Staged orchidopexy: simplifying the second stage

Abstract

In some cases high undescended testes cannot be brought into the scrotum by means of a standard orchidopexy, but require different procedures such as autotransplantation, Fowler-Stephens orchidopexy, or staged orchidopexy. Over a period of 3 years 9 months the authors employed staged orchidopexy in 15 cases; 14 of these have already undergone the second stage. In 6 cases a modified Corkery operation was performed: after anchoring the gonad to the tuberculum pubis (first stage), a Silastic sheet is placed to cover the testis and cord, suturing it beneath the internal oblique muscle and external oblique fascia. This sheet of Silastic is not placed around the whole testis, as originally described by Corkery, but lies on the gonad and cord separating them from the overlying layers. As the purpose of this modification is to create a solid plane against vas/vessel injury during the second stage, the sheet of Silastic used is much thicker than the one originally described. In the 5 children who have undergone the modified second stage so far, isolation of the testis during the second procedure has proved easier and safer with respect to possible cord injuries. Our data indicate better results using this technique, compared to a standard staged procedure, with regard to secondary testicular atrophy.