Dropping the Ball The geopolitical management of cryptorchidism Wayne Brisbane, PGY-1 Department of Surgery

Overview Decline in the amount of orchiopexies performed by pediatric surgeons? What is the current state of treatment for cryptochidism. Europe – Hormonal treatment – Nordic consensus – Current practice United States – Guidelines – Current practice

Definitions Retractile Testis: can be “milked” into the scrotum, where it will remain, at least temporarily. Undescended Testis: absence of testis in the scrotum secondary to cryptorchid testis or vanishing testis.

Hormone Treatment B-hCG was originally introduced at a treatment in Intranasal GnRH use began in Use has had varying degrees of enthusiasm over the last years. Effective in about 20% of cases. 3 1.Schapiro B. [25 ears of hormonal treatment of cryporchidism]. Harefuah 1957; Bartsch G and Frick J. Therapeutic effects of luteinizing hormone releasing hormone (LH-RH) in cryptorchidism. Andrologia 1974; 6: Pyorala S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab 1995; 80:

Pyorala S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab 1995; 80:

When to drop the ball 1950’s around age age age Gross, R.E. and Jewett, T.C., Jr.: Surgical experiences from 1,222 operations for undescended testis. J Am Med Assoc, 160: 634, The timing of elective surgery on the genitalia of male children with particular reference to undescended testes and hypospadias. Pediatrics, 56: 479, Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics, 97: 590, 1996

Treatment window between 6 and 12 months of age, at least by 18 months. Medical therapy has success rates of 20% and is beneficial before or after surgical orchiopexy to increase fertility index. Lack long tern follow up data Palpable Testis: orchidofuniculoysis and orchiopexy Non palpable Testis: Inguinal surgical exploration, possible laparoscopy Intrabdominal testis for boys > 10 years old should be removed. If bilateral in boys < 10, Fowler-Stephens procedure is an option.

New York state health department maintains data on all operations performed in New York hospitals. Total of 36,484 patients underwent orchiopexy. – 26,575 outpatient – 9,909 inpatient

Baumracker, G.: Incidence of testicular pathology. Bull U S Army Med Dep, 5:312,1946

Summary Orchiopexy surgeries are occurring at relatively the same rate in some states. Unclear in WA. Ideally these surgeries are performed prior to age 1 yo, however this is difficult to accomplish on a global scale.