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Timing of Orchidopexy for Undescended Testis in Israel: A Quality of Care Study
Guy Hidas1, Jacob Ben Chaim1, Refael Udassin2
1Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Insights
Surgical correction for undescended testis (UDT) is recommended before age 1 to prevent testicular damage. This study found that orchidopexy (surgical correction) is often delayed, with most children undergoing the procedure after age 1.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Pediatrics
Background:
- Undescended testis (UDT) requires timely surgical correction (orchidopexy) before age 1 to prevent irreversible testicular damage.
- Delayed orchidopexy can lead to long-term complications.
Purpose of the Study:
- To assess if orchidopexy for UDT is delayed within the current medical system.
- To investigate referral patterns as a potential cause for these delays.
Main Methods:
- Retrospective chart review of 813 children who had orchidopexy for UDT between 2003-2013.
- Data collected included age at surgery and health insurance.
- Survey of 63 pediatricians on their UDT referral practices.
Main Results:
- Median age for orchidopexy was 1.49 years; only 11% had surgery before age 1.
- 53% of children underwent surgery between ages 1 and 2.
- Pediatrician referrals occurred at a median age of 1 year.
Conclusions:
- Orchidopexy for UDT is frequently delayed in this medical system.
- Improved awareness and earlier specialist consultation are needed for timely surgical intervention.
- Earlier surgery can lead to better patient outcomes and prevent complications.
Background:
Strong evidence suggests that in order to prevent irreversible testicular damage surgical correction (orchidopexy) for undescended testis (UDT) should be performed before the age of 1 year.
Objectives:
To evaluate whether orchidopexy is delayed in our medical system, and if so, to explore the pattern of referral for orchidopexy as a possible contributing factor in such delays.
Methods:
We conducted a retrospective chart review of all children who underwent orchidopexy for UDT between 2003 and 2013 in our institution. We collected data on the age at surgery and the child's health insurance plan. We also surveyed pediatricians from around the country regarding their pattern of UDT patient referral to a pediatric urologist or surgeon for surgical correction.
Results:
A total of 813 children underwent orchidopexy in our institute during the study period. The median age at surgery was 1.49 years (range 0.5-13). Only 11% of the children underwent surgery under the age of 1 year, and 53% between the ages of 1 and 2 years. These findings were consistent throughout the years, with no difference between the four health insurance plans. Sixty-three pediatricians who participated in the survey reported that they referred children to surgery at a median age of 1 year (range 0.5-3 years).
Conclusions:
Our results demonstrate delayed orchidopexy in our medical system. There is a need to improve awareness for early specialist consultation in order to facilitate earlier surgery and better care.
