An international multicenter cohort study of management and outcomes of undescended testis in German-speaking countries

BACKGROUND: Undescended 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. METHODS: We 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. RESULTS: Twenty-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 non-palpable 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 follow-up, 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. CONCLUSION: In 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.