Timing of orchidopexy for undescended testis

Introduction and Objectives: Strong evidence suggests that in order to prevent irreversible testicular damage surgical correction (orchiopexy) for undescended testis (UDT) should be performed before the age of one year. Recently, a large database study in USA demonstrated that despite this strong guideline recommendation, only 16% of children undergoing orchidopexy in USA fall under this recommendation. The Objective of the current study is to evaluate whether a delay in orchidopexy also exists in our medical system, and if so, to explore the pattern of referral for orchidopexy as a possible contributing factors for such delays. Methods: Step I - A retrospective chart review of all children who underwent orchidopexy for UDT between 2003 and 2013 in our institution. We collected data regarding the age at surgery, background diseases, and type of health insurance. Step II - we surveyed pediatricians from around the country and asked for their pattern of UDT patients' referral to a pediatric urologist or a pediatric surgeon for surgical correction. Results: Step I - 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 before the age of one year, 53% between the ages of one to two years. We found that these findings were consistent throughout the years we examined, with no difference between the four different health insurance plans children belonged to. 79 (9.7%) of the children had major underline diseases. In this group of patients the median age at surgery was 2 years. Step II - Sixty-three pediatricians who participated in the survey reported that they referred children to surgery (a urologist or a pediatric surgeon) at a median age of one year (range: 0.5-3 years). Conclusions: Half of the children in our institute underwent orchidopexy for UDT were 18 months or younger at the time of surgery, and most of them were operated on before they reached the age of 24 month. These findings are superior to those reported in USA, yet are still not optimal. There is a need to improve awareness for early specialist consultation in order to facilitate earlier surgery and better care.