Rates of orchiopexies in Sweden: 1977-1991

Laparoscopy for Abdominal Testes: Nationwide Analysis of German Routine Data

Introduction: Laparoscopy has been used for the evaluation of impalpable testes for more than 30 years. However, its use for intra-abdominal testes has never been evaluated in a population-based approach. Neither has the share of timely orchiopexies of intra-abdominal testes according to published guidelines. We aimed to provide this information by using nationwide administrative data for hospital reimbursements. Materials and Methods: We obtained data for procedures for exploration and orchiopexy of intra-abdominal testes in Germany from 2005 through 2018 and analyzed them with linear regression for the use of laparoscopy and timely repair. Results: In 2005, laparoscopy was already used in more than 60% of explorations, which composed 76% (95% confidence interval [CI]: 72 to 79) of children operated before their first birthday and 68% (95% CI: 65 to 70) of children up to 4 years of age. Throughout the study period, laparoscopy became increasingly popular for orchiopexy of intra-abdominal testes with a yearly increase of 1.8% (95% CI: 1.2 to 2.5, P < .001) in the first year of life and 1.3% (95% CI: 0.2 to 3.4, P < .001) until the age of 4. The share of patients treated before their first birthday increased yearly by 1.9% for explorations and 1.6% for orchiopexies (P < .001 for both) but did not exceed 30% in 2018. Conclusion: Laparoscopy is the method of choice for exploration of intra-abdominal testes and orchiopexy. In this study, more than 70% of boys were treated after their first birthday, thus not meeting the time limit set by guidelines.

Cryptorchidism after the Fukushima Daiichi Nuclear Power Plant accident:causation or coincidence?

Cryptorchidism (undescended testes) is among the most common congenital diseases in male children. Although many factors have been linked to the incidence of cryptorchidism, and testicular androgen plays a key role in its pathogenesis, the cause remains unknown in most cases. Recently, a Japanese group published a speculative paper entitled, "Nationwide increase in cryptorchidism after the Fukushima nuclear accident." Although the authors implicated radionuclides emitted from the Fukushima accident as contributing to an increased incidence of cryptorchidism, they failed to establish biological plausibility for their hypothesis, and glossed over an abundance of evidence and expert opinion to the contrary. We assessed the adequacy of their study in terms of design setting, data analysis, and its conclusion from various perspectives. Numerous factors must be considered, including genetic, environmental, maternal/fetal, and social factors associated with the reporting of cryptorchidism. Other investigators have established that the doses of external and internal radiation exposure in both Fukushima prefecture and the whole of Japan after the accident are too low to affect testicular descent during fetal periods;thus, a putative association can be theoretically and empirically rejected. Alternative explanations exist for the reported estimates of increased cryptorchidism surgeries in the years following Japan's 2011 earthquake, tsunami, and nuclear crisis. Data from independent sources cast doubt on the extent to which cryptorchidism increased, if at all. In any case, evidence that radionuclides from the Fukushima Daiichi Nuclear Power Plant could cause cryptorchidism is lacking.

Secular trends in the incidence and timing of surgical intervention for congenital undescended testis and surgically treated hypospadias in Ontario, Canada between 1997 and 2007

INTRODUCTION

Recent studies have suggested contradictory trends in the incidence of undescended testis (UDT) and hypospadias (HYP), partly because of methodological issues and ascertainment bias. The recently described association of "testicular dysgenesis syndrome" links concomitant UDT and HYP, with decreasing sperm counts and testicular cancer. Current guidelines suggest that orchidopexy for UDT should be performed by 18 months of age.

OBJECTIVE

We conducted a retrospective population-based cohort study to estimate the incidence of UDT, HYP, and concomitant UDT and HYP in Ontario, based on a surgical procedure performed in the 5 years after birth. We hypothesized that the incidence of UDT and HYP are stable in the province of Ontario, Canada, over an 11-year time period.

STUDY DESIGN

Linked administrative databases held at the Institute of Clinical Evaluative Sciences (ICES) in the province of Ontario, were used to identify all live male newborns between 1997 and 2007. Incidence rates of UDT, HYP and concomitant UDT and HYP were calculated by identifying a surgical procedure for these anomalies, within 5 years of birth. Incidence trends were analyzed using the Cochrane Armitage test for trend. Age at surgery for surgical intervention for an orchidopexy or HYP repair was determined.

