Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands (MEVDAM, JK).
Netherlands Organization for Applied Scientific Research, Leiden/Utrecht, The Netherlands (MK, HBMVG, FHP)
Med Decis Making. 2013 Oct;33(7):906-19. doi: 10.1177/0272989X13493145. Epub 2013 Jul 2.
Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchidopexy. The age at which orchidopexy should be performed is controversial for both congenital and acquired UDT.
A decision analysis is performed in which all available knowledge is combined to assess the outcomes of orchidopexy at different ages.
Without surgery, unilateral congenital UDT and bilateral congenital UDT are associated with average losses in quality-adjusted life-years (QALYs) of 1.53 QALYs (3% discounting 0.66 QALYs) and 5.23 QALYs (1.91 QALYs), respectively. Surgery reduces this QALY loss to on average 0.84 QALYs (0.21 QALYs) for unilateral UDT and 1.66 QALYs (0.40 QALYs) for bilateral UDT. Surgery at detection will lead to the lowest QALY loss of 0.91 (0.34) and 1.73 (0.60) QALYs, respectively, for unilateral and bilateral acquired UDT compared with surgery during puberty and no surgery. No sensitivity analysis is able to change the preferences for these strategies.
Based on our decision analytic model using societal valuations of health outcomes, surgery for unilateral UDT (both congenital and acquired) yielded the lowest loss in QALYs. 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), orchidopexy at any age provides considerable benefit, in particular through improved fertility. As there is no strong effect of timing, the age at which orchidopexy is performed should 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.
隐睾症（UDT）或睾丸未降是男孩中最常见的生殖器异常，可以通过睾丸固定术进行手术治疗。对于先天性和获得性 UDT，何时进行睾丸固定术存在争议。
进行决策分析，将所有可用知识结合起来评估不同年龄进行睾丸固定术的结果。
如果不进行手术，单侧先天性 UDT 和双侧先天性 UDT 分别导致平均质量调整生命年（QALY）损失 1.53 QALY（3%折扣 0.66 QALY）和 5.23 QALY（1.91 QALY）。手术将单侧 UDT 的 QALY 损失平均降低至 0.84 QALY（0.21 QALY），双侧 UDT 降低至 1.66 QALY（0.40 QALY）。检测时进行手术将导致单侧和双侧获得性 UDT 的 QALY 损失最低，分别为 0.91（0.34）和 1.73（0.60），与青春期进行手术和不进行手术相比。没有敏感性分析能够改变对这些策略的偏好。
根据我们使用健康结果的社会价值进行决策分析模型，单侧 UDT（先天性和获得性）的手术导致 QALY 损失最低。考虑到结果的差异较小，在单侧 UDT 的情况下，手术的实施和时间可以根据患者（或家长）的偏好进行。对于双侧 UDT（先天性和获得性），任何年龄的睾丸固定术都有很大的益处，特别是通过提高生育能力。由于没有时间的强烈影响，睾丸固定术的实施年龄应与父母和患者讨论。关于时间问题的更多临床证据可能会在未来修改这些结果和建议。
