title: Management of cryptorchidism: a survey of clinical practice in Italy.
abstract: BACKGROUND
  An evidence-based Consensus on the treatment of undescended testis (UT) was recently published, recommending to perform orchidopexy between 6 and 12 months of age, or upon diagnosis and to avoid the use of hormones. In Italy, current practices on UT management are little known. Our aim was to describe the current management of UT in a cohort of Italian children in comparison with the Consensus guidelines. As management of retractile testis (RT) differs, RT cases were described separately.
  
  
  METHODS
  Ours is a retrospective, multicenter descriptive study. An online questionnaire was filled in by 140 Italian Family Paediatricians (FP) from Associazione Culturale Pediatri (ACP), a national professional association of FP. The questionnaire requested information on all children with cryptorchidism born between 1/01/2004 and 1/01/2006. Data on 169 children were obtained. Analyses were descriptive.
  
  
  RESULTS
  Overall 24% of children were diagnosed with RT, 76% with UT. Among the latter, cryptorchidism resolved spontaneously in 10% of cases at a mean age of 21.6 months. Overall 70% of UT cases underwent orchidopexy at a mean age of 22.8 months (SD 10.8, range 1.2-56.4), 13% of whom before 1 year. The intervention was performed by a paediatric surgeon in 90% of cases, with a success rate of 91%. Orchidopexy was the first line treatment in 82% of cases, while preceded by hormonal treatment in the remaining 18%. Hormonal treatment was used as first line therapy in 23% of UT cases with a reported success rate of 25%. Overall, 13 children did not undergo any intervention (mean age at last follow up 39.6 months). We analyzed the data from the 5 Italian Regions with the largest number of children enrolled and found a statistically significant regional difference in the use of hormonal therapy, and in the use of and age at orchidopexy.
  
  
  CONCLUSIONS
  Our study showed an important delay in orchidopexy. A quarter of children with cryptorchidism was treated with hormonal therapy. In line with the Consensus guidelines, surgery was carried out by a paediatric surgeon in the majority of cases, with a high success rate.
authors.affiliation: Institute for Maternal and Child Health IRCCS Burlo Garofolo, Department of Paediatrics, Trieste, Italy. marchetti@burlo.trieste.it
authors.forename: Federico
authors.initials: F
authors.lastname: Marchetti
authors.forename: Jenny
authors.initials: J
authors.lastname: Bua
authors.forename: Gianluca
authors.initials: G
authors.lastname: Tornese
authors.forename: Gianni
authors.initials: G
authors.lastname: Piras
authors.forename: Giacomo
authors.initials: G
authors.lastname: Toffol
authors.forename: Luca
authors.initials: L
authors.lastname: Ronfani
mesh_terms: D002675:Child, Preschool; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003456:Cryptorchidism / Q000628:therapy*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008875:Middle Aged; D056126:Orchiopexy / Q000706:statistics & numerical data; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone