Guideline implementation for the treatment of undescended testes: Still room for improvement
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Read the article on jpedsurg.org ↗Article · Jun 2018 · 1 min read
In brief
In brief
Multi-institutional study of 4,448 boys found that 81% of orchidopexies for congenital undescended testis occurred after the recommended age of 1 year, with delayed referral identified as the primary barrier to guideline-compliant early surgery. Analysis revealed significant variation in surgical timing between hospital and outpatient settings.
Written by the GCMD Library team from the article.
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) 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.