Cryptorchidism, commonly referred to as undescended testis, is one of the most frequently encountered congenital anomalies of the male genital system, characterized by failure of one or both testes to descend into the scrotum by birth. Globally, the condition affects approximately 2–5% of full-term male neonates and up to 30% of preterm infants, making it a major paediatric surgical concern worldwide. Although spontaneous testicular descent may occur during the first few months of life, thereby necessitating surgical intervention to prevent long-term complications such as subfertility, testicular malignancy, torsion, and psychological morbidity.1,2 Testicular descent is a complex physiological process occurring in two distinct phases: the transabdominal phase and the inguinoscrotal phase, regulated by hormonal, anatomical, and mechanical factors. Disruption of these mechanisms can result in arrested descent at various anatomical locations, leading to palpable or non-palpable undescended testes. Several histopathological studies have demonstrated progressive loss of germ cells and impaired maturation of spermatogonia in undescended testes, particularly after the first year of life, highlighting the importance of early diagnosis and timely surgical correction.3 Orchidopexy is the definitive treatment for cryptorchidism and aims to position the testis within the scrotum, preserve testicular viability, optimize future fertility potential, and allow long-term surveillance for malignancy. International guidelines, including those from the American Urological Association and other paediatric surgical bodies, strongly recommend performing orchidopexy between 6 months and 1 year of age, based on evidence showing improved fertility outcomes and reduced testicular damage with early intervention.4 Advances in surgical techniques, including laparoscopic approaches for non-palpable testes, have further improved surgical success rates. Despite well-established guidelines, global studies continue to report variability in the timing of orchidopexy. Population-based data from developed countries reveal improved adherence to early surgery recommendations; however, delayed intervention still occurs due to factors such as delayed referral, healthcare access disparities, and lack of parental awareness. Studies evaluating surgical outcomes have emphasized that age at surgery, laterality, testicular position, and associated anomalies significantly influence postoperative results, including testicular size, viability, and risk of re-ascent or atrophy.5,6 In the Indian context, cryptorchidism constitutes a significant workload for paediatric surgical services, particularly in tertiary care centres serving large and diverse populations. Indian studies have consistently shown late presentation and delayed orchidopexy, with many children undergoing surgery beyond the recommended age due to inadequate neonatal screening, delayed diagnosis, limited access to specialized care, and socioeconomic constraints. Unlike developed countries, systematic newborn and infant genital examination programs are not uniformly implemented in India, especially in rural and semi-urban settings, contributing to delayed referral.7 Furthermore, Indian children often present with associated conditions such as inguinal hernia or hydrocele, and bilateral cryptorchidism is not uncommon in tertiary referral hospitals. Institutional studies from India have reported that delayed orchidopexy is associated with reduced testicular size and higher rates of postoperative testicular atrophy, reinforcing the need for early intervention and regular outcome audits in tertiary care settings.8,9 Evaluating surgical outcomes in the Indian healthcare context therefore provides valuable insight into real-world effectiveness of orchidopexy and helps identify gaps in early diagnosis, referral pathways, and long-term follow-up. In view of these considerations, the present study was undertaken to evaluate the surgical outcomes following orchidopexy for cryptorchidism in children treated at a tertiary care centre, with emphasis on testicular position, viability, and postoperative complications. AIM AND OBJECTIVE To evaluate the outcomes following orchidopexy in children with cryptorchidism treated at a tertiary care centre.

