Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

Abstract

Background: Current guidelines recommend orchidopexy for cryptorchidism by 12 months of age, yet this is not universally adhered to. The aim of this systematic review and meta-analysis was to compare outcomes between orchidopexies performed before and after 1 year of age.

Methods: MEDLINE and Embase were searched (September 2015) using terms relating to cryptorchidism, orchidopexy and the outcomes of interest. Studies were eligible for inclusion if they compared orchidopexy at less than 1 year of age (early) with orchidopexy at 1 year or more of age (delayed) and reported the primary outcome (testicular atrophy) or one of the secondary outcomes (fertility potential, postoperative complication, malignancy). Studies were excluded when more than 50 per cent of infants had intra-abdominal testes, or the population included infants with disorders of sexual differentiation. Additional studies were identified through reference list searching. Unpublished data were sought from the ORCHESTRA study investigators.

Results: Fifteen eligible studies were identified from 1387 titles. There was no difference in atrophy rate between early orchidopexy and delayed orchidopexy (risk ratio 0·64, 95 per cent c.i. 0·25 to 1·66; 912 testes). Testicular volume was greater (mean difference 0·06 (95 per cent c.i. 0·01 to 0·10) ml; 346 testes) and there were more spermatogonia per tubule (mean difference 0·47 (0·31 to 0·64); 382 testes) in infants undergoing early orchidopexy, with no difference in complication rate (risk ratio 0·68, 0·27 to 1·68; 426 testes). No study reported malignancy rate.

Conclusion: Atrophy and complication rates do not appear different between early and delayed orchidopexy, and fertility potential may be better with early orchidopexy. Imprecision of the available data limits the robustness of these conclusions.

Figure 1

PRISMA diagram for the study

Figure 2

Forest plot comparing testicular atrophy in boys with cryptorchidism who underwent orchidopexy at less than 1 year of age with those who had the operation at or after the age of 1 year. A Mantel–Haenszel fixed‐effect model was used. Risk ratios are shown with 95 per cent confidence intervals

Figure 3

Forest plot comparing grouped postoperative complications, including testicular atrophy, in boys with cryptorchidism who underwent orchidopexy at less than 1 year of age with those who had the operation at or after the age of 1 year. A Mantel–Haenszel fixed‐effect model was used. Risk ratios are shown with 95 per cent confidence intervals

Figure 4

Forest plot comparing the number of spermatogonia per tubule in boys with cryptorchidism who underwent orchidopexy at less than 1 year of age with those who had the operation at or after the age of 1 year. An inverse‐variance fixed‐effect model was used. Mean differences are shown with 95 per cent confidence intervals

Figure 5

Forest plot comparing tubular diameter in boys with cryptorchidism who underwent orchidopexy at less than 1 year of age with those who had the operation at or after the age of 1 year. An inverse‐variance random‐effects model was used. Mean differences are shown with 95 per cent confidence intervals

Figure 6

Forest plot comparing testicular volume at surgery in boys with cryptorchidism who underwent orchidopexy at less than 1 year of age with those who had the operation at or after the age of 1 year. An inverse‐variance fixed‐effect model was used. Mean differences are shown with 95 per cent confidence intervals