Temporal trends in orchidopexy, Great Britain, 1992-1998.

Abstract

Concern has been expressed in recent years about worsening male reproductive health, possibly mediated by increasing exposures to environmental endocrine-disrupting agents. Trends suggested large increases in cryptorchidism in Britain and the United States between the 1950s and 1980s, although published data on recent trends have been scarce. We examined numbers of orchidopexy procedures, as a marker for cryptorchidism, using routine hospital admission data for England, Wales, and Scotland for fiscal years 1992-1993 through 1998-1999. Annual trends in orchidopexy rates were analyzed by age, in-patient admission versus day case, and geographical region. Orchidopexy rates were also obtained from the General Practice Research Database (GPRD) for England to cross-validate the hospital admissions data. Orchidopexy rates for boys 0-14 years old fell by 33% (from 23.5 to 15.8 per 10,000 population) between 1992 and 1998, with the steepest decline (50%) in 5-9-year-olds. The decreasing trend for 0-14-year-olds was evident in every region in England, in Wales, and in Scotland. Rates remained stable for men 15 or more years old, at 0.7 per 10,000. There was a marked shift from in-patient to day-case procedures. Rates from the GPRD showed a similar downward trend to the hospital data. Our findings could represent either an underlying decrease in the frequency of undescended testis or a fairly dramatic improvement in the diagnosis of cryptorchidism--resulting in fewer orchidopexies performed for retractile testis--in Great Britain during the 1990s, or both. Either way, our findings do not support the postulate of a recent worsening of male reproductive health of the scale suggested by some recent commentators on the endocrine disruptor hypothesis.

Prevalence of Cryptorchidism, Retractile Testis and Orchiopexy in School Children

“…Abantanga and Amaning [8] noted that the mean age of orchiopexy was 5.0 years in Ghana. Although our results seem to be high, it is similar to previous reports from western and African countries [1,2,7,12] and the reasons of late orchiopexy may be similar to those in England and in USA.…”

The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort

“…These observational trends are also supported by historical hospital data for orchidopexy procedures in the UK, where a near doubling in surgery for cryptorchidism was observed over a 30-year period between the mid-1950s and 1980s 11 12. Although a more recent study of UK orchidopexy rates did not confirm these trends,7 similar increasing temporal trends in congenital cryptorchidism have been reported in other European countries,2 13 and our findings are also consistent with the increasing prevalence of other male reproductive disorders, such as hypospadias and reduced semen quality 3…”

“…Recent data from large, longitudinal population studies carried out in Denmark and Finland report the prevalence of cryptorchidism at birth of 8.2% and 2.2%, respectively 2. Historical data from the UK have suggested that the occurrence of cryptorchidism has increased since the 1950s with an estimated prevalence of 4.1% in the mid 1980s,6 although this has not been supported by recent data on temporal trends in orchidopexy rates 7…”

What is new in cryptorchidism and hypospadias—a critical review on the testicular dysgenesis hypothesis

“…The orchidopexy rate has also not changed significantly in different publications within the last 40 years. The cumulative orchidopexy rate in different countries is stable around 2.4% to 3.8% [89,[111][112][113][114][115], with a minor transient increment of orchidopexy rates in Denmark and UK from 1980 to 1990 [89,116]. Also in New York area, the orchidopexy rate has been stable during the last decades [117].…”