Postoperative surveillance following orchiopexy: practice variations and recommendations

Postoperative surveillance following orchiopexy: practice variations and recommendations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postoperative surveillance following orchiopexy: practice variations and recommendations Yael Dreznik, Nadav Peled, Tal May, Maya Paran, David Ben Meir, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6177225/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Orchiopexy is a common pediatric procedure for cryptorchidism, affecting 1–1.5% of one-year-old infants. Post-orchiopexy follow-up is essential to monitor testicular position and growth, yet there are no standardized guidelines regarding the frequency and duration of follow-up visits. Aim To assess follow-up patterns, adherence rates, and re-ascent incidence in children undergoing orchiopexy during a decade following the procedure. Methods A retrospective cohort study was conducted on pediatric patients who underwent orchiopexy between 2013 and 2014 at a tertiary center. Data on demographics, surgical details, post-operative follow-up adherence as documented until 31/12/2024, and outcomes were analyzed. Results Between 2013 and 2014, 158 children underwent orchiopexy due to undescended testis at our institution. Among them, adherence to long-term follow-up was low, with only 6.3% completing the recommended annually monitoring. Over the entire study period, 7 patients (4.4%) required reoperation due to recurrent undescended testis. The median time to re-ascent diagnosis was 22 months. Conclusion This study highlights the importance of structured follow-up in the first years post-orchiopexy to identify testicular re-ascent. It is recommended to prioritize adherence to this critical period. Beyond the first years, the necessity of annual follow-up visits should be reconsidered, based on risk stratification. Further research is needed to establish evidence-based protocols for post-operative surveillance. orchiopexy pediatric surveillance follow-up Introduction Orchiopexy is a common surgical procedure performed in the pediatric population to treat undescended testicles (cryptorchidism), that has an estimated prevalence of 1-1.5% among 1 year-old-infants [ 1 ]. Post-orchiopexy follow-up is essential for monitoring two key outcomes: assessing testicular position for potential re-ascent and evaluating testicular volume in order to rule out the development of testicular atrophy. Boys treated for undescended testis are at an elevated risk of developing testicular malignancy. As a result, regular screening and self-examination are recommended both during and after puberty [5 ]. Re-ascent rates following orchidopexy vary across different studies, with reported rates ranging from 2.4–4%- a 10-year review of outcomes following inguinal orchidopexy found a re-ascent rate of 4%, while a recent prospective multicenter study reported a lower rate of 2.4%.[ 2 ], [ 3 ], [ 4 ]. Currently, there are no clear guidelines or standardized recommendations for the frequency and duration of post-operative follow-up visits following orchiopexy in children. This lack of uniformity in surveillance practices has led to significant variations in patient care across different institutions and healthcare providers. The absence of evidence-based guidelines raises several important questions: How many follow-up visits are necessary to ensure optimal outcomes? What should be the ideal time intervals between these visits? At what point can patients be safely discharged from surgical follow-up? These uncertainties highlight the need for a comprehensive evaluation of current practices and the development of standardized protocols to guide post-operative care after orchiopexy. Our study aims to review our experience and practice variations on post-operative surveillance following orchiopexy in the pediatric population. Methods Study design A retrospective cohort study was conducted on all pediatric patients who underwent orchiopexy for undescended testis between 2013 and 2014 in a tertiary center. The study included all patients diagnosed with cryptorchidism, with comprehensive long-term follow-up of their medical records extending until the end of 2024. Data collection encompassed age at diagnosis, surgical details, postoperative complications, and long-term surveillance, including re-ascending testis and reoperation, ensuring a thorough evaluation of outcomes over a full decade. The study exclusion criteria included cases referred from external centers for reoperation, patients with a history of ipsilateral inguinal hernia repair, and individuals without follow-up data. Additionally, ambulatory patients presenting with suspected strangulated inguinal hernia were excluded, as well as those with suspected undescended testicular torsion requiring immediate surgical exploration, even if orchidopexy was performed concurrently. These exclusions were implemented to ensure a homogeneous study population and to focus on primary orchiopexy procedures with consistent follow-up data. Data acquisition and analysis The study