Neurodevelopmental Delay Associated With Delayed Orchiopexy for Children With Cryptorchidism

s recommend orchiopexy by 18 mo of age to optimize outcomes. Previous studies have shown that nearly half of cases do not meet this benchmark. Our goal was to identify whether a diagnosis of neurodevelopmental delay (NDD) correlated with delayed surgical management.

We performed a retrospective cohort study of patients under 18 y old at a single tertiary care children's hospital who underwent orchiopexy for congenital cryptorchidism from January 1, 2016-December 31, 2023. Orchiopexies for other indications were excluded. Data included age, demographics, comorbidities, unilaterality versus bilaterality, two-stage procedure, and complications. These variables were compared between patients identified to have NDD and those without. Nonparametric continuous data are shown as median/interquartile interval and categorical as frequencies/percentages. Student's t-test and Mann-Whitney U-test compared continuous data, and Chi-square and Fisher exact test compared categorical data.

A total of 149 patients were evaluated. The median (interquartile interval) age was 10 mo (120.4) at referral and 16 mo (109.0) at surgery. Fifty-five percent had surgery by 18 mo. Sixteen patients had a diagnosis of NDD whereas 133 did not. Comparing the NDD and no NDD cohorts, patients with NDD were more likely to have referral and orchiopexy after 18 mo (P = 0.05, P = 0.04). Patients with NDD underwent surgery at a median 72 mo (119) versus 15 mo (64). Children with NDD were more likely to require bilateral repair (P < 0.001). Average surgical follow-up was 13.7 mo. The complication rate was 14.1%: 5.4% short-term, 8.7% long-term. There was no difference in complications between groups (P = 0.84).

Patients with NDD were less likely to undergo orchiopexy for undescended testicle by the recommended 18 mo of age compared to their peers without NDD.