Age at Orchiopexy JPS Review

This is Todd Ponssky with the Journal of Pediatric Surgery, and today we are in Taromina, Sicily, and we are at the Italian Society of Pediatric Surgery and with our host, our wonderful host Carmelo Romero. Carmelo, thank you for having us here. Hello, hi, I'm very excited to us tonight is uh social dinner of our 48 national meeting of the Italian Society of Pediatric Surgery with international participation. Thank you very much. Thank you and this is actually a very impressive meeting and it's an honor to be here. And so we're going to take this opportunity to discuss a paper. The title of the paper is Age at Orchidopexy of the Undescended Testicle in the United States and the first author is Dr. Williams. And we have with us Professor Augustino Piero from Toronto Sick Kids who's going to briefly talk to us about this paper. Uh thank you much Todd. This is has been a great opportunity to read this paper. It's a very interesting one on a subject which is highly debated. when is the most appropriate time to do an orchidopexy in children with descending testicles. And the American urological Association released some guidelines that this operation should be done uh around one year of age but not later than 18 months. Uh the paper has reviewed two major databases in the United States and found out that actually the timing of the surgery of the orchidopexy in children is not really following these guidelines. And 70% of these children actually get the orchidopexy six months beyond the suggested ideal time to do the orchidopexy. And that's 70, 7-0. 7-0, 70. Uh and so the median time is between four and five years of age. So the debate continues, is this affecting the fertility later on of these children or not? We don't know. Okay. So we have another expert here, Professor Prem Puri, uh who's from Dublin and uh Professor Puri has obviously published a lot about this topic. So Professor Puri, what are your thoughts? Well, we we published a paper in the Lancet several years ago wherein we showed that what matters is not the timing of surgery, you know, it depends whether the patient has unilateral cryptochism or bilateral cryptochism or if their testis is palpable or impalpable. We examined semen in 142 adults who had a orchidopexy between the ages of 7 and 13 years of age. And what we found was that the semen analysis uh was normal or acceptable in patients who had a unilateral cryptochism. And also patients who had bilateral palpable testes, palpable in the superficial pouch that they they also had semen which was normal or acceptable. Whereas those patients who had bilateral impalpable testes, the testes were either in the deep in the abdomen or canalicular, all these patients in our study were azospermic. So what the future research should be, I think we need to examine semen in patients who have had a bilateral impalpable testes and have had the operation done before the age of one year. That's where we should be putting our research emphasis on. I agree. So, let me just see if I got this right. This paper showed that the AUA recommends that you make the diagnosis of an undescended testicle at six months of age, you have a year Yes. to repair it so that should be 18 months it should be fixed. And they found that 70% of United States surgeons go after that point. Correct. But Professor Puri's point is, maybe that is not always correct and that patients that had a palpable testicle that had a orchidopexy at a later age had completely normal semen. Uh so this is a very uh interesting paper. It definitely brings to light a very controversial topic that we still don't know the answers to. We hope you enjoyed this review and we'll see you next time. Thank you. Age at Is it age at orchy? The title is Age at Orchy. No, age at Orchy in the United States, I think. That's good enough.