Age at orchidopexy as an indicator of the quality of regional child health services.

Early treatment for primary undescended testis (UDT) is necessary to prevent testicular degeneration and improve fertility. The general recommended age for orchidopexy is before 2 years of age. Comparing the age distribution of orchidopexy between different services may give an indirect indication of the quality of the child health services, since timely diagnosis and referral will lead to boys undergoing orchidopexy at the optimal age. This paper reviews the age distribution of boys having orchidopexies for UDT between 1997 and 2006 in the South Island of New Zealand and the state of Victoria, Australia: 64.2% of boys on the South Island and 48.0% of boys in Victoria had orchidopexies before the age of 5. There was a considerable difference in the proportions of children from 0 to 4 years and from 10 to 14 years between the two regions. No distinct trend in age was seen in either population during the period reviewed. These results show that many boys do not receive treatment for UDT at the optimal age. Age at orchidopexy may be an indicator of the quality (in terms of diagnosis, access and timeliness) of a region's paediatric surgical service and may identify where attention should be paid if earlier diagnosis and referral is to be achieved.

[Procedural sedation with propofol in non-painful interventions in children]. / Sedatie met propofol voor niet-pijnlijke procedures bij kinderen.

UNLABELLED: Propofol is the sedative of choice in our hospital for all procedural sedations in children older than 3 months. Data were collected from all patients who underwent PSA with propofol in the period from November 2007 to December 2009. The procedure was performed by a paediatrician experienced in airway management, sedation and paediatric IC, and a specialized nurse. Patient characteristics, American Society of Anesthesiologists (ASA) classification, vital parameters and propofol dosage were registered on specially designed forms. Patient data were analyzed and compared with data from a non-matched historical cohort of patients who in the past had undergone PSA with chloral hydrate. RESULTS: 204 procedural sedations with intravenous propofol were performed in 196 patients. The mean cumulative induction dose was 3.39 mg/kg (SD: 1.34) and the mean maintenance dose was 4.05 mg/kg/h (SD: 2.23). The success rate was 99.5%, compared to 88.6% in the cohort that had received PSA with chloral hydrate. 1 procedure was aborted because of desaturation due to an obstructed airway, for which a jaw thrust was performed. No complications were observed in 199 procedures (97.5%). In 4 procedures a mild and transient desaturation (85-89%) occurred. CONCLUSION: The results suggest that propofol can be used safely and is effective for procedural sedation in selected children, provided that PSA is performed by experienced and trained staff.

Predictors of recurrence after inguinal herniotomy in boys.

BACKGROUND: Recurrence is the most important complication of inguinal hernia repair in childhood, but little is known about its contributing factors. The aim of our study was to identify factors evident at the time of primary surgery that may be predictive of subsequent recurrence. METHODS: All hernias in boys operated on by the Christchurch-based Paediatric Surgical Service of the South Island of New Zealand between September 1996 and December 2007 were reviewed. Characteristics of initial hernias that recurred were compared with hernias that did not recur. RESULTS: There were 2,471 primary herniotomies in boys, of which 17 recurred, giving an overall recurrence rate of 0.69%. Factors predicting an increased likelihood of later recurrence were inadvertent opening of the hernial sac during its dissection off the vas and vessels (OR = 5.1, P = 0.0039) and larger size of the hernia (P = 0.0037). Ten recurrences (62.5%) occurred in infants less than 37 weeks gestation. Hernias considered 'massive' at the time of surgery tended to recur earlier (P = 0.006), as did those where the sac was opened (P = 0.011). The side of the hernia and initial strangulation did not differ significantly between the two groups. CONCLUSIONS: Larger hernial sacs and sacs inadvertently opened during surgery are predictors of later recurrence. Low gestation and specific comorbidities were also associated with a higher likelihood of recurrence.

Review of the extent to which orchidopexy is performed at the optimal age: implications for health services.

BACKGROUND: In recent decades, the recommended age for orchidopexy for primary undescended testes has decreased, in the expectation that this might improve subsequent fertility. The aim of this study was to investigate whether this is reflected in a reduction in the age at which orchidopexies are carried out, and the implications for child health services. METHODS: All boys who underwent an orchidopexy for an undescended testis carried out by the Christchurch-based paediatric surgical service between January 1997 and December 2007 were identified through a prospectively collected database. They were analysed according to the age at time of operation and year of surgery to determine whether there was any trend over time. The proportions of children younger than 2 years and between 2 and 5 years of age were calculated for each year. RESULTS: In total, 788 boys underwent orchidopexies for primary undescended testes, with 335 (42.5%) boys having surgery before the age of 2 (mean age 54.3 months, median 31.1 months). During the whole 11-year period, there was no significant change in age at orchidopexy, whereas from 2003, a significant trend towards lower age at operation (Spearman's rank -0.1112, P = 0.0071) and a significant increase in the proportion of boys having surgery before the age of 2 (Spearman's rank 0.9000, P = 0.0374) were seen. CONCLUSIONS: Although there has been a modest reduction in the mean age of orchidopexy since 2003, overall, the mean age at orchidopexy remains well above the recommended optimal age, implying that more attention should be paid towards earlier diagnosis and referral for primary undescended testes.