P1.063: Neurodevelopmental Delay Correlates with a Delay in Orchiopexy for Children with Cryptorchism

Background: For children with congenital cryptorchidism, current guidelines recommend orchiopexy by 18 months of age to optimize outcomes. Previous studies have shown that nearly half of all cases do not meet this benchmark. Our goal was to identify patient factors that may predict delays in surgical management.

Methods: We performed a retrospective review of patients under 18 years old at a single tertiary care children’s hospital who underwent orchiopexy for congenital cryptorchidism from 1/1/2016-12/31/2023. Retractile and vanishing testicles were excluded. Orchiopexies for other indications were excluded. Data included age at referral and intervention, demographics, comorbidities, unilaterality versus bilaterality, two-stage procedure, and complications. Nonparametric continuous data is shown as median/interquartile range (IQR), and categorical as frequencies/percentages. Chi square and Fisher’s exact test compared categorial data.

Results: A total of 149 patients were evaluated. Age at referral and surgery were all right-skewed distributions, therefore median is used for analysis. Median (IQR) age at time of referral was 10 months (102.4) and 16 months (109.0) at time of surgery. 55% had surgery by 18 months. Twenty-nine patients required bilateral repair with the second repair occurring at a median (IQR) of 25 months (118.0). Patients with neurodevelopmental delays, defined as diagnosed underdevelopment of the child’s nervous system or delay in reaching developmental milestones, were significantly more likely to have referral and orchiopexy after 18 months (p=0.05, p=0.04). Neurodevelopmentally delayed patients underwent surgery at a median age of 72 months (119) compared to 15 months (64) in those without developmental delay and were more likely to require bilateral repair (p < 0.001). 65.5% had an inguinal approach, 25% laparoscopic, and 12.5% scrotal, which was not significantly different from patients without neurodevelopmental delay (p=0.07). The average follow-up with the pediatric surgery clinic for all patients was 13.7 months. The overall complication rate was 14.1%, 5.4% short-term complications and 8.7% long-term (Table 1). There was no difference in complications based on presence or absence of neurodevelopmental delay (p=0.84).

Conclusion: Neurodevelopmental delay was found to significantly correlate with delayed surgical referral and ultimately orchiopexy for congenital cryptorchidism. This has the potential to impact patient outcomes, both developmentally and functionally, but this was beyond the scope of this study. Further investigation is needed to both understand the impact of delayed orchiopexy on this vulnerable patient population and identify the best strategy for correcting this disparity.