Management of cryptorchidism in children: guidelines.
OBJECTIVE
To develop clinical guidelines for the management of cryptorchidism in pre-pubertal boys, from early diagnosis through therapy to long-term follow-up and prognosis.


METHODS
Systematic review of articles from the medical literature, referenced since 1966, using validated search strategies through the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, EMBASE, DARE, ACP Journal Club, National Guidelines Clearinghouse, Guidelines International Network. Relevant articles published after 1988 were taken as the basis for the statements. Each statement was graded on the basis of the study design and on its methodological quality (GRADE approach). A multidisciplinary panel of local experts discussed and evaluated each statement on the strength of this evidence.


RESULTS
28 statements based on the best available evidence were drafted. The experts agreed with all but two statements, which were rated uncertain.


CONCLUSIONS
Cryptorchidism is best diagnosed clinically, and treated by surgical orchiopexy at age 6-12 months, without a routine biopsy. If no testis is palpable, or if other signs of hypovirilisation such as hypospadias are present, the chromosomal sex and hormonal status must be assessed. Laparoscopy is the best way of diagnosing and managing intra-abdominal testes.
Gapany
Christophe
C
Service of Pediatric surgery, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, Lausanne, Switzerland. Christophe.Gapany@chuv.ch
Frey
Peter
P
Cachat
Françoise
F
Gudinchet
Françoise
F
Jichlinski
Patrice
P
Meyrat
Blaise-Julien
BJ
Ramseyer
Pascal
P
Theintz
Gérald
G
Burnand
Bernard
B
D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000453:epidemiology / Q000601:surgery*; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D013557:Switzerland / Q000453:epidemiology; D013521:Urologic Surgical Procedures, Male / Q000379:methods*