Purpose: Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchiopexy. The purpose of this study is to assess the health outcomes of orchiopexy at different ages (or no orchiopexy) in order to identify which boys at what ages benefit most from surgery.
Method: A decision analysis was performed in which all available knowledge is combined to assess the outcomes of orchiopexy at different ages (base case analysis). Furthermore a sensitivity analysis was performed to assess in which way and to what extent the optimal age of surgical intervention is influenced by gaps in current knowledge.
Result: Without surgery, unilateral and bilateral congenital UDT are associated with average losses in quality adjusted life years (QALYs) of 1.53 QALY (mainly caused by loss of cosmesis) and 5.23 QALYs (mainly caused by infertility) respectively. Surgery on average reduces this QALY-loss to 0.85 QALY for unilateral UDT and 1.67 QALY for bilateral UDT. Surgery at detection will lead to the lowest QALY loss of 0.93 and 1.77 QALY for respectively unilateral and bilateral acquired UDT compared to surgery during puberty and no surgery.Sensitivity analysis demonstrated that these findings are robust for almost all scenarios with the exception of congenital UDT that may benefit from waiting till at least six months of age before orchiopexy is performed.
Conclusion: Based on our decision analytic model using societal valuations of health outcomes, we conclude that surgery of unilateral UDT (both congenital and acquired) yielded the lowest loss in QALYs. In clinical practice such QALY-losses and –gains may differ from patient to patient. Given the modest differences in outcomes, there is room for patient (or parent) preference with respect to the performance and timing of surgery in case of unilateral UDT. For bilateral UDT (both congenital and acquired) orchiopexy at any age provides considerable benefit, in particular through increased paternity. As there is no strong effect of timing, the age of orchiopexy is to be discussed with the parents and the patient. More clinical evidence on issues related to timing may in the future modify these results and hence this advice.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making