Management of cryptorchism and risk of testicular cancer.

Cryptorchism is an established risk factor for testicular cancer, but the role of age at surgical correction is unclear. The authors investigated this relation using information obtained from comprehensive medical records dating to childhood. They conducted a case-control study of 183 Kaiser Permanente members, who were diagnosed with testicular cancer during 1973-1996 and who were 15 years or younger when they first joined the health plan, and 551 controls. Notes pertaining to the testes were reviewed up to the case's diagnosis date or comparable date among the controls. The odds ratio for the association of a history of cryptorchism with testicular cancer risk was 4.8 (95% confidence interval (CI): 1.9, 11.8). Compared with no history of cryptorchism, men with a history who had natural descent or successful orchiopexy by the 11th birthday were not at increased risk of testicular cancer (odds ratio = 0.6, 95% CI: 0.08, 5.4). However, successful treatment of cryptorchism only after the 11th birthday, or never, was related to a 32-fold increased risk (95% CI: 4, 250). Orchiopexy was performed before the 11th birthday on three men who developed testicular cancer but, in each, the procedure failed. In contrast, all four of the early orchiopexies performed on the controls were successful. Boys with failed orchiopexy should be considered for reoperative orchiopexy or orchiectomy to prevent testicular cancer.