We performed retrospective case note review of boys with BIATs (2005-2017). Primary outcome was testicular atrophy based on clinical assessment after at least 4 months. Secondary outcomes included requirement for testosterone replacement in those approaching puberty.
Twenty-nine boys with BIATs were identified. 22/29 have completed bilateral surgery. Median age at first procedure was 1.7 years. 18/29 completed treatment with two normal sized testes in their scrotum. 4/29 patients have completed treatment with either unilateral (n=3) or bilateral (n=1) testicular atrophy. 3/29 patients had unsuccessful surgery on the first side (2 atrophy, 1 excision intra-abdominal remnant), and then remaining testis left within the abdomen, rather than risk pre-pubertal anorchia. 4/29 boys have had successful surgery on one side and await contralateral procedure. 51/58 testes were operated with an atrophy rate of 14% (Median followup 64 weeks; range 16-610 weeks).
8/29 boys underwent endocrine evaluation. Of 2 post-pubertal boys, one required testosterone treatment despite normal appearing testes. 2/6 prepubertal boys had abnormal endocrine function biochemically. One prepubertal boy with a single IAT had normal biochemical function.
We describe the treatment course and cosmetic outcome for 29 boys with BIATs, the largest series reported. Failure rate of FSO is in keeping with previous literature. Cosmetic outcome may not predict normal endocrine function. We recommend endocrine evaluation of all boys with BIATs.