No increases in the rate of undescended testis in Hungary during the last 50 years: A population-based study

Prevalence of congenital cryptorchidism in China: A nationwide population-based surveillance study, 2007-2021

BACKGROUND

Despite cryptorchidism being a common genital abnormality in male newborns with significant prevalence variations globally, there is a notable scarcity of epidemiological data on this condition in China.

OBJECTIVE

This study aimed to delineate the prevalence pattern of cryptorchidism in Chinese population over the past 15 years using nationwide surveillance data.

MATERIALS AND METHODS

Data from the China National Population-based Birth Defects Surveillance System (2007-2021) were analyzed to calculate the prevalence rates of cryptorchidism, stratified by birth year, maternal age, maternal residence, and geographic region. Adjusted prevalence rate ratios were computed using Poisson regression, while trends in prevalence and average annual percent change (AAPC) were assessed using the joinpoint regression model.

RESULTS

During the study period, a total of 1,833 cases of cryptorchidism were identified among 2,565,964 full-term male births, resulting in prevalence rates of 7.14, 5.60, and 1.54 per 10,000 births for overall, isolated, and associated cryptorchidism, respectively. The overall prevalence increased from 3.86 to 11.20 per 10,000 births, with an AAPC of 7.9% (95% confidence interval: 5.5-11.0). Significant variations were observed across maternal age (< 20 years, 7.62/10,000; 20-24 years, 6.14/10,000; 25-29 years, 6.96/10,000; 30-34 years, 7.48/10,000; ≥35 years, 9.22/10,000), maternal residence (urban vs. rural, 10.99/10,000 vs. 2.86/10,000), and geographic region (eastern, 12.38/10,000; central, 2.36/10,000; western, 2.63/10,000). Approximately one-third of cryptorchidism cases were bilaterally, while two-thirds were unilateral. Commonly observed associated abnormalities included congenital hydrocele testis, as well as anomalies in the genital organs, circulatory system, and musculoskeletal system.

CONCLUSION

Despite lower rates compared to other countries, the increasing trend in prevalence of cryptorchidism necessitates further investigation and intervention.

Abdominal Cryptorchidism with Complete Dissociation between the Testis and Deferent Duct Mimicking Testicular Regression Syndrome

Complete separation of the deferent duct from the epididymis in cryptorchid testes residing in the abdomen is an extremely rare variant of developmental disorders of the testis and epididymis. Available sources mention only three clinical cases similar to our observations. The unique anatomic aspects of this disorder hamper the correct diagnosis of an intra-abdominal cryptorchid testis. Two boys with nonpalpable left-sided cryptorchidism underwent diagnostic laparoscopy, revealing an intra-abdominally located testis. The epididymis was completely separated from the deferent duct, and the epididymis and testis were supplied by testicular vessels. Exploration of the inguinal canal revealed blind-ending deferent ducts. The testis was brought down through the inguinal canal and fixed in the scrotum in both boys. The follow-up examination at 6 months revealed no signs of testicular atrophy or malposition of the testis in either patient. With our observations in mind, the exclusive use of a transscrotal or transinguinal approach as the initial surgical exploration in the treatment of patients with nonpalpable forms of cryptorchidism may be inappropriate. Careful laparoscopic examination of the abdominal cavity is indispensable in children with suspected testicular regression syndrome or nonpalpable forms of cryptorchidism.

Secular trends in the incidence and timing of surgical intervention for congenital undescended testis and surgically treated hypospadias in Ontario, Canada between 1997 and 2007

INTRODUCTION

Recent studies have suggested contradictory trends in the incidence of undescended testis (UDT) and hypospadias (HYP), partly because of methodological issues and ascertainment bias. The recently described association of "testicular dysgenesis syndrome" links concomitant UDT and HYP, with decreasing sperm counts and testicular cancer. Current guidelines suggest that orchidopexy for UDT should be performed by 18 months of age.

OBJECTIVE

We conducted a retrospective population-based cohort study to estimate the incidence of UDT, HYP, and concomitant UDT and HYP in Ontario, based on a surgical procedure performed in the 5 years after birth. We hypothesized that the incidence of UDT and HYP are stable in the province of Ontario, Canada, over an 11-year time period.

STUDY DESIGN

Linked administrative databases held at the Institute of Clinical Evaluative Sciences (ICES) in the province of Ontario, were used to identify all live male newborns between 1997 and 2007. Incidence rates of UDT, HYP and concomitant UDT and HYP were calculated by identifying a surgical procedure for these anomalies, within 5 years of birth. Incidence trends were analyzed using the Cochrane Armitage test for trend. Age at surgery for surgical intervention for an orchidopexy or HYP repair was determined.

RESULTS

The incidence of UDT, defined by an orchidopexy within 5 years of birth, has remained stable in Ontario, Canada (8.2/1000 male live births, p-value for trend 0.9, 95% CI 8.0-8.4). The incidence of hypospadias has similarly remained stable (3.8/1000 male live births, p-value for trend 0.8, 95% CI 3.7-3.9). The incidence of concomitant UDT and HYP repair showed a significant increase over the 11-year period (0.2/1000 male live births, p-value for trend 0.03, 95% CI 0.2-0.3). The median age at orchidopexy (23 months, IQR 16-34 months) was beyond guideline recommendations, with earlier orchidopexy in recent years. The median age at hypospadias repair was 17 months (IQR 12-26 months).

DISCUSSION

The variable rates of incidence for UDT and HYP can be explained by variations in study methodology and differing data sources utilized. The current study uses a surgical procedure to minimize information bias to correctly identify index cases of UDT and HYP.

CONCLUSIONS

The incidence of undescended testis and hypospadias, over 5 years after birth, has remained stable in the province of Ontario between 1997 and 2007 (Summary Table). Concomitant UDT and HYP incidence showed a significant increase over this time period. Most boys in Ontario, Canada, undergo orchidopexy beyond 18 months of age.

Undescended testes: an update

PURPOSE OF REVIEW

This article summarizes the latest evidence on the risk factors, management and outcomes of undescended testes (UDTs).

RECENT FINDINGS

UDTs remain common, with increasing evidence that acquired UDT or the ascending testis syndrome should be considered part of the spectrum of this disease. Prompt diagnosis and early referral for surgical evaluation and treatment would seem most likely to result in an optimal functional and cosmetic outcome. Hormonal treatment, rather than orchidopexy, remains popular in some centers, despite a lack of good evidence to support its efficacy, although it may have an important adjunct role in optimizing fertility. Although often performed, ultrasound does not generally assist in the diagnosis and management of UDT, with enhanced education of primary care physicians more likely to facilitate early referral. The testis, rather than quiescent, appears biologically active in the male infant, with increasing evidence of an adverse impact on future spermatogenesis and fertility in men with a UDT.

SUMMARY

Male infants with a UDT should be diagnosed and referred early for surgical evaluation. It seems likely that the optimal timing for surgery should be before the boy's first birthday. There remains a need for high-quality, long-term outcomes data to guide optimal management.