Clements JM, Horwood JF, Turnock RR
Alderhey Children`s Hospital, Department of Paediatric Surgery, Merseyside, Liverpool, UK.
Optimal treatment of cryptorchidism has been the subject of debate for many years. Consequently, experts from five Nordic countries met in 2006 to review pertinent literature and to condense guidelines on best clinical practice for undescended testes (UDT).
Case notes from a single surgeons practice were reviewed from 1st January 2010 31st December 2012. The surgical approach was either trans-inguinal (92% cases) or trans-scrotal (8% cases). Patients with retractile testes, those requiring laparoscopic treatment (LT) and/or staged surgery (SS) and recurrent UDT were excluded. The age of the child at operation was our definitive primary outcome measurement. Secondary outcomes included day case completion, successful testicular placement, scrotal haematoma, wound infection, readmission rate, testicular atrophy and re-operation rate.
Alderhey is a Regional Paediatric Centre, hence principal recommendations of the Nordic Consensus are inherently satisfied. One hundred nineteen patients were identified of which 17 were excluded for clinically impalpable testes (9 LT and 8 SS), and a further 2 excluded due to previous surgery. From 100 cases remaining, complete data was obtained from 72 cases and 11 cases had bilateral UDT hence 83 procedures were included. The median age at operation was 21 months (8-156 months). Details of the outcome are depicted in table 1.
Table 1: Outcome of the patients
|Procedures performed as a day case||71/72||98.6|
|Successful testicular Placement||82/83||98.8|
The surgical approach employed was highly successful. However, the median age at operation fell outside the Nordic Consensus recommendations (6-12 months) and is a cause for concern. These data may reflect a delay in diagnosis, failure of recognition and referral from the primary healthcare sector or poor parental compliance. Delayed correction of UDT can have potentially adverse long-term implications and requires further investigation.
- Martin Ritzén E, Bergh A, Bjerknes R, Christiansen P, Cortes D, Haugen S, et al. Nordic consensus on treatment of undescended testes. Acta Paediatr. 2007; 96: 638-643.
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