Orchidopexy patterns in Austria from 1993 to 2009

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Abstract

Objective

To evaluate orchidopexy patterns in Austria.

Material and methods

All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type.

Results

Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p < 0.001) and 3–7 years (p < 0.001) increased, while the rate in boys older than 7 years decreased (p < 0.001). Year of birth (p < 0.0001) and place of residence (p < 0.0001 and p < 0.024) are significant predictors for having early orchidopexy.

Conclusion

In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.

Introduction

Undescended testis (UDT) is one of the most common congenital abnormalities with a prevalence of about 1% at the age of one year [1]. UDT is a risk factor for impaired spermatogenesis and male infertility [2]. Although in UDT after birth the germ cell count may be normal, their number decreases dramatically within the first two years of life, especially in the second half of the first year. After two years, the normal age-related number of spermatogonia is found only in about 10% of UDT [3]. Over time, gonocytes fail to disappear and adult dark spermatogonia fail to appear, and thus there is failure to establish an adequate adult stem cell pool [4]. In a randomized controlled trial, early orchidopexy was shown to be beneficial in improving testicular growth [5].

Moreover, the relative risk of testicular tumor in UDT is 2.75–8 [6]. The etiology of testicular cancer is poorly understood, and the only consistent risk factor is UDT [7]. It is yet not clearly understood if age at orchidopexy has an influence on the later risk of tumor, although recent data support the concept that early orchidopexy reduces the risk of malignancy [8].

These findings are reflected in numerous guidelines that recommend orchidopexy at between 6 and 18 months of life [9], [10]. In this study, we analyzed the data from all orchidopexies for UDT performed in Austrian hospitals from 1993 to 2009.

Section snippets

Data collection

We used the database of ÖGIS (‘Austrian Health Information System’) at the GÖG (Austrian federal research and planning institute for health care and competence and funding center of health promotion), a national database of administrative and billing data from all public and private hospitals in Austria, to identify all patients who underwent orchidopexy between 1993 and 2009.

Patients and epidemiologic variables

We identified all orchidopexies performed for UDT between January 1993 and December 2009 in Austria for patients not

Results

Between 1993 and 2009, 19,998 boys and young men underwent orchidopexy. The average age at operation decreased from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). The total incidence of orchidopexies was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. This phenomenon is due to an increasing number of operations on boys younger than 7 years (Fig. 1). Table 2 shows the total numbers and OP rates by age group, corresponding to

Discussion

Austria is a Western European country with 8.4 million inhabitants and a national health insurance system. In this study, we had the chance to conduct a nationwide review of all orchidopexies performed in public and private hospitals in Austria between 1993 and 2009. Our data analysis emphasizes three major findings, which will be discussed in detail.

  • The total incidence of orchidopexy is significantly increasing throughout the study period.

  • The incidence of orchidopexies in younger boys is

Conclusions

Analysis of all orchidopexies performed in Austria between 1993 and 2009 showed that the total incidence of orchidopexy rose significantly. Moreover, the incidence of orchidopexies performed before 24 months of life was constantly rising over the study period with significant geographic differences.

Ethical approval

The study was carried out in accordance with the Ethics Committee of the Medical University of Vienna.

Conflict of interest

None of the authors have any conflicts of interest, including specific financial interests regarding this article.

Funding

No funding or other financial support was received.

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