Consultants’ attitudes to the ideal age for orchidopexy

Aims: recent consensus statements recommend orchidopexy for undescended testis be performed between 6-12 months of age. We designed a survey to determine what age consultants believe is the optimal age for orchidopexy, as well as surveying other aspects of surgery for testicular maldescent. Methods: anonymous survey of UK consultants (n=122) who participated in an international prospective audit of orchidopexy outcomes. Preferences and management strategies were compared between different groups of surgeons (specialist paediatric general surgeons, specialist paediatric urologists and general surgeons/urologists, with an interest in general surgery of childhood (but who mainly treat adult patients)). Results: there were 105 responses (62 specialist paediatric surgeons, 30 specialist paediatric urologists and 13 general surgeons/urologists) from 25 centres; overall response rate was 86%. The median preferred age for orchidopexy was 10.5 months (range 3-24). This differed significantly between groups with a median of 12 months amongst specialist paediatric surgeons, 9 months amongst specialist paediatric urologists and 12 months amongst general surgeons/urologists (p=<0.001). Fifty-one consultants (49%) stated the optimal age to perform orchidopexy was 12 months or more. Consultants cited concerns about the possible long-term effects of general anaesthesia at young age and higher atrophy rates in younger children as the main reasons for postponing orchidopexy until aged 12 months.Conclusion: there remains no consensus amongst surgeons as to the optimal age for orchidopexy. Management practice of undescended testis varies across differing specialty of surgeon, particularly in regard to optimal age of surgery