was approved by the local institutional review board committee. All data was collected via the computerized hospitalization records for each participating patient. Data including age, pre-operative visit, operative data and post-operative outcomes were collected. Surgical technique The surgical procedures were performed by two experienced teams - urologists and pediatric surgeons - in equal measure over the years and using the same surgical technique. The surgical technique for palpable inguinal testes consisted of an inguinal incision, identification of the testis, and orchiopexy with fixation to the scrotum using nonabsorbable sutures. In cases of non-palpable testes, the procedure was initiated with a laparoscopic approach. Based on intraoperative assessment, either a single-stage or two-stage orchiopexy was performed (Fowler-Stephens), depending on whether sufficient testicular vessel length was achieved to allow tension-free placement of the testis in the scrotum. Post-operative surveillance protocol Post-operative surveillance protocol Patients were scheduled for a postoperative follow-up, at the first few weeks following syrgery, as detailed in the discharge letter provided on the day of surgery. After the first post-operative visit, typically scheduled within one week to one month following surgery, all patients were instructed to attend a follow-up appointment without exception. In most cases, the subsequent follow-up was scheduled within one year of the surgery. However, in certain cases where specific indications justified earlier assessment, additional follow-up appointments were recommended accordingly. The general recommendation among most study participants was to conduct follow-ups at least annually for several consecutive years until puberty. Statistical analysis Descriptive statistical methods were employed for the analysis of all collected data, including average, range, distribution, minimum, and maximum. Results Patient characteristics From January 1, 2013, to December 31, 2014, a total of 158 children underwent orchiopexy at a median age of 19 months at our institution. Of these, 66 (41.7%) underwent right-sided orchiopexy, 67 (42.4%) underwent left-sided orchiopexy, and 25 (15.8%) underwent bilateral orchiopexy in a single surgical procedure. Comorbidities were defined as major conditions that could impact the timing of the scheduled orchiopexy, such as congenital heart defects requiring surgery, complex anorectal malformations, or significant neurological impairment. Unpalpable testis was scheduled for diagnostic laparoscopy, as mentioned in the “methods” section. The epidemiological characteristics are presented in Table 1 . Table 1 patients epidemiological characteristics surveillance data Characterization n = 158 median age at surgery, months (range) 19 (6-210) Comorbidity (%) 16 (10%) Unpalpable testis 12 (7.6%) orchiopexy Left orchiopexy (%) 67 (42.4%) Right orchiopexy (%) 66 (41.7%) Bilateral orchiopexy (%) 25 (15.9%) Post-operative surveillance data The follow-up of was conducted until 31.12.2024- a decade following the surgery. During the clinic follow-up, physical findings and the need for further visits were documented. Postoperative follow-up patterns varied significantly among patients who underwent orchiopexy. While most patients attended at least one follow-up visit, a substantial proportion (34.8%) had only a single documented appointment, and only 6.3% adhered to all recommended follow-ups. The median age at the first postoperative visit was 21 months, occurring approximately one month after surgery. By the last documented visit, the median patient age was 51 months, reflecting the extended follow-up period. The epidemiological characteristics and post operative surveillance data are presented in Table 1 . Table 2 post operative surveillance data Characterization n = 158 Post operative surveillance data Median age in months at first postoperative visit (range) 21 (7-211) Median time in months from surgery to first postoperative visit (range) 1 (0.25-9) Median no. of follow up visits (range) 2 (1–15) Median age in months at the last documented visit (range) 51 (7-211) No. of patients with only 1 follow up visit 55 (34.8%) No. of patients who attended all recommended follow-up visits. 10 (6.3%) Only ten patients, constituting approximately 6% of the study population, adhered to consecutive follow-up visits until the completion of monitoring as determined by the physician in the clinic. Graph no. 1 details the range of follow up appointments in the study group. Reascending testis The assessment of the number of patients requiring reoperation was conducted on the study population- The objective was to evaluate the time interval from the initial surgery to the diagnosis of testicular ascent, and to identify any surgical risk factors associated with this condition (testicular fixation under mild tension to the scrotum, difficulty securing the testicle to the base of the scrotum, intra-abdominal testes) that could better guide postoperative follow-up protocols. During the study period, 7 patients (4.4%) underwent re-do orchiopexy