Prescrotal Orchiopexy for the Palpable Undescended Testicle ( UDT ) : Initial Experience and Comparison with the Standard Inguinal Approach (original) (raw)
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The Journal of Urology, 2008
Prescrotal orchiopexy is emerging as an alternative surgical approach to undescended testicles. We compare operative times, success rates and complications of single incision prescrotal orchiopexy and the traditional inguinal approach. Materials and Methods: During a 3-year period all patients who underwent prescrotal orchiopexy were retrospectively reviewed and compared to age matched controls operated on via the traditional inguinal approach. Data collected included preoperative and postoperative testicular positioning, operative time and complications, including testicular atrophy and ascent. Exclusion criteria were retractile or ectopic testis, incomplete data, including lack of followup, and a concurrent procedure at the time of orchiopexy. Results: A total of 63 orchiopexies were performed using the prescrotal approach (mean patient age 4.6 years) and the inguinal approach (4.7 years). Average surgical times for the prescrotal and inguinal groups were 34 and 64 minutes, respectively (p ϭ 0.002). Followup ranged from 6 to 42 months. Complication rates between the groups were similar. However, 2 hernias (3%) occurred in the prescrotal group, of which 1 was incarcerated and associated with Meckel's diverticulum, and 1 was a late recurrence. Conclusions: With the paucity of literature on prescrotal orchiopexy potential complications may be underreported. Despite the limitations of sample size, prescrotal orchiopexy may be associated with a 3% risk of postoperative hernia. A single incision prescrotal orchiopexy is still a viable approach for patients with primary palpable undescended testicles. Advantages include shorter operative time, a cosmetically appealing single incision and possibly less pain.
Single Scrotal Incision Orchiopexy for Palpable Undescended Testis
Asian Journal of Surgery, 2006
To prospectively evaluate the Bianchi single scrotal incision technique for orchiopexy in boys with palpable undescended testis. METHODS: A total of 35 orchiopexies were performed in 28 patients. The patent processus vaginalis was dissected and cut high without ligation, while in Bianchi's original procedure, the patent processus vaginalis is dissected up to the external inguinal canal, ligated high and divided. Testicular size and position were assessed at 2 and 6 weeks and 6 months.
Single scrotal incision orchiopexy - a systematic review
International braz j urol, 2013
To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods: A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery. Results: A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%), there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. Conclusions: Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.
A modified technique for scrotal fixation during orchiopexy
African Journal of Paediatric Surgery, 2011
Background: Undescended testes are a common problem, affecting up to 3% of newborn males. The goals of orchiopexy in humans are to provide adequate scrotal fi xation, to prevent recurrent torsion of the testis and spermatic cord or ascent of the testis, and to achieve these goals with minimal trauma to the testis. The best method of achieving fi xation remains controversial. Purpose: The aim of our study is to evaluate our modifi ed extra Dartos pouch technique in retaining testis in the scrotum. Patients and Methods: A prospective randomized study included 159 patients with 185 orchiopexies age ranging from 5 months to 14 years with the mean age of 49.5 ± 33.3 months (4.08 years). They were divided into two groups: Group I for whom the extra Dartos pouch technique was applied were compared to Group II for whom classic sub-Dartos pouch technique was done. Results: Testis was located in the superfi cial inguinal pouch in 102 cases (64.1%) and intra-canalicular in 57 cases (35.6%). Hernial sac was found in 153 cases (96.2%), postoperative wound infection occurred in 3 cases (1.9%) and hematoma formation in three cases (1.9%); one case reported ascent of the testis and another one had testicular atrophy in the follow-up period which extends now up to 3 years and we are still in follow-up with those cases. Conclusion: Our modifi ed technique for extra Dartos pouch fi xation seems to be a fast reliable method for orchiopexy; however, comparative studies and long-term assessment is still needed to establish this method.
Outcome Analysis of Redo Orchiopexy: Scrotal vs Inguinal
The Journal of urology, 2016
Redo-orchiopexy after previous surgery is technically challenging, and requires skills and care to ensure preservation of cord structures. Herein we report our experience with redo-orchiopexy in children. After obtaining research ethics board approval a retrospective review was completed looking at patients who underwent a redo-orchiopexy between January 2004 to May 2015. Variables evaluated included primary procedure, type of redo procedure, operative time, shift of surgical route, operative and postoperative complications and testicular location at last follow-up. 3384 orchiopexies were performed in this study period, with 61 children requiring a redo-orchiopexy (1.8 %). Mean patient age at redo-orchiopexy was 6.4 ± 3.6 years (1.5-17.1 years), and mean follow-up period was 24.9 months (2.1-99.6 months). In these patients, the primary surgical procedure preceeding redo surgery was inguinal orchiopexy in 45.9 %, scrotal orchiopexy in 13.1%, laparoscopic approach in 13.1 %, or status...
