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Current Pediatric Research

Orchidopexy for undescended testis among Saudi children: is it conducted at the optimal age?

Author(s): Khalid Fouda Neel

Vol. 14, No. 1 (2010-01 - 2010-06)

Khalid Fouda Neel

Division of Urology, Department of Surgery, King Saud University, Riyadh, Saudi Arabia


Current evidence-based studies indicate the need to perform orchidopexy for undescended testicles early in life, between the ages of 6 and 12 months. Despite this evidence, we observed a significant delay in the actual age that such a procedure is performed in Saudi Arabia. Therefore, we retrospectively examined all of our patients who received an orchidopexy, identified their age at the procedure, and, if the procedure was performed after 12 months of age, noted the reason for the delay. We found that the mean age at orchidopexy in our cohort was approximately four and half years old, indicating the need for greater awareness of the recommended time frame for this procedure among health providers and parents of patients.

Key words: Undescended testis, orchidopexy, timing of surgery, age, Saudi Arabia
Accepted July 21st 2009


Proper function of the undescended testis depends strongly upon the age at which the testicle descends into its normal scrotal position [1]. The current evidence-based recommendation is to perform orchidopexy, between 6 and 12 months of age [1-4], which prevents additional testicular damage and its subsequent impact on fertility [3]. Although assessment of testicular position is a well-established part of the initial general check-up of a neonate, there are alarming reports suggesting that the age at which orchidopexy is performed is significantly later than the recommended time frame, with various explanations for this delay [5-7].

In this study, we examined the age at which orchidopexy is performed in Saudi Arabia to assess if a similar delay is occurring. If so, we hope that this report will draw this problem to the attention of medical practitioners in Saudi Arabia and provide information on how to prevent it.

Material and Methods

We retrospectively reviewed the charts for all patients who underwent orchidopexy over a 10-year span (1998-2008) in two hospitals in Riyadh, one a private open access hospital and the other a general hospital, all performed by one surgeon (KN). We looked at the age at which the problem was identified, whether this identifica-tion was by the parents or if they were referred to us by a medical practitioner, when the problem was actually referred to the surgeon, and the age at which the procedure was performed.


Between 1998 and 2008, 345 boys underwent orchidop-exy by a single surgeon in both hospitals. Of this cohort, 58 received a bilateral orchidopexy (16.8%). Only 170 patients (49.2%) were diagnosed with cryptorchidism before the age of 12 months. Of the patients diagnosed after 12 months of age, 20 patients (5.8%) were identified during their pre-school health check up, and 155 (45%) were diagnosed by their parent or pediatrician after their first year of life (Table 1).

Table 1: Age presentation of Saudi patients with un-descended testis

Total # Diagnosed before
the age of 1 year
Diagnosed after
the age of 1 year
Diagnosed at
pre-school checkup
345 patients
(bilateral in 58 patients)
170 (49.2%) 155 (45%) 20 (5.8%)

Table 2: Age at surgical intervention

Total # Surgery before
the age of 1 year
Surgery after
the age of 1 year
345 patients 102 (29.5%) 243 (70.5%)٭

٭62 patients (18%) were diagnosed at optimum age but surgery was delayed.

Out of the 345-patient cohort, 102 had their surgery before 12 months of age (29.5%), while 62 patients (18%) diagnosed before the age of 12 months were counseled that the testicle may descend on its own, and therefore were not referred for early evaluation. The actual age of orchidopexy ranged between 6 and 144 months, with a mean age of 54.8 months (Table 2)..


Despite previous controversy, current evidence-based studies indicate that early intervention for an undescended testis may improve fertility (1-4) and decrease the risk of testicular cancer (8,9). Therefore, the current recommended age for orchidopexy is between 6 and 12 months of age (2-4). Accordingly, it is recommended that patients with an undescended testicle be referred to a specialized surgeon early to prevent any future damage.

Unfortunately, our data showed that there is a significant delay in the referral of patients with an undescended testi-cle either because the condition was not identified early on, or the doctor gave false reassurance that the testicle may descend by itself even after the age of 6 months, or the parents of the patient failed to seek proper surgical advice because they feared surgery and didnít appreciate its importance. This resulted in a significant delay in the timing of orchidopexy, shifting the average age of surgi-cal intervention to four and a half years. This average age is consistent with the average age at orchidopexy observed in other studies (5-7) , indicating the need for more health awareness.

It is imperative that proper examination of male genitalia is carried out soon after delivery as well as during the early immunization schedule, and if there is any suspicion of an undescended testicle, the child should be referred to a specialized surgeon for further assessment and follow-up. The current recommendations is: 1. If the testis ( uni-lateral or bilateral) is either felt in the groin and canít be brought down to the scrotum, or the testis is not palpable, or itís felt in the groin and can be pulled to the scrotum but returns at once to the groin, the child should be re-ferred for operation between the age of 6 and 12 months 2. if the testis can be pulled to the scrotum and remains their after traction is released, the child is diagnosed with retractile testis, and he needs an annual follow-up to de-tect later ascend. 3. in case of bilateral nonpalpable testis and either hypospadias or micropenis the child should be seen immediately by a DSD team(3). The current evidence shows that orchidopexy ,if indicated and done early in life, will improve fertility [1,4].

Although the results of this retrospective study are worrying, similar studies in a large population in different Saudi cities should be carried out to further explore this problem.


Current evidence based studies clearly recommend the referral of patients with undescended testis to a specialized surgeon by the age of 6 months. However, the mean age at which orchidopexy is performed is significantly delayed beyond the recommended timeframe in Saudi patients, indicating the need for more heath awareness among health providers and the community.


  1. Murphy F, Sri Paran T, Puri P. Orchidopexy and its impact on fertility. Pediatr Surg Int 2007; 23:625-632.
  2. European Association of Urology guidelines 2007
  3. Martin Ritzen E, Bergh A, Christiansen P, Cortes D, Haugen SE, JŲrgensen N etal . Nordic Consensus on treatment of undescended testis. Acta Paediatrica 2007; 638-643.
  4. American Academy of Pediatrics, Section on Urology. Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. Pediatrics 1996; 97:590-594.
  5. McCabe JE, Kenny SE. Orchidopexy for undescended testis in England: is it evidence based? J Ped Surg 2008; 43: 353-357.
  6. Bonney T, Southwell B, Donnath S, Newgreen D, Hutson J. Orchidopexy trends in the pediatric popula-tion of Victoria 1999-2006. Journal of Pediatric Sur-gery 2009; 44: 427-431.
  7. Bruijnen CJP, Vogels HDE, Beasley SW. Review of the extent to which orchidopexy is performed at the op-timal age: Implications for health services. ANZ J Surg 2008; 78: 1006-1009.
  8. Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Eng J Med 2007; 356:1835-1841.
  9. Walsh T, DallíEra MA, Croughan MS, Carroll PR, Turek PJ. Prepubertal orchidopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol 2007; 178: 1440-1446.

Khalid Fouda Neel

Division of Urology, Department of Surgery
King Saud University
P.O. 2925 Riyadh 11461, Saudi Arabia
e-mail: kfouda(at)KSU.EDU.SA

Curr Pediatr Res 2010; 14 (1): 39-41

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