Lactancia materna exclusiva y cáncer infantil

Lactancia materna exclusiva y cáncer infantil

Journal of Paediatrics and Child Health 44 (2008) 10–13

Juan A Ortega-García, Josep Ferrís-Tortajada, Alberto M Torres-Cantero, Offie P Soldin, Encarna Pastor Torres, Jose L Fuster-Soler, Blanca Lopez-Ibor and Luis Madero-López

Objetivo: Se ha sugerido que existe una asociación inversa entre la lactancia materna y el riesgo de cáncer en la infancia. Se investigó la asociación entre lactancia materna exclusiva y cáncer en la infancia (CI) en un estudio de casos y controles realizado en España.

Métodos: Se comparó la información que proporcionaron las madres sobre la lactancia materna en 187 niños de seis o más meses de edad con CI con la información de 187 hermanos emparejados por edad en el grupo control. La información se obtuvo a través de entrevistas personales utilizando la Historia Medioambiental Pediátrica.

Resultados: La duración media de la lactancia materna exclusiva fue de 8,43 semanas en los casos y 11,25 semanas en los controles. Los casos se había alimentado con biberón con mayor frecuencia que los controles (OR: 1,8; IC 95%:1,1-2,8). Los casos fueron amantados significativamente con menor frecuencia durante al menos dos meses (OR 0,5; IC 95% 0.3–0.8), durante al menos cuatro meses (OR 0,5; IC 95% 0,3–0,8), y durante 24 semanas o más (OR 0.5; IC 95% 0.2–0.9).

Conclusiones: La lactancia materna se asocia de forma inversa con el cáncer infantil, la protección aumenta con la duración de la lactancia exclusiva. Deberían realizarse investigaciones adicionales sobre los posibles mecanismos que expliquen esta asociación. Mientras tanto, debería alentarse a las madres para que amamantaran a sus hijos.

Efecto de la lactancia materna prolongada y exclusiva en la talla, peso, adiposidad y tensión arterial a la edad de 6 años y medio.

Efecto de la lactancia materna prolongada y exclusiva en la talla, peso, adiposidad y tensión arterial a la edad de 6 años y medio: evidencias provenientes de un amplio ensayo clínico.

Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z, Dzikovich I, Shishko G, Collet JP, Martin RM, Davey Smith G, Gillman MW, Chalmers B, Hodnett E, Shapiro S; PROBIT Study Group.
Department of Pediatrics, McGill University Faculty of Medicine, Montreal, PQ, Canada. michael.kramer@mcgill.ca
Am J Clin Nutr. 2007 Dec;86(6):1717-21.
INTRODUCCIÓN: Las pruebas de que la lactancia materna protege frente a la obesidad y frente a otras enfermedades crónicas proviene casi únicamente de estudios observacionales, que tienen la limitación de los sesgos debidos a factores de confusión, sesgo de selección y publicación selectiva. OBJETIVO: Valoramos si una intervención diseñada para promover la lactancia materna exclusiva y prolongada tenía consecuencias en la talla, peso, adiposidad y tensión arterial a los 6 años y medio. MÉTODO: El Ensayo sobre la intervención de Promoción de la Lactancia Materna (estudio PROBIT) es un ensayo clínico aleatorizado por grupos sobre una intervención de promoción de lactancia materna basada en La Iniciativa de Hospitales Amigos de los Niños (OMS/UNICEF). Se incluyeron un total de 17.046 niños sanos amamantados, estos niños provenían de 31 maternidades de Bielorrusia y sus clínicas afiliadas; 13.889 niños (81.5%) se siguieron hasta los 6 años y medio realizándoles medidas duplicadas de las variables antropométricas y de tensión arterial. Se realizó un análisis por intención de tratar, con ajustes estadísticos por grupos en los hospitales o clínicas para permitir inferencias a nivel individual. RESULTADOS: La intervención experimental conllevó una mayor prevalencia de lactancia materna exclusiva a los 3 meses en el grupo experimental que en el grupo control (43,3% y 6,4% respectivamente; p< style=""> a lo largo de la infancia. No se observaron efectos significativos de la intervención en la talla, en el índice de masa corporal, ni en la medida de la cintura o cadera, tríceps o grosor del pliegue subescapular, ni en la tensión arterial sistólica o diastólica. CONCLUSIONES: La intervención de promoción de la lactancia maternal conllevó un aumento sustancial en la duración y exclusividad de la lactancia pero no redujo las medidas de adiposidad, no incrementó la talla ni disminuyó la tensión arterial a los 6 años y medio en el grupo experimental. Los beneficios que se han comunicado previamente sobre estos aspectos podrían ser consecuencia de los factores de confusión no controlados y del sesgo de selección.

Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials.

BMJ. 2007 Oct 6;335(7622):703. Epub 2007 Sep 20.
van Sluijs EM, McMinn AM, Griffin SJ.

Comment in: BMJ. 2007 Oct 6;335(7622):677-8.

Se trata de una nueva revisión sistemática sobre la eficacia de las intervenciones para promover la actividad física en niños y adolescentes.

Los autores encontraron pocas pruebas del efecto de las intervenciones en población infantil,.

Sin embargo, si se encontraron pruebas de la efectividad (Strong) de las intervenciones basadas en la escuela con participación de la familia o la comunidad (intervenciones múltiples) para el incremento la actividad física en adolescentes.

ICSI.Guía de actividades preventivas para niños y adolescentes

El Institute for Clinical Systems Improvement (ICSI) editó en Octubre del 2007 la nueva guia de salud para niños y adolescentes,13ª edición.
Como siempre lo hace basada en las mejores pruebas científicas, ordena las actividades según niveles de evidencia, las distribuye por grupos de edad.
Recomendable para ver el estado de las intervenciones y recomendaciones que se realizan en nuestro modelo de atención primaria en el área de la prevención y comparar con lo hallado en la bibliografía actual.
Se puede descargar todo el documento en formato PDF en: http://www.icsi.org/home/preventive_services_for_children_and_adolescents_762.html

Child-parent screening for familial hypercholesterolaemia: screening strategy based on a meta-analysis.

BMJ. 2007 Sep 22;335(7620):599. Epub 2007 Sep 13.
Comment in: BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Sep 22;335(7620):573-4.
Wald DS, Bestwick JP, Wald NJ.
OBJECTIVE: To develop a population screening strategy for familial hypercholesterolaemia.
DESIGN: Meta-analysis of published data on total and low density lipoprotein (LDL) cholesterol in people with and without familial hypercholesterolaemia according to age. Thirteen studies reporting on 1907 cases and 16 221 controls were used in the analysis. Included studies had at least 10 cases and controls with data on the distribution of cholesterol in affected and unaffected individuals.
MAIN OUTCOME MEASURES: Detection rates (sensitivity) for specified false positive rates (0.1%, 0.5%, and 1%) in newborns and in age groups1-9, 10-19, 20-39, 40-59, and > or =60 years.
RESULTS: Serum cholesterol concentration discriminated best between people with and without familial hypercholesterolaemia at ages 1-9, when the detection rates with total cholesterol were 88%, 94%, and 96% for false positive rates of 0.1%, 0.5%, and1%. The results were similar with LDL cholesterol. Screening newborns was muchless effective. Once an affected child is identified, measurement of cholesterol would detect about 96% of parents with the disorder, using the simple rule thatthe parent with the higher serum cholesterol concentration is the affected parent.
CONCLUSIONS: The proposed strategy of screening children and parents for familial hypercholesterolaemia could have considerable impact in preventing the medical consequences of this disorder in two generations simultaneously.

The effectiveness of universal school-based programs for the prevention of violent and aggressive behavior:Task Force on Community Preventive Service

Esta revisión sistemática de la TFCPS, sobre la intervención basada en la escuela mediante programas para prevenir y disminuir el comportamiento violento, concluye con la existencia de una fuerte evidencia de la eficacia de estos programas que recomienda su uso universal.
Me ha parecido muy interesante el hallazgo de una evidencia de efectividad en estos programas que va más allá del comportamiento violento o agresivo ya que también aportan mejoras en el rendimiento escolar, los niveles de actividad, la atención, las habilidades sociales, e incluso en problemas internos como la ansiedad o la depresión.