Study Design This study was designed as a prospective observational study to evaluate the surgical outcomes following orchidopexy in children with cryptorchidism. Study Setting The study was conducted in the Department of Paediatric Surgery at a tertiary care teaching hospital. The hospital caters to both urban and rural populations and functions as a referral centre for paediatric surgical cases. Study Population The study population comprised male children diagnosed with cryptorchidism, presenting to the outpatient department or admitted for surgical management and undergoing orchidopexy during the study period. Age Group • 6 months to 12 years. • Only male children were included. Sample Size A minimum of 42 patients were included in the study. All eligible patients fulfilling the inclusion criteria and undergoing orchidopexy during the study period were enrolled using consecutive sampling. Inclusion Criteria 1. Male children aged 6 months to 12 years. 2. Children with cryptorchidism diagnosed at birth or during early infancy. 3. Patients undergoing first-time orchidopexy. 4. Children operated at the recommended age of 9 months to 1 year, whenever feasible. 5. Parents or legal guardians willing to provide written informed consent. 6. Patients available for postoperative follow-up. Exclusion Criteria 1. Retractile testes. 2. Ectopic testes. 3. Children with previous inguinal or scrotal surgery. 4. Associated disorders of sexual development. 5. Syndromic children or those with multiple congenital anomalies. 6. Patients lost to follow-up. Definition of Outcome Measures Testicular Position Testicular position was considered successful when the operated testis was located within the dependent portion of the scrotum, remained stable without tension, and could be maintained in the scrotum on gentle manipulation during follow-up examination. Testicular Viability Testicular viability was defined by the presence of: • Normal testicular consistency on palpation • Absence of progressive reduction in size • No clinical evidence of ischemia or necrosis A testis fulfilling these criteria at follow-up was considered viable. Testicular Re-ascent Re-ascent was defined as migration of a previously scrotal testis to a higher position, such that it could no longer be maintained in the scrotum on gentle manipulation during follow-up examination. Testicular Atrophy Testicular atrophy was defined as: • A clinically evident reduction in testicular size compared to the contralateral testis, or • A testis that was soft, poorly formed, or significantly smaller on serial follow-up examinations Any testis meeting these criteria was classified as atrophic. Unfavourable Outcome An unfavourable surgical outcome was defined as the occurrence of testicular re-ascent and/or testicular atrophy during the follow-up period. Preoperative Evaluation All patients underwent a standardized preoperative assessment, which included: Clinical Evaluation • Detailed perinatal and birth history • Age at diagnosis • Side of involvement (right / left / bilateral) • Position of testis (palpable or non-palpable) • Presence of associated conditions such as: o Inguinal hernia o Hydrocele o Hypospadias Physical Examination • General physical examination • Local examination to determine testicular position • Examination of contralateral testis Radiological Evaluation • Clinical Diagnosis • Ultrasonography of abdomen and pelvis was performed in selected cases, especially in non-palpable testes, to aid localization. Pre-Anaesthetic Evaluation • All patients were evaluated by the anaesthesia team and optimized prior to surgery. Timing of Surgery • Orchidopexy was performed preferably between 9 months and 1 year of age, in accordance with current paediatric surgical guidelines. • Older children presenting late were also included and operated accordingly. Surgical Technique All surgeries were performed under general anaesthesia by experienced paediatric surgeons. Palpable Undescended Testis • Standard open inguinal orchidopexy was performed. • Steps included: o Inguinal incision o Mobilization of the spermatic cord o High ligation of patent processus vaginalis (if present) o Creation of a subdartos pouch o Tension-free placement and fixation of the testis in the scrotum Non-Palpable Undescended Testis • Diagnostic laparoscopy was performed. • Depending on intraoperative findings: o Laparoscopic orchidopexy o Staged procedure when required Postoperative Care • Routine postoperative monitoring • Analgesics and antibiotics as per hospital protocol • Patients were discharged after ensuring stable postoperative recovery Follow-Up Protocol Patients were followed up at: • 1 month • 6 months • 12 months During each follow-up visit, the following were assessed: • Position of the testis • Testicular size and consistency • Evidence of testicular atrophy • Re-ascent of testis • Postoperative complications (infection, hematoma, wound issues) Outcome Measures Primary Outcome Measures 1. Successful placement of testis in the scrotum 2. Maintenance of testicular viability Secondary Outcome Measures 1. Testicular atrophy 2. Re-ascent of testis 3. Postoperative complications 4. Parent/guardian satisfaction Data Collection All data were recorded in a pre-designed proforma, including demographic details, operative findings, and follow-up outcomes. Statistical Analysis Data were entered into Microsoft Excel. Statistical analysis was performed using SPSS software. Categorical variables were expressed as frequency and percentage. Continuous variables were expressed as mean ± standard deviation. A p-value < 0.05 was considered statistically significant.

