Although there has been a modest reduction in the mean age of orchidopexy since 2003, overall, the mean age at orchidopexy remains well above the recommended optimal age, implying that more attention should be paid towards earlier diagnosis and referral for primary undescended testes.

Larger hernial sacs and sacs inadvertently opened during surgery are predictors of later recurrence. Low gestation and specific comorbidities were also associated with a higher likelihood of recurrence.

Abstract:Early treatment for primary undescended testis (UDT) is necessary to prevent testicular degeneration and improve fertility. The general recommended age for orchidopexy is before 2 years of age. Comparing the age distribution of orchidopexy between different services may give an indirect indication of the quality of the child health services, since timely diagnosis and referral will lead to boys undergoing orchidopexy at the optimal age. This paper reviews the age distribution of boys having orchidopexies for UDT between 1997 and 2006 in the South Island of New Zealand and the state of Victoria, Australia: 64.2% of boys on the South Island and 48.0% of boys in Victoria had orchidopexies before the age of 5. There was a considerable difference in the proportions of children from 0 to 4 years and from 10 to 14 years between the two regions. No distinct trend in age was seen in either population during the period reviewed. These results show that many boys do not receive treatment for UDT at the optimal age. Age at orchidopexy may be an indicator of the quality (in terms of diagnosis, access and timeliness) of a region's paediatric surgical service and may identify where attention should be paid if earlier diagnosis and referral is to be achieved.

Complication rates were relatively low compared with those reported previously, but were considered achievable in most paediatric surgical units. Specific attention should be paid to the youngest infants, as this group has the highest complication rate. Minimum standards can be proposed based on these and other published outcomes.

It is not possible to predict reliably which patients who present with a unilateral hernia would benefit from bilateral exploration, although the size of the hernia has a positive correlation with the size of the contralateral processus vaginalis/hernial sac. Those with "massive" hernias on the presenting side were more likely to have "large" contralateral hernial sacs, but how many of these would subsequently become symptomatic remains uncertain.