TIMING OF ORCHIDOPEXY – SERBIAN REFERRAL CENTER EXPERIENCE
Keywords:
cryptorchidism, pediatrics, timely surgery, orchidopexy, testical cancerAbstract
Introduction: Undescended testis or cryptorchidism is one of the most common male congenital malformations of genitalia where one or both testes have not moved into the scrotum. The therapy gold standard is orchidopexy. European guidelines are recommending intervention between the ages of 6 to 12 months, and American Urology Association from 6 to 18 months, to lower the risks of subfertility and testicular carcinoma.
Objective: The aim of the study is to evaluate whether orchidopexy performed for patients referred to our center is done within the recommended time period.
Methods: We retrospectively reviewed the charts of patients with cryptorchidismtreated in our center from 2016 to 2018. We classified the timing of orchidopexy before the 18 months and after the 18 months.
Results: A total of 322 children were treated in our center during the study period. All patients underwent surgical treatment that included: orchidopexy (300 pts., 93.2%), orchiectomy (5 pts., 1.6%), laparoscopic exploration of abdominal cavity (13 pts., 4%) and testicle rudiment resection (4 pts., 1.2%). The median age at surgery was 4 years (range 0.9–18). Operation was done in the optimal period within 18 months of age in only 68 patients (21.1%).
Conclusion: The majority of the patients studied at our center had operation at a later age than recommended because of late referrals. National program for educating referring physicians and parents is necessary to reduce the impact of delayed surgery.
References
Sijstermans K, Hack WW, Meijer RW, van der Voort-Doedens LM. The frequency of undescended testis from birth to adulthood: a review. Int J Androl. 2008; 31(1):1-11.
Berkowitz GS, Lapinski RH, Dolgin SE, Gazella JG, Bodian CA, Holzman IR. Prevalence and natural history of cryptorchidism. Pediatrics. 1993; 92(1):44-9.
Kollin C, Ritzén EM. Cryptorchidism: a clinical perspective. Pediatr Endocrinol Rev. 2014; 11(2):240-50.
Barthold JS, González R. The epidemiology of congenital cryptorchidism, testicular ascent and orchiopexy. J Urol. 2003; 170(6):2396-401.
Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay S, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol. 2016; 12(6):335-43.
Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et al. American Urological Assocation. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014; 192(2):337-45.
Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976; 8(1):33-4.
Gatti JM1, Ostlie DJ. The use of laparoscopy in the management of nonpalpable undescended testes. Curr Opin Pediatr. 2007; 19(3):349-53.
Dieckmann KP, Pichlmeier U. Clinical epidemiology of testicular germ cell tumors. World J Urol. 2004; 22(1):2-14.
Engeler DS, Hösli PO, John H, Bannwart F, Sulser T, Amin MB, et al. Early orchiopexy: prepubertal intratubular germ cell neoplasia and fertility outcome. Urology 2000; 56(1):144-8.
Park KH, Lee JH, Han JJ, Lee SD, Song SY. Histological evidences suggest recommending orchiopexy within the first year of life for children with unilateral inguinal cryptorchid testis. Int J Urol. 2007; 14(7):616-21.
Virtanen HE, Cortes D, Rajpert-De Meyts E, Ritzén EM, Nordenskjöld A, Skakkebaek NE, et al. Development and descent of the testis in relation to cryptorchidism. Acta Paediatr. 2007; 96(5):622-7.
Hadziselimovic F, Hocht B, Herzog B, Buser MW. Infertility in cryptorchidism is linked to the stage of germ cell development at orchidopexy. Horm Res. 2007; 68(1):46-52.
Hadziselimovic F, Herzog B, Buser M. Development of cryptorchid testes. Eur J Pediatr. 1987; 146(Suppl 2):S8-12.
Kollin C, Karpe B, Hesser U, Granholm T, Ritzén EM. Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years. J Urol. 2007; 178(4 Pt 2):1589-93. discussion 1593.
Canavese F, Mussa A, Manenti M, Cortese MG, Ferrero L, Tuli G, et al. 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. 2009; 19(6):388-91.
Walsh TJ, Dall'Era MA, Croughan MS, Carroll PR, Turek PJ. Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. 2007; 178(4 Pt 1):1440-6; discussion 1446.
Bayne AP, Alonzo DG, Hsieh MH, Roth DR. Impact of anatomical and socioeconomic factors on timing of urological consultation for boys with cryptorchidism. J Urol. 2011; 186(4 Suppl):1601-5.
Kokorowski PJ, Routh JC, Graham DA, Nelson CP. Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism. Pediatrics 2010; 126(3):e576-82.
Yiee JH, Saigal CS, Lai J, Copp HL, Churchill BM, Litwin MS; Urologic Diseases in America Project. Timing of orchiopexy in the United States: a quality-of-care indicator. Urology 2012; 80(5):1121-6.
Hensel KO, Caspers T, Jenke AC, Schuler E, Wirth S. Operative management of cryptorchidism: guidelines and reality-a 10-year observational analysis of 3587 cases. BMC Pediatr. 2015; 15:116-24.
Hrivatakis G, Astfalk W, Schmidt A, Hartwig A, Kugler T, Heim T, et al. The timing of surgery for undescended testis - a retrospective multicenter analysis. Dtsch Arztebl Int. 2014; 111(39):649-57.
Dave S, Liu K, Garg AX, Shariff SZ. Secular trends in the incidence and timing of surgical intervention for congenital undescended testis and surgically treated hypospadias in Ontario, Canada between 1997 and 2007. J Pediatr Urol. 2018; 14(6):552.e1-552.e7.
Alhazmi H, Junejo NN, Albeaiti M, Alshammari A, Aljallad H, Almathami A, et. al. Timing of orchidopexy at a tertiary center in Saudi Arabia: reasons for late surgery. Ann Saudi Med. 2018; 38(4):284-7.
Hidas G, Ben Chaim J, Udassin R, Graeb M, Gofrit ON, Zisk-Rony RY, et. al. Timing of Orchidopexy for Undescended Testis in Israel: A Quality of Care Study. Isr Med Assoc J. 2016; 18(11):697-700.
