20 years of transcrotal orchidopexy for undescended testis: Results and outcomes

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Abstract

Background

The role of the transcrotal approach to the undescended testis remains controversial despite its increasing popularity. The authors update their previous published series and review the literature on this subject, aiming to delineate the value of this technique.

Methods

The authors performed a retrospective review of the transcrotal primary orchidopexy carried out to treat palpable undescended testis at Royal Manchester Children's Hospital between 1993 and 2005. A structured review of literature published since the proposal of this technique was also performed.

Results

122 procedures were included. The transcrotal approach was successfully completed in 119 (97.5%). Additional groin incision was needed in three (2.5%) to further mobilize the spermatic cord. No immediate complications were recorded and 8.4% required a reoperative procedure. On review of the literature, a total of 16 articles were discovered spanning 1695 transcrotal procedures, including the previously published authors' experience. On combining the data, the transcrotal approach required an additional groin incision in 4.4% of cases, 1.6% experienced immediate and/or early complications, and the overall recurrence rate was 2.0%.

Conclusions

Transcrotal orchidopexy for the treatment of palpable undescended testes is a safe procedure with a long-term success rate comparable to the two-incision approach.

Introduction

The majority of undescended testicles are palpable distal to the inguinal canal [1]. In 1989, Bianchi and Squire [2] proposed that orchidopexy for the palpable undescended testis should commence with a scrotal incision, and that an additional groin incision be reserved for the few high testes that will not otherwise reach the scrotum, after maximal possible mobilization through the scrotum. The ‘Transcrotal Orchidopexy’ has the advantage of much less dissection, greater comfort for the patient, rapid healing, excellent cosmesis and a well maintained testicular position. In 1995, Bianchi and colleagues followed this up with a case series of 367 orchidopexies [3] that confirmed low complication rates and a success rate comparable to the two-incision procedure.

This paper presents the results of a further case record review of transcrotal orchidopexies for the palpable undescended testes performed at the Royal Manchester Children's Hospital from 1993 to 2005 by Bianchi and colleagues, which bring the published Manchester experience up to 489 procedures. The authors have also reviewed the literature published over the last 20 years relating to this surgical technique.

Section snippets

Materials and methods

The authors retrospectively reviewed the case records of all children who underwent orchidopexy from 1993 to 2005 at Royal Manchester Children's Hospital. The children were under the care of Bianchi and colleagues who carry out the transcrotal approach [2] as the default procedure for all children with a palpable undescended testicle. All patients who underwent primary transcrotal orchidopexy for the treatment of palpable undescended testis were included. Position of the testes was confirmed

Results

A total of 126 orchidopexies were identified for case review within the study period. Exclusion criteria led to four procedures being removed from the study. The remaining group consisted of 118 patients, of whom four had bilateral procedures giving a total of 122 orchidopexies. The age range at first operation was between 10 months and 8 years. Before operation, the position of the testes was the neck of the scrotum in 11 patients (9.0%), the external inguinal ring in 34 (27.9%), the inguinal

Discussion

Conventional orchidopexy today is still performed according to the concepts of Schuller [20] in 1881 and Bevan [21], [22] in 1899 and 1903. The experiences of Bianchi and Squire [2] and Hazebroek et al. [23] confirmed that the testicular vessels and the vas in the majority of palpable undescended testicles, after dissection of the cremaster and the processus vaginalis (Fig. 1), are long enough to allow the testes to reach the scrotum without tension. Based on these observations, the approach

Conclusions

Published data from the last 20 years confirm that transcrotal orchidopexy is followed by uncomplicated healing and a well-placed scrotal testis. In comparison with the conventional two-incision operation, transcrotal orchidopexy offers the advantage of an aesthetic single scrotal crease incision, less dissection and greater comfort for the day-case child. Moreover, the literature suggests that the transcrotal orchidopexy offers at least a comparable recurrence rate to the two-incision approach

Conflict of interests

There are no conflicting interests for any of the authors.

Funding

None.

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