Sobre este mismo tema, la revisión School-based secondary prevention programmes for preventing violence. Cochrane Database Syst Rev. 2006 Jul 19;3:CD004606.

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004606/frame.html

y un meta-análisis muy reciente, de los mismos autores de esta revisión Cochrane, que completa estos resultados: Wilson S, Lipsey M. Update of a meta-analysis of school-based intervention programs. Am J Prev Med. 2007;33(Suppl):S130--S143.

Screening for Lipid Disorders in Children

¿Y no tendrá colesterol mi nene?

U.S. Preventive Services Task Force
Fecha de publicación: julio de 2007
Resumen de la recomendación:
La USPSTF concluye (como la previnfante Olga ;-) que las pruebas son insuficientes para recomendar o desaconsejar el cribado rutinario de dislipemias en lactantes, niños, adolescentes y adultos jóvenes (de hasta 20 años).
Mas información en www.ahcpr.gov/clinic/uspstf/uspschlip.htm
O sea, que a seguir estándonos quietecitos, ¿eh? :-)

Obesity prevention and the primary care pediatrician's office.

Current Opinion in Pediatrics. 19(3):354-361, June 2007.

Perrin, Eliana M a; Finkle, Joanne P b; Benjamin, John T a
Abstract: Purpose of review: The obesity epidemic confronts the pediatrician every day in the office. Pediatricians should help curb the epidemic through prevention and the usual pediatric primary care tasks of screening, communication and anticipatory counseling. This review highlights findings from recent literature to guide office-based prevention of obesity in children.
Recent findings: More and more, children and society feel the effects of the obesity epidemic; prevention efforts need to begin earlier. Pediatricians' efforts to screen help identify at-risk children who may benefit from early lifestyle changes. The identification of overweight children also helps foster the appropriate work up of comorbidities. Pediatricians' communication of weight trajectories, which includes techniques like motivational interviewing, may help parents to adopt behavioral prescriptions. Pediatricians should focus on promoting breastfeeding, limiting television, increasing physical activity and reducing sugar-sweetened beverages. New tools used in the training setting show promising results.
Summary: Pediatricians must focus efforts on preventing childhood overweight, while awaiting effective treatment options for this chronic illness with its many associated morbidities. Such prevention involves sensitively communicating early body mass index screening results to parents and helping them to adopt key behavioral changes in diet and physical activity.

How to Read the New Recommendation Statement: Methods Update from the U.S. Preventive Services Task Force

Mary B. Barton, MD, MPP; Therese Miller, DrPH; Tracy Wolff, MD, MPH; Diana Petitti, MD, MPH; Michael LeFevre, MD, MSPH; George Sawaya, MD; Barbara Yawn, MD, MS, MSc; Janelle Guirguis-Blake, MD; Ned Calonge, MD, MPH; Russell Harris, MD, MPH, for the U.S. Preventive Services Task Force

Ann Intern Med. 2007 Jun 18; [Epub ahead of print]

Since 2001, the U.S. Preventive Services Task Force (USPSTF) has worked to refineits methods of evidence review and assessment and to create more usable documentsin response to clinicians' needs. These changes have resulted in a revisedgrading system, as well as a new format and new language for the recommendationstatement. This paper focuses on the changes to and the new look of the USPSTF recommendation statement. The new recommendation statement comprises 9 sections. Important changes include standardization of the format of the summary statementto specify what service is being recommended in what population; standardizationof the headings in the rationale section; a change in the wording of the grade Crecommendation and the I statement; and a new section, called "Other Considerations," in which salient issues related to cost-effectiveness, mandates,and other implementation issues are described.

