There is still dilema when orchiopexy is to be done,as infertility is the main problem but parents reluctant to do early operation.
If pathologists are right that 6month old boys with retentio testis show defects
of normal testis tissue than we should become active as soon as possible.
If spontaneous decent is mostly complete by age of 3months then why should we not attempt orchidopexy at that age?
The question was about the earliest age for attempting to find and pull down the UDT.
6 mo is a reasonable earliest age for orhiopexi.
Second half of first year is optimum. Gives the testes a chance to descend since there is a neonatal testerone surge at six months which may lead to descend or at least improve the position of testes.
A testis that didn't descent at 6th mo age , never descend . Thus operation earlier than 6 mo is n't recommended. Except for some instances ( eg; prune belly syn ) the best recommended time for operation is 9-15 mo of age.
Between 6 - 12 months, as decent of testis is complete by age of 6 month.
Early testicular changes (between 6 till 18 months) may have histopathologically no late importance. Just inform the parents about that. You can wait till 18 months for orchidopexy.
There is no Dilemma. (The dilemma is in head of surgeons)
PLS NOTE:
Second half of first year is optimum. Gives the testes a chance to descend since there is a neonatal testerone surge at six months which may lead to descend or at least improve the position of testes.
It is better to give the baby chance for 6 months after birth with follow up then consel the parent with the advantage of early orchiopexy as regard to fertility aspect
There is an evidence of histopathological changes at 12 months , so operation should be done before 12 months
So Saad Usif. What would you do when parents bring child at 10 month? Do you ask them to wait till 1 yr age??
Suffice to say that UDT should be done in second half of first year.
agreed, 6-12 months. Most testicles will come down by 6 months if they are going to come down and by waiting until the child is slightly older reduces the risk of anesthetic complications. The only additional comment I would make is that an UDT is more common in a premature baby and this should be accounted for when determining the "months" of age.
UDT with manifest hernia should be operated earlier. As also UDT with history of herniotomy done in past on same side should be operated early as the cause is mechanical. Similary Ectopic testes should be operated upon earlier.
The fertility of the child should not be determined by the UDT and the timing of surgery. I agree with Dr Patankar regarding timing of surgery. For palpable UDT with Inguinal Hernia, I manage it laparoscopically as the hernia requires earlier operation than the UDT.
If support (Anesthesia) systems are in place, 6 - 12 months of age.
But not later than 18 months of age.
Perform the surgery beteeen 8-12 months I think is the best option but treatment can be' customized according to the patients and the hospital facilities
In my Country Parents usually are reluctant to make a prior surgery,but I agree with DR Krishna.
Because of some reports regarding begining of ultrastructral change in some testicular cells after 6-12 months the best time of surgery is between 6-12 months .
Best time is 6 - 12 months but should not delay beyond 18 months
UDT is more common in premature babies..so wait for maturity first upto the age of 6 to 8 months ,if still not descende then we can for operation upto one year to 15 months..
In my experience, I noticed that, in case of unilateral UDT, if it is clinically palpable and did not descend untill the age of 6 months, it will never descend spontaneously by giving more time. So, I prefere to explore by the age of 6 months as long there is good anesthesia team and no other contraindications. More over, most of UDT are associated with patent processus vaginalis and excision of this hernial sac is mandatory, so, I prefere small inguinal incision for herniotomy,proper dissection and getting good length , making suitable tunnel and fixing the testis in a subdartos pouch.
In case of bilateral UDT especially with small scrotal sac, I prefer giving a short course of pregnyl 1500 iu weekly for 4 weeks and if no response, usually I prefere not to delay orchiopexy after the first year of life.
Dr Taha Ahmed - I would agree with you about Pregnyl in B/L non-palpablde testes. How about Bil Palpable UDT - would you still use it or proceed with Orchidopex.
In bilateral palpable testes, we are advising Pregnyl if the scrotal sac is small. But if the sac is of good size, we proceed directly for orchiopexy. myself, i prefere bilateral orchiopexy in the same session. Some of my colleagues in the department prefere unilateral orchiopexy delaying the other side few months later.
After 6 months and before first birthday ...although fertility should not be much of an issue in case of unilateral UDT. It is true that convincing parents is a real challenge and I feel it is an art in itself ..............But when facts [Pros and cons ] are discussed with parents usually they accept the offer of Surgical correction.
I agree wih anjan ..... should be in second half of first year.... otherwise children get lost to follow up and dont show up ununtil four to five years.
Present consensus supports surgical treatment at 6 months of age. Support for this approach is based on the following rationale: (1) descent is unlikely in full-term males after age 6 months (2) testicular growth is restored after early orchidopexy (3) hormone therapy is not considered effica cious and (4) orchidopexy for abdominal testes may be facilitated in young infants soon after the hormonal surge. In boys with a histor y of prematurity, spontaneous descent may be delayed and therefore continued obser vation for 6 months beyond the expected date of deliver y or, especially if testicular position is marginal, until a year of age may be warranted.
6-9monthas if totally intraabdominal and not beyond 12months for the ones below the ingiunal ring
I agree ..... should be in second half of first year.... otherwise children get lost to follow up and don't show up until four to five years.
I have learned that the testis can still descend spontaneously within the first 6 months of life. So for me 6 months would be the earliest date.
Regarding the previous comment: I don't think it's technically very difficult to do an orchidopexy at the age of 3 months, but the question is what is the benefit if there is a chance it goes down by 6 months ?
Although 6 months is widely accepted, new evidence suggests that testicular changes and damage are seen as early as 3 mths in undescended testis. Although the other school of thought is an inherent defect within the testis that has led to the incomplete descent and early orchidopexy might not necessarily produce the desired effect.
The best way to find an answer, in my opinion is to do a randomised controlled trial on orchidopexy at varying ages and compare the outcomes in large numbers. However, the feasibility of such a trial along with variation of UDT at different levels from high scrotum to the impalpable testis, will prove it difficult to interpret and come to a consensus.
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