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Ideal timing of orchiopexy: a systematic review

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Abstract

The ideal management of cryptorchidism is a highly debated topic within the field of pediatric surgery. The optimal timing of orchiopexy is particularly unclear, as existing literature reports mixed recommendations. The aim of this study was to determine, based on a systematic review, the most favorable age at which orchiopexy should be performed. We conducted a systematic search of MEDLINE, Embase, CINAHL, and the Cochrane Library to find relevant articles. Two researchers quality assessed each study using the following tools: AMSTAR (systematic reviews), Jadad (RCTs), and MINORS (non-RCTs). We developed a conclusion based on the highest quality studies. We found one relevant systematic review, one RCT, and 30 non-RCTs. Fertility potential was greatest when orchiopexy was performed before 1 year of age. Additionally, orchiopexy before 10–11 years may protect against the increased risk of testicular cancer associated with cryptorchidism. Orchiopexy should not be performed before 6 months of age, as testes may descend spontaneously during the first few months of life. The highest quality evidence recommends orchiopexy between 6 and 12 months of age. Surgery during this timeframe may optimize fertility potential and protect against testicular malignancy in children with cryptorchidism.

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References

  1. Cortes D, Kjellberg EM, Breddam M et al (2008) The true incidence of cryptorchidism in Denmark. J Urol 179:314–318

    Article  PubMed  Google Scholar 

  2. Thonneau PF, Candia P, Mieusset R (2003) Cryptorchidism: incidence, risk factors, and potential role of environment; an update. J Androl 24:155

    PubMed  Google Scholar 

  3. Thong M, Lim C, Fatimah H (1997) Undescended testes: incidence in 1,002 consecutive male infants and outcome at 1 year of age. Pediatr Surg Int 13:37–41

    Article  Google Scholar 

  4. Pasqualotto FF, Locambo CV, Athayde KS et al (2003) Measuring male infertility: epidemiological aspects. Rev Hosp Clín Fac Med Univ São Paulo 58:173–178

    Google Scholar 

  5. Murphy F, Paran TS, Puri P (2007) Orchidopexy and its impact on fertility. Pediatr Surg Int 23:625–632

    Article  PubMed  Google Scholar 

  6. Cendron M, Keating MA, Huff DS et al (1989) Cryptorchidism, orchiopexy and infertility: a critical long-term retrospective analysis. J Urol 142:559–562 discussion 572

    CAS  PubMed  Google Scholar 

  7. Bostofte E, Serup J, Rebbe H (1982) Relation between sperm count and semen volume, and pregnancies obtained during a twenty-year follow-up period. Int J Androl 5:267–275

    Article  CAS  PubMed  Google Scholar 

  8. Bonde JPE, Ernst E, Jensen TK et al (1998) Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. The Lancet 352:1172–1177

    Article  CAS  Google Scholar 

  9. Comploj E, Pycha A (2012) Diagnosis and management of cryptorchidism. Eur Urol Suppl 11:2–9

    Article  Google Scholar 

  10. Batata M, Whitmore W Jr, Hilaris B et al (1976) Cancer of the undescended or maldescended testis. Am J Roentgenol 126:302–312

    Article  CAS  Google Scholar 

  11. Canavese F, Mussa A, Manenti M et al (2009) Sperm count of young men surgically treated for cryptorchidism in the first and second year of life: fertility is better in children treated at a younger age. Eur J Pediatr Surg 19:388–391

    Article  CAS  PubMed  Google Scholar 

  12. Pettersson A, Richiardi L, Nordenskjold A et al (2007) Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 356:1835–1841

    Article  CAS  PubMed  Google Scholar 

  13. Bruijnen CJ, Vogels HD, Beasley SW (2008) Review of the extent to which orchidopexy is performed at the optimal age: implications for health services. ANZ J Surg 78:1006–1009

    Article  PubMed  Google Scholar 

  14. Kollin C, Karpe B, Hesser U et al (2007) Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. J Urol 178:1589–1593

    Article  PubMed  Google Scholar 

  15. Park KH, Lee JH, Han JJ et al (2007) Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis. Int J Urol 14:616–621

    Article  PubMed  Google Scholar 

  16. Kim S, Hwang EC, Hwang IS et al (2011) Testicular catch up growth: the impact of orchiopexy age. Urology 78:886–889

    Article  PubMed  Google Scholar 

  17. Mengel W, Hienz H, Sippe W II et al (1974) Studies on cryptorchidism: a comparison of histological findings in the germinative epithelium before and after the second year of life. J Pediatr Surg 9:445–450

