The risk of failure after primary orchidopexy: An 18 year review

Abstract

Objective

To review the primary orchidopexy failure rate and outcome of repeat orchidopexy in a tertiary paediatric surgical centre and identify risk factors.

Methods

A prospectively collected and validated audits system was used to identify all boys having a repeat orchidopexy from August 1990 to December 2008 (18 years).

Results

In total, 1538 boys underwent orchidopexy with 1886 testicles operated on. Of these 348 (22.6%) patients had bilateral cryptorchidism. A need for repeat orchidopexy was identified in 31 boys resulting in a primary failure rate of 1.6% over the 18 years. Unilateral orchidopexy as the primary operation had a 1.5% failure rate. The failure rate for bilateral cryptorchidism was 1.87% per testicle rising to 1.93% per testicle when the primary operation was synchronous bilateral orchidopexy. Orchidopexy failure occurred in 9 patients (1.97%) who were under 24 months, 15 (2.67%) who were between 24 and 72 months and 7 (0.8%) over 72 months at time of first operation.

Conclusion

Possible risk factors for primary orchidopexy failure are bilateral operation and older age at time of operation. Failure in achieving a satisfactory scrotal position (and testicular loss) following orchidopexy has been postulated as a potential surgical standard for revalidation of paediatric surgeons. This study adds important contemporary data to inform that process.

Introduction

The first successful orchidopexy was reported in 1877, performed by Thomas Annandale in Edinburgh [1]. Since then many operations have been described for the treatment of undescended testes (UDT) [2], most importantly the technique reported by Bevan in 1899. His four key principles of testicular mobilisation, ligation of processus vaginalis, division of fibres adherent to the cord, and repositioning and fixation of testis in the scrotum remain the main components of orchidopexy today [3].

Recurrence rates of up to 20% have been reported but may be as low as 0.2% in specialist paediatric units [4], [5], [6], [7]. Accurate figures for specialist centres are difficult to quantify due to referrals for recurrence from other centres, but Noseworthy believes the true failure rate to be around 1–2% [8]

The aim of this study was to review the failure rate of primary orchidopexy and outcome of repeat orchidopexy in a tertiary paediatric surgical centre and identify factors affecting failure.