Abstract
BackgroundAn evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.MethodsOurs is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.ResultsOverall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.ConclusionsOur study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.
Highlights
An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones
After the exclusion of 3 cases who did not meet the inclusion criteria and 5 cases with spontaneous resolution of cryptorchidism in the first 6 months of age, 169 children were considered in the final analysis: 127 with UT and 41 with retractile testis (RT) (1 with unknown position)
Our study showed that one out of 4 children with UT have been treated with hormones (55% of patients treated with human chorionic gonadotropin (hCG), 45% with luteinizing hormone-releasing hormone (LHRH)) as first line therapy at a mean age of 21,6 months
Summary
An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. An up-to-date evidence-based Consensus on the treatment of UT has been published [3] with the following recommendations: a) hormones are not recommended [4]; b) orchidopexy should be performed between 6 and 12 months of age, or upon diagnosis, if it occurs later; c) orchidopexy should be performed at centres with both paediatric surgeons or urologists and paediatric anaesthesiologists These recommendations, in line with those by Swiss surgeons [5], are important in order to avoid adulthood consequences of UT, such as azoospermia or oligospermia [6,7], endocrine insufficiency [8,9] and possible tumoral degeneration [10,11,12]. According to the Consensus, RT should not undergo surgery but should be followed-up once yearly given the possible risk of reascent [13,14,15]
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