SURGICAL APPROACH TO THE INCOMPLETELY DESCENDED TESTIS AFTER LAPAROSCOPIC ORCHIDOPEXY

Abstract

Introduction and Objective: Laparoscopic orchidopexy has become a well accepted modality for the treatment of intraabdominal testis. As with all surgery, occasionally we will have an imperfect result and in other cases we have chosen not to do a vessel transection and left the testis outside of the scrotum. A review of the literature reveals no prior description of a reoperative technique to further descend the testis that has not been fully brought down after laparoscopic orchidopexy. Methods: We reviewed our records of all patients that underwent redo orchidopexy over the last 12 years after an initial laparosopic orchidopexy. We found 11 patients (12 testis) that underwent surgery to further the descend the testis. 10/11 patients received HCG preoperatively. All the testis were initially approached via an inguinal incision near the neoring. Careful mobilization of the testis and the cord is all that is necessary but at times there has been a need to extend the dissection intraabdominally to get additional length. Once adequate length is obtained the testis is placed back in the dartos pouch as with a regular orchidopexy. Results: We found that all 12 testis were adequately descended using the described dissection. In 10 patients that received HCG the dissection was facilitated and adequate length was achieved without any additional intraabdominal dissection. The one patient that did not receive preop HCG stimulation required extensive intraabdominal dissection but this patient had also undergone one prior attempt to bring the testes down that had been unsuccessful. In no instance was atrophy of the testis noted post operatively. Conclusions: It appears simple dissection of the testis that is incompletely descended after laparoscopic orchidopexy is highly successful especially if HCG stimulation is used preoperatively. Access to the abdominal cavity is simple and dissection along the cord can easily be done if additional length is needed.