Timing of orchiopexy for undescended testis in Israel: A quality of care study

Background: Strong evidence suggests that in order to prevent irreversible testicular damage surgical correction (orchiopexy) for undescended testis (UDT) should be performed before the age of 1 year. Objectives: To evaluate whether orchiopexy is delayed in our medical system, and if so, to explore the pattern of referral for orchiopexy as a possible contributing factor in such delays. Methods: We conducted a retrospective chart review of all children who underwent orchiopexy for UDT between 2003 and 2013 in our institution. We collected data on the age at surgery and the child’s health insurance plan. We also surveyed pediatricians from around the country regarding their pattern of UDT patient referral to a pediatric urologist or surgeon for surgical correction. Results: A total of 813 children underwent orchiopexy in our institute during the study period. The median age at surgery was 1.49 years (range 0.5–13). Only 11% of the children underwent surgery under the age of 1 year, and 53% between the ages of 1 and 2 years. These findings were consistent throughout the years, with no difference between the four health insurance plans. Sixty-three pediatricians who participated in the survey reported that they referred children to surgery at a median age of 1 year (range 0.5–3 years). Conclusions: Our results demonstrate delayed orchiopexy in our medical system. There is a need to improve awareness for early specialist consultation in order to facilitate earlier surgery and better care.