A REGIONAL AUDIT OF ORCHIDOPEXY SURGERY FOR UNDESCENDED TESTIS WITHIN A PAEDIATRIC SURGERY NETWORK
Aim: To look at the geographical distribution of orchidopexies performed within our regional paediatric surgical network.
Methods: A retrospective multi-centre audit of all patients who underwent orchidopexy during 2016 was performed across networked trusts in our region. Practice was audited against UK and European guidelines.
Results: 302 orchidopexy procedures were performed across nine centres. 179/302 procedures (59%) were performed at the tertiary paediatric surgery unit, and 123/302 (41%) were performed at peripheral sites. Median age at referral was 31 months, with 15% of patients (35/237) referred before the recommended age of 6 months. 56/302 patients (19%) underwent ultrasound prior to referral. 31/35 patients (90%) referred before six months of age were reviewed by a specialist before eight months of age. Median age at the time of surgery was 41 months, with 75/302 (25%) undergoing orchidopexy before 18 months. All operations performed at peripheral sites were day cases; there were no unplanned overnight admissions at the tertiary centre. 42% in the inguinal canal, 39% of testes were located in the superficial inguinal pouch. Intra-abdominal testes represented 17% and these were all operated upon at the tertiary centre. 27 patients were identified who underwent surgery at the tertiary paediatric surgery centre who could have been operated upon at a hospital closer to home.
Conclusion: The regional network provides an effective service for the provision of orchidopexy surgery. Late referral from primary care prevents the provision of surgery at the recommended age (12-18 months). Ultrasound scanning is an unnecessary utilisation of resources. Regional network guidelines have been written and primary care providers contacted to highlight the need for early referral and the lack of value of ultrasound. A re-audit will evaluate the effectiveness of these measures.