ROLE OF PREOPERATIVE INJECTION BETA-HCG IN OPEN ORCHIOPEXY FOR INTRAPERITONEAL UNDESCENDED TESTES – AN EXPERIENCE OF FIVE CASES FROM PERIPHERAL TERTIARY HEALTHCENTRE WITH REVIEW OF LITERATURE

Introduction: Cryptorchidism, or undescended testes (UDT) is defined as the failure of normal descent of the one or both testis into the scrotum. It is one of the most common congenital anomalies in male infants, with an estimated incidence of 1–3% in full-term neonates and up to 30% in preterm infants. Among these, 20–30% of cases involve non-palpable testes, which can be located intra-abdominally, inguinally, or absent altogether. [1] A normal functioning hypothalamic-pituitary-testicular (HPT) axis is essential for the testicular descend. [2] About 70% of UDT descend spontaneously till 1 year of age, especially before 3 months age, after which spontaneous descend is highly unlikely.[3] The management of non-palpable testes is essential to prevent complications such as infertility, testicular atrophy, testicular torsion, malignancy.[1,4] Human chorionic gonadotropin (hCG), a hormone that mimics the luteinizing hormone (LH), has been proposed as a therapeutic option to stimulate testicular descent in cases of cryptorchidism. Beta-hCG injections are used to trigger testosterone production in Leydig cells, potentially facilitating testicular descent especially in low lying testis in the inguinal canal or close to it. However, the efficacy of this approach, particularly in cases of intraperitoneal non-palpable testes, remains controversial, with success rates varying widely across studies. [5,6] Laparoscopic orchiopexy remains the standard treatment for non-palpable testes, hormonal therapy can be used as an adjunct to the open orchiopexy in selected cases of palpable UDT, lying close to the deep inguinal ring (DIR), especially in resource limited peripheral settings where, laparoscopic procedures are not possible due to unavailability of instruments and expertise. This case series aims to evaluate the role of Beta-hCG injection as an adjunct in the management of intraperitoneal undescended testes mostly at or around the DIR enhancing the efficacy, safety, and providing insights into optimizing open orchiopexy procedure in the resource limited rural settings.