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

Bsr., Allin; Dumann, Eva; Fawkner-Corbett, David; Kwok, Chun Shing; Skerritt, Clare

doi:10.1002/bjs5.36

Cited by 36 publications

(28 citation statements)

References 47 publications

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“…In another study, increased duration of undescended testis was significantly associated with increased depletion of germ cells (OR 1.02, for each month) and Leydig cells (OR 1.01, for each month) (212). A systematic review and meta-analysis in 2018 showed that boys who underwent orchiopexy before the age of 1 year had 0.06 mL larger testicular volume (95% CI 0.01-0.10) and higher number of spermatogonia per tubule [mean difference 0.47 (95% CI 0.31-0.64)] than those operated after 1 year of age (213). After orchiopexy in boys with unilateral cryptorchidism, serum inhibin B increased, and serum FSH decreased, suggesting an improved Sertoli cell function (214).…”

Section: Age At Treatmentmentioning

confidence: 99%

Hypogonadism and Cryptorchidism

et al. 2020

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Congenital cryptorchidism (undescended testis) is one of the most common congenital urogenital malformations in boys. Prevalence of cryptorchidism at birth among boys born with normal birth weight ranges from 1.8 to 8.4%. Cryptorchidism is associated with a risk of low semen quality and an increased risk of testicular germ cell tumors. Testicular hormones, androgens and insulin-like peptide 3 (INSL3), have an essential role in the process of testicular descent from intra-abdominal position into the scrotum in fetal life. This explains the increased prevalence of cryptorchidism among boys with diseases or syndromes associated with congenitally decreased secretion or action of androgens, such as patients with congenital hypogonadism and partial androgen insensitivity syndrome. There is evidence to support that cryptorchidism is associated with decreased testicular hormone production later in life. It has been shown that cryptorchidism impairs long-term Sertoli cell function, but may also affect Leydig cells. Germ cell loss taking place in the cryptorchid testis is proportional to the duration of the condition, and therefore early orchiopexy to bring the testis into the scrotum is the standard treatment. However, the evidence for benefits of early orchiopexy for testicular endocrine function is controversial. The hormonal treatments using human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) to induce testicular descent have low success rates, and therefore they are not recommended by the current guidelines for management of cryptorchidism. However, more research is needed to assess the effects of hormonal treatments during infancy on future male reproductive health.

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Section: Age At Treatmentmentioning

confidence: 99%

Hypogonadism and Cryptorchidism

et al. 2020

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“…53) A recent systematic review found no difference in testicular volume or spermatogonia in orchiopexy before versus after 1 year of age, although better fertility potential with orchiopexy performed before 1 year of age was found. 54) To protect fertility potential and decrease malignant changes, surgical exploration and orchiopexy are recommended between Table 3. Diagnostic imaging studies for undescended testes…”

Section: Surgical Therapymentioning

confidence: 99%

Comparison of diagnostic and treatment guidelines for undescended testis

Shin

Jeon

2020

Clin Exp Pediatr

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Cryptorchidism or undescended testis is the single most com mon genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, unde scended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treat ment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to pro tect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intraabdominal un de scended testis, or who underwent delayed orchiopexy. Pa tients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general pop ulation. Selfexamination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.

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“…Generally, the patient's age at the time of surgery is not considered to influence the success rate [Docimo, 1995]. In a recent systematic review on 912 orchidopexies, Allin et al [2018] found a 2.0% testicular atrophy rate after orchidopexy in patients <12 month of age compared to 4.9% in boys >12 months of age at surgery. The difference is not significant ( p = 0.36).…”

Section: Cosmeticsmentioning

confidence: 99%

“…Adult men with persisting cryptorchidism have azoospermia in 85% of bilateral cases and 15-20% of unilateral cases, because unilateral cryptorchidism may involve the same pathological mechanism in both testes [Cortes, 1998]. Today, there is good evidence that early orchidopexy for congenital cryptorchidism between 6 months and 1 year of age will improve the fertility potential dramatically in a significant part of bilateral as well as unilateral cases [Thorup et al, 2012[Thorup et al, , 2015Hutson et al, 2016c;Allin et al, 2018]. Some patients with syndromic cryptorchidism, as for example patients with Down syndrome or 45,X/46,XY males, will of course remain infertile.…”

Section: Fertilitymentioning

confidence: 99%

Surgical Management of Undescended Testis - Timetable and Outcome: A Debate

Thorup

Cortes

2019

Sex Dev

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Around 1.4-3.8% of boys in the Western world are operated because of cryptorchidism. This means that orchidopexy remains one of the most common surgical procedures performed in boys. As a consequence, several consensus reports, guidelines, and reviews dealing with the management of cryptorchidism have been published recently. Based on our research and 30 years' experience with the management of cryptorchidism, the intention of the present publication is to advise on the surgical management and comment on the expected outcome, especially with focus on the controversies related to guidelines and reviews. Except for late referral and waiting lists, which may be practical problems, there is no reason to postpone orchidopexy for nonsyndromic congenital cryptorchid testes beyond 6 months. There is good evidence that such strategy improves the fertility potential and decreases the risk of testicular cancer. In cases with genuine gonadotropin insufficiency, early surgical correction is not enough and adjuvant LH-RH treatment should be implemented to improve the fertility potential. Cryopreservation may be an option in case of treatment failure of adjuvant LH-RH. A prerequisite for such management includes serum hormone assessment and evaluation of testicular biopsies at orchidopexy. Ascended testes contribute to 20-60% of operative cases and should be treated when diagnosed.

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

Cited by 36 publications

References 47 publications

Hypogonadism and Cryptorchidism

Hypogonadism and Cryptorchidism

Comparison of diagnostic and treatment guidelines for undescended testis

Surgical Management of Undescended Testis - Timetable and Outcome: A Debate

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