Orchidopexy: the younger the better?

The optimum age for orchidopexy in childhood remains controversial. Many believe that it should be performed before the child's second birthday, when irreversible changes occur in testicular morphology. Others have shown an increase in the risk of damage to the spermatic cord structures in early operation, resulting in gonadal atrophy. We reviewed 200 patients: 100 had had orchidopexy before and 100 after their second birthday. From the case records and from long-term review, we found that 5% of the testes in each group became atrophic. Some testes, which were 'normal' at the 6-month review, had subsequently failed to increase in size, whereas some which were initially diagnosed as 'atrophic' had grown, by long-term follow-up to a similar, normal size compared with the contralateral organ. In the older group, we also found that 19 testes that had previously been diagnosed as having descended normally had ascended subsequently.