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Recent studies have reported that the incidence of undescended testis (UDT) in patients with abdominal wall defects, such as gastroschisis and omphalocele, was as high as 40%.1,2 This is much higher than term infants without associated anomalies. Although various mechanical, hormonal, and genetic theories have been postulated to describe testicular descent,3,4 the mechanism contributing to this condition remains controversial. Several studies have postulated that failure of testicular descent is due to decreased intra-abdominal pressure. This was demonstrated in an experimental rat model.5 Kaplan et al. also demonstrated an association between abdominal wall defects (gastroschisis, omphalocele, and umbilical hernia) and the incidence of UDT.6 In general, patients with omphalocele have a high prevalence of associated malformations, including chromosomal abnormalities, which may cause testicular maldescent. Patients with gastroschisis rarely have associated malformations; thus, the pathogenesis of testicular maldescent in these patients remains unclear. Clinical factors related to UDT in patients with gastroschisis are poorly understood.
In this study, we aimed to investigate the incidence and risk factors associated with the presence of UDT in infants with gastroschisis.
MethodsMale neonates who underwent surgery for gastroschisis between January 1982 and December 2019 at our institution were enrolled in this study. We retrospectively reviewed the incidence of UDT from the clinical records by collecting the following information: gestational age, birthweight, Apgar score, and concomitant malformations. The maximum diameter of the abdominal defect (defect size), presence of liver prolapse, timing of abdominal wall closure, and duration of artificial respiration were evaluated to reflect the severity of gastroschisis. Additional patient data were analyzed including spontaneous testicular descent during the observation period and the necessity for orchidopexy. The patients were divided into two groups based on the presence or absence of UDT. Clinical factors, including gestational age, birthweight, Apgar score, prenatal diagnosis of gastroschisis, maximum diameter of the abdominal defect, presence of liver prolapse, concomitant malformations, timing of abdominal wall closure, and duration of artificial respiration were compared to identify the risk factors related to UDT.
In this study, the timing of abdominal wall closure was defined as the age at first fascial closure. For patients who underwent sutureless closure,7 the timing of abdominal wall closure was defined as the age at which the defect...