📃 Paper Title: Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months or 3 years
🧍 Author: Claude Kollin
🕒 Year: 2007
📚 Journal: The Journal of Urology
🌎 Country: Sweden
ㅤContext to the study:
Can you cite a study highlighting the benefits of early orchiopexy in boys with unilaterally undescended testes?
ㅤ✅ Take-home message of study:
Early orchiopexy leads to better outcomes for testicular growth in unilateral undescended testis.
Orchiopexy at 9 months is better than orchiopexy at 3 years.
Partial catch-up of testicular growth in the retained testis compared to scrotal testis was seen for orchiopexy at 9 months and not orchiopexy at 3 years.
ㅤ Single centre, unblinded randomised control trial
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Study participants:
Total participants: 155
Orchiopexy at 9 months: n=72
Orchiopexy at 3 years: n=83
Inclusion criteria:
Congenital unilateral palpable undescended testis at ages 0-3 weeks or at 6 months.
Exclusion criteria:
Spontaneous descent, recognised syndromes, other birth defects or other pathological conditions afflicting the external genitalia, prematurity (less than 37 weeks of gestation) and prior groin surgery.
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Key study outcomes:
Testicular volume was measured via ultrasound at ages 6, 12, 24, 39 and 48 months.
During the first 6 months postnatally the volume of the descended testis increased by 70%, while the increase in the retained testis was only 40%.
Orchiopexy at age 9 months resulted in a statistically significant increase in median testicular volume from 0.35 ml at 6 months to 0.42 ml at 2 years, 0.49 at 3 years and 0.50 ml at 4 years (p0.001).
In contrast, orchiopexy at age 3 years did not result in significant growth of the retained testes (0.35ml at 6 months, 0.33ml at 2 years, 0.38ml at 3 years, 0.38m at 4 years (p>0.05).
Retained-to-scrotal testis ratio (median):
9 months: 0.68 at 6 months to 0.81 at 4 years (p<0.001) -** increase.**
3 years: 0.68 at 6 months to 0.56 at 4 years (p<0.001) -** decrease.**
At ages 2, 3 and 4 years there were significant differences in this ratio between the early and late treatment groups, demonstrating the partial catch-up growth of early treated testes (p=0.001).
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Study Limitations:
Testicular volume (dependent variable) is not a direct measure of spermatogenic activity.
Conclusions cannot be made about the effect of early orchiopexy on spermatogenesis.
Study was not blinded, and allocation was not concealed.
One surgeon was responsible for 95% of operations and ultrasound examinations.
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