Comparison of Single-Incision Scrotal Orchiopexy and Traditional Two-Incision Inguinal Orchiopexy for Primary Palpable Undescended Testis in Children: A Systematic Review and Meta-Analysis

Chengjun Yu,Ling Wang,Tao Lin,Jie Zhao,Jiandong Lu,Dawei He,Lian Kang,Yang Hu,Guanghui Wei,Shengde Wu

doi:10.3389/fped.2022.805579

Abstract

PurposeTo compare the safety, efficacy, and cosmetic results of single-incision scrotal orchiopexy (SISO) and traditional two-incision inguinal orchiopexy (TTIO) for primary palpable undescended testes (PUDTs) in children.Materials and MethodsA systematic literature search of all relevant studies published on PubMed, Embase, Medline, Cochrane Library, Web of Science database, and Wanfang data until July 2021 was conducted. The operative time, hospitalization duration, conversion rate, wound infection or dehiscence, scrotal hematoma or swelling, testicular atrophy, reascent, hernia or hydrocele, analgesics needs, and cosmetic results were compared between SISO and TTIO using the Mantel–Haenszel or inverse-variance method.ResultsA total of 17 studies involving 2,627 children (1,362 SISOs and 1,265 TTIOs) were included in the final analysis. The conversion rate of SISO was 3.6%. The SISO approach had a statistically significant shorter operative time than the TTIO approach for PUDT (weighted mean difference−11.96, 95% confidence interval −14.33 to −9.59, I2 = 79%, P < 0.00001) and a shorter hospital stay (weighted mean difference−1.05, 95% confidence interval −2.07 to −0.03, P = 0.04). SISO needed fewer analgesics and had better cosmetic results than TTIO. SISO had a similar total, short-term, or long-term complication rate with TTIO.ConclusionCompared with TTIO, SISO has the advantages of shorter operative time, shorter hospitalization duration, less postoperative pain, and better cosmetic appealing results. SISO is a safe, effective, promising, and potential minimal invasive surgical approach for PUDT. SISO is an alternative to TTIO in selected cryptorchid patients, especially for lower positioned ones.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021268562.

Highlights

Cryptorchidism, or undescended testes (UDTs), is one of the most common congenital abnormalities in male neonates, with a prevalence of 1.0–4.6% in full-term boys and a higher incidence in preterm boys [1]
The single-incision scrotal orchiopexy (SISO) approach had a statistically significant shorter operative time than the traditional two-incision inguinal orchiopexy (TTIO) approach for palpable undescended testes (PUDTs) and a shorter hospital stay
Compared with TTIO, SISO has the advantages of shorter operative time, shorter hospitalization duration, less postoperative pain, and better cosmetic appealing results

Summary

Introduction

Cryptorchidism, or undescended testes (UDTs), is one of the most common congenital abnormalities in male neonates, with a prevalence of 1.0–4.6% in full-term boys and a higher incidence in preterm boys [1]. ∼80% of the UDT are palpable and located in the inguinal canal, external inguinal ring, or even upper scrotal [3], making the traditional two-incision inguinal orchiopexy (TTIO) the best surgical approach to correct cryptorchidism [4]. The TTIO has two incisions: one inguinal incision to open the external oblique fascia and inguinal canal to visualize the cord structure and dissect the processus vaginalis; another second scrotal incision to fix the descended testis within the scrotum [5, 6]. It was believed that the TTIO was convenient and helpful for sufficient mobilization of the spermatic cord, separation and high ligation of the processus vaginalis or hernia sac to avoid subsequent hernia or hydrocele, and most importantly, to achieve adequate vessel length for cryptorchid testis to be placed in the scrotum without tension [7, 8]

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