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Age at orchidopexy in the UK: has new evidence changed practice?
Catherine J Bradshaw1, Georgina Corbet-Burcher1, Rowena Hitchcock1
1Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford Children's Hospital, Oxford, UK.
Introduction:
Research suggesting progressive deterioration in an undescended testis has led to the reduction in the target age for orchidopexy to 6-12 months of age. This age was selected as normal testicular descent is unlikely after 3 months of age and it is timed to prevent early gonadocyte developmental delay as suggested by Hutson and Hasthorpe. This study aims to determine the current age at orchidopexy in one UK training centre and whether changing targets have altered practice.
Methods:
The demographics of orchidopexies performed at a single unit between 1998 and 2011 were reviewed.
Results:
A total of 1325 orchidopexies were performed over 13 years. The median age at orchidopexy fell between 1998 and 2011. There was an initial drop in the age for orchidopexy in 2000 corresponding with the change in target age to "less than 18 months". However, no subsequent improvement was seen over the following decade.
Discussion:
Early orchidopexy is not being achieved. We have identified how slowly such advice is implemented locally and recognise the national need to address this. The approach should include earlier primary care referral directly from the routine postnatal check to a centre prepared to undertake surgery in this age group.
