Prevalence and risk factors of acquired undescended testis in boys with cerebral palsy: A cross-sectional study.

BACKGROUND: Boys with cerebral palsy (CP) are at increased risk for acquired undescended testis (aUDT), yet the prevalence, associated risk factors, and clinical consequences of UDT in this population remain incompletely defined. Delayed recognition may predispose affected patients to testicular atrophy and long-term reproductive complications. METHODS: This cross-sectional study included 240 boys aged 1-15 years with a confirmed diagnosis of CP who underwent standardized genital examination at a tertiary care center. aUDT was defined as a testis previously documented as scrotal but subsequently found outside the scrotum. Neurological characteristics, perinatal factors, comorbidities, hormonal profiles, and ultrasonographic findings were analyzed. Multivariable logistic regression was used to identify independent factors associated with aUDT. RESULTS: aUDT was identified in 58 patients (24.2%). The prevalence of UDT differed significantly according to motor severity and was highest among boys classified in the most severe Gross Motor Function Classification System (GMFCS) category (p = 0.017). Boys with UDT had lower gestational age and birth weight. The prevalence of aUDT was significantly higher among premature boys and those with a history of neonatal intensive care unit (NICU) admission and was also associated with a longer NICU stay (all p < 0.05). aUDT was also significantly more prevalent in patients with malnutrition or gastrostomy requirement (p < 0.001), hip dysplasia (p < 0.001), and scoliosis (p = 0.005). Multivariable analysis identified prematurity (OR 2.6; 95% CI 1.3-5.2), hip dysplasia (OR 3.1; 95% CI 1.2-8.3), and malnutrition or gastrostomy requirement (OR 3.1; 95% CI 1.6-6.1) as independent predictors of aUDT. Hormonal parameters did not differ between boys with and without UDT. Testicular atrophy was observed in 34.5% of boys with UDT and was markedly more common among newly diagnosed cases than previously recognized cases (65.4% vs. 9.4%, p < 0.001). CONCLUSION: aUDT is common among boys with CP and is strongly associated with motor severity and multiple perinatal and clinical risk factors. The high prevalence of testicular atrophy in newly identified cases highlights the consequences of delayed recognition. Routine, structured genital examination should be incorporated into multidisciplinary follow-up of boys with CP, particularly those with severe motor impairment or significant comorbidities, to enable timely detection and intervention.