Orchiopexy age and testicular catch-up growth in unilateral cryptorchidism: a retrospective cohort study.

UNLABELLED: International guidelines recommend orchiopexy for patients with cryptorchidism between 6 and 18 months of age; however, in practice, surgery is often delayed. Direct comparative evidence of outcomes after timely versus delayed orchiopexy remains limited. Therefore, this study evaluated the impact of orchiopexy age on testicular catch-up growth. Patients with unilateral inguinal cryptorchidism were stratified based on the age at the time of surgery: the early surgery group (6-18 months) and the late surgery group (19-30 months). Testicular volume was measured using ultrasonography at 1 year post-operatively. The testicular atrophy index (TAI) and the testicular growth ratio (TGR) were used to assess testicular growth. From 2016 to 2024, 72 patients were enrolled. In the early surgery group, the postoperative TAI was significantly lower than the preoperative TAI (0.332 versus 0.425; p = 0.002), and the TGR was significantly greater on the cryptorchid side than on the contralateral side (1.327 versus 1.082; p < 0.001). However, these expected outcomes were not observed in the late surgery group. Furthermore, compared with the late surgery group, the early surgery group had a significantly lower postoperative TAI (p = 0.027) and a significantly greater cryptorchid TGR (p = 0.026). CONCLUSIONS: Compared with delayed orchiopexy, orchiopexy performed between 6 and 18 months yielded significantly greater improvements in testicular growth. These findings suggest that performing orchiopexy at the recommended age is optimal and may improve future spermatogenesis. WHAT IS KNOWN: • Current international guidelines recommend orchiopexy for patients with cryptorchidism between 6 and 18 months of age. In clinical practice, orchiopexy is frequently delayed. • Direct comparative evidence of outcomes between patients who underwent surgery within the recommended window and those who underwent delayed surgery remains scarce. WHAT IS NEW: • Orchiopexy at 6-18 months yields significant testicular catch-up growth at one year relative to baseline, whereas surgery delayed to 19-30 months does not. • Compared with orchiopexy at 19-30 months, surgery at 6-18 months is associated with significantly greater improvements in testicular growth.