Is routine excision of dysplastic testicular remnants/nubbins associated with nonpalpable testis necessary? Is routine fixation of contralateral solitary testis indicated? A survey on the prevalent practice among Indian pediatric surgeons

Abstract

Background and Aims: Dysplastic nubbin also referred to as testicular regression syndrome (TRS) is found in 5% of cases of the Non palpable testis (NPT). There is no consensus on the excision of the above and fixation of the contralateral solitary testis. We aimed to survey the prevalent practice of the same among members of the Indian Association of Pediatric Surgeons (IAPS). Methods: A structured questionnaire was sent through group e-mail and social media platforms to IAPS members to identify their practices in management. Results: A total of 132 surgeons responded to the questionnaire. Excision of intra-abdominal and inguinoscrotal TRS remnants was practiced by 84% (95% confidence interval [CI] 77%–89%) and 82% (95% CI 74%–87%). Fixation of contralateral solitary testis was practiced by 62% (95% CI 53%–70%) in the above scenario. Among the respondents, 30% reported encountering torsion of solitary testis during their career and this experience was a significant factor (P = 0.01) in deciding contralateral orchidopexy. Scrotal infection/necrosis was not encountered by a majority (72%) and it was not a deterrent factor in preventing contralateral orchidopexy (P = 0.68). Conclusions: The majority of pediatric surgeons favored the removal of intra-abdominal/inguinoscrotal TRS remnants identified during laparoscopy for NPT. A majority favored sutureless fixation of the contralateral solitary testis.

Keywords

• laparoscopy
• nonpalpable testis
• orchidopexy
• testicular nubbin
• testicular regression syndrome
• undescended testis
• vanishing testis syndrome