Valor de la intervención breve y los tratamientos

Miguel Barrueco, Generoso Gómez Cruz, Miguel Torrecilla, Alfonso Pérez Trullén y Cruz Bartolomé Moreno.
Arch Bronconeumol. 2007;43(6):334-9

El tratamiento del tabaquismo incluye conceptos como el consejo sanitario antitabáquico, la intervención breve o la intervención intensiva y el tratamiento farmacológico, pero carecemos de información suficiente acerca de su empleo en adolescentes. Los programas escolares destinados a niños y jóvenes, que son quizá los más ampliamente utilizados y los que cuentan con mayor experiencia, deben cumplir una serie de características muy bien definidas y en los últimos años se ha cuestionado su eficacia. En la actualidad no se dispone de información suficiente acerca de la eficacia de los tratamientos en niños y jóvenes fumadores que desean dejar el tabaco. Diversas guías clínicas recomiendan el consejo y la intervención mínima en adolescentes, pero se muestran menos categóricas en lo que respecta a la utilización de los tratamientos farmacológicos. La integración del consejo y de la intervención breve en los programas de prevención y control del tabaquismo que se realizan en los centros escolares posibilitaría la utilización de este instrumento de tratamiento del tabaquismo en niños y jóvenes, aunque la información disponible acerca de este tipo de tratamientos en niños y adolescentes es insuficiente y debería ser objeto de investigación, especialmente por parte de los profesionales especializados en diagnóstico y tratamiento del tabaquismo.

Factores de riesgo cardiovascular en la edad infantil. Resultados globales del estudio Cuatro Provincias

Carmen Garcésa y Manuel de Oya (en nombre de los investigadores del estudio Cuatro Provincias) Unidad de Lípidos. Fundación Jiménez Díaz. Universidad Autónoma de Madrid. Madrid. España.
Rev Esp Cardiol 2007; 60: 517 - 524
La aterosclerosis es un proceso que se inicia en las primeras décadas de la vida y evoluciona de forma asintomática, en general, sin expresión clínica hasta la edad adulta. En el estudio Cuatro Provincias hemos analizado, en 1.275 niños de edad prepuberal, factores de riesgo (dieta, variables antropométricas, concentraciones de lípidos, vitaminas y algunos determinantes genéticos) que pueden estar relacionados con la aparición de la enfermedad coronaria en la edad adulta. En esta revisión resumimos de forma global, las principales aportaciones del estudio. El estudio 4P ha reflejado que los aspectos relacionados con el síndrome metabólico (obesidad, concentraciones elevadas de glucosa y triglicéridos) que conducen a la enfermedad coronaria en el adulto están ya expresados en la edad escolar. En este sentido, los niños de las provincias con una alta mortalidad coronaria pesan más y tienen unas concentraciones más altas de triglicéridos y glucosa. El porcentaje de niños que supera las concentraciones recomendables de colesterol total y colesterol unido a lipoproteínas de baja densidad es elevado en todas las provincias. A pesar de que hay aspectos positivos, como que las concentraciones de colesterol unido a lipoproteínas de alta densidad son también elevadas y que la prevalencia del alelo ε4 del gen de la apo-E, claramente relacionada con el riesgo cardiovascular, es baja en el conjunto de la población, si las alteraciones metabólicas descritas persisten, la situación de España respecto al riesgo cardiovascular puede empeorar en el futuro. Estos aspectos metabólicos se asocian con una alimentación rica en grasas y con un bajo consumo de hidratos de carbono, alejada de las recomendaciones actuales para la infancia. Su corrección en edades tempranas tendría enormes beneficios en la prevención de la enfermedad coronaria.

Child Abuse: Approach and Management

KELLY COLLEEN MCDONALD, MAJ, MC.Am Fam Physician 2007;75:221-8

Child abuse is a common diagnosis in the United States and should be considered any time neglect or emotional, physical, or sexual abuse is a possibility. Although home visitation programs have been effective in preventing child maltreatment, much of the approach to and management of child abuse is directed by expert opinion or legal mandate. Any suspicion of abuse must be reported to Child Protective Services. A multidisciplinary approach is recommended to adequately evaluate and treat child abuse victims; however, the responsibility often lies with the family physician to recognize and treat these cases at first presentation to prevent significant morbidity and mortality. (Am Fam Physician 2007;75:221-8. Copyright © 2007 American Academy of Family Physicians.)

Benefits and harms associated with the practice of bed sharing: a systematic review.

Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M, Moher D,
Dingwall O, Schachter H, Cote A.
Arch Pediatr Adolesc Med. 2007 Mar;161(3):237-45.
(Comment in: Arch Pediatr Adolesc Med. 2007 Mar;161(3):305-6.)

