Witten/Herdecke University, Department of Paediatrics, Centre for Clinical and Translational Research (CCTR), Wuppertal University Hospital, Wuppertal, Germany.
Cardiovascular Research, Bayer Pharma AG, Wuppertal, Germany.
BJU Int. 2018 Oct;122(4):644-653. doi: 10.1111/bju.14171. Epub 2018 Mar 9.
To assess the implementation of the current guideline and identify potential underlying causes for late surgery in children with undescended testis (UDT) in Germany. UDT is the most common surgical issue in paediatric urology and to avoid malignant degeneration and subfertility current guidelines recommend orchidopexy during the first year of life; however, this seems not to be implemented in practice.
In all, 5 547 patients with cryptorchidism at 16 hospitals nationwide were studied regarding age at orchidopexy between 2003 and 2016. Multivariate analysis was performed to identify factors influencing timing of surgery. Additionally, a survey on knowledge of UDT management was conducted amongst physicians treating boys and final-year medical students.
Between 2003 and 2008 only 4% of boys with UDT underwent surgery before the age of 1 year. After the guideline update from 2009, this figure was 5% from 2010 to 2012, and 8% from 2013 to 2016. The presence of a specialised department for paediatric surgery, as well as a high UDT case-to-year ratio positively influenced the timing of orchidopexy. The survey revealed discipline-specific differences in the levels of knowledge about UDT management. One-third of respondents did not know the guideline recommendations and 61% felt insufficiently informed. International comparisons revealed significant differences in the age at surgery of boys with UDT, with Germany and Great Britain ranging in the middle of the field.
Currently, only a small proportion of boys with UDT are operated upon during their first year of life. The level of knowledge in attending physicians remains in need of improvement. This should be actively addressed, i.e. by campaigns and educational programmes. Further studies are needed to investigate the underlying causes of late orchidopexy in UDT.
评估德国未降睾丸（UDT）儿童手术延迟的现行指南实施情况，并确定潜在的根本原因。UDT 是小儿泌尿外科最常见的手术问题，为避免恶性转化和不育，目前的指南建议在生命的第一年进行睾丸固定术；然而，这似乎在实践中并未得到实施。
在全国 16 家医院，对 5547 例隐睾症患者的睾丸固定术年龄进行了研究，时间为 2003 年至 2016 年。采用多变量分析确定影响手术时机的因素。此外，还对治疗男孩的医生和医学专业的最后一年学生进行了 UDT 管理知识调查。
2003 年至 2008 年，只有 4%的 UDT 男孩在 1 岁前接受手术。2009 年指南更新后，2010 年至 2012 年这一比例为 5%，2013 年至 2016 年为 8%。小儿外科专科科室的存在以及 UDT 病例与年份之比高，这两个因素都对睾丸固定术的时机产生了积极影响。调查显示，在 UDT 管理知识方面，不同学科之间存在差异。三分之一的受访者不知道指南建议，61%的人觉得自己信息不足。国际比较显示，患有 UDT 的男孩手术年龄存在显著差异，德国和英国处于中等水平。
目前，只有一小部分 UDT 男孩在生命的第一年接受手术。主治医生的知识水平仍有待提高。应积极解决这一问题，例如通过宣传活动和教育项目。还需要进一步研究以探讨 UDT 中睾丸固定术延迟的根本原因。