due to re-ascent of the operated testis. Table 3 outlines the main characteristics of patients who underwent re-operation. Table 3 Reascending testis Characterization n = 7 median age at 1st surgery, months (range) 22 (16–34) No. of patients with risk factors for re-ascent orchiopexy 4 (57%) Median time to diagnosis of re-ascent testis (from 1st surgery, in months) (range) 22 (3–37) No. of post-operative visits from 1st surgery to 2nd surgery (median) 4 median age at 2nd surgery, months (range) 44 (37–62) Testicular atrophy Testicular atrophy was documented in three patients postoperatively, as confirmed by physical examination and postoperative ultrasound evaluation. None of these patients underwent orchiectomy. Discussion Cryptorchidism, or undescended testis (UDT), is the most common urogenital malformation in newborns, affecting up to 5% of male infants at birth. The prevalence decreases to 1-1.5% by one year of age due to spontaneous descent [6 ]. Cryptorchidism is associated with increased risks of impaired fertility, testicular malignancy, and torsion. Early diagnosis and treatment are crucial, with guidelines recommending orchiopexy between 6–18 months of age [7 ]. Orchiopexy, the surgical repositioning of the testis within the scrotal sac, is the standard treatment. Despite advances in surgical techniques, follow-up studies show re-ascent rates of 2.4-4% and atrophy rates of 2–3% after primary orchiopexy. Although redo orchiopexy is a technically challenging procedure, it is associated with a high rate of success [8 ]. Long-term outcomes and, especially- long term follow up visits post operatively- remain uncertain and debated. Many studies address, among other things, the surgical technique for performing orchidopexy, the rate of complications, and the need for re-operation. Currently, there is no recommendation based on existing data regarding the follow-up after orchidopexy. Just as the importance of long-term follow-up is crucial in cases with risk factors, such as an intra-abdominal testis, there is also a need to determine whether every patient should be scheduled for annual follow-up visits in the clinic and whether there is merit in conducting routine follow-up over a prolonged period when the benefits are unclear. Our experience shows that, on average, after three (3) post-operative outpatient clinic, most patients (n = 108, 68%) no longer return for further assessments. Moreover, only six percent (6%) of the study population continue to attend follow-up visits as recommended in the last discharge letter until the end of the follow-up period. The study population included seven children (7, 4.4%) who required re-orchiopexy due to the testis’s ascent into the inguinal canal. These patients were diagnosed with the need for reoperation within a median time of 22 months from the initial surgery. More than half of them presented with risk factors for reascending testis at the first surgery, such as testicular fixation under mild tension to the scrotum, intra-abdominal testis, and fixation of the testicle to the upper part of the scrotum due to short spermatic vessels. It can be stated that at least four follow-up visits over a two-year period following surgery provided sufficient information to determine the need for reoperation in these patients. Furthermore, no patient in the study population was diagnosed with the need for reoperation beyond this time frame. The limitations of this study include its retrospective nature and the possibility that some patients received post-operative follow-up care at other hospitals or clinics. Regarding the latter limitation, it is important to note that the Israeli healthcare system operates on a mutual insurance model through health maintenance organizations (HMOs). A patient seeking care from a different HMO typically requires transitioning to a new insurer. Therefore, we estimate that the proportion of patients who did not attend follow-up at our institution due to seeking care elsewhere is relatively low. We believe that while it may be appropriate to recommend careful and long-term annual follow-up in certain situations, there are cases where fewer follow-up visits can be recommended. It should also be mentioned that boys treated for undescended testis face a higher risk of developing testicular malignancy. Therefore, we recommend teaching patients how to perform self-examinations during and after puberty as part of regular screening and early detection efforts. To conclude, and based on the study results, we believe that it may be feasible to establish guidelines stratifying the postoperative population into groups based on their risk of requiring reoperation. Patients at lower risk for reoperation are recommended to follow a more flexible follow-up schedule, with the option of extending the intervals between visits. In contrast, patients at higher risk, as determined by intraoperative findings, are advised to adhere to a stricter, long-term follow-up protocol. In all cases, ensuring at least four follow-up visits within the first three years after surgery remains important, along with monitoring adherence to the follow-up plan. Declarations Conflict of Interest : The authors declare that they have no conflict of interest. Funding : There is no funding source. Ethical approval : This article does not contain any studies with human participants or animals performed by any of the authors. Author Contribution: Conceptualization: [Y. D]; Methodology: [Y.D, N. P]; Formal analysis and investigation: [T.M, M.P], Writing - original draft preparation: [Y.D, N.P]; Writing - review and editing: [D.B.M, D.K] References Sijstermans K, Hack WWM, Meijer RW, Voort-Doedens LVD. The frequency of undescended testis from birth to adulthood: a review. Int J Androl. 