Verena Ellerkamp1, Andreas Schmid2, Gunnar Blumenstock3, Georg Hrivatakis4, Wolfgang Astfalk5, Steffan Loff6, Joerg Jörg Fuchs2, Sabine Zundel7. 1. University Hospital Tuebingen, Department for Pediatric Surgery and Pediatric Urology, Germany. Electronic address: verena.ellerkamp@med.uni-tuebingen.de. 2. University Hospital Tuebingen, Department for Pediatric Surgery and Pediatric Urology, Germany. 3. Eberhard Karls University of Tuebingen, Department of Clinical Epidemiology and Applied Biostatistics, Germany. 4. Outpatient Clinic for Pediatric and Adolescent Surgery, Stuttgart, Germany. 5. Outpatient Clinic for Surgery, Reutlingen, Germany. 6. Olga hospital Stuttgart, Pediatric Surgery Clinic, Stuttgart, Germany. 7. Kantonsspital Lucerne, Department of Pediatric Surgery, Lucerne, Switzerland.
Abstract
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.
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.
Authors: Tanja Kuiri-Hänninen; Jaakko Koskenniemi; Leo Dunkel; Jorma Toppari; Ulla Sankilampi Journal: Front Endocrinol (Lausanne) Date: 2019-07-23 Impact factor: 5.555