Editorial comment

Abstract

The approach to the palpable undescended testis has changed little during the past century. Recently, the scrotal approach to the undescended testis has been adopted, with a number of variations. The authors of this report describe two groups of patients: those with palpable testes beyond the external ring and those with testes in the inguinal canal. They recommend a scrotal approach for the former and an inguinal approach for the latter based on the likelihood of finding a patent inguinal hernia. Our group documented approximately 20% of ectopic or ascended testes to have a patent hernia, and the current series confirms this finding. 1 Parsons J.K. Ferrer F. Docimo S.G. The low scrotal approach to the ectopic or ascended testicle prevalence of a patent processus vaginalis. J Urol. 2003; 169: 1832-1833 Abstract Full Text Full Text PDF PubMed Google Scholar We had recommended a secondary inguinal incision in all cases with a patent hernia, but since then we have evolved to an approach similar to the one described here. As Koyle 2 Koyle M.A. Editorial comment to: The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis. J Urol. 2003; 169: 1832-1833 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar eloquently stated, the clinical significance of these “hernias” associated with low undescended testes is unclear, and they can generally be ligated effectively through the scrotum. I agree with these authors that the high likelihood of finding a patent hernia associated with testes above the external ring suggests that the inguinal approach is more straightforward in these cases. The place for scrotal orchiopexy continues to be defined, but for many of us it is an indispensable technique applicable to most undescended testes.