Chan E, Wayne C, Nasr A; FRCSC for Canadian
Association of Pediatric Surgeon Evidence-Based Resource.
The ideal management of cryptorchidism is a
highly debated topic within the field of pediatric surgery. The optimal timing
of orchiopexy is particularly unclear, as existing literature reports mixed
recommendations. The aim of this study was to determine, based on a systematic review,
the most favorable age at which orchiopexy should be performed. We conducted a
systematic search of MEDLINE, Embase, CINAHL, and the Cochrane Library to find
relevant articles. Two researchers quality assessed each study using the
following tools: AMSTAR (systematic reviews), Jadad (RCTs), and MINORS
(non-RCTs). We developed a conclusion based on the highest quality studies. We
found one relevant systematic review, one RCT, and 30 non-RCTs. Fertility
potential was greatest when orchiopexy was performed before 1 year of age.
Additionally, orchiopexy before 10–11 years may protect against the increased
risk of testicular cancer associated with cryptorchidism. Orchiopexy should not
be performed before 6 months of age, as testes may descend spontaneously during
the first few months of life. The highest quality evidence recommends
orchiopexy between 6 and 12 months of
age. Surgery during this timeframe may optimize fertility potential and protect
against testicular malignancy in children with cryptorchidism.