Timing of orchidopexy and its relationship to post-operative testicular atrophy: results from the ORCHESTRA study

Background: in 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering age at orchidopexy to under 1 years old. There are concerns that a younger age at operation may increase post-operative testicular atrophy. The ORCHESTRA study aimed to establish current age at orchidopexy in a multicentre, international audit and see if testicular atrophy was affected by age at operation. Methods: the study was performed over a 3 month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was performed using a standardized, pre-determined protocol. The primary outcome was post-operative testicular atrophy. Secondary outcomes were wound infections, re-operations and unplanned hospital stays related to anaesthetic events. Results: 417 patients were included of whom only 48 (11.5%) underwent orchidopexy prior to 1 year of age. There was no difference in anaesthetic complications( 1yrs 6/294 (1.6%)), p=>0.999. Complete follow-up was available in 331(80%) patients. There was no difference in the atrophy rate in those under one (1/37(2.7%)) versus older boys(9/294) (3.1%)), p>0.999. Re-operation rates were 0/37 in 1yrs, p=>0.999. There were more wound infection in boys 1 yrs (7/294(2.4%)), p=0.025. Conclusion: only 11.5% of boys receive surgery before 1 yrs old. There was no increased risk of post-operative testicular atrophy for early surgery although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy carried out over the age of one.