Timing of orchiopexy in children with congenital undescended testis in Latin America: A multicenter retrospective study.
In a retrospective study of 4,481 children undergoing orchiopexy at 31 Latin American centers, 81.8% received surgery after the guideline-recommended age of 18 months, with delayed referral and healthcare-access barriers frequently reported among delayed cases.
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In a retrospective study of 4,481 children undergoing orchiopexy at 31 Latin American centers, 81.8% received surgery after the guideline-recommended age of 18 months, with delayed referral and healthcare-access barriers frequently reported among delayed cases.
Research significance
The study demonstrates a regional timing-of-care gap; it supports the inference that earlier diagnosis, referral, and access interventions could increase timely orchiopexy, but it does not test such interventions or show reductions in infertility, testicular malignancy, or other clinical outcomes.
Source abstract
BACKGROUND: Congenital undescended testis (CUDT) is the most common urogenital anomaly in boys and is associated with impaired fertility potential and an increased risk of testicular malignancy later in life. International guidelines recommend orchiopexy between 6 and 18 months of age; however, regional data from Latin America remain scarce. OBJECTIVE: To evaluate the timing of orchiopexy in children with CUDT in Latin America. STUDY DESIGN: Multicenter retrospective observational study including patients younger than 18 years with CUDT who underwent orchiopexy between January 1, 2023, and December 31, 2025, across participating Latin American centers. In an exploratory secondary analysis, a hierarchical multivariable logistic regression model, accounting for clustering by participating hospital, was used to assess factors independently associated with orchiopexy after 18 months of age. RESULTS: A total of 4481 patients from 14 countries and 31 centers were included. The median age at orchiopexy was 50 months (IQR 24-90), with a mean age of 60.5 months (95% CI 59.3-61.7). Only 18.2% of patients underwent surgery at or before 18 months of age, whereas 81.8% were treated after the recommended timeframe. The proportion treated by 18 months ranged from 4.7% in one participating hospital in Uruguay to 62.0% in one participating hospital in Argentina. Significant differences in age at surgery were observed across participating hospitals (p < 0.001). Among patients treated after 18 months, delayed referral and healthcare access barriers were the most frequently reported associated factors. In the hierarchical multivariable analysis accounting for clustering by participating hospital, intra-abdominal testicular location remained independently associated with lower odds of orchiopexy after 18 months of age (OR 0.71, 95% CI 0.55-0.91), whereas surgeon specialty, hospital level, and laterality were not independently associated with delayed orchiopexy. CONCLUSIONS: More than 80% (more than four out of five) of children with CUDT treated at participating hospitals across Latin America underwent orchiopexy later than recommended by current international guidelines. These findings highlight an important gap in timely access to care and underscore the need for strategies that promote earlier diagnosis, prompt referral, and timely surgical treatment.