17 BILATERAL ORCHIDOPEXIES: SYNCHRONOUS OR METACHRONOUS? Departmental Review and Survey of BAPS and BAPU Members
Ibrahim Mostafa, Mohamed Shalaby, Mark Woodward
Bristol Royal Hospital for Children, Bristol, United Kingdom

Abstract

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 paediatric surgeons and paediatric 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. Paediatric urologists were significantly more likely to undertake SBO than paediatric general surgeons.

188 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. SBO was financially advantageous by comparison to MBO as a 2nd operation was avoided, and treatment was completed 6 months more quickly. There was no statistical difference in the complication rate between the two groups (7.6% in SBO vs 9.1% in MBO).

Conclusions: The majority of UK surgeons, in particular paediatric urologists, favour SBO. In addition, SBO 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.


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