Cryptorchidism: A 20-Year Journey of Patient Outcomes and Family Concerns – A Cohort Study at a Single Center

Background: Undescended testis (UDT), or cryptorchidism, is a prevalent pediatric condition with significant implications for fertility and malignancy risk if untreated. Affecting 1–5% of male infants, UDT is influenced by genetic, hormonal, and environmental factors. Methods: This retrospective cohort study examines 470 pediatric UDT cases treated at a single center over two decades (2004–2024) at a single pediatric surgery center - The Maternity and Child Teaching Hospital, Al Qadisiya, Iraq, focusing on surgical outcomes, fertility, long-term testicular health, and family concerns. Inclusion criteria; Patients were identified from hospital records and outpatient clinic registries confirmed diagnosis of UDT (unilateral or bilateral), availability of complete medical records, patients who underwent chromosomal analysis as part of their diagnostic workup, and underwent surgical intervention within the study timeframe at our center with at least three years of follow-up. Results: The mean age at diagnosis was 18 months, with 45% diagnosed within the first year. Unilateral UDT predominated (60%), and testicular position influenced size and outcomes. Surgical success was achieved in 90% of cases, with minor complications including wound infections (5%) and reoperations (5%). Earlier diagnosis correlated with improved fertility outcomes, with normal spermatogenesis observed in 75% of early cases but declining significantly with delayed treatment (P < 0.05). Chromosomal abnormalities, present in 9% of patients, heightened family concerns, particularly regarding fertility and psychosocial impacts. Conclusion: Family concerns evolved through stages of care, initially focusing on fertility and malignancy risks, then shifting to surgical safety and postoperative recovery. Tailored counseling and psychosocial support were integral to family satisfaction. This study underscores the importance of early diagnosis, multidisciplinary care, and culturally sensitive family engagement to optimize outcomes and enhance the quality of life for patients with UDT. Future recommendations include routine genetic screening and targeted educational initiatives to address community-specific challenges.