Authors
Toledano M.B., Hansell A.L., Jarup L., Quinn M., Jick S., Elliott P.

Title
Temporal trends in orchidopexy, Great Britain, 1992-1998

Source
Environmental Health Perspectives. 111(1):129-32. 2003.

Summary
A condition in which one or both testicles are not within the scrotum is referred to as cryptorchidism. An undescended testicle may reside anywhere along its path of descent, such as inside the abdominal cavity, in the inguinal canal (the groin), or in an ectopic location. Early diagnosis and urological surgical treatment of the undescended testicle are essential in preventing adverse consequences. Orchidopexy, a well-established operation that brings an undescended testicle into the scrotum, is most often performed on infants over one year of age. It is not uncommon for undescended testicles to descend by the first year of infancy; however, it is rare for a testicle to descend after the age of one year. The rationale for performing orchidopexy is the prevention of potential problems associated with cryptorchidism including impaired fertility, testicular germ cell cancers, testicular torsion and inguinal hernia.

Between the 1950s and 1980s, increasing rates of cryptorchidism had been reported in Britain and the United States. As part of a wider investigation into the trends of testicular cancer in Great Britain, Toledano et al. sought to determine the epidemiology of cryptorchidism over the period 1992-1998 for England, Wales, and Scotland. As a marker for cryptorchidism, trends in orchidopexy procedures were examined using routine hospital admissions data and the General Practice Research Database (GPRD). The results of the analysis indicated a 33% decrease in orchidopexy rates in boys 0-14 years old, with the steepest decline (50%) among the 5-9 year age group. Orchidopexy rates for men over the age of 15 years remained stable. These trends were observed in every region of England, Wales, and Scotland.

The adverse trends in human reproductive health, such as increased incidences of cryptorchidism and testicular cancer, have been linked to environmental endocrine disrupter exposure. However, the results of the present investigation do not support the claim of a recent worsening in male sexual differentiation. Recent policy recommendations that cryptorchidism be detected and surgically treated between six months and two years may have affected trends in orchidopexy. In addition, it is probable that some of the decline in orchidopexy rates might be reflected in a reduced number of inappropriate surgical operations for retractile testes. Although an increase in the prevalence of undescended testis cannot be discounted, a dramatic improvement in the diagnosis of cryptorchidism would have had to have occurred simultaneously in a short period of time, which the authors regard as an unlikely scenario.