The timing of surgery for undescended testis - a retrospective multicenter analysis

Abstract

Background: n Germany, it is recommended that the surgical treatment of an undescended testis should be carried out between the ages of 6 months and 1 year to lower the risks of subfertility and testicular carcinoma. Although this recommendation has appeared in the German guidelines from 2007 onward, orchidopexy is still frequently performed at later ages.

Method: We retrospectively analyzed data from seven pediatric surgical services in the German state of Baden-Württemberg on all boys who underwent orchidopexy from 2009 to 2012. We classified the timing of surgery as Age Group I (before the first birthday), Age Group II (between the first and second birthdays), and Age Group III (after the second birthday). We determined whether preoperative hormonal treatment was given and distinguished primary from secondary undescended testis.

Results: Among 2213 boys who underwent orchidopexy, 1850 had primary and 363 had secondary undescended testis. Of those with primary undescended testis, the percentages of boys who underwent surgery in Age Groups I, II, and III were (respectively, with 95% confidence intervals): 18.7% (17-20.6%), 24.4% (22.5-26.5%), and 57% (54.6-59.2%). A small percentage of boys in each group also received preoperative hormonal treatment. From 2009 to 2012, there was a secular trend favoring earlier orchidopexy. In 2012, 28 boys (14.2% [9.7-20.0%]) had orchidopexy in outpatient pediatric surgery practices before their first birthday, while 68 did on hospital inpatient services (40.7% [33.2-48.6%]).

Conclusion: Most of the patients studied had surgery at a later age than recommended. Adherence to the guidelines in this respect is nonetheless relatively good in Germany compared to other countries, as studies from abroad have yielded findings that are just as bad or worse.

Figure 1

Differences between a) outpatient practices and b) hospital services with respect to the percentage of orchidopexies in each age category

Figure 2

International comparison with respect to mean age at time of orchidopexy (a), mean age on presentation (b), and the percentage of orchidopexies performed up to the age of 12 (c) or 24 (d) months. GB, United Kingdom; USA, United States of America; A, Austria; S, Sweden; DK, Denmark; CN, People‘s Republic of China; SGP, Singapore; NZ, New Zealand; RIL, Republic of Ireland; I, Italy; D, Germany.