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

B S R Allin,C Kwok,E Dumann,D Fawkner-Corbett,C Skerritt

doi:10.1002/bjs5.36

B S R Allin, C Kwok + Show 3 more

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https://doi.org/10.1002/bjs5.36

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Abstract

BackgroundCurrent 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.MethodsMEDLINE 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 Unpublished data were sought from the ORCHESTRA study investigators.ResultsFifteen eligible studies were identified from 1387 titles.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.ConclusionAtrophy 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.

Highlights

Cryptorchidism affects between 2⋅4 and 5 per cent of live-born boys[1,2,3,4]
After hand-searching of the reference lists of the 12 eligible studies identified from database searching, a further three eligible studies were identified
Four studies[24,30,32,36] including 912 testes contributed data to analysis of the primary outcome, testicular atrophy, with no difference in rates seen between boys who underwent orchidopexy before 1 year of age and those who had orchidopexy at or after 1 year of age

Summary

Introduction

Cryptorchidism affects between 2⋅4 and 5 per cent of live-born boys[1,2,3,4]. Undescended testes are known to be associated with an increased incidence of testicular malignancy and subfertility, even after orchidopexy[5,6,7,8,9,10]. 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). 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).

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