Repair undescended testis before age 13

General

Clinical Question:
What's the best time to correct undescended testis?

Bottom Line:
The risk of testicular cancer doubles if you wait until after the patient is 12 years of age to surgically correct undescended testis. (LOE = 2b)

Reference:
Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007;356:1835-1841.  [PMID:17476009]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Population-based

Synopsis:
Although some previous case-control studies have suggested an increased risk of testicular cancer if repair was delayed till adolescence, results have been mixed and the case-control design is subject to considerable inherent bias. This Swedish study linked men in a registry of all hospital discharges with a second registry that tracked the incidence of cancer. They were able to gather data for 16,983 men who underwent surgery between 1964 and 1999, and followed them up for a mean of 12.4 years. The mean and median ages of orchipexy were 8.6 years and 8.5 years, respectively. The authors divided patients into groups according to the age at surgery, and found a clear spike in the risk of testicular cancer at 13 years or older. The standardized incidence ratio was 2.2 (95% CI, 1.6 - 3.1) for children younger than 13 years at the time of surgery compared with 5.4 (95% CI, 3.2 - 8.5) for children 13 years and older at the time of surgery. The absolute risk was relatively low, since there were only 56 cases of testicular cancer in the cohort (0.3%).

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