Orchiopexy without Transparenchymal Fixation Suturing: A 29-Year Experience

Abstract

We sought to gain insight into the outcomes of nontunical orchiopexy through assessment of elective and emergent orchiopexies performed by a single surgeon from 1985 to 2014. We demonstrate that successful orchiopexy does not require a fixation suture that pierces the tunica albuginea. We retrospectively analyzed 1,104 orchiopexies in patients 1 day to 25 years old performed by a single urologist during a 29-year period. A total of 155 procedures were performed in 101 patients to remedy torsion, and 949 procedures were performed in 778 patients for undescended testes. The orchiopexy method for all patients was the same, involving no transparenchymal fixation suture. Operative notes, followup appointments and long-term testicular condition were analyzed. Appropriate testicular size and position were considered successful outcomes. Testicular atrophy, suprascrotal location, torsion and long-term pain were considered undesired outcomes. Of the 1,104 orchiopexy cases evaluated 1,090 were deemed successful, with normal testicular position and size postoperatively. A total of 14 testes in 8patients showed undesired outcomes (postoperative atrophy in 4 testes, long-term pain in 2 and failure to retain appropriate position postoperatively in 8). Orchiopexy avoiding transparenchymal suturing through the tunica albuginea is a successful approach for fixation of the testis in the scrotum. Considering the high rate of favorable outcomes with this technique, and assuming that tunical invasion negatively impacts spermatogenesis, we consider a tunical suture unnecessary.