Review of the extent to which orchidopexy is performed at the optimal age: implications for health services

Abstract

Background: In recent decades, the recommended age for orchidopexy for primary undescended testes has decreased, in the expectation that this might improve subsequent fertility. The aim of this study was to investigate whether this is reflected in a reduction in the age at which orchidopexies are carried out, and the implications for child health services.

Methods: All boys who underwent an orchidopexy for an undescended testis carried out by the Christchurch-based paediatric surgical service between January 1997 and December 2007 were identified through a prospectively collected database. They were analysed according to the age at time of operation and year of surgery to determine whether there was any trend over time. The proportions of children younger than 2 years and between 2 and 5 years of age were calculated for each year.

Results: In total, 788 boys underwent orchidopexies for primary undescended testes, with 335 (42.5%) boys having surgery before the age of 2 (mean age 54.3 months, median 31.1 months). During the whole 11-year period, there was no significant change in age at orchidopexy, whereas from 2003, a significant trend towards lower age at operation (Spearman's rank -0.1112, P = 0.0071) and a significant increase in the proportion of boys having surgery before the age of 2 (Spearman's rank 0.9000, P = 0.0374) were seen.

Conclusions: Although there has been a modest reduction in the mean age of orchidopexy since 2003, overall, the mean age at orchidopexy remains well above the recommended optimal age, implying that more attention should be paid towards earlier diagnosis and referral for primary undescended testes.