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Undescended testis: The recommended surgery is being performed too late

Deutsches Aerzteblatt International

Undescended testis is commonly found in newborn boys and usually normalizes spontaneously by the age of six months. In one in a hundred boys, however, at least one testis remains undescended--a condition associated with impaired fertility and a higher risk of testicular cancer in later life. About 3500 boys are affected with this condition in Germany each year. In the currently valid medical guideline for the treatment of undescended testis, early surgery is recommended, i.e., orchidopexy before the child's first birthday, in order to prevent late sequelae. Nonetheless, despite this recommendation, most patients in Germany are still being treated far too late, as shown in the study by Georg Hrivatakis and coauthors that appears in the current issue of the Deutsches Ärzteblatt International (Dtsch Arztebl Int 2014; 111: 649-57). Only one out of five affected boys undergoes surgery before his first birthday, and more than half do so only after their second birthday.

The authors point out that the recommendation for early surgery is followed to just about the same inadequate extent in other countries. They suspect that reservations about surgery on infants often lead to inappropriately delayed treatment. As they also point out, a comparison of their findings with data obtained eight years ago reveals a mild improvement in the timing of surgery for undescended testis.

Even so, the frequency of timely surgery is still far too low overall, as pediatricians Kai O. Hensel and Stefan Wirth state in the accompanying editorial (Dtsch Arztebl Int 2014; 111: 647-8). They stress that the treatment of boys with undescended testis clearly needs to be improved. The affected boys' parents, as well as their treating physicians, need to be regularly informed about the sequelae of undescended testis and the advantages of early surgery.


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