O4357: Is a Testicular Biopsy Necessary during Orchidopexy in Older Boys with Undescended Testes?

Background: Cryptorchidism, or undescended testis, is a common condition that affects newborn males. The risk of testicular cancer may increase for those patients who are treated beyond puberty, emphasizing early detection and treatment. There is no consensus in the literature about the utility of testicular biopsy at the time of orchiopexy to assess malignancy risk for an undescended testis.

Methods: We retrospectively evaluated patients treated by one surgeon at our institution for undescended testes from 2008 to 2024. Patients included are those who underwent orchiopexy and testicular biopsy versus orchiectomy after a diagnosis of undescended testis was made. Primary end point was to assess biopsy results to determine benign versus malignant pathology of the undescended testis.

Results: A total of 26 patients were identified. Age of the patients ranged 9-21 years with a mean age of 13.12 years. Most patients (88.5%) did not have a prior history of scrotal surgery. Location of the undescended testis during orchiopexy was abdominal (15.4%), high inguinal canal (15.4%), inguinal canal (61.5%) and scrotum (7.7%) based on intraoperative findings. Laterality of the orchiopexy/orchiectomy was left (38.5%), right (53.8%), and bilateral (7.7%). None (0/26) of the biopsies reported cancer or germ cell neoplasia in situ.

Conclusion: Currently at our institution, it has been our practice standard to perform testicular biopsy at the time of orchiopexy in post-pubertal boys to ensure there is no evidence of carcinoma in situ. Our study results indicate that this policy may need to be amended as there were no reported malignant changes in any of the biopsies performed to date in our population.