Management of Undescended Testicle in Patients With Prune Belly Syndrome: 30 Years of Experience in the French Cohort - A Multicentric Study

Abstract BACKGROUND Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by bilateral intraabdominal undescended testes, abdominal wall flaccidity, and urinary tract dilation. Surgical management of cryptorchidism in PBS is technically challenging due to anatomical and urological anomalies. This study aimed to evaluate outcomes of different orchidopexy techniques, laparoscopic vs. open and one-stage vs. two-stage, in a national multicenter PBS cohort over 30 years. METHODS We retrospectively reviewed 56 PBS patients treated between 1990 and 2023 in 22 French centers using data from the MARVU National Registry. Testicular position and size at last follow-up were compared across surgical techniques and staging approaches. RESULTS A total of 87 orchidopexies were performed at a median age of 22 months; 62 (71%) were one-stage and 25 (29%) two-stage. Laparoscopy was used in 25 procedures (29%), more frequently in recent years. At a median follow-up of 7.5 years, 66 testes (76%) were located intrascrotally and 68 (79%) were of normal size. Testicular atrophy was observed in 15 cases (17%) and ectopic positioning in 18 (21%). No significant differences were found in anatomical outcomes based on surgical approach (intrascrotal position: 88% laparoscopic vs. 71% open, p=0.11) or staging (atrophy: 19% one-stage vs. 12% two-stage, p=0.54). Limitations include retrospective design and lack of hormonal or fertility data. CONCLUSIONS Both one- and two-stage orchidopexies, whether laparoscopic or open, provide comparable anatomical outcomes in PBS-related cryptorchidism. Technique selection should be individualized. Prospective studies are needed to evaluate long-term endocrine and reproductive function.