NEW YORK (Reuters Health) - For boys with cryptorchism, orchiopexy before age 11 offers the best protection against testicular cancer, according to a report in the April 1st American Journal of Epidemiology.

While cryptorchism has been consistently linked to an increased risk of testicular cancer, the authors explain, the role and appropriate timing of surgical treatment for cryptorchism remain unclear.

Dr. Lisa Herrinton and colleagues from Kaiser Permanente in Oakland, California used medical records from the Kaiser Permanente Medical Care Program of Northern California to examine the outcomes of cryptorchism management strategies.

"This study is different than those conducted in the past because we had medical records dating to the boys' early years," Dr. Herrinton told Reuters Health. "Thus, we were able to separate boys whose orchiopexies failed or succeeded. This had not been done in past studies."

Twelve men had both testicular cancer and a history of cryptorchism, the report indicates. Among ten of these men, three had failed at least one orchiopexy, three had received successful orchiopexies at age 12 years or older, two had received no treatment, and two had not received treatment by age 10 and 13 years.

In contrast, the researchers note, among 8 controls with a history of cryptorchism who did not develop testicular cancer, six had successful resolution of their cryptorchism by their 11th year, either naturally or as a result of surgery. One of the remaining 2 controls was untreated, and the second had incomplete medical records.

"We observed no increased risk of testicular cancer among men whose cryptorchism had been successfully resolved by their 11th birthday," the authors conclude, "but a 32-fold increased risk among men whose cryptorchism persisted after this age."

As for the appropriate timing for orchiopexy, Dr. Herrinton said, "I believe there is reason to wait in the hopes of spontaneous descent, but not past a certain age, and 10 or 11 years may be an upper limit on that age."

Dr. Herrinton said that the best policy is "to carefully follow-up boys who undergo orchiopexy to ensure that the procedure succeeds and to further treat with re-operative orchiopexy or orchiectomy those whose procedures fail."

Given the nearly complete medical information available for this study, Dr. Herrinton concluded: "I believe it would unwise to wait for further research information before taking a more aggressive approach to following-up and treating failed orchiopexy."

Am J Epidemiol 2003;157:602-605.

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