INTRODUCTION AND OBJECTIVES: It is well established that orchiopexy for the intra-abdominal testicle is associated with a higher rate of postoperative testis atrophy than orchiopexy for the inguinal testis. As it has been suggested that HCG (human chorionic gonadotropin) injections may increase blood flow to the testis, we evaluated if the use of preoperative HCG therapy could reduce the rate of postoperative atrophy after orchiopexy.

METHODS: We retrospectively reviewed charts from 1027 consecutive orchiopexies between 2006 and 2008 to determine those who had intra-abdominal testicles at the time of surgery. Patients were given or not given HCG injections preoperatively at the discretion of the surgeon. Both laparoscopic and open inguinal approaches were included. Success was defined as survival of the testicle and its presence in the scrotum. We used Chi-square test and Fisher exact test to conduct the analysis.

RESULTS: Nonpalpable testes were identified preoperatively in 214/1027 (20.8%) cases. 107 received HCG (case group) as compared to 107 who did not (control group). In the case group, 85 testicles were intra-abdominal at the time of exploration and 54 in the control group. Survival rates were 92.2% at a median follow up of 203 days and 94.0% at a median follow up of 25.5 days in the case and control groups, respectively. The overall survival for case and control group is not significant (p=0.3383). There was no difference in survival between those who had laparoscopy as compared to an open approach either for the case group or the control group. In the case group, 12.9% (11/85) underwent Fowler-Stephens orchiopexy (FSO) with a survival of 77.8% which is not significantly different from those who did not have FSO (p=0.2417). Similarly in the control group, 14.8% (8/54) underwent FSO with a 50.0% survival which is significantly lower (p=0.001) with a survival rate of 100% for those who did not have FSO.

CONCLUSIONS: We have not demonstrated an improvement in the overall success of intra-abdominal orchiopexy with the preoperative use of HCG. Although there is no difference in need for FSO between the two groups, when performed there is a significantly reduced rate of survival in this subgroup of patients without HCG treatment. Success or other potential benefits from preoperative HCG therapy needs to be further evaluated with a randomized controlled trial.

Source of Funding: none