BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa052.
In 2011 a consensus statement from the British Association of Paediatric Urologists recommended lowering the age at orchidopexy to under 1 year. There are concerns that a younger age at operation may increase postoperative testicular atrophy. The ORCHESTRA study aimed to establish the current age at orchidopexy in a multicentre, international audit and to see whether testicular atrophy was affected by age at operation.
The study was undertaken over a 3-month period in 28 centres in boys undergoing orchidopexy for unilateral, palpable undescended testes. Data collection was done using a standardized, predetermined protocol. The primary outcome was postoperative testicular atrophy. Secondary outcomes were wound infections, reoperations, and unplanned hospital stays related to anaesthetic events.
A total of 417 patients were included, of whom only 48 (11.5 per cent) underwent orchidopexy before 1 year of age. There was no difference in anaesthetic complications in boys aged less than 1 year versus older patients: 0 of 48 (0 per cent) versus 6 of 369 (1.6 per cent) (P = 0.999). Complete follow-up was available for 331 patients (79.4 per cent). There was no difference in atrophy rate between those aged less than 1 year and older boys: 1 of 37 (3 per cent) versus 9 of 294 (3.1 per cent) (P = 0.999). Reoperation rates were 0 of 37 (0 per cent) and 7 of 294 (2.4 per cent) respectively (P = 1.000). There were more wound infections in boys under 1 year of age: 4 of 37 (11 per cent) versus 7 of 294 (2.4 per cent) (P = 0.025).
Only 11.5 per cent of boys underwent surgery before the age of 1 year. There was no increased risk of postoperative testicular atrophy with early surgery, although there was a higher rate of wound infection. Further study is required to demonstrate that early orchidopexy is not inferior to orchidopexy undertaken in boys aged over 1 year.
2011 年，英国小儿泌尿科医师协会发布了一项共识声明，建议将隐睾症的手术年龄降低至 1 岁以下。人们担心手术年龄越小，术后睾丸萎缩的风险越高。ORCHESTRA 研究旨在确定多中心国际审计中隐睾症的当前手术年龄，并观察手术年龄是否会影响睾丸萎缩。
该研究在 28 个中心进行，为期 3 个月，纳入了接受单侧可触及未降睾丸隐睾症手术的男孩。数据收集使用标准化的预定方案进行。主要结局是术后睾丸萎缩。次要结局是伤口感染、再次手术以及与麻醉事件相关的计划外住院。
共纳入 417 例患者，其中只有 48 例（11.5%）在 1 岁以下接受隐睾症手术。1 岁以下男孩和年龄较大的患者麻醉并发症发生率无差异：48 例中无（0%）和 369 例中 6 例（1.6%）（P=0.999）。331 例（79.4%）患者可获得完整随访。1 岁以下和年龄较大的男孩之间的萎缩率无差异：37 例中 1 例（3%）和 294 例中 9 例（3.1%）（P=0.999）。再次手术率分别为 0/37（0%）和 7/294（2.4%）（P=1.000）。1 岁以下男孩的伤口感染发生率更高：37 例中 4 例（11%）和 294 例中 7 例（2.4%）（P=0.025）。
只有 11.5%的男孩在 1 岁之前接受手术。尽管早期手术的伤口感染发生率较高，但术后睾丸萎缩的风险没有增加。需要进一步研究来证明早期隐睾症与 1 岁以上男孩的隐睾症手术一样不会导致不良后果。
