Guideline implementation for the treatment of undescended testes: Still room for improvement

Background

Early orchidopexy (OP) around the age of 1 year is recommended in boys with congenital undescended testis (UDT) worldwide since decades. Former retrospectives studies did not distinguish congenital from acquired UDT with a consecutive negative bias concerning the age at surgery.

Methods

In a retrospective analysis, data of all boys who underwent OP in eight pediatric surgery institutions from 2009 to 2015 were analyzed. Congenital or acquired UDT were differentiated. Patients were categorized into 3 groups of age at surgery: (1) < 12?months, (2) 12–24?months, (3) > 24?months. Data of one institution were analyzed in detail: exact age of first referral, exact age at surgery, intraoperative findings.

Results

Out of 4448 boys, 3270 boys had congenital UDT. In 81% (2656 cases) surgery was performed beyond the age of 1 year, in 54.4% (1780) beyond the age of 2 years. chi-Square statistics showed a higher rate of early operations in hospitals compared to outpatient services and in Germany compared to Switzerland. In 694 congenital detailed cases, median age at referral was 13?months range 0–196], median age at surgery was 15?months range 0–202].

Conclusion

Delayed referral is the main reason for guideline non-conform delayed surgery in UDT.

Type of Study

Clinical Research paper.

Level of evidence

Level III: Treatment Study.