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Assessment of the Trend in Timing of Surgery for Cryptorchidism: Has Earlier Surgical Intervention Been Achieved
Taiju Hyuga1, Koki Sugimura1, Tatsuya Muto1
1Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Shimotsuke, Japan.
Insights
Early surgery for cryptorchidism is increasing but remains insufficient. An early initial visit is crucial for timely surgical intervention in infants with undescended testes.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Pediatrics
Background:
- Cryptorchidism, or undescended testes, affects infant health.
- Timely surgical intervention is recommended for optimal outcomes.
Purpose of the Study:
- To investigate the age at surgery for cryptorchidism.
- To identify factors associated with early surgical intervention.
Main Methods:
- Retrospective study of 664 cryptorchidism cases (2007-2023).
- Early surgery defined as <1 year old.
- Early detection and initial visit defined.
Main Results:
- Proportion of early surgery increased significantly from 6.3% to 30.9%.
- Early initial visit, surgical era, hypospadias, and multiple congenital anomalies were linked to early surgery.
- Delayed initial visits occurred in 55.5% of early detected cases.
Conclusions:
- While early initial visits and surgeries are increasing, they remain insufficient.
- Early initial visits are essential for timely cryptorchidism surgery.
- Immediate referral upon suspicion of cryptorchidism is critical.
Objectives:
This study aimed to investigate age at surgery for cryptorchidism and to identify factors associated with early surgery.
Methods:
This retrospective study investigated 664 cases of cryptorchidism treated surgically between 2007 and 2023. Early surgery was defined as surgery at less than 1 year old. The cases detected at birth or at the 1-month checkup were defined as early detected cases and age at initial visit less than 6 months old was defined as early initial visit.
Results:
The proportion of early surgery increased over time, from 6.3% in 2007-2011 to 30.9% in 2020-2023 (OR 1.67, 95% CI 1.39-2.02; p < 0.001). Multivariate analyses demonstrated that early initial visit, era of surgery, hypospadias and multiple congenital anomalies were independently associated with early surgery. Among 200 early detected cases, 55.5% of these had delayed initial visits (at or over 6 months old). In early detected cases, multivariate analysis demonstrated that the shorter intervals from detection to initial visit and from surgical plan to the date of surgery were independently associated with early surgery. Even among early detected and early visiting cases, some surgeries were delayed due to patient-related factors.
Conclusions:
Age at initial visit is getting earlier, and surgery for cases less than 1 year old is also increasing, but remains insufficient. To achieve earlier surgical intervention for cryptorchidism, an early initial visit is essential. When findings suggestive of cryptorchidism are identified, immediate referral is crucial, and further observation is unnecessary.
