BACKGROUND: Cryptorchidism occurs in over 1% of boys and in one third of cases is bilateral. Often in bilateral cases the anatomic location of one testis will be more apparent than that of the contralateral gonad. The objective of our study was to determine, based on surgical findings, the frequency with which testicular anatomic location of bilateral undescended testes is symmetric.
METHODS: 172 patients with a preoperative diagnosis of bilateral undescended testes who underwent surgical exploration and in whom two testes were identified were reviewed. The mean age was 61.3 months with a range of 3 months to 20 years. Testicular location was stratified according to eight anatomic “steps” from intraabdominal (>4cm from internal ring, 2-4cm, <2 cm) to internal ring, inguinal canal, external ring, superficial inguinal pouch and perineal. For each patient the anatomic site of each testis and surgical procedure required for orchidopexy were recorded.
RESULTS: In 62% of cases, the testes were located exactly symmetrically and in an additional 31% the testicular location differed by one anatomic “step”. The surgical techniques applied included inguinal orchidopexy (88%), laparoscopic and robotic orchidopexy (11%) and transabdominal orchidopexy (1%). For intraabdominal testes, direct, one and two-stage Fowler Stephens orchidopexies were performed. In 90% of cases the surgical technique was identical for both sides.
CONCLUSIONS: In cases of bilateral undescended testes two thirds will have symmetric anatomic location. In 93% of cases the location of one testis will predict within one anatomic “step” the location of the contralateral gonad and surgical technique will be symmetric in 90%. These findings have significant implications for counseling families and predicting the necessary surgical approach required when only one testis has been localized preoperatively.