OBJECTIVE: To examine evidence of benefits and harms to children associated with bed sharing, factors (eg, smoking) altering bed sharing risk, and effective strategies for reducing harms associated with bed sharing.
DATA SOURCES: MEDLINE, CINAHL, Healthstar, PsycINFO, the Cochrane Library, Turning Research Into Practice, and Allied and Alternative Medicine databases between January 1993 and January 2005. STUDY SELECTION: Published, English-language records investigating the practice of bed sharing (defined as a child sharing a sleep surface with another individual) and associated benefits and harms in children 0 to 2 years of age.
DATA EXTRACTION: Any reported benefits or harms (risk
factors) associated with the practice of bed sharing.
DATA SYNTHESIS: Forty observational studies met our inclusion criteria. Evidence consistently suggests that there may be an association between bed sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers. This does not mean that no association between bed sharing and SIDS exists among nonsmokers, but that existing data do not convincingly establish such an association. Data also suggest that bed sharing may be more strongly associated with SIDS in younger infants. A positive
association between bed sharing and breastfeeding was identified. Current data
could not establish causality. It is possible that women who are most likely to
practice prolonged breastfeeding also prefer to bed share.
CONCLUSION: Well-designed, hypothesis-driven prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the relationship between bed sharing, its benefits, and its harms.

Infant sleep position, head shape concerns, and sleep positioning devices

Lynne Hutchison, Alistair Stewart, Edwin Mitchell (2007)

Journal of Paediatrics and Child Health 43 (4), 243–248.

Aim: The Back To Sleep campaign has successfully promoted the use of the supine sleep position for infants, with a corresponding decrease in sudden infant death syndrome death rates around the world. The aim of this study was to survey current infant sleep position practices, concerns about plagiocephaly, and the use of sleep positioning devices.
Methods: A postal survey of 400 mothers of infants aged 6 weeks to 4 months was carried out in Auckland, New Zealand.
Results: Of the 278 (69.5%) respondents, the supine position was usually used in 64.8%, the prone position in 2.9%, with 32.3% using the side position or a combination of side and back positions. Approximately one-third had a concern about their infant’s head shape, and 80% described practices to help prevent head deformation. Thirty per cent reported they had changed their infant’s sleep position because of head shape concerns. A third of the mothers used some sort of positioning system to maintain the infant’s sleep position.
Conclusions: Anxieties about plagiocephaly, aspiration of vomit, and poor quality sleep are the main concerns that parents have about sleeping their infants on their backs. Further education is needed to inform mothers about these issues and to alleviate their fears.

Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].

CMAJ. 2007 Apr 10;176(8):S1-13.2006

Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E;

Obesity CanadaClinical Practice Guidelines Expert Panel. Department of Medicine, Julia McFarlane Diabetes Research Centre, Diabetes andEndocrine Research Group, University of Calgary, Calgary, Alta.dcwlau@ucalgary.ca

We have attempted to use a rigorous, evidence-based approach to the development of the practice recommendations, while also acknowledging the breadth of topics to be assessed and the inherent limitations of the obesity literature on these topics.
In addition to making recommendations for treatment interventions, the most common application of clinical practice guidelines, we have also provided recommendations on interventions related to screening and prevention at the individual and population levels.
The recommendations are based on a prespecified process that was overseen by the Steering Committee. Specific chapters of the guidelines were delegated to a group of content experts within the Expert Panel, who performed a systematic literature review and were responsible for drafting the recommendations for each chapter. Recommendations were appraised by an independent Evidence-based Review Committee, members of which assessed whether the assigned level of evidence reflected the strength of the existing literature. The interactive process by which the recommendations were developed, reviewed and revised included 4 joint meetings of the Steering Committee and Expert Panel. The final draft of the guidelines was reviewed by the Steering Committee and by external stakeholders and experts, who included representatives from academia, industry and government and non government officials.

Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Arch Dis Child. 2007 May;92(5):416-22..

Westwood M, Fayter D, Hartley S, Rithalia A, Butler G, Glasziou P, Bland M,Nixon J, Stirk L, Rudolf M.

BACKGROUND: Population monitoring has been introduced in UK primary schools inan effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised.