2008;31(1):1–11. Selin C, Hallabro N, Anderberg M, Börjesson A, Salö M. Orchidopexy for undescended testis-rate and predictors of re-ascent. Pediatr Surg Int. 2024 May 28;40(1):139. Penson D, Krishnaswami S, Jules A, McPheeters ML. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics. 2013;131(6):e1897–e1907. Timing of orchidopexy and its relationship to postoperative testicular atrophy: results from the ORCHESTRA study. BJS Open. 2021;5(1). Shin J, Jeon GW. Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr. 2020 Nov;63(11):415-421. Taran I, Elder JS. Results of orchiopexy for the undescended testis. World J Urol. 2006 Aug;24(3):231-9. Hutson JM, Balic A, Nation T, Southwell B. Cryptorchidism. Semin Pediatr Surg. 2010 Aug;19(3):215-24. Noseworthy J. Recurrent undescended testes. Semin Pediatr Surg. 2003 May;12(2):90-3. Graphs Graph 1 is available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Graphno.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6177225","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":429464961,"identity":"d285e119-848e-44e8-92e8-ab4c493b3ab2","order_by":0,"name":"Yael Dreznik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYHACxgMMbGC6meEDkGJjJ0IPXAvjDJAWZuK1MDAz84ApAsoNjh8+cICh7J6c/OzmZmObX9vk+ZgZGD98zMGj5UxawgGGc8XGjHMONifn9t02bGNmYJacuQ2PlgM5BgcY2xISmyUSmw/n9txmBGphY+bFp+X8+w8gLfVtIC2WPbftCWu5kcMA0pLAA9SSzPDjdiJBLZI3nhkcSDiXYDgDqMWwt+F2chszYzNev/CdT3744ENZgrz8jPTHEj/+3Lad39588MNHPFoUDgCJBBiPsQ1MNuBWDwTyqNJ/8CoeBaNgFIyCEQoAI71UNIlbPEEAAAAASUVORK5CYII=","orcid":"","institution":"Schneider Children’s Medical Center of Israel","correspondingAuthor":true,"prefix":"","firstName":"Yael","middleName":"","lastName":"Dreznik","suffix":""},{"id":429464962,"identity":"8a93ec06-bc83-470f-b0d5-e21f7f41c6f7","order_by":1,"name":"Nadav Peled","email":"","orcid":"","institution":"Ariel university","correspondingAuthor":false,"prefix":"","firstName":"Nadav","middleName":"","lastName":"Peled","suffix":""},{"id":429464963,"identity":"67858baf-c1a3-430b-b664-713b1ea12678","order_by":2,"name":"Tal May","email":"","orcid":"","institution":"Schneider Children’s Medical Center of Israel","correspondingAuthor":false,"prefix":"","firstName":"Tal","middleName":"","lastName":"May","suffix":""},{"id":429464964,"identity":"f36ca8d2-46ce-40d3-a142-b012e4ac4e83","order_by":3,"name":"Maya Paran","email":"","orcid":"","institution":"Schneider Children’s Medical Center of Israel","correspondingAuthor":false,"prefix":"","firstName":"Maya","middleName":"","lastName":"Paran","suffix":""},{"id":429464965,"identity":"9914edd0-64cb-4a27-b10d-dfd3f9c6fb39","order_by":4,"name":"David Ben Meir","email":"","orcid":"","institution":"Schneider Children’s Medical Center of Israel","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Ben","lastName":"Meir","suffix":""},{"id":429464966,"identity":"adae9aaa-261e-4636-b086-af7a5c3a8f91","order_by":5,"name":"Dragan Kravarusic","email":"","orcid":"","institution":"Schneider Children’s Medical Center of Israel","correspondingAuthor":false,"prefix":"","firstName":"Dragan","middleName":"","lastName":"Kravarusic","suffix":""}],"badges":[],"createdAt":"2025-03-07 10:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6177225/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6177225/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79565879,"identity":"09cc75ce-e99b-424b-8877-09a031a0aac0","added_by":"auto","created_at":"2025-03-31 09:32:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":467800,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6177225/v1/5dbd1836-8d25-4e50-aad5-7204e636cf49.pdf"},{"id":78652362,"identity":"3688a04c-d244-4939-974b-7c9841f5e58b","added_by":"auto","created_at":"2025-03-17 08:43:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":174411,"visible":true,"origin":"","legend":"","description":"","filename":"Graphno.docx","url":"https://assets-eu.researchsquare.com/files/rs-6177225/v1/2bcccd7f855409f7fc49966c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Postoperative surveillance following orchiopexy: practice variations and recommendations","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOrchiopexy is a common surgical procedure performed in the pediatric population to treat undescended testicles (cryptorchidism), that has an estimated prevalence of 1-1.5% among 1 year-old-infants [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003ePost-orchiopexy follow-up is essential for monitoring two key outcomes: assessing testicular position for potential re-ascent and evaluating testicular volume in order to rule out the development of testicular atrophy.