Bilateral orchidopexies: synchronous or metachronous? Survey of BAPS and BAPU members and single-centre comparison
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In brief
In brief
Survey of UK pediatric surgeons and urologists examining practice patterns for bilateral orchidopexy, comparing synchronous (both sides same operation) versus metachronous (staged) approaches. Retrospective review of 188 patients found no difference in complication rates, with 70% of consultants preferring synchronous repair for cost-effectiveness and treatment efficiency.
Written by the GCMD Library team from the article.
Background/Aim
Approximately 20% of undescended testes (UDT) are bilateral. It is unclear whether bilateral orchidopexy (BO) should be undertaken synchronously (SBO) or metachronously (MBO). Our aim was to investigate current UK practice and the complications of SBO vs MBO.
Materials & methods
Following approval of BAPS and BAPU ethics committee, a survey was circulated to UK consultant pediatric surgeons and urologists regarding practice. A departmental retrospective review was additionally carried out for patients undergoing BO between 2005 and 2017.
Results
Forty-three consultant surgeons from 20 centres completed the survey. Overall, SBO was preferred by 70% for bilateral palpable UDT versus 30% for bilateral impalpable UDT. When one side was palpable and the other impalpable, 70% preferred SBO. Pediatric urologists were significantly more likely to undertake SBO than pediatric general surgeons. One hundred eighty-eight patients (376 testicular units) were identified who had undergone BO with a median follow up of 9 months. 144/188 (76.6%) underwent SBO, while 44 had MBO. There was no statistical difference in the complication rate between the two groups (7.6% in SBO vs 9.1% in MBO; p = 0.66).
Conclusions
The majority of the responding UK consultants, in particular pediatric urologists, favor SBO. This potentially offers a reduction in cost, more rapid completion of treatment, and is not associated with additional complications by comparison to MBO. We recommend SBO to be standard practice for bilateral UDT whenever possible.
Level of Evidence
Level III, Retrospective Comparative Study.