Evaluation and Treatment of Cryptorchidism: AUA Guideline

Kolon, Thomas F.; Herndon, C.D. Anthony; Baker, Linda A.; Baskin, Laurence S.; Baxter, Cheryl; Cheng, Earl Y.; Diaz, Mireya; Lee, Peter A.; Seashore, Carl; Tasian, Gregory E.; Barthold, Julia Spencer

doi:10.1016/j.juro.2014.05.005

Cited by 407 publications

(444 citation statements)

References 44 publications

Supporting

Mentioning

371

Contrasting

Unclassified

Order By: Relevance

“…In our series, the median age of the boys at the time of referral was 45 months, with 73% of boys referred well beyond the recommended age of <12 months for appropriate surgical management. 9,10 The overuse of ultrasound also adds to the burden on the Canadian healthcare system. A large retrospective study was undertaken by Kanaroglou and colleagues with boys with undescended testis in Ontario, Canada.…”

Section: Discussionmentioning

confidence: 99%

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Wong

Bansal

Lorenzo

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction: Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists. Methods: We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed. Results: Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes. Conclusion: Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.

show abstract

Section: Discussionmentioning

confidence: 99%

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Wong

Bansal

Lorenzo

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…According to the 1996 American Academy of Pediatrics recommendation 32 and the recently published American Urological Associaton (AUA) guidelines 33 on the topic, orchidopexy should be performed before one year of age based on changes in the number of germ cells in the UDT that start to occur beyond that age. 34 Results from a randomized, controlled trial comparing testicular growth after surgery performed at nine months vs. at three years of age indicated that early orchidopexy was followed by a partial catch-up testicular growth, which was not seen after late operation.…”

Section: Timingmentioning

confidence: 99%

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

Braga

Lorenzo

Romao

2017

CUAJ

View full text Add to dashboard Cite

show abstract

“…During this process there is also apoptosis of germ cells, and it is postulated that these persistent undifferentiated germ cells may lead to malignancy in the long term13. The latest guidance from several professional associations14, 15, 16, 17, including a recent British Association of Paediatric Urologists (BAPU) consensus statement, recommends performing orchidopexy by 12 months of age.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

et al. 2018

View full text Add to dashboard Cite

BackgroundCurrent guidelines recommend orchidopexy for cryptorchidism by 12 months of age, yet this is not universally adhered to. The aim of this systematic review and meta‐analysis was to compare outcomes between orchidopexies performed before and after 1 year of age.MethodsMEDLINE and Embase were searched (September 2015) using terms relating to cryptorchidism, orchidopexy and the outcomes of interest. Studies were eligible for inclusion if they compared orchidopexy at less than 1 year of age (early) with orchidopexy at 1 year or more of age (delayed) and reported the primary outcome (testicular atrophy) or one of the secondary outcomes (fertility potential, postoperative complication, malignancy). Studies were excluded when more than 50 per cent of infants had intra‐abdominal testes, or the population included infants with disorders of sexual differentiation. Additional studies were identified through reference list searching. Unpublished data were sought from the ORCHESTRA study investigators.ResultsFifteen eligible studies were identified from 1387 titles. There was no difference in atrophy rate between early orchidopexy and delayed orchidopexy (risk ratio 0·64, 95 per cent c.i. 0·25 to 1·66; 912 testes). Testicular volume was greater (mean difference 0·06 (95 per cent c.i. 0·01 to 0·10) ml; 346 testes) and there were more spermatogonia per tubule (mean difference 0·47 (0·31 to 0·64); 382 testes) in infants undergoing early orchidopexy, with no difference in complication rate (risk ratio 0·68, 0·27 to 1·68; 426 testes). No study reported malignancy rate.ConclusionAtrophy and complication rates do not appear different between early and delayed orchidopexy, and fertility potential may be better with early orchidopexy. Imprecision of the available data limits the robustness of these conclusions.

show abstract

Evaluation and Treatment of Cryptorchidism: AUA Guideline

Cited by 407 publications

References 44 publications

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

Systematic review and meta-analysis comparing outcomes following orchidopexy for cryptorchidism before or after 1 year of age

Contact Info

Product

Resources

About