\u003c/p\u003e\n\u003cp\u003eBoys treated for undescended testis are at an elevated risk of developing testicular malignancy. As a result, regular screening and self-examination are recommended both during and after puberty [5\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eRe-ascent rates following orchidopexy vary across different studies, with reported rates ranging from 2.4\u0026ndash;4%- a 10-year review of outcomes following inguinal orchidopexy found a re-ascent rate of 4%, while a recent prospective multicenter study reported a lower rate of 2.4%.[\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eCurrently, there are no clear guidelines or standardized recommendations for the frequency and duration of post-operative follow-up visits following orchiopexy in children. This lack of uniformity in surveillance practices has led to significant variations in patient care across different institutions and healthcare providers.\u003c/p\u003e\n\u003cp\u003eThe absence of evidence-based guidelines raises several important questions: How many follow-up visits are necessary to ensure optimal outcomes?\u003c/p\u003e\n\u003cp\u003eWhat should be the ideal time intervals between these visits? At what point can patients be safely discharged from surgical follow-up? These uncertainties highlight the need for a comprehensive evaluation of current practices and the development of standardized protocols to guide post-operative care after orchiopexy.\u003c/p\u003e\n\u003cp\u003eOur study aims to review our experience and practice variations on post-operative surveillance following orchiopexy in the pediatric population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted on all pediatric patients who underwent orchiopexy for undescended testis between 2013 and 2014 in a tertiary center. The study included all patients diagnosed with cryptorchidism, with comprehensive long-term follow-up of their medical records extending until the end of 2024. Data collection encompassed age at diagnosis, surgical details, postoperative complications, and long-term surveillance, including re-ascending testis and reoperation, ensuring a thorough evaluation of outcomes over a full decade.\u003c/p\u003e \u003cp\u003eThe study exclusion criteria included cases referred from external centers for reoperation, patients with a history of ipsilateral inguinal hernia repair, and individuals without follow-up data. Additionally, ambulatory patients presenting with suspected strangulated inguinal hernia were excluded, as well as those with suspected undescended testicular torsion requiring immediate surgical exploration, even if orchidopexy was performed concurrently. These exclusions were implemented to ensure a homogeneous study population and to focus on primary orchiopexy procedures with consistent follow-up data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData acquisition and analysis\u003c/h3\u003e\n\u003cp\u003e The study was approved by the local institutional review board committee. All data was collected via the computerized hospitalization records for each participating patient. Data including age, pre-operative visit, operative data and post-operative outcomes were collected.\u003c/p\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003eThe surgical procedures were performed by two experienced teams - urologists and pediatric surgeons - in equal measure over the years and using the same surgical technique. The surgical technique for palpable inguinal testes consisted of an inguinal incision, identification of the testis, and orchiopexy with fixation to the scrotum using nonabsorbable sutures.\u003c/p\u003e \u003cp\u003eIn cases of non-palpable testes, the procedure was initiated with a laparoscopic approach. Based on intraoperative assessment, either a single-stage or two-stage orchiopexy was performed (Fowler-Stephens), depending on whether sufficient testicular vessel length was achieved to allow tension-free placement of the testis in the scrotum.\u003c/p\u003e\n\u003ch3\u003ePost-operative surveillance protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003ePost-operative surveillance protocol\u003c/div\u003e \u003cp\u003ePatients were scheduled for a postoperative follow-up, at the first few weeks following syrgery, as detailed in the discharge letter provided on the day of surgery. After the first post-operative visit, typically scheduled within one week to one month following surgery, all patients were instructed to attend a follow-up appointment without exception. In most cases, the subsequent follow-up was scheduled within one year of the surgery. However, in certain cases where specific indications justified earlier assessment, additional follow-up appointments were recommended accordingly.\u003c/p\u003e \u003cp\u003eThe general recommendation among most study participants was to conduct follow-ups at least annually for several consecutive years until puberty.