Orchiopexy through a single high transverse scrotal incision
African journal of paediatric surgery : AJPS
Palpable Undescended Testis (PUT) represents a common paediatric problem in many premature and some mature infants. There are several surgical techniques to correct PUT either through combined inguinal and scrotal incision or single transverse scrotal incision. This study assessed single high transverse scrotal incision for the management of PUT as regards to feasibility, postoperative success and final cosmetic results. One hundred twenty patients were managed at the Paediatric Surgery Department of Tanta University Hospital with PUT during the period from March 2010 to March 2014. They were all operated at the age of 6-12 months. We excluded recurrent cases, and cases older than 12 months. Through high transverse scrotal incision, the layers were divided, and the canal entered through the external ring, dissecting the PUT and bringing it through the incision. Hernia sac, if present, was ligated at the neck. Creation of the dartos pouch was then made through the same incision. All ...
Orchiopexy for Intra-Abdominal Testes: Factors Predicting Success
The Journal of Urology, 2009
Purpose: Intra-abdominal testes can be treated with several surgical procedures. We evaluated factors influencing the outcome of orchiopexy for intra-abdominal testis. Materials and Methods: We retrospectively reviewed 156 consecutive orchiopexies performed for intra-abdominal testis, defined as a nonpalpable testis on examination and located in the abdomen at surgery. All surgical approaches were included in the study. Primary outcome was the overall success rate and secondary outcomes were success based on surgical approach, age and a patent processus vaginalis. Success was considered a testis with normal texture and size compared to the contralateral testis at followup. Multivariate analysis was performed to determine factors predictive of success. Results: The overall success rate of all orchiopexies was 79.5%. Median patient age at orchiopexy was 12 months and mean followup was 16 months. Of the patients 117 had a patent processus vaginalis at surgery. One-stage abdominal orchiopexy was performed in 92 testes with 89.1% success. Of these cases 32 were performed laparoscopically with 96.9% success. One-stage Fowler-Stephens orchiopexy was performed in 27 testes and 2-stage Fowler-Stephens orchiopexy was performed in 37 with success in 63.0% and 67.6%, respectively. Multivariate analysis revealed that 1-stage orchiopexy without vessel division had more successful outcomes than 1 and 2-stage Fowler-Stephens orchiopexy (OR 0.24, p ϭ 0.007 and 0.29, p ϭ 0.19, respectively). Neither age at surgery nor an open internal ring was significant (p ϭ 0.49 and 0.12, respectively). Conclusions: The overall success of orchiopexy for intra-abdominal testis is 79.5%. While patient selection remains a critical factor, 1-stage orchiopexy without vessel division was significantly more successful and a laparoscopic approach was associated with the fewest failures for intra-abdominal testes.
Journal of Surgery, 2020
Background: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. Aim of the current study was to compare between classic inguinal approach and scrotal single incision approach to perform orchiopexy for management of un-descended testis in infants and to clarify which is better; inguinal orchidopexy or scrotal orchidopexy. Patients and methods: we included forty male patients with undescended testis who were divided into two groups; group A included twenty patients and they were surgically managed with single transscrotal orchiopexy and group B included twenty patients and they were surgically managed with classic inguinal approach by two incisions (inguinal and scrotal). We assessed operative time and complications as wound infection, recurrence and testicular atrophy. Results: Operative time in group A was shorter than the operative time of group B which was managed by the inguinal approach (p=0.004). Immediate post-operative complications as; skin site infection, hematoma and edema, in group A were slightly more than the complications in group B (p=0.002). group A showed no recurrence or testicular atrophy after six months while group B showed 2 cases of recurrence and one case of testicular atrophy (p=0.005). At three months after surgery, cosmetic results and patients satisfaction of the incision scar was higher in group A than group B (p<0.001). Conclusions: performing orchiopexy through single scrotal incision approach is better than the approach of inguinal incision regarding operative time, rabid healing time, parents' satisfaction, fewer long-term complications, less incidence of testicular atrophy and recurrence.