Age At Surgery For Undescended Testis And Risk Of Testicular Cancer

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Men's health
Article Date: 13 May 2007 - 0:00 PDT

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UroToday.com - While all urologists would agree that an undescended testis found in a school-age boy should be treated with an inguinal orchidopexy, whether the procedure results in a decrease in testicular cancer risk remains unclear. The traditional teaching has been that the procedure is performed to facilitate testicular examination, since the risk of developing a germ cell tumor is not significantly lowered.

In the May 3 issue of the New England Journal of Medicine, Pettersson and colleagues from Stockholm report on an epidemiological study designed to determine whether the patient's age at the time of orchidopexy impacts the risk of a subsequent testicular malignancy.

A total of 16.983 men were identified who underwent an orchidopexy for cryptorchidism between 1964 and 1999. The risk of a subsequent germ cell tumor in the cohort was compared to the general population and stratified by age.

A total of 56 patients developed testicular cancer during the follow-up period, which as expected was higher than the general population. Interestingly, those patients who underwent orchidopexy before the age of 13 exhibited a lower relative risk of testicular cancer (2.23, 95% CI 1.58 to 3.06) when compared with men who underwent surgery after puberty (relative risk 5.54, 9%% CI 3.20 to 8.53).

While fortunately the majority of children with cryptorchidism are diagnosed before their first year of life, occasionally older children and adolescents are referred with undescended testes. This large epidemiological study based on a reliable patient and tumor registry suggests that patients who undergo orchidopexy after puberty may exhibit almost twice the risk of testicular cancer than children who undergo surgery before the age of 13. Perhaps these patients should undergo more intense surveillance for early testicular cancer detection.

Andreas Pettersson, M.D., Lorenzo Richiardi, M.D., Ph.D., Agneta Nordenskjold, M.D., Ph.D., Magnus Kaijser, M.D., Ph.D., and Olof Akre, M.D., Ph.D.

N Engl J Med. 2007 May 3;356(18):1835-41

Reviewed By UroToday.com Contributing Editor Ricardo F. Sánchez-Ortiz, MD

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