An International Multicenter Cohort Study of Management and Outcomes of Undescended Testis in German-speaking Countries

BackgroundUndescended testis (UDT) is the most common congenital genitourinary anomaly in boys.Guidelines recommend orchidopexy by 12-18 months to optimize fertility and reduce malignancy risk, but adherence is often poor.The objectives of this study were to asses institutional management for UDT and evaluate surgical practices and long-term patients outcomes following orchidopexy. MethodsWe conducted a multicenter observational study in German-speaking countries using a standardized questionnaire on UDT management and collected retrospective data on all patients who underwent orchidopexy in 2009, allowing 10 years of follow-up.Clinical records and patient/parent questionnaires were analyzed for perioperative data, complications, and long-term outcomes. ResultsTwenty-seven departments completed the questionnaire, and 18 provided patient data on 419 testicular units.Palpation was nearly universal, ultrasound use varied (50% for palpable, >80% for non-palpable), and MRI was rarely performed.For palpable testes, the combined inguinal-scrotal approach was most common, while laparoscopy was preferred for nonpalpable testes.About one-third of departments reported changes in management practices over the past decade, often driven by institutional or policy shifts.Surgery was frequently delayed: 6.9% of patients underwent orchidopexy before 12 months and 27.2% before 18 months.Significant differences between pediatric surgeons and urologists were noted in sonography use, operative access, fixation technique, and suture material (all p<0.001).However, complication rates, reoperation, testis position, and growth did not differ.At followup, 1.7% of testes were not in scrotal position, 5.4% did not have age-appropriate growth with no follow-up data in 12.9% of patients for testis position and in 20.6% for growth respectively.Parent-reported satisfaction was high. ConclusionIn German-speaking countries, various techniques are used for orchidopexy with some changes in the daily practice over time.Late orchidopexy may be related to delayed referral or secondary ascent.Nevertheless, long-term outcomes for testis position, growth, and satisfaction remain favorable with a low complication rate.Late orchidopexy may be related to delayed referral or secondary ascent.