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

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.

More information

Identifiers

ORCID for Nigel Hall: orcid.org/0000-0001-8570-9374

Catalogue record

Export record