    Article  CAS  PubMed  Google Scholar 

  18. Canadian association of pediatric surgeons: CAPS evidence-based resource (2013)

  19. Graham B, Regehr G, Wright JG (2003) Delphi as a method to establish consensus for diagnostic criteria. J Clin Epidemiol 56:1150–1156

    Article  PubMed  Google Scholar 

  20. Shea BJ, Grimshaw JM, Wells GA et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10

    Article  PubMed Central  PubMed  Google Scholar 

  21. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  22. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  PubMed  Google Scholar 

  23. Kogan SJ, Tennenbaum S, Gill B et al (1990) Efficacy of orchiopexy by patient age 1 year for cryptorchidism. J Urol 144:508–509 discussion 512–513

    CAS  PubMed  Google Scholar 

  24. Lee PA, O’Leary LA, Songer NJ et al (1996) Paternity after unilateral cryptorchidism: a controlled study. Pediatrics 98:676–679

    CAS  PubMed  Google Scholar 

  25. Wiser A, Raviv G, Weissenberg R et al (2009) Does age at orchidopexy impact on the results of testicular sperm extraction? Reprod Biomed Online 19:778–783

    Article  CAS  PubMed  Google Scholar 

  26. Tasian GE, Hittelman AB, Kim GE et al (2009) Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol 182:704–709

    Article  PubMed  Google Scholar 

  27. McAleer IM, Packer MG, Kaplan GW et al (1995) Fertility index analysis in cryptorchidism. J Urol 153:1255–1258

    Article  CAS  PubMed  Google Scholar 

  28. Taskinen S, Wikstrom S (1997) Effect of age at operation, location of testis and preoperative hormonal treatment on testicular growth after cryptorchidism. J Urol 158:471–473

    Article  CAS  PubMed  Google Scholar 

  29. Trsinar B, Muravec UR (2009) Fertility potential after unilateral and bilateral orchidopexy for cryptorchidism. World J Urol 27:513–519

    Article  PubMed  Google Scholar 

  30. Coughlin MT, Bellinger MF, Lee PA (1999) Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. J Urol 162:986–988

    Article  CAS  PubMed  Google Scholar 

  31. Engeler DS, Hösli PO, John H et al (2000) Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Urology 56:144

    Article  CAS  PubMed  Google Scholar 

  32. Hadziselimovic F, Herzog B (2001) The importance of both an early orchidopexy and germ cell maturation for fertility. The Lancet 358:1156–1157

    Article  CAS  Google Scholar 

  33. Nagar H, Haddad R (1997) Impact of early orchidopexy on testicular growth. Br J Urol 80:334–335

    Article  CAS  PubMed  Google Scholar 

  34. Riebel T, Herrmann C, Wit J et al (2000) Ultrasonographic late results after surgically treated cryptorchidism. Pediatr Radiol 30:151–155

    Article  CAS  PubMed  Google Scholar 

  35. Lee PA, Coughlin MT (2002) Leydig cell function after cryptorchidism: evidence of the beneficial result of early surgery. J Urol 167:1824–1827

    Article  PubMed  Google Scholar 

  36. Lala R, De Sanctis C, Canavese F et al (1992) Early medical and surgical treatment of cryptorchidism: clinical, anatomic, and histologic findings. Pediatr Surg Int 7:368–371

    Article  Google Scholar 

  37. Gracia J, Sanchez Zalabardo J, Sanchez Garcia J et al (2000) Clinical, physical, sperm and hormonal data in 251 adults operated on for cryptorchidism in childhood. BJU Int 85:1100–1103

    Article  CAS  PubMed  Google Scholar 

  38. Puri P, O’Donnell B (1988) Semen analysis of patients who had orchidopexy at or after seven years of age. Lancet 332:1051–1052

    Article  Google Scholar 

  39. Kumar D, Bremner D, Brown P (1989) Fertility after orchiopexy for cryptorchidism: a new approach to assessment. Br J Urol 64:516–520

    Article  CAS  PubMed  Google Scholar 

  40. Taskinen S, Hovatta O, Wikstrom S (1996) Early treatment of cryptorchidism, semen quality and testicular endocrinology. J Urol 156:82–84

    Article  CAS  PubMed  Google Scholar 

  41. Cortes D, Thorup M Jr, Visfeldt J (2001) Cryptorchidism: aspects of fertility and neoplasms. Horm Res Paedia 55:21–27

