Timing of orchidopexy and effect on surrogate outcomes for fertility: a systematic review and meta-analysis

PURPOSE: Cryptorchidism is a common congenital abnormality affecting male infants and is associated with impaired germ cell maturation and infertility. Current guidelines recommend orchidopexy between 6 and 18 months of age to optimize fertility-related outcomes; however, the real-world feasibility of early surgery is limited, and the benefits of earlier intervention remain uncertain. This study aimed to evaluate whether orchidopexy before 12 months reduces testicular atrophy and postoperative complications compared with surgery after 12 months. METHODS: A systematic literature search of five databases was conducted following PRISMA guidelines. Studies comparing early (< 12 months) versus late orchidopexy in boys with cryptorchidism were included, based on thresholds within the available data. The primary outcome was testicular atrophy; secondary outcomes included postoperative complications and fertility-related markers. Random-effects meta-analyses were performed with outcomes reported as odds ratios (OR) and 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE framework. RESULTS: Sixteen studies were included. Meta-analysis of 1855 testes from five studies showed no significant difference in testicular atrophy between orchidopexy before 12 months (OR 1.05, 95% CI 0.49–2.23; I² = 0%). Pooled analysis of 757 testes across three studies showed no significant difference in postoperative complication rates (OR 1.15, 95% CI 0.44–2.99; I² = 36%). The overall quality of evidence was rated low for both outcomes. CONCLUSION: Available data of low quality suggest that orchidopexy before 12 months does not significantly reduce testicular atrophy or postoperative complications compared with later surgery.