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Timing of orchidopexy and its relationship to post-operative testicular atrophy: results from the ORCHESTRA study

Timing of orchidopexy and its relationship to post-operative testicular atrophy: results from the ORCHESTRA study
Timing of orchidopexy and its relationship to post-operative testicular atrophy: results from the ORCHESTRA study
Background: in 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering age at orchidopexy to under 1 years old. There are concerns that a younger age at operation may increase post-operative testicular atrophy. The ORCHESTRA study aimed to establish current age at orchidopexy in a multicentre, international audit and see if testicular atrophy was affected by age at operation. Methods: the study was performed over a 3 month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was performed using a standardized, pre-determined protocol. The primary outcome was post-operative testicular atrophy. Secondary outcomes were wound infections, re-operations and unplanned hospital stays related to anaesthetic events. Results: 417 patients were included of whom only 48 (11.5%) underwent orchidopexy prior to 1 year of age. There was no difference in anaesthetic complications(<1yrs 0/48 (0%) vs >1yrs 6/294 (1.6%)), p=>0.999. Complete follow-up was available in 331(80%) patients. There was no difference in the atrophy rate in those under one (1/37(2.7%)) versus older boys(9/294) (3.1%)), p>0.999. Re-operation rates were 0/37 in < 1yrs vs 7/294(2.7%) in >1yrs, p=>0.999. There were more wound infection in boys < 1yrs (4/37(10.5%)) vs >1 yrs (7/294(2.4%)), p=0.025. Conclusion: only 11.5% of boys receive surgery before 1 yrs old. There was no increased risk of post-operative testicular atrophy for early surgery although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy carried out over the age of one.
2474-9842
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Skerritt, Claire
06084c43-73d7-49a6-9146-0f09bf44d4c8
Bradshaw, Catherine
95d27711-b910-463a-b9f0-ec4bc277ff08
McCarthy, Liam
025f5c9f-16a3-4e5a-ab9e-763e57b28fda
Woodward, Mark
97f9be2a-f89a-4d55-8d6d-2c974e181366
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Skerritt, Claire
06084c43-73d7-49a6-9146-0f09bf44d4c8
Bradshaw, Catherine
95d27711-b910-463a-b9f0-ec4bc277ff08
McCarthy, Liam
025f5c9f-16a3-4e5a-ab9e-763e57b28fda
Woodward, Mark
97f9be2a-f89a-4d55-8d6d-2c974e181366

Hall, Nigel, Skerritt, Claire, Bradshaw, Catherine, McCarthy, Liam and Woodward, Mark (2020) Timing of orchidopexy and its relationship to post-operative testicular atrophy: results from the ORCHESTRA study. BJS Open. (In Press)

Record type: Article

Abstract

Background: in 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering age at orchidopexy to under 1 years old. There are concerns that a younger age at operation may increase post-operative testicular atrophy. The ORCHESTRA study aimed to establish current age at orchidopexy in a multicentre, international audit and see if testicular atrophy was affected by age at operation. Methods: the study was performed over a 3 month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was performed using a standardized, pre-determined protocol. The primary outcome was post-operative testicular atrophy. Secondary outcomes were wound infections, re-operations and unplanned hospital stays related to anaesthetic events. Results: 417 patients were included of whom only 48 (11.5%) underwent orchidopexy prior to 1 year of age. There was no difference in anaesthetic complications(<1yrs 0/48 (0%) vs >1yrs 6/294 (1.6%)), p=>0.999. Complete follow-up was available in 331(80%) patients. There was no difference in the atrophy rate in those under one (1/37(2.7%)) versus older boys(9/294) (3.1%)), p>0.999. Re-operation rates were 0/37 in < 1yrs vs 7/294(2.7%) in >1yrs, p=>0.999. There were more wound infection in boys < 1yrs (4/37(10.5%)) vs >1 yrs (7/294(2.4%)), p=0.025. Conclusion: only 11.5% of boys receive surgery before 1 yrs old. There was no increased risk of post-operative testicular atrophy for early surgery although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy carried out over the age of one.

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Accepted/In Press date: 17 November 2020

Identifiers

Local EPrints ID: 445384
URI: http://eprints.soton.ac.uk/id/eprint/445384
ISSN: 2474-9842
PURE UUID: 3b789402-746c-4576-84ff-cee73c97ab4f
ORCID for Nigel Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 07 Dec 2020 17:31
Last modified: 13 Dec 2021 03:06

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Contributors

Author: Nigel Hall ORCID iD
Author: Claire Skerritt
Author: Catherine Bradshaw
Author: Liam McCarthy
Author: Mark Woodward

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