A total of 42 male children with cryptorchidism who underwent orchidopexy and completed follow-up were included in the study. Table 1: Baseline Demographic Profile of Study Participants (n = 42) Variable Number (n) Percentage (%) Age at surgery 9–12 months 28 66.7 >12 months to 5 years 10 23.8 >5 years to 12 years 4 9.5 Mean age at surgery (months) 17.4 ± 22.6 — Laterality Right 16 38.1 Left 22 52.4 Bilateral 4 9.5 Interpretation: Most children underwent surgery within the recommended age of 9–12 months (66.7%). Left-sided undescended testis was more common than right-sided, and bilateral involvement was seen in 9.5%. Table 2: Clinical Characteristics of Cryptorchidism (n = 42) Variable Number (n) Percentage (%) Palpability Palpable UDT 34 81.0 Non-palpable UDT 8 19.0 Clinical location (best clinical assessment) High scrotal / superficial inguinal pouch 12 28.6 Inguinal canal 22 52.4 Not palpable (likely intra-abdominal/atrophic) 8 19.0 Associated findings Inguinal hernia / patent processus vaginalis (PPV) 18 42.9 Hydrocele 6 14.3 Interpretation: The majority had palpable testes (81%). Most testes were located in the inguinal canal (52.4%). A significant proportion had associated hernia/PPV (42.9%), which is commonly encountered with undescended testes. Table 3: Operative Details (n = 42) Variable Number (n) Percentage (%) Type of procedure Open inguinal orchidopexy 34 81.0 Laparoscopic orchidopexy 8 19.0 PPV ligation performed 18 42.9 Mean operative time (minutes) Open orchidopexy (n=34) 44.8 ± 11.6 — Laparoscopic orchidopexy (n=8) 61.5 ± 13.2 — Hospital stay Median (IQR) days 1 (1–2) — Operative time comparison: Open vs Laparoscopy → p = 0.002 Interpretation: Open orchidopexy was performed in most cases (81%). Laparoscopic surgery was used for non-palpable testes. Operative time was significantly higher in the laparoscopic group (p = 0.002). Most children required only short hospital stay. Table 4: Primary Surgical Outcomes at 12-Month Follow-up (n = 42) Outcome Number (n) Percentage (%) Successful scrotal position 39 92.9 Re-ascent 2 4.8 Testicular atrophy 3 7.1 Overall “unfavourable outcome” 5 11.9 Interpretation: Orchidopexy achieved successful scrotal positioning in 92.9%. The rates of re-ascent (4.8%) and atrophy (7.1%) were low, indicating good overall surgical outcomes. Interpretation: Unfavourable outcomes were significantly higher in children undergoing surgery after 12 months (p = 0.027) and in non-palpable testes (p = 0.032), suggesting these factors are associated with poorer postoperative outcomes. Table 5: Association of Key Factors with Unfavourable Outcome (Re-ascent/Atrophy) (n = 42) Factor Unfavourable outcome n/N (%) Favourable outcome n/N (%) p-value Age at surgery 9–12 months (n=28) 1/28 (3.6) 27/28 (96.4) >12 months (n=14) 4/14 (28.6) 10/14 (71.4) 0.027 Palpability Palpable (n=34) 2/34 (5.9) 32/34 (94.1) Non-palpable (n=8) 3/8 (37.5) 5/8 (62.5) 0.032

Cryptorchidism is one of the most common congenital anomalies managed by paediatric surgeons, and orchidopexy remains the definitive treatment aimed at achieving a stable scrotal position, preserving testicular viability, and reducing long-term complications. The present prospective observational study evaluated surgical outcomes following orchidopexy in children treated at a tertiary care centre and demonstrated a high overall success rate with acceptable complication rates. In the present study, the majority of children (66.7%) underwent orchidopexy between 9 and 12 months of age, reflecting improved adherence to recommended guidelines for early surgical correction. International guidelines advocate orchidopexy between 6 and 12 months of age to optimize fertility potential and reduce histological damage to germ cells.4 Studies have shown that early surgery is associated with better preservation of germ cell count and testicular growth compared to delayed intervention.3 The relatively early age at surgery in the present study likely contributed to the favourable outcomes observed. Left-sided cryptorchidism was more common than right-sided involvement, and