title: Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review.
abstract: OBJECTIVE
  Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism.
  
  
  METHODS
  We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria.
  
  
  RESULTS
  Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare.
  
  
  CONCLUSIONS
  The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.
authors.affiliation: Center for Surgical Quality and Outcomes Research, Nashville, TN 37203-1738, USA. david.penson@vanderbilt.edu
authors.forename: David
authors.initials: D
authors.lastname: Penson
authors.forename: Shanthi
authors.initials: S
authors.lastname: Krishnaswami
authors.forename: Astride
authors.initials: A
authors.lastname: Jules
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McPheeters
mesh_terms: D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D056126:Orchiopexy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: cryptorchidism; systematic review; undescended testicle