Abstract
BackgroundUndescended testis is one of the most common paediatric surgical diagnoses. A lot of research has been done to date, to standardise the surgical management of intra-abdominal and extra-abdominal undescended testis. High inguinal undescended testis is a unique clinical encounter which demands additional surgical measures over conventional orchidopexy for better surgical results.Main body of abstractOpen inguinal orchidopexy is a routine and quite straightforward operation for the majority of extra-abdominal undescended testis. However, there are instances in which the testis, even though situated in the inguinal region, poses a challenge for surgeons, to bring it in the scrotum by routine open inguinal orchiopexy. High inguinal testis can be defined as “any intra-canalicular testis present higher up in the inguinal canal and cannot be brought down easily to the scrotum by routine surgery as in standard orchiopexy (open or laparoscopy) and require additional lengthening manoeuvres”. It needs additional surgical lengthening manoeuvres like Prentiss, along with the steps of routine orchiopexy to bring it down in the scrotum. This review article describes the various nomenclatures of undescended testis, appropriate investigations and also various additional surgical measures in the management of difficult high inguinal testis.ConclusionHigh inguinal undescended testis poses a unique technical challenge even to well-experienced surgeons. It is very important that surgeons dealing with this condition are well aware of the anatomy in this region and also various different manoeuvres described to date to bring the testis down in the scrotum.
Highlights
ConclusionHigh inguinal undescended testis poses a unique technical challenge even to well-experienced surgeons
Definition and various nomenclatures in undescended testis In normal males, the midpoint of the testis is at or below the level of mid-scrotum
The mode and nature of the surgery depend on the position of the testis, and high inguinal testis poses a particular challenge to surgeons
Summary
Undescended testis is a common problem in the paediatric population which if persists for more than 6 months should be addressed surgically. The mode and nature of the surgery depend on the position of the testis, and high inguinal testis poses a particular challenge to surgeons. Routine inguinal or scrotal orchidopexy will result in fixation of the testis in scrotum under tension leading to secondary atrophy or retraction of the testis. The use of laparoscopy is well established in the intra-abdominal testis might not always help in high inguinal testis. Other conditions like retractile testis can be followed up until puberty with 6 months yearly ultrasonic evaluation to look for testicular volume which if found decreasing prompts for a surgical treatment
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