bilateral cryptorchidism was observed in 9.5% of cases. This distribution is consistent with previous reports, which have documented a higher incidence of left-sided undescended testes due to delayed descent on the left side during foetal development.1 Bilateral involvement, though less frequent, is clinically significant because it carries a higher risk of subfertility and endocrine dysfunction. Most testes in the present study were palpable (81%), with the inguinal canal being the most common location. These findings are comparable to earlier studies reporting palpable testes in 70–85% of cases.5 Associated inguinal hernia or patent processus vaginalis was identified in 42.9% of patients, reinforcing the well-established embryological association between cryptorchidism and failure of processus vaginalis closure.10 Open inguinal orchidopexy was the most commonly performed procedure, while laparoscopic orchidopexy was reserved for non-palpable testes. Operative time was significantly longer for laparoscopic procedures compared to open orchidopexy (p = 0.002), which is consistent with previous studies reporting increased operative duration for laparoscopy due to port placement and intracorporeal dissection.11 However, laparoscopic orchidopexy offers superior visualization and diagnostic accuracy for non-palpable testes and has been shown to achieve comparable success rates.12 The primary outcome of the study demonstrated a successful scrotal position in 92.9% of cases, which is comparable with reported success rates ranging from 85% to 95% in published literature.13 The rates of re-ascent (4.8%) and testicular atrophy (7.1%) observed in the present study fall within acceptable limits and are similar to those reported by other institutional series.9 Importantly, the present study identified age at surgery and palpability of the testis as significant factors influencing surgical outcomes. Children operated after 12 months of age had a significantly higher rate of unfavourable outcomes compared to those operated earlier (p = 0.027). This finding aligns with multiple studies that have demonstrated increased risk of testicular atrophy and suboptimal outcomes with delayed orchidopexy.6 Similarly, non-palpable testes were associated with poorer outcomes compared to palpable testes (p = 0.032), which may be attributed to higher intra-abdominal location, shorter spermatic vessels, and compromised blood supply.1 In the Indian context, delayed presentation remains a common challenge due to lack of awareness, inadequate neonatal screening, and delayed referral to paediatric surgical services. Several Indian studies have reported that a significant proportion of children undergo orchidopexy beyond the recommended age, which adversely affects surgical outcomes.8 The findings of the present study reinforce the need for early diagnosis and timely referral to improve outcomes in children with cryptorchidism. Overall, the results of this study confirm that orchidopexy is a safe and effective procedure when performed at an appropriate age, with high success rates and low complication rates. Early surgery and palpable testicular position are associated with better outcomes, emphasizing the importance of adherence to recommended surgical timelines and thorough preoperative evaluation.

The present study demonstrates that orchidopexy is a safe and effective surgical procedure for the management of cryptorchidism in children, with a high rate of successful scrotal positioning and a low incidence of postoperative complications. Early surgical intervention, particularly when performed between 9 and 12 months of age, was associated with significantly better outcomes. Delayed surgery and non-palpable testes were found to be important factors contributing to unfavourable outcomes such as testicular atrophy and re-ascent. These findings emphasize the importance of early diagnosis, timely referral, and adherence to recommended surgical timelines to optimize surgical outcomes in children with cryptorchidism.

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