Outcomes of long term follow up post orchidopexy
Vikrant Kumbhar, MBBS, MS General Surgery, MCh Paediatric Surgery, Oluwatomini Fashina, MBBS, Madhavi Kakade, FRCS Paediatric Surgery, Anthony Owen, FRCS paediatric Surgery, Nitin Patwardhan, FRCS paediatric Surgery, Khalid Elmalik, FRCS paediatric Surgery, Bala Eradi, FRCS paediatric Surgery, Haitham Dagash, FRCS paediatric Surgery, Ashok Rajimwale, FRCS.
Leicester Royal Infirmary, Leicester, United Kingdom.
Background: Cryptorchidism is a common paediatric surgical condition affecting approximately 10% term and 30% preterm new-borns. It can be unilateral or bilateral (10%), palpable or impalpable (20-30%) depending on their position. Orchidopexy is a common paediatric surgical operation performed by paediatric surgeons/urologists globally. We present our single centre experience of post orchidopexy outcomes.Methods: This is a retrospective review of post orchidopexy outcomes at a tertiary care centre in England and approved by the Childrens hospital internal review board. Data was collected from the hospital’s digital databases (ORMIS, ICE) between January 2015 & December 2019. During this period we looked at the type of operation performed (open or laparoscopic), laparoscopic single or staged, laterality & post-operative outcome (atrophy, ascent) over a long term follow period. Results: Total numbers of patients included in this review were 1045. 209 patients underwent bilateral, 466 right and 370 underwent left orchidopexy. 857 of 1045 children underwent open surgery and 188 underwent laparoscopic surgery. Of the 188 undergoing laparoscopic orchidopexy; 3 underwent one stage orchidopexy and 130 underwent staged orchidopexy. 55 of 188 patients had diagnostic laparoscopy for impalpable testes however these children had conventional open orchidopexy. On postoperative follow up testicular atrophy was found in 56 (33 open and 23 laparoscopic) of 1045 (5.36%). Ascent of the testis was found in 41 (38 open and 4 laparoscopic) of 1045 (4.02%) (Table 1).Conclusion: Our series is one of the largest series describing the post orchidopexy outcomes. The overall atrophy rate in our series is 5.36% (3.85% for open orchidopexy and 12.23% for laparoscopic). The atrophy rates quoted in literature are 2 – 8% which is comparable to our data. The overall rate of ascent following orchidopexy in our series is 4.02%. Ascent rates for open and laparoscopic orchidopexies are 4.43% and 2.13% respectively. The ascent rates are not very well documented in literature; a limited number of series report the rates between 2 – 3 % for laparoscopy and 0.2-13% for open. The slightly higher rate of atrophy in our series could be a reflection of a large number of patients and longer follow up. Based on our review we recommend longer follow up post orchidopexy.
|Atrophy rates||33 (3.85%)||23 (12.23%)||56 (5.36%)|
|Ascent rates||38 (4.43%)||4 (2.13%)||41 (4.02%)|
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