    Article  CAS  Google Scholar 

  42. Walsh TJ, Dall’Era MA, Croughan MS et al (2007) Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. Comment J Urol 178:1440–1446

    Article  Google Scholar 

  43. Strader CH, Weiss NS, Daling JR et al (1988) Cryptorchism, orchiopexy, and the risk of testicular cancer. Am J Epidemiol 127:1013–1018

    CAS  PubMed  Google Scholar 

  44. Forman D, Pike M, Davey G et al (1994) Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise. BMJ 308:1393–1399

    Article  Google Scholar 

  45. Herrinton LJ, Zhao W, Husson G (2003) Management of cryptorchism and risk of testicular cancer. Am J Epidemiol 157:602–605

    Article  PubMed  Google Scholar 

  46. Møller H, Prener A, Skakkebxk NE (1996) Testicular cancer, cryptorchidism, inguinal hernia, testicular atrophy, and genital malformations: case-control studies in Denmark. Cancer Causes Control 7:264–274

    Article  PubMed  Google Scholar 

  47. Pinczowski D, McLaughlin J, Läckgren G et al (1991) Occurrence of testicular cancer in patients operated on for cryptorchidism and inguinal hernia. J Urol 146:1291

    CAS  PubMed  Google Scholar 

  48. Swerdlow A, Higgins C, Pike M (1997) Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ 314:1507–1511

    Article  CAS  PubMed  Google Scholar 

  49. Wenzler DL, Bloom DA, Park JM (2004) What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol 171:849–851

    Article  PubMed  Google Scholar 

  50. Hamza A, Elrahim M, Elnagar O et al (2001) Testicular descent: when to interfere? Eur J Pediatr Surg 11:173–176

    Article  CAS  PubMed  Google Scholar 

  51. Virtanen H, Toppari J (2008) Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 14:49–58

    Article  CAS  PubMed  Google Scholar 

  52. Ritzén EM, Bergh A, Bjerknes R et al (2007) Nordic consensus on treatment of undescended testes. Acta Paediatr 96:638–643 Oslo, Norway: 1992

    Article  PubMed  Google Scholar 

  53. Springer A, Huber C, Reck C et al (2010) Delayed referral despite appropriate knowledge in cryptorchidism as a cause of delayed orchidopexies in Austria. Klinische Pädiatrie 222:248–251

    Article  CAS  PubMed  Google Scholar 

  54. Kokorowski PJ, Routh JC, Graham DA et al (2010) Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism. Pediatrics 126:576–582

    Article  Google Scholar 

  55. Steckler RE, Zaontz MR, Skoog SJ et al (1995) Cryptorchidism, pediatricians, and family practitioners: patterns of practice and referral. J Pediatr 127:948–951

    Article  CAS  PubMed  Google Scholar 

  56. Thorup J, Jensen C, Langballe O et al (2011) The challenge of early surgery for cryptorchidism. Scand J Urol Nephrol 45:184–189

    Article  CAS  PubMed  Google Scholar 

  57. Bujan L, Mieusset R, Mansat A et al (1989) Testicular size in infertile men: relationship to semen characteristics and hormonal blood levels. Br J Urol 64:632–637

    Article  CAS  PubMed  Google Scholar 

  58. Takihara H, Cosentino M, Sakatoku J et al (1987) Significance of testicular size measurement in andrology II. Correlation of testicular size with testicular function. J Urol 137:416

    CAS  PubMed  Google Scholar 

  59. Puri P, Sparnon A (1990) Relationship of primary site of testis to final testicular size in cryptorchid patients. Br J Urol 66:208–210

    Article  CAS  PubMed  Google Scholar 

  60. Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181:452–461

    Article  PubMed  Google Scholar 

  61. Elder J (1988) The undescended testis. Hormonal and surgical management. Surg Clin North Am 68:983–1005

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H 8L6, Canada

    Emily Chan, Carolyn Wayne & Ahmed Nasr

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  1. Emily Chan
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  2. Carolyn Wayne
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  3. Ahmed Nasr
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FRCSC for the Canadian Association of Pediatric Surgeon Evidence-Based Resource

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Correspondence to Ahmed Nasr.

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Chan, E., Wayne, C., Nasr, A. et al. Ideal timing of orchiopexy: a systematic review. Pediatr Surg Int 30, 87–97 (2014). https://doi.org/10.1007/s00383-013-3429-y

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