Current practice patterns in cryptorchidism management in Türkiye: A nationwide survey

Abstract

Objective: Cryptorchidism is one of the most common congenital anomalies in boys, and management strategies may vary according to surgical training and clinical experience. This study evaluated current practice patterns and consensus among pediatric surgeons, urologists, and pediatric urologists in Turkey. Methods: A nationwide cross-sectional survey was conducted among pediatric surgeons, urologists, and pediatric urologists in Turkey. The questionnaire assessed management preferences for palpable undescended testes (UDTs), intra-abdominal testes (IATs), retractile testes, and selected special clinical situations. Responses were compared using chi-square or exact tests. Results: A total of 153 clinicians participated, including 107 pediatric surgeons, 24 urologists, and 22 pediatric urologists. For palpable UDTs, orchiopexy at 12–18 months was most commonly preferred by pediatric surgeons (54.2%) and urologists (54.2%), whereas pediatric urologists most commonly preferred 6–11 months (54.5%); the difference among specialties was not statistically significant. Preoperative hormonal therapy was rarely used. Ultrasonography for palpable UDTs was requested more frequently by urologists, whereas most pediatric urologists considered it unnecessary. Laparoscopic-assisted single-stage orchiopexy was the preferred approach for low IATs, while two-stage Fowler–Stephens orchiopexy was favored for high IATs. Most participants recommended follow-up for retractile testes until puberty, although orchiopexy was preferred in selected cases. Management of special clinical situations was similar across specialties. Conclusions: Cryptorchidism management in Turkey was largely consistent with current international guidelines. Although differences existed regarding preoperative imaging and the management of IATs and retractile testes, a high level of consensus was observed across specialties.

Keywords

• Cryptorchidism
• Orchiopexy
• Intra-Abdominal Testes
• Retractile Testis

Supporting Institution

no funding

Project Number

no

Ethical Statement

The study was approved by the institutional ethics committee (Approval No: 2023-YÖNP-0090; Date: 16.02.2023).

Thanks

We extend our gratitude to the esteemed Society of Pediatric Surgery, Urology, and Pediatric Urology members for their valuable support in participating in our study survey. Additionally, we would like to express our appreciation to Çetin Toraman from Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of Medical Education, for providing invaluable assistance with the statistical analysis of our study.

Türkiye'de kriptorşidizm yönetiminde güncel klinik yaklaşımlar: Ulusal bir anket çalışması

Abstract

Amaç: Kriptorşidizm erkek çocuklarda en sık görülen konjenital anomalilerden biridir ve yönetim stratejileri cerrahi eğitim ile klinik deneyime göre değişiklik gösterebilir. Bu çalışmada, Türkiye'deki çocuk cerrahları, ürologlar ve çocuk ürologları arasında kriptorşidizm yönetimine ilişkin güncel uygulamalar ve görüş birliği değerlendirildi. Yöntem: Türkiye'de görev yapan çocuk cerrahları, ürologlar ve çocuk ürologları arasında ulusal düzeyde kesitsel bir anket çalışması gerçekleştirildi. Anket, palpe edilebilen inmemiş testisler (UDT), intraabdominal testisler (IAT), retraktil testisler ve seçilmiş özel klinik durumlara yönelik yönetim tercihlerini değerlendirdi. Uzmanlık grupları arasındaki karşılaştırmalar ki-kare veya uygun durumlarda kesin testler kullanılarak yapıldı. Bulgular: Çalışmaya 107 çocuk cerrahı, 24 ürolog ve 22 çocuk üroloğu olmak üzere toplam 153 klinisyen katıldı. Palpe edilebilen inmemiş testislerde çocuk cerrahları (%54,2) ve ürologlar (%54,2) en sık 12–18 ay arasında, çocuk ürologları (%54,5) ise 6–11 ay arasında orşiopeksiyi tercih etti; ancak uzmanlık grupları arasındaki fark istatistiksel olarak anlamlı değildi. Preoperatif hormonal tedavi nadiren tercih edildi. Palpe edilebilen UDT'lerde ultrasonografi, ürologlar tarafından daha sık istenirken, çocuk ürologlarının çoğu bunu gerekli görmedi. Alçak yerleşimli IAT'lerde laparoskopi yardımlı tek aşamalı orşiopeksi, yüksek yerleşimli IAT'lerde ise iki aşamalı Fowler–Stephens orşiopeksi en sık tercih edilen yöntemlerdi. Katılımcıların çoğu retraktil testislerde puberteye kadar izlem önerirken, seçilmiş olgularda orşiopeksi tercih edildi. Özel klinik durumların yönetimi uzmanlık grupları arasında benzerdi. Sonuç: Türkiye'de kriptorşidizm yönetimi büyük ölçüde güncel uluslararası kılavuzlarla uyumluydu. Preoperatif görüntüleme ile intraabdominal ve retraktil testislerin yönetiminde bazı farklılıklar bulunmasına rağmen, uzmanlık alanları arasında yüksek düzeyde görüş birliği gözlendi.

Keywords

• Kriptorşidizm
• Orşiopeksi
• İntraabdominal Testis
• Retraktil Testis

Supporting Institution

Hiçbir kurumdan destek alınmamıştır

Project Number

no

Ethical Statement

Çalışma, kurum etik kurulu tarafından onaylanmıştır (Onay No: 2023-YÖNP-0090; Tarih: 16.02.2023).

Thanks

Çalışma anketimize katılarak değerli desteklerini esirgemeyen saygıdeğer Çocuk Cerrahisi, Üroloji ve Çocuk Üroloji Derneği üyelerine minnettarız. Ayrıca, çalışmamızın istatistiksel analizinde paha biçilmez yardımlarını sağlayan Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi Tıp Eğitimi Bölümü'nden Çetin Toraman'a da teşekkürlerimizi sunmak isteriz.

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