title: The timing of surgery for undescended testis - a retrospective multicenter analysis.
abstract: BACKGROUND
  n Germany, it is recommended that the surgical treatment of an undescended testis should be carried out between the ages of 6 months and 1 year to lower the risks of subfertility and testicular carcinoma. Although this recommendation has appeared in the German guidelines from 2007 onward, orchidopexy is still frequently performed at later ages.
  
  
  METHODS
  We retrospectively analyzed data from seven pediatric surgical services in the German state of Baden-Württemberg on all boys who underwent orchidopexy from 2009 to 2012. We classified the timing of surgery as Age Group I (before the first birthday), Age Group II (between the first and second birthdays), and Age Group III (after the second birthday). We determined whether preoperative hormonal treatment was given and distinguished primary from secondary undescended testis.
  
  
  RESULTS
  Among 2213 boys who underwent orchidopexy, 1850 had primary and 363 had secondary undescended testis. Of those with primary undescended testis, the percentages of boys who underwent surgery in Age Groups I, II, and III were (respectively, with 95% confidence intervals): 18.7% (17-20.6%), 24.4% (22.5-26.5%), and 57% (54.6-59.2%). A small percentage of boys in each group also received preoperative hormonal treatment. From 2009 to 2012, there was a secular trend favoring earlier orchidopexy. In 2012, 28 boys (14.2% [9.7-20.0%]) had orchidopexy in outpatient pediatric surgery practices before their first birthday, while 68 did on hospital inpatient services (40.7% [33.2-48.6%]).
  
  
  CONCLUSIONS
  Most of the patients studied had surgery at a later age than recommended. Adherence to the guidelines in this respect is nonetheless relatively good in Germany compared to other countries, as studies from abroad have yielded findings that are just as bad or worse.
authors.affiliation: Outpatient clinic for Pediatric and Adolescent Surgery, Stuttgart, Outpatient clinic for surgery, Reutlingen, Department of Pediatric Surgery and Pediatric Urology, Eberhard Karls University of Tübingen, Outpatient clinic for Pediatric and Adolescent Surgery,, Stuttgart, Outpatient clinic for Pediatric and Adolescent Surgery, Ulm, Lorettoklinik, Pediatric Surgery, Tübingen, Department of Pediatric and Adolescent Surgery, Olga Hospital, Stuttgart.
authors.forename: Georg
authors.initials: G
authors.lastname: Hrivatakis
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Astfalk
authors.forename: Andreas
authors.initials: A
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Hartwig
authors.forename: Thomas
authors.initials: T
authors.lastname: Kugler
authors.forename: Thomas
authors.initials: T
authors.lastname: Heim
authors.forename: Axel
authors.initials: A
authors.lastname: Clausner
authors.forename: Albrecht
authors.initials: A
authors.lastname: Frunder
authors.forename: Harduin
authors.initials: H
authors.lastname: Weber
authors.forename: Steffan
authors.initials: S
authors.lastname: Loff
authors.forename: Joerg
authors.initials: J
authors.lastname: Fuchs
authors.forename: Verena
authors.initials: V
authors.lastname: Ellerkamp
mesh_terms: D015984:Causality; D002675:Child, Preschool; D015897:Comorbidity; D003456:Cryptorchidism / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007248:Infertility, Male / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D056126:Orchiopexy / Q000706:statistics & numerical data*; D057234:Preoperative Period; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome