European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes

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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.

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Article · Nov 2023 · 1 min read

In brief

This 2023 EUPSA survey reveals variable adherence to EAU/ESPU guidelines for undescended testis management among European pediatric surgeons. While most follow core recommendations like laparoscopic evaluation and staged procedures for high testes, significant practice variation exists in surgical timing, hormonal therapy use, and management of vanishing testes and postpubertal cases.

Only 46% of European pediatric surgeons perform orchidopexy before 12 months, despite EAU/ESPU guideline recommendations for early intervention.
Laparoscopy is the preferred diagnostic approach for nonpalpable testes (78%), with most surgeons performing single-stage orchidopexy for peeping testes.
Hormonal therapy for bilateral UDT remains underutilized, with only a minority of surgeons recommending it to improve fertility potential.
Management of vanishing testes shows significant practice variation, indicating a need for clearer guideline recommendations in this scenario.
Personal experience and institutional practice strongly influence surgical decisions, even among surgeons who report following international guidelines.

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