Early Orchidopexy Does Prevent Testicular Cancer

Abstract

Urology| August 01 2003 Early Orchidopexy Does Prevent Testicular Cancer AAP Grand Rounds (2003) 10 (2): 13–14. https://doi.org/10.1542/gr.10-2-13 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Early Orchidopexy Does Prevent Testicular Cancer. AAP Grand Rounds August 2003; 10 (2): 13–14. https://doi.org/10.1542/gr.10-2-13 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: orchidopexy, testicular cancer, cryptorchidism Source: Herrinton L, Zhao W, Husson G. Management of cryptorchidism and risk of testicular Herrinton L, Zhao W, Husson G. Management of cryptorchidism and risk of testicular cancer. Am J Epidemiol. 2003;157:602–605. A history of cryptorchidism is considered a risk factor for developing carcinoma of the testis. Traditionally, patients have been counseled that orchidopexy does not reduce the risk of developing testicular carcinoma but that it does facilitate early diagnosis. These statements are based on epidemiologic data from a time period when orchidopexy was generally performed in older children and adolescents. In recent decades, orchidopexy has been recommended around the patient’s first birthday. This case-control study using medical records of 183 Kaiser Permanente members diagnosed with testicular cancer from 1973–1996 and 551 controls sought to clarify the effect of orchidopexy on testicular cancer risk. The odds ratio for the association of a history of cryptorchidism and testicular cancer was 4.8 (95% CI, 1.9–11.8). Patients who were successfully treated with orchidopexy prior to their 11th birthday were not at an increased risk for testicular carcinoma (odds ratio 0.6; 95% CI, .08–5.4). Those with successful orchidopexy after their 11th birthday or those who never underwent orchidopexy had a 32-fold increased risk (95% CI, 4–250). The authors data, added to the recent literature,1,2 strongly suggests that early successful orchidopexy does, in fact, preclude the increased risk of testis carcinoma that is associated with a history of cryptorchidism. Orchidopexy should occur around the child’s first birthday. Persistent cryptorchidism should be treated with repeat orchidopexy or even orchiectomy. The increased risk of carcinoma was traditionally attributed to inherent abnormalities of the testis that led initially to maldescent and, subsequently, to neoplasia. The lower occurrence of carcinoma in the contralateral, normally descended testis was offered as support of this hypothesis.2 Since 3% of male infants are diagnosed with an undescended testis, then 3% of testicular cancers would be expected to develop in patients with a history of cryptorchidism if there were not an increased risk. Again, if there was not an increased risk, half of the tumors in patients with a history of cryptorchidism should occur in the contralateral descended testis. In fact, the frequency of tumors that developed in the contralateral descended testis was only 0.9–1.3%.2 The need for medical records spanning infancy to adulthood makes replicating this study using a larger sample size unlikely without a multi-center collaboration. Since that is not likely to happen in the near future, we need to strongly consider orchidopexy at age 1 year and, based on this study, certainly prior to adolescence in patients with cryptorchidism. You do not currently have access to this content.