Surgical standards for revalidation are growing in the UK. For paediatric surgery, primary orchidopexy is thought to be one procedure that could be used as a ‘plumb line’ for this. These authors looked at 1538 boys who underwent 1886 orchidopexies (22.6% bilateral) over the course of 18 years. The four principle components for testicular mobilisation (Bevan technique of 1899) were adhered to – testicular mobilisation, ligation of the patent processus vaginalis, division of fibres adherent to the cord and fixation of the testis in the scrotum. All boys were entered into a prospective database and followed up for a minimum of 24 months. Boys were operated on by different surgeons over that time period and grade of operator was taken into account in analysis. Planned two-stage procedures and testicular fixation for other reasons were exclusion factors. The primary failure rate was 1.6%, failure being a testis not in the scrotum or early atrophy on follow-up. Late atrophy was not assessed. Preoperative testicular position was also not always assessed. Failure rate was 1.1% in boys <24 months and 2.89% in those older. The authors quote anecdotal evidence suggesting that older boys are more active early post surgery which may give rise to the higher failure rate with age. Repeat orchidopexy was successful in 86.3% of those needing it. Bilateral synchronous orchidopexy had a slightly higher failure rate of 1.9%. The authors conclude that factors which may increase failure rate are synchronous bilateral procedures and procedures on older boys.

The risk of failure after primary orchidopexy: an 18 year review.
McIntosh LA, Scrimgeour D, Youngson GC, Driver CP.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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