RESULTS

The incidence of UDT, defined by an orchidopexy within 5 years of birth, has remained stable in Ontario, Canada (8.2/1000 male live births, p-value for trend 0.9, 95% CI 8.0-8.4). The incidence of hypospadias has similarly remained stable (3.8/1000 male live births, p-value for trend 0.8, 95% CI 3.7-3.9). The incidence of concomitant UDT and HYP repair showed a significant increase over the 11-year period (0.2/1000 male live births, p-value for trend 0.03, 95% CI 0.2-0.3). The median age at orchidopexy (23 months, IQR 16-34 months) was beyond guideline recommendations, with earlier orchidopexy in recent years. The median age at hypospadias repair was 17 months (IQR 12-26 months).

DISCUSSION

The variable rates of incidence for UDT and HYP can be explained by variations in study methodology and differing data sources utilized. The current study uses a surgical procedure to minimize information bias to correctly identify index cases of UDT and HYP.

CONCLUSIONS

The incidence of undescended testis and hypospadias, over 5 years after birth, has remained stable in the province of Ontario between 1997 and 2007 (Summary Table). Concomitant UDT and HYP incidence showed a significant increase over this time period. Most boys in Ontario, Canada, undergo orchidopexy beyond 18 months of age.

Cryptorchidism in Sweden: A Nationwide Study of Prevalence, Operative Management, and Complications

OBJECTIVES

To review the cumulative prevalence, operative management, and complications of treatment for cryptorchidism in Sweden.

STUDY DESIGN

A nationwide observational study from longitudinal register data of all Swedish-born boys 0-18 years of age, diagnosed with cryptorchidism from 2001 to 2014. Primary outcomes were occurrence and age at primary surgery. Secondary outcomes included type of procedure and surgical site infection.

RESULTS

Of 20 375 boys diagnosed with cryptorchidism in 2001-2014, 12 766 were surgically treated. The cumulative childhood prevalence was 1.8% (95% CI, 1.5-2.0), with a higher prevalence in boys born prematurely, small for gestational age, or with low birth weight. The median age at treatment decreased from 6.2 years in 2001 to 3.4 years in 2014 (P < .001). Still, 94.1% (95% CI, 92.7-95.6) had surgery after the recommended 1 year of age in 2014. Variations in age at surgery between Swedish counties were great (range, 2.9-5.9 years of age). There were no deaths within 30 days after surgery and the frequency of surgical site infection was low (1.4%; 95% CI, 1.1-1.6).

CONCLUSIONS

The cumulative childhood prevalence of cryptorchidism was high, and complications were rare. Few boys underwent surgery in a timely manner according to clinical guidelines, and standards of care varied considerably across the country. Further research and collective actions are needed to improve the detection and management of congenital cryptorchidism.

Frequency of revision orchidopexy in Australia 1995-2014

BACKGROUND/AIM

International criteria currently suggest orchidopexy at 6-12months for congenital undescended testis (UDT). Some children require repeat orchidopexy for recurrent UDT. This study aimed to assess practice in Australia over a 20-year period.

METHODS

We examined 20years of Australian orchidopexy data (1995-2014) from the Department of Human Services to explore the national revision orchidopexy rates over time.

RESULTS

The total number of orchidopexy revisions was 890 over 20years compared with 25,984 primary operations. More than 50% of all primary and revision orchidopexies in 0-14year-old boys were performed in major population centers of NSW and Victoria (which hold 52% male population of same age), with a small number of revisions on 15-24year-old males. The incidence of revision orchidopexy significantly decreased over the 20-year period in boys ages 0-14years old, from 276 operations between 1995 and 1999 decreasing to 165 operations between 2010 and 2014 (-53%), compared to a population increase of +15% (p<0.05).

CONCLUSION

These data demonstrate a decrease in revision orchidopexy since 1995, which may be related to change in referral practice with more children undergoing orchidopexy (primary and revision) by pediatric surgeons over the 20-year period.

LEVEL OF EVIDENCE

Level IV.

TYPE OF STUDY

Therapeutic Case Series with no Comparison Group.

Risk factors for cryptorchidism

Undescended testis - known as cryptorchidism - is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors that contribute to the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases in fetal development - between 8-15 weeks (the first phase of decent) and 25-35 weeks gestation (the second phase of descent); the failure of a testis to descend permanently is probably caused by disruptions to one or both of these phases, but the causes and mechanisms of such disruptions are still unclear. A broad range of putative risk factors have been evaluated in relation to the development of cryptorchidism but their plausibility is still in question. Consistent evidence of an association with cryptorchidism exists for only a few factors, and in those cases in which evidence seems unequivocal the factor is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor could vary considerably between mother-son pairs depending on an array of genetic, maternal, placental and fetal factors - all of which could vary between regions. Thus, the role of causative factors in aetiology of cryptorchidism requires further research.

