Scrotal Raphe Research Articles

Female Longitudinal Anal Muscles or Conjoint Longitudinal Coats Extend into the Subcutaneous Tissue along the Vaginal Vestibule: A Histological Study Using Human Fetuses

PurposeIt is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor.Materials and MethodsUsing immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology.ResultsIn late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue.ConclusionIn terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani.

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps

Reconstruction of a Perineoscrotal Defect Using Bilateral Medial Thigh Fasciocutaneous Flaps

Deliberate Self-Insertion of a Perineal Needle for Sexual Pleasure: A New Form of Autoerotic Behavior?

A 55-year-old male patient presented acutely to the urology service having inserted a 7 cm sewing needle into his perineum. He had no prior history of psychiatric illness. He stated that he had performed this practice on a regular basis over severalyears forself-gratification,withoutanypartner involvement. Maximum pleasure was obtained by insertion ofa needle into his perineal body but he had previously always managed to extract the needle by leaving a portion of it exposed. On this occasion, he had inserted it completely 12 hours prior to presenting and was subsequently unable to remove it. He denied any voiding difficulties or bowel symptoms. Physical examination revealed a soft non-tender abdomen and a tattoo covering the penile shaft. Rectal examination was unremarkable. Perineal examination revealed a tender erythematous area over the perineal raphe consistent with recent foreign body insertion. No urethral tenderness was detected. Plain abdominal X-ray demonstrated a thin metallic density opacity in-line with and overlying the inferior fifth of his pubic symphysis (Fig. 1). Computerized tomography demonstrated that all the urogenital structures were intact with a needle lodged anterior to the anus and posterior to the penile root (Fig. 2). Following discussion at a dedicated uroradiological conference, a multimodality approach involving ultrasound localization and extraction under general anaesthesia was offered to the patient. However, as he was asymptomatic, he discharged himself and declined any further intervention. He was informed of all the potential risks in writing but refused treatment and requested no additional hospital appointments. Self-embeddingbehaviorinvolvingsoft tissueforeignbodies is a discrete form of self-injury, typically occurring in patients with mental health concerns. There are reports in the literature of self-insertion of foreign bodies in the forearm for the purposes of attempting self-harm (Wraight, Belcher, & Critchley,2008). Young,Shiels,Murakami,Coley,and Hogan (2010) have identified cases of metal foreign body insertion and highlighted the role of the radiologist in image-guided foreign body retrieval. Multiple reports exist of thoracoabdominal induced trauma secondary to sewing needle injury via stabbingoraccidental ingestion(Sobnach, Castillo, Blanco Vinent, Kahn, & Bhyat, 2011). There are further reports of the incidental discovery of a sewing needle in the liver following investigations for anaemia; these were managed conservatively (Feng, Wang, & Sun, 2009).

Trans-Scrotal Penile Degloving, a New Procedure for Corporoplasties

The subcoronal approach is the most widely used skin degloving procedure for corporoplasty. Although it is relatively easy and it fully exposes the corpora cavernosa, it is not free from several complications (subcoronal lymphedema, decrease of glans sensitivity, paraphimosis, distal skin necrosis), which sometimes require a postoperative circumcision, or a preoperative prophylactic circumcision. To describe our own degloving approach, the "Trans-scrotal Penile Degloving (TPD)", that is suitable for most corporoplasties, and to present the outcomes. This is a retrospective analysis conducted on 89 patients (pts) presenting with different penile diseases, and submitted to the TPD during Corporoplasty, from February 2008 to July 2010: Congenital curvature (26 pts); Peyronie's Disease (PD) with penile curvature (18 pts); PD with erectile dysfunction and curvature (25 pts); Redo surgery with complex tunica albuginea remodeling and prosthesis implant (20 pts). The TPD approach calls for a 5 cm incision to be placed ventrally on the scrotal raphe at the penile base: penile degloving is then easily carried out up to the coronal line. Subsequently, the dorsal neurovascular bundle is normally isolated and all types of different corporoplasties can be carried out. Any complication occurring during or after surgery has been registered. Patient follow-up controls were performed on day 7, month 1 and month 3 post-surgery: -No pre- or post-operative circumcision procedures were required; -There was no evidence of post-operative preputial edema or penile skin necrosis or loss of glans sensitivity; -In 6 patients, we noted a mild scrotal sub-dartos hematoma, which reabsorbed spontaneously. TPD, which represents an evolution of our previous combined subcoronal-trans-scrotal approach, may be advantageously performed in most corporoplasties with optimal aesthetic and functional outcomes, and may replace in many cases the subcoronal approach without its associated complications.

Polled Intersex Syndrome with Urethral Atresia in a Goat

A 5-day-old hornless goat was referred with dysuria since birth. The scrotum was absent, and a small penis-like structure was seen below the perineal raphe. On the laparotomy, the testicles were found near the inguinal ring- and attached to a uterus-like structure. On histological analysis, the uterus-like structure was blind-end. Germ cells were absent in the testis. The karyotype of this goat was 60, XX and the SRY gene was absent. The goat was homozygous for a DNA deletion responsible for the Polled Intersex Syndrome (PIS). To the authors' knowledge, this is the first report as the clinical case of the PIS-/- goat with urethral atresia.

