Imaging Before Operation for Undescended Testes: Is It Necessary?

Introduction: Cryptorchidism occur in 1% of all males born full term. Existing international guidelines do not recommend routine pre-referral imaging, however, the use of imaging before operative intervention is still prevalent in our locality. Aim: To assess the use of radiological imaging prior to operative management for children with undescended testis (UDT) and their clinical impact. Method: Retrospective review of children under 17 years' old who underwent orchidopexy was done from January 2015 to January 2020. Demographics, types of imaging studies, the indications for imaging and its findings were correlated with intra-operative findings. Data analysis were done using Fisher-exact and student t-test. Results: A total of 286 testes in 254 patients were reviewed. Overall, 36.6% patients (n=93) had imaging before operative intervention. One hundred and four testes had imaging with 89 ultrasound and 4 magnetic resonance imaging before surgery. Imaging was booked by neonatologists (n=55, 52.8%), general paediatricians (n=23, 22.1%), paediatric surgeons (n=19, 18.3%), adult general surgeons (n=5.8%) and endocrinologist (n=1, 1.0%). Indications were to document testicular location (n=88, 84.6%), to detect mullerian structures (n=9, 8.7%), document testicular sizes (n=4, 3.8%) and for other reasons (n=3, 2.9%). Ultrasound only correctly identify testicular position in 26.0% (27/104 studies). Cost impact was HKD$25960 per annum. Conclusion: Pre-referral imaging is seen in more than one third of all UDT in our locality, of that less than a third correlate with intra-operative position. Therefore, we do not recommend pre-referral imaging for solely to localise the testis, but it might be useful in patient with suspicion of disorder of sexual development to look for Mullerian structures. Timely referral to paediatric surgical centre is crucial for better resource management.