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistical methods were employed for the analysis of all collected data, including average, range, distribution, minimum, and maximum.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eFrom January 1, 2013, to December 31, 2014, a total of 158 children underwent orchiopexy at a median age of 19 months at our institution. Of these, 66 (41.7%) underwent right-sided orchiopexy, 67 (42.4%) underwent left-sided orchiopexy, and 25 (15.8%) underwent bilateral orchiopexy in a single surgical procedure.\u003c/p\u003e \u003cp\u003eComorbidities were defined as major conditions that could impact the timing of the scheduled orchiopexy, such as congenital heart defects requiring surgery, complex anorectal malformations, or significant neurological impairment. Unpalpable testis was scheduled for diagnostic laparoscopy, as mentioned in the \u0026ldquo;methods\u0026rdquo; section.\u003c/p\u003e \u003cp\u003eThe epidemiological characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epatients epidemiological characteristics surveillance data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacterization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;158\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emedian age at surgery, months (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (6-210)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnpalpable testis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eorchiopexy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft orchiopexy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight orchiopexy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral orchiopexy (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePost-operative surveillance data\u003c/h3\u003e\n\u003cp\u003eThe follow-up of was conducted until 31.12.2024- a decade following the surgery.\u003c/p\u003e \u003cp\u003eDuring the clinic follow-up, physical findings and the need for further visits were documented.\u003c/p\u003e \u003cp\u003ePostoperative follow-up patterns varied significantly among patients who underwent orchiopexy. While most patients attended at least one follow-up visit, a substantial proportion (34.8%) had only a single documented appointment, and only 6.3% adhered to all recommended follow-ups. The median age at the first postoperative visit was 21 months, occurring approximately one month after surgery. By the last documented visit, the median patient age was 51 months, reflecting the extended follow-up period.\u003c/p\u003e \u003cp\u003eThe epidemiological characteristics and post operative surveillance data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epost operative surveillance data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacterization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;158\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePost operative surveillance data\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age in months at first postoperative visit (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (7-211)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian time in months from surgery to first postoperative visit (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.25-9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian no. of follow up visits (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age in months at the last documented visit (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (7-211)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of patients with only 1 follow up visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of patients who attended all recommended follow-up visits.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOnly ten patients, constituting approximately 6% of the study population, adhered to consecutive follow-up visits until the completion of monitoring as determined by the physician in the clinic. Graph no. 1 details the range of follow up appointments in the study group.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eReascending testis\u003c/h2\u003e \u003cp\u003eThe assessment of the number of patients requiring reoperation was conducted on the study population- The objective was to evaluate the time interval from the initial surgery to the diagnosis of testicular ascent, and to identify any surgical risk factors associated with this condition (testicular fixation under mild tension to the scrotum, difficulty securing the testicle to the base of the scrotum, intra-abdominal testes) that could better guide postoperative follow-up protocols.\u003c/p\u003e \u003cp\u003eDuring the study period, 7 patients (4.4%) underwent re-do orchiopexy due to re-ascent of the operated testis. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e outlines the main characteristics of patients who underwent re-operation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReascending testis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacterization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emedian age at 1st surgery, months (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (16\u0026ndash;34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of patients with risk factors for re-ascent orchiopexy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian time to diagnosis of re-ascent testis (from 1st surgery, in months) (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3\u0026ndash;37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of post-operative visits from 1st surgery to 2nd surgery (median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emedian age at 2nd surgery, months (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (37\u0026ndash;62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTesticular atrophy\u003c/h2\u003e \u003cp\u003eTesticular atrophy was documented in three patients postoperatively, as confirmed by physical examination and postoperative ultrasound evaluation. None of these patients underwent orchiectomy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCryptorchidism, or undescended testis (UDT), is the most common urogenital malformation in newborns, affecting up to 5% of male infants at birth. The prevalence decreases to 1-1.5% by one year of age due to spontaneous descent [6\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e]. Cryptorchidism is associated with increased risks of impaired fertility, testicular malignancy, and torsion. Early diagnosis and treatment are crucial, with guidelines recommending orchiopexy between 6\u0026ndash;18 months of age [7\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e]. Orchiopexy, the surgical repositioning of the testis within the scrotal sac, is the standard treatment. Despite advances in surgical techniques, follow-up studies show re-ascent rates of 2.4-4% and atrophy rates of 2\u0026ndash;3% after primary orchiopexy. Although redo orchiopexy is a technically challenging procedure, it is associated with a high rate of success [8\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eLong-term outcomes and, especially- long term follow up visits post operatively- remain uncertain and debated.\u003c/p\u003e\n\u003cp\u003eMany studies address, among other things, the surgical technique for performing orchidopexy, the rate of complications, and the need for re-operation. Currently, there is no recommendation based on existing data regarding the follow-up after orchidopexy. Just as the importance of long-term follow-up is crucial in cases with risk factors, such as an intra-abdominal testis, there is also a need to determine whether every patient should be scheduled for annual follow-up visits in the clinic and whether there is merit in conducting routine follow-up over a prolonged period when the benefits are unclear.\u003c/p\u003e\n\u003cp\u003eOur experience shows that, on average, after three (3) post-operative outpatient clinic, most patients (n\u0026thinsp;=\u0026thinsp;108, 68%) no longer return for further assessments. Moreover, only six percent (6%) of the study population continue to attend follow-up visits as recommended in the last discharge letter until the end of the follow-up period.\u003c/p\u003e\n\u003cp\u003eThe study population included seven children (7, 4.4%) who required re-orchiopexy due to the testis\u0026rsquo;s ascent into the inguinal canal. These patients were diagnosed with the need for reoperation within a median time of 22 months from the initial surgery. More than half of them presented with risk factors for reascending testis at the first surgery, such as testicular fixation under mild tension to the scrotum, intra-abdominal testis, and fixation of the testicle to the upper part of the scrotum due to short spermatic vessels. It can be stated that at least four follow-up visits over a two-year period following surgery provided sufficient information to determine the need for reoperation in these patients. Furthermore, no patient in the study population was diagnosed with the need for reoperation beyond this time frame.\u003c/p\u003e\n\u003cp\u003eThe limitations of this study include its retrospective nature and the possibility that some patients received post-operative follow-up care at other hospitals or clinics. Regarding the latter limitation, it is important to note that the Israeli healthcare system operates on a mutual insurance model through health maintenance organizations (HMOs). A patient seeking care from a different HMO typically requires transitioning to a new insurer. Therefore, we estimate that the proportion of patients who did not attend follow-up at our institution due to seeking care elsewhere is relatively low.\u003c/p\u003e\n\u003cp\u003eWe believe that while it may be appropriate to recommend careful and long-term annual follow-up in certain situations, there are cases where fewer follow-up visits can be recommended. It should also be mentioned that boys treated for undescended testis face a higher risk of developing testicular malignancy. Therefore, we recommend teaching patients how to perform self-examinations during and after puberty as part of regular screening and early detection efforts.