Development of the external anal sphincter with special reference to intergender difference: observations of mid-term fetuses (15-30 weeks of gestation)

To investigate intergender differences in muscle cleavage and joining during development of the external anal sphincter (EAS), we examined semiserial sections of 16 fetuses between 15 and 30 weeks of gestation (6 males and 10 females). The subcutaneous part of the EAS (EASsc) developed along the male perineal raphe and extended posteriorly. Thus, the male EAS was characterized by anterior protrusion of the subcutaneous muscle, in contrast to the almost circular female EAS. In both genders, the bulbospongiosus anlage (or the levator ani anlage) issued muscle fibers to form the superficial (or deep) part of the EAS. The EASsc communicated with the superficial part in males, whereas the female bulbospongiosus tended to communicate with the levator ani rather than the EAS. In both genders, the longitudinal muscle bundle(s) of the anorectum contributed to perineal body formation. However, the male perineal body also had a thick fascia between the rhabdosphincter and the levator. The bulbospongiosus seems to play a critical role in forming the EAS. A strict intergender difference in subcutaneous muscle development is evident along the perineal raphe, as the raphe is not evident in females. These results help to explain variations in the EAS, including anal malformations.

Medial Thigh Fasciocutaneous Flaps for Reconstruction of the Scrotum following Fournier Gangrene

Sir: Reconstruction of the scrotum following loss of scrotal skin caused by Fournier gangrene or trauma remains a challenge for plastic surgeons. Several reconstructive options, including primary closure, skin grafting, and flaps, are available.1,2 We have attempted several techniques and now favor single-stage reconstruction of the scrotum with medial thigh fasciocutaneous advancement flaps for reconstruction after Fournier disease. The medial thigh fasciocutaneous advancement flap uses a triangular island of skin and subcutaneous tissue on the proximal aspect of the medial thigh. The dimensions of the flap vary according to the defect's requirements and can be safely measured up to 6 × 15 cm. The flap to cover the scrotal defect is raised distally, advanced cephalad, and rotated medially toward the inguinal canal (Fig. 1) to create an ipsilateral hemiscrotum. Performing this maneuver bilaterally allows for creation of a new scrotum with both flaps sutured together, creating a new midline raphe (Fig. 2). The defects on the donor sites are closed primarily in layers. A drain is left in place for 2 or 3 days. The senior author has performed scrotal reconstruction with the medial thigh fasciocutaneous advancement flap on four consecutive patients in the setting of Fournier gangrene, with no flap loss and with excellent functional and cosmetic results.Fig. 1.: Rotation of a medial thigh fasciocutaneous flap to cover the testes.Fig. 2.: The final result, showing the new scrotum created by two flaps.Medial thigh fasciocutaneous flaps allow for a more natural appearing scrotum with less bulkiness than myofasciocutaneous or free flaps.2,3 A comparison of published techniques is offered in Table 1.1–5 Our clear preference is reconstruction with the medial thigh fasciocutaneous advancement flap.Table 1: Treatment Options for Scrotal Reconstruction after Fournier GangreneIn very obese patients, the medial thigh fasciocutaneous advancement flap should be avoided to prevent an excessively thick neoscrotum. Because the donor area is closed primarily, the medial thigh fasciocutaneous advancement flap results in less donor-site morbidity than other techniques. Also, the skin of the medial thigh provides an excellent color, hair distribution, and texture match. In our experience, the cosmetic results achieved with medial thigh fasciocutaneous flaps have been far superior to other techniques. Although a unilateral medial thigh fasciocutaneous advancement flap can be used, it is our preference to use bilateral flaps for cases of complete scrotal skin loss. This requires smaller flaps on each thigh, resulting in defects that can be closed primarily with ease. Also, the neoscrotum has a more natural appearance if it is created with bilateral flaps, resulting in a tension-free closure at the midline, imitating the scrotal raphe. Finally, having attempted both a proximally and a distally based flap, we would like to make known that we prefer the proximally (cephalad) based flap. It can be raised all the way to the inguinal ligament, rotated medially, and advanced without difficulty, allowing for a tension-free closure. We believe the advantages of the medial thigh fasciocutaneous flap for reconstruction of the scrotum after Fournier gangrene include improved and unparalleled cosmetic outcome, reestablishment of a near natural environment for the testes, and minimal morbidity in a technically uncomplicated, single-stage operation. DISCLOSURE The authors have no financial disclosures. Pirko Maguina, M.D. Division of Plastic, Cosmetic, and Reconstructive Surgery; University of Illinois College of Medicine at Chicago; Chicago, Ill. Karina L. Paulius, M.D. Department of Surgery; University of Illinois College of Medicine at Chicago; Mount Sinai Hospital Program; Chicago, Ill. Santosh Kale, M.D. Division of Plastic Surgery; Washington University School of Medicine; St. Louis, Mo. Ramasamy Kalimuthu, M.D. Division of Plastic, Cosmetic, and Reconstructive Surgery; University of Illinois College of Medicine at Chicago; Chicago, Ill.

Perineal groove: A rare congenital abnormality of failure of fusion of the perineal raphe and discussion of its embryological origin

We present a case where a baby girl was born with failure of fusion of the perineal raphe. To our knowledge, there has been limited reports of this form of congenital abnormality in the literature and is referred to as "perineal groove." The incidence of perineal groove is unclear but it is considered to be rare. This case reviews the embryological origin of this congenital abnormality.

Management of male H-type anorectal malformations

H-type anorectal malformations (ARM) are extremely rare in males. Herein, we have described our experience of managing this variety. From September 1993 to February 2009, seven boys with H-type ARM were managed in the Department of Pediatric Surgery, Chittagong Medical College and Hospital, Chittagong, Bangladesh. Clinical features, operative procedures and outcomes were analyzed. Age ranged from 1 day to 4 years. The passage of meconium was seen in urine of four boys, through ectopic openings in the perineum in three boys. One patient had a round worm passing through an ectopic opening. Three boys' perineum showed meconium dots/streak along scrotal raphe. Anus was absent in all. Two patients had rectopenilurethral (RPU) and rectoscrotal (RS) fistula; two boys had anoscrotal and anoperineal fistula; one boy had pinhole anus with RS and RPU fistula. One boy had rectoperineal and RS fistula. One patient had rectobulbar urethral