The ultrasonic description of postpubertal testicles in men who have undergone prepubertal orchiopexy for cryptorchidism

Purpose: We provide a sonographic description of postpubertal testicles in patients who have undergone prepubertal orchiopexy with placement; of a sut ure through the tunica albuginea, Materials and Methods: Testicular ultrasound was performed in men who had u ndergone prepubertal testicular fixation for cryptorchidism using a suture passed through the tunica albuginea. Comparison was made to the sonographic appearance of cryptorchid testicles not secured with a fixating suture thr ough the tunica albuginea. The operative report for each patient was review ed with specific attention to use and type of suture material, and age at o rchiopexy, Results: Ultrasonography was performed on 22 men in whom a tunica albuginea fixating suture was placed during orchiopexy for cryptorchidism, Average p atient age at orchiopexy was 5.6 years and median time from orchiopexy to t his examination was 14.8 years, Right cryptorchidism existed in 64% of-the men, No significant difference was noted in size between the 2 testicles in any patient. Ultrasonography did not identify any parenchymal abnormalitie s, A tunica albuginea calcification with posterior shadowing on the side of fixation was noted in 32% of patients, of whom 3 had calcified areas evide nt on physical examination. An area of subtunical hypoechogenicity was note d in 14% of patients. All tunical abnormalities were associated with the us e of chromic suture. The remaining 12 patients (54%) had normal sonographic and physical examinations. The control group comprised 6 men who underwent orchiopexy without a fixating suture through the tunica albuginea. These m en were examined identically and no sonographic abnormalities were noted in the tunica albuginea or testicular parenchyma. At a median of 16 months no patient had been diagnosed with testicular cancer or had a change in testi cular self-examination. Conclusions: Tunics albuginea calcifications and hypoechogenic cysts are co mmon ultrasonic findings in men who have undergone orchiopexy using a sutur e passed through the tunica albuginea. Parenchymal lesions should not be co nsidered secondary to this procedure and must be treated as de novo abnorma lities. These changes seem to be induced by the use of a fixating suture th rough the tunica albuginea.