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CER 88: Evaluation and Treatment of Cryptorchidism Comparative Effectiveness Review Number 88 Evaluation and Treatment of Cryptorchidism Comparative Effectiveness Review Number 88 Evaluation and Treatment of Cryptorchidism Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10065-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, TN Investigators: David F. Penson, M.D., M.P.H. Shanthi Krishnaswami, M.B.B.S., M.P.H. Astride Jules, M.D., M.P.H. Jeffrey C. Seroogy, B.S. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 13-EHC001-EF December 2012 This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10065-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Penson DF, Krishnaswami S, Jules A, Seroogy JC, McPheeters ML. Evaluation and Treatment of Cryptorchidism. Comparative Effectiveness Review No. 88. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007- 10065-I.) AHRQ Publication No. 13-EHC001-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. Comparative Effectiveness Reviews will be updated regularly. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Shilpa H. Amin, M.D., M.Bsc., FAAFP Director, EPC Program Task Order Officer Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project. Ms. Sharana Jones served as project coordinator, shepherding, planning, and implementing tasks. Ms. Sanura Latham assisted with locating studies and creating tables. Ms. Tracy Shields and Ms. Rachel Walden, library scientists on the project, lent their keen searching skills to the review. Key Informants Laurence S. Baskin, M.D. Paul J. Kokorowski, M.D., M.P.H. Professor, Department of Urology and Fellow, Pediatric Urology Pediatrics Children’s Hospital Boston, Harvard Department Chief, Pediatric Urology Medical School University of California San Francisco Boston, MA Children's Medical Center San Francisco, CA Thomas F. Kolon, M.D. Associate Professor, Urology Victoria K. Cortessis, Ph.D. University of Pennsylvania School of Assistant Professor of Research, Department Medicine of Preventive Medicine Children’s Hospital of Philadelphia Keck School of Medicine Philadelphia, PA University of Southern California Los Angeles, CA Jacob Rajfer, M.D. Professor, Division of Urology, Department Steven G. Docimo, M.D. of Surgery Vice Chairman and Professor of Urology University of California at Los Angeles Program Director, Pediatric Urology Los Angeles, CA Fellowship, Children’s Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh, PA iv Technical Expert Panel Laurence S. Baskin, M.D. Paul J. Kokorowski, M.D., M.P.H. Professor, Department of Urology and Fellow, Pediatric Urology Pediatrics Children’s Hospital Boston, Harvard Department Chief, Pediatric Urology Medical School University of California San Francisco Boston, MA Children's Medical Center San Francisco, CA Thomas F. Kolon, M.D. Associate Professor, Urology Victoria K. Cortessis, Ph.D. University of Pennsylvania School of Assistant Professor of Research, Department Medicine of Preventive Medicine Children’s Hospital of Philadelphia Keck School of Medicine Philadelphia, PA University of Southern California Los Angeles, CA Jose L. Gonzalez, M.D., J.D., M.S.Ed., C.P.E. State of Texas, Medicaid Medical Director Galveston, TX Peer Reviewers Doug A. Husmann, M.D. Paul J. Kokorowski, M.D., M.P.H. Chair, Department of Urology Fellow, Pediatric Urology Mayo Clinic Children’s Hospital Boston, Harvard Rochester, MN Medical School Boston, MA John M. Hutson, M.D. Professor, University of Melbourne Thomas F. Kolon, M.D. Chairman, Pediatric Surgery Associate Professor, Urology Melbourne, Australia University of Pennsylvania School of Medicine Chester Koh, M.D. Children’s Hospital of Philadelphia Pediatric Urology Director, Robotic Surgery Philadelphia, PA Program Children’s Hospital of Los Angeles Caleb Nelson, M.D., M.P.H. Saban Research Institute Assistant Professor, Surgery and Pediatrics Los Angeles, CA Co-Director, Kidney Stone Center Harvard University Boston, MA v Evaluation and Treatment of Cryptorchidism Structured Abstract Objectives. We assessed the effectiveness of imaging for identifying and correctly locating testicles, the use of hormonal stimulation for treatment planning and hormones for achieving testicular descent, and choices among surgical treatments, including surgical approach (open vs. laparoscopic). Data sources. We searched MEDLINE® via PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase, as well as reference lists of included studies. Review methods. We included studies published in English from January 1980 to February 2012. We included studies of prepubescent males with cryptorchidism. For treatment planning studies, we included all designs except case reports. Imaging studies needed to have confirmatory surgical data. For treatment studies, we required an appropriate comparison arm. We excluded studies of disorders of sexual development or ambiguous genitalia. Two reviewers independently assessed the quality (risk of bias) for each study and the overall strength of the evidence, with discrepancies adjudicated by a third reviewer. Results. We identified 60 unique studies meeting our review criteria; eight were of good, eight were of fair, and 44 were of poor quality. The accuracy of imaging to identify the presence or absence of testicles was 21 to 76 percent for ultrasonography (US), 42 to 92 percent for magnetic resonance imaging (MRI), 60 percent for computed tomography (CT) scan, and 100 percent for magnetic resonance
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