A Three-Year Retrospective Evaluation of Primary Orchidopexy at Alderhey Children's Hospital: Comparison with the Nordic Consensus Guidelines
Presented in National Medical Students Paediatric Conference (NMSPC) 2013, Brighton, UK
Clements JM, Horwood JF, Turnock RR
Alderhey Children`s Hospital, Department of Paediatric Surgery, Merseyside, Liverpool, UK.
Introduction
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).

Methods
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.

Results
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
ParameterIncidencePercentage (%)
Procedures performed as a day case71/7298.6
Successful testicular Placement82/8398.8
Scrotal Haematoma0/830
Wound Infection3/833.6
Readmission1/831.2
Testicular atrophy1/831.2
Reoperation1/831.2


Conclusion
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.

References :
  1. 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.

DOI: 10.7199/ped.oncall.2013.31S
How to Cite URL :
JM C, JF H, RR T..Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=6351&type=C&tid=0&imgid=0&reportid=803&tbltype=
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.