Transscrotal orchidopexy: orchidopexy revised

Abstract

In a study of 120 orchidopexies for palpable undescended testes, the observation of Schuller [9] and Bevan [1, 2] that most testicular undescent was associated with a shorter than normal processus vaginalis was confirmed. Division of the processus vaginalis allowed 1.5–3.5 cm of further testicular descent. The testicular vascular pedicle was always long enough to allow tension-free placement of the testis in an ipsilateral extradartos pouch except in those testes that had been retained at a high level within the inguinal canal. It is proposed that the majority of orchidopexies for palpable undescended testes should commence with a scrotal incision, and that an additional groin incision and retroperitoneal vascular pedicle mobilisation be reserved for the few high testes that will not otherwise reach the scrotum. The technique has the advantage of a single incision, much less dissection and disruption of tissue, greater comfort for the “day-case” child, rapid healing with excellent cosmesis, and a well maintained testicular position in the scrotum. The high scrotal incision allows such easy direct access to the processus vaginalis and external inguinal ring that we also recommend this approach for routine inguinal herniotomy in children.