DESIGN: Systematic review with discussion of evidence gaps and future research.

DATA SOURCES: Published and unpublished studies (any language) from electronic databases (inception to July 2005),clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies.

REVIEW METHODS: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence.

RESULTS: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse.

CONCLUSIONS: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

Surgery for Undescended Testes and Risk for Testicular Cancer: Age Matters

Orchiopexy in the first few years of life means less risk for testicular cancer.
At 1 year of age, about 1% of boys have undescended testes (cryptorchidism). Most experts recommend that orchiopexy should be performed before the age of 2 years because some research has suggested a link between testicular cancer and older age at surgery.
Swedish investigators identified 16,983 men in a national registry who had received a diagnosis of cryptorchidism from 1964 through 1999 and who had undergone orchiopexy before age 20 (mean age at surgery, 8.6 years). During a mean follow-up of 12.4 years, 56 men developed testicular cancer. Compared with risk in the general population, the risk for testicular cancer among those who underwent surgery before age 13 was increased (relative risk, 2.2); this twofold increased risk was noted for patients treated at all ages before 13. Among those who underwent surgery after age 13, the risk increased significantly (RR, 5.4).
Comment: These data clearly support the current recommendation that orchiopexy for undescended testis should be performed during the first few years of life.
— Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine May 9, 2007
Citation(s):
Pettersson A et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007 May 3; 356:1835-41.

Abstinence education has no effect on US teenagers' sexual activity.

Tanne JH.
BMJ. 2007 Apr 28;334(7599):867.

Although the United States spends about $88m (£44m; 65m) a year teaching teenagers to abstain from sex outside marriage, young people in the programmes are just as likely to have sex as those who don't receive counselling, a new study says.
Teenagers who received abstinence education did not delay sexual activity any longer than those in a control group. When they became sexually active they had the same number of partners and were as likely to use condoms or other contraceptives as those who had not been counselled.
This rigorous, well designed study adds to and confirms previous research findings that abstinence only education programmes are ineffective and a waste of taxpayer dollars. It is called for more comprehensive programmes that not only teach abstinence but also provide information on contraception and safe sex.

Youth and Road Safety, report published by the World Health Organization (WHO).

Road traffic crashes are the leading cause of death among young people between 10 and 24 years, according to a new report published by the World Health Organization (WHO). The report, Youth and Road Safetysays that nearly 400 000 young people under the age of 25 are killed in road traffic crashes every year. Millions more are injured or disabled.

http://whqlibdoc.who.int/publications/2007/9241594640_eng.pdf

http://whqlibdoc.who.int/publications/2007/9241595116_eng.pdf

Nordic consensus on treatment of undescended testes.

Acta Paediatr. 2007 Feb 23; [Epub ahead of print]

Related Articles

Nordic consensus on treatment of undescended testes.

Martin Ritzen E, Bergh A, Bjerknes R, Christiansen P, Cortes D, Haugen S, Jorgensen N, Kollin C, Lindahl S, Lackgren G, Main K, Nordenskjold A, Rajpert-De Meyts E, Soder O, Taskinen S, Thorsson A, Thorup J, Toppari J, Virtanen H.

Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.

Aim: To reach consensus among specialists from the Nordic countries on the present state-of-the-art in treatment of undescended testicles. Methods: A group of specialists in testicular physiology, paediatric surgery/urology, endocrinology, andrology, pathology and anaesthesiology from all the Nordic countries met for two days. Before the meeting, reviews of the literature had been prepared by the participants. Recommendations: The group came to the following unanimous conclusions: (1) In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long term adverse effects on spermatogenesis. Thus, surgery is to be preferred. (2) Orchiopexy should be done between 6 and 12 months of age, or upon diagnosis, if that occurs later. (3) Orchiopexy before age one year should only be done at centres with both paediatric surgeons/urologists and paediatric anaesthesiologists. (4) If a testis is found to be undescended at any age after 6 months, the patient should be referred for surgery-to paediatric rather than general surgeons/urologists if the boy is less than one year old or if he has bilateral or non-palpable testes, or if he has got relapse of cryptorchidism.

PMID: 17326760 [PubMed - as supplied by publisher]