Med Decis Making - Management of undescended testis: a decision analysis.

Tópicos

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Resumo

CKGROUND: Undescended testis (UDT) or cryptorchidism is the most common genital anomaly seen in boys and can be treated surgically by orchidopexy. The age at which orchidopexy should be performed is controversial for both congenital and acquired UDT.METHODS: A decision analysis is performed in which all available knowledge is combined to assess the outcomes of orchidopexy at different ages.RESULTS: Without surgery, unilateral congenital UDT and bilateral congenital UDT are associated with average losses in quality-adjusted life-years (QALYs) of 1.53 QALYs (3% discounting 0.66 QALYs) and 5.23 QALYs (1.91 QALYs), respectively. Surgery reduces this QALY loss to on average 0.84 QALYs (0.21 QALYs) for unilateral UDT and 1.66 QALYs (0.40 QALYs) for bilateral UDT. Surgery at detection will lead to the lowest QALY loss of 0.91 (0.34) and 1.73 (0.60) QALYs, respectively, for unilateral and bilateral acquired UDT compared with surgery during puberty and no surgery. No sensitivity analysis is able to change the preferences for these strategies.CONCLUSIONS: Based on our decision analytic model using societal valuations of health outcomes, surgery for unilateral UDT (both congenital and acquired) yielded the lowest loss in QALYs. Given the modest differences in outcomes, there is room for patient (or parent) preference with respect to the performance and timing of surgery in case of unilateral UDT. For bilateral UDT (both congenital and acquired), orchidopexy at any age provides considerable benefit, in particular through improved fertility. As there is no strong effect of timing, the age at which orchidopexy is performed should be discussed with the parents and the patient. More clinical evidence on issues related to timing may in the future modify these results and hence this advice.

Resumo Limpo

ckground undescend testi udt cryptorchid common genit anomali seen boy can treat surgic orchidopexi age orchidopexi perform controversi congenit acquir udtmethod decis analysi perform avail knowledg combin assess outcom orchidopexi differ agesresult without surgeri unilater congenit udt bilater congenit udt associ averag loss qualityadjust lifeyear qali qali discount qali qali qali respect surgeri reduc qali loss averag qali qali unilater udt qali qali bilater udt surgeri detect will lead lowest qali loss qali respect unilater bilater acquir udt compar surgeri puberti surgeri sensit analysi abl chang prefer strategiesconclus base decis analyt model use societ valuat health outcom surgeri unilater udt congenit acquir yield lowest loss qali given modest differ outcom room patient parent prefer respect perform time surgeri case unilater udt bilater udt congenit acquir orchidopexi age provid consider benefit particular improv fertil strong effect time age orchidopexi perform discuss parent patient clinic evid issu relat time may futur modifi result henc advic

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