\u003c/p\u003e\n\u003cp\u003eTo conclude, and based on the study results, we believe that it may be feasible to establish guidelines stratifying the postoperative population into groups based on their risk of requiring reoperation. Patients at lower risk for reoperation are recommended to follow a more flexible follow-up schedule, with the option of extending the intervals between visits. In contrast, patients at higher risk, as determined by intraoperative findings, are advised to adhere to a stricter, long-term follow-up protocol. In all cases, ensuring at least four follow-up visits within the first three years after surgery remains important, along with monitoring adherence to the follow-up plan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: The authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: There is no funding source.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e: This article does not contain any studies with human participants or animals performed by any of the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u0026nbsp;\u003c/strong\u003eConceptualization: [Y. D]; Methodology: [Y.D, N. P]; Formal analysis and investigation: [T.M, M.P], Writing - original draft preparation: [Y.D, N.P]; Writing - review and editing: [D.B.M, D.K]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSijstermans K, Hack WWM, Meijer RW, Voort-Doedens LVD. The frequency of undescended testis from birth to adulthood: a review. Int J Androl. 2008;31(1):1\u0026ndash;11.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSelin C, Hallabro N, Anderberg M, B\u0026ouml;rjesson A, Sal\u0026ouml; M. Orchidopexy for undescended testis-rate and predictors of re-ascent. Pediatr Surg Int. 2024 May 28;40(1):139.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePenson D, Krishnaswami S, Jules A, McPheeters ML. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics. 2013;131(6):e1897\u0026ndash;e1907.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTiming of orchidopexy and its relationship to postoperative testicular atrophy: results from the ORCHESTRA study. BJS Open. 2021;5(1).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShin J, Jeon GW. Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr. 2020 Nov;63(11):415-421.\u003c/li\u003e\n \u003cli\u003eTaran I, Elder JS. Results of orchiopexy for the undescended testis. World J Urol. 2006 Aug;24(3):231-9.\u003c/li\u003e\n \u003cli\u003eHutson JM, Balic A, Nation T, Southwell B. Cryptorchidism. Semin Pediatr Surg. 2010 Aug;19(3):215-24.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNoseworthy J. Recurrent undescended testes. Semin Pediatr Surg. 2003 May;12(2):90-3.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraph 1 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"orchiopexy, pediatric, surveillance, follow-up","lastPublishedDoi":"10.21203/rs.3.rs-6177225/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6177225/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOrchiopexy is a common pediatric procedure for cryptorchidism, affecting 1–1.5% of one-year-old infants. Post-orchiopexy follow-up is essential to monitor testicular position and growth, yet there are no standardized guidelines regarding the frequency and duration of follow-up visits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess follow-up patterns, adherence rates, and re-ascent incidence in children undergoing orchiopexy during a decade following the procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective cohort study was conducted on pediatric patients who underwent orchiopexy between 2013 and 2014 at a tertiary center. Data on demographics, surgical details, post-operative follow-up adherence as documented until 31/12/2024, and outcomes were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween 2013 and 2014, 158 children underwent orchiopexy due to undescended testis at our institution. Among them, adherence to long-term follow-up was low, with only 6.3% completing the recommended annually monitoring. Over the entire study period, 7 patients (4.4%) required reoperation due to recurrent undescended testis. The median time to re-ascent diagnosis was 22 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights the importance of structured follow-up in the first years post-orchiopexy to identify testicular re-ascent. It is recommended to prioritize adherence to this critical period. Beyond the first years, the necessity of annual follow-up visits should be reconsidered, based on risk stratification. Further research is needed to establish evidence-based protocols for post-operative surveillance.\u003c/p\u003e","manuscriptTitle":"Postoperative surveillance following orchiopexy: practice variations and recommendations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-17 08:43:04","doi":"10.21203/rs.3.rs-6177225/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b878a1f-3ab5-45c0-a985-064ff2ad32e1","owner":[],"postedDate":"March 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-31T09:23:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-17 08:43:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6177225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6177225","identity":"rs-6177225","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}