Operative Management of Cryptorchidism: Guidelines and Reality--a 10-year Observational Analysis of 3587 Cases

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2015 Sep 12

PMID 26357871

Citations 15

Authors

Kai O Hensel

Tawa Caspers

Andreas C Jenke

Ekkehard Schuler

Stefan Wirth

Affiliations

Soon will be listed here.

Abstract

Background: Undescended testis (UDT) is the most common disorder in pediatric surgery and one of the most important risk factors for malignancy and subfertility. In 2009 local guidelines were modified and now recommend treatment to be completed by the age of 1. Aim of this study was to analyze age distribution at the time of orchidopexy, whether the procedure is performed according to guideline recommendations and to assess primary care pediatricians' attitude regarding their treatment approach.

Methods: We retrospectively analyzed 3587 patients with UDT regarding age at orchidopexy between 2003 and 2012 in 13 German hospitals. Furthermore, we conducted an anonymized nation-wide survey among primary care pediatricians regarding their attitude toward management of UDT.

Results: Before modification of the guideline 78% (n = 1245) of the boys with UDT were not operated according to guideline recommendations. After the modification that number rose to 95% (n = 1472). 42% of the orchidopexies were performed on patients aged 4 to 17 years. 46% of the primary care pediatricians were not aware of this discrepancy and 38% would only initiate operative management after the first year of life. In hospitals with pediatric surgery departments significantly more patients received orchidopexy in their first year of life (p < .001).

Conclusion: The guideline for UDT in Germany has not yet been implemented sufficiently. Timing of orchidopexy must be optimized in order to improve long-term prognosis. Both primary care providers and parents should be educated regarding the advantages of early orchidopexy in UDT. Prospective studies are needed to elucidate the high rate of late orchidopexies.

Citing Articles

Surgical treatment of cryptorchidism: current insights and future directions.

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The Time of Diagnosis and Surgical Treatment of Congenital Cryptorchidism: A Single Center's Observational Study in Greece.

Kaselas C, Florou M, Tirta M, Bitzika S, Sidiropoulou D, Spyridakis I Cureus. 2024; 16(1):e51580.

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Orchidopexy for Ascending Testicles in Adulthood After Remote Hernia Repair: A Report of Two Cases.

Wald M Cureus. 2023; 15(6):e39885.

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Are we still too late? Timing of orchidopexy.

Schmedding A, van Wasen F, Lippert R Eur J Pediatr. 2023; 182(3):1221-1227.

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