Abstract
Introduction The aim of this study was to assess the adherence to the European Association of
Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the
management of undescended testes (UDT).
Materials and Methods An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons'
Association (EUPSA).
Results Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively.
In total, 92% recommend conservative management of retractile testes and 58% offer
close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography.
If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy.
In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending
spermatic vessel is heterogenous with a majority ending the operation, followed by
exploration of the inguinal canal and removal of the testicular nubbin with optional
fixation of the contralateral testis. Only a minority recommends hormonal therapy
to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal
in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines.
Unawareness of guidelines was the most common reason cited for nonadherence. International
guidelines were found to have the greatest influence on clinical practice; however,
personal experience and institutional practice seem to play an important role.
Conclusion Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members;
however, personal and institutional practice impact decision making. Hormonal therapy
in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could
be improved.
Keywords undescended testis - cryptorchidism - pediatric surgery - practice patterns - guidelines
