Testicular neoplasia in undescended testes of cryptorchid boys-does surgical strategy have an impact on the risk of invasive testicular neoplasia?

UNLABELLED We investigated whether or not surgical strategy has an impact on the risk of invasive testicular neoplasia in cases of cryptorchidism. We made a database study of the incidence of testicular neoplasia at surgery for cryptorchidism in childhood, and evaluated if such abnormalities were found in special categories of patients, and also of the incidence of testicular neoplasia after orchiopexy with a simultaneous testicular biopsy in childhood. At surgery for cryptorchidism the risk of testicular neoplasia was 7/182 (4%) in cases with intra-abdominal testis, abnormal external genitalia other than cryptorchidism, or diagnosed abnormal karyotype, versus no case in the 1281 patients without these characteristics (Fisher's exact test, p < 0.00005). These clinical characteristics occurred most often in bilateral cryptorchidism 82/339 (24%) versus 103/1127 (9%) in unilateral cryptorchidism (Fisher's exact test, p < 0.00005). At follow-up, the risk of testicular neoplasia was 7/830 (1%). The relative risk of testicular neoplasia was about 4. CONCLUSION Based on our data and the literature we recommend: 1) Taking a testicular biopsy at surgery for cryptorchidism in childhood in intra-abdominally placed testes, or if the patient has abnormal external genitalia or a known abnormal karyotype. These clinical characteristics occur most often in cases of bilateral cryptorchidism. 2) Surgery for cryptorchidism before 10 years of age 3) Clinical control, after surgery for cryptorchidism. In cases of testicular atrophy orchiectomy must be considered.