Orchidopexy patterns in Austria from 1993 to 2009

OBJECTIVE

To evaluate orchidopexy patterns in Austria.

MATERIAL AND METHODS

All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type.

RESULTS

Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p < 0.001) and 3-7 years (p < 0.001) increased, while the rate in boys older than 7 years decreased (p < 0.001). Year of birth (p < 0.0001) and place of residence (p < 0.0001 and p < 0.024) are significant predictors for having early orchidopexy.

CONCLUSION

In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.

Age at cryptorchidism diagnosis and orchiopexy in Denmark: a population based study of 508,964 boys born from 1995 to 2009

PURPOSE

Early treatment for cryptorchidism may be necessary to preserve fertility. International guidelines now recommend that congenital cryptorchidism be treated with orchiopexy before age 1 year. Acquired cryptorchidism should be treated at presentation. To our knowledge the rate of adherence to these guidelines in recent years is unknown. Thus, we present data on age at cryptorchidism diagnosis and orchiopexy in recent Danish birth cohorts.

MATERIALS AND METHODS

A population of 508,964 Danish boys born alive from January 1, 1995 to December 31, 2009 was identified using the Danish Civil Registration System. Five birth cohorts were defined, including 1995 to 1997, 1998 to 2000, 2001 to 2003, 2004 to 2006 and 2007 to 2009. The boys were followed in the Danish National Patient Registry for a diagnosis of cryptorchidism and for an orchiopexy procedure. Data were analyzed using the Kaplan-Meier estimator and Cox regression models.

RESULTS

During followup 10,094 boys were diagnosed with cryptorchidism, of whom 5,473 underwent orchiopexy. Mean age at diagnosis in boys followed at least 6 years was 3.3 years (95% CI 3.3-3.4) in the 1995 to 1997 cohort, 3.1 (95% CI 3.1-3.2) in the 1998 to 2000 cohort and 2.9 (95% CI 2.8-2.9) in the 2001 to 2003 cohort while mean age at orchiopexy was 3.8 (3.7-3.9), 3.6 (3.5-3.7) and 3.3 years (3.2-3.4), respectively.

CONCLUSIONS

In the more recent birth cohorts of 1995 to 2009 we observed a shift toward younger age at cryptorchidism diagnosis and orchiopexy.

Les différentes anomalies de la reproduction masculine sont-elles en augmentation ? Faits et controverses, possibles facteurs en cause: une analyse actualisée des données de la littérature et des registres

Au cours des dernières décennies, de nombreuses observations dans la faune sauvage d’anomalies relatives à l’appareil génital et à la fonction de reproduction mâle, certaines évoquant les données de la toxicologie expérimentale, ont conduit à s’interroger sur la toxicité de facteurs environnementaux pour la reproduction de l’homme. De plus, un certain nombre d’études suggère une augmentation de la prévalence des troubles de la reproduction de l’homme adulte au cours des dernières décennies dans de nombreux pays développés. Les données les mieux documentées concernent le cancer du testicule, son rythme de croissance suggérant le rôle de facteurs environnementaux et/ou de mode de vie. Toutefois, des différences régionales et ethniques considérables dans les taux d’incidence absolue pourraient impliquer des facteurs génétiques concomitants. Parallèlement, il semble que la qualité du sperme a diminué dans de nombreux pays, à en juger aussi bien par des méta-analyses que par des analyses statistiques de données d’un seul centre. Au début des années 2000, Skakkebæk et al. à Copenhague ont formulé l’hypothèse d’une origine commune à ces différentes anomalies lors du développement du testicule durant la gestation. Existe-t-il pour ces différentes conditions des données indiquant un lien de causalité avec une exposition environnementale/professionnelle à des composés reprotoxiques ? Ne serait-ce plutôt l’exposition chronique à de très nombreux composés chimiques à faible dose qui pourrait être impliquée ? Les facteurs de style de vie jouent-ils un rôle ? L’ensemble de ces questions se fondant sur une somme d’études, dont les résultats sont loin d’être univoques, a été la source de nombreux débats aussi bien au sein de la communauté scientifique que dans les médias. Les meilleures réponses possibles à ces questions complexes sont naturellement fondamentales pour les instances en charge de l’évaluation du risque et les politiques de santé publique qu’il convient d’adopter. La présente revue donne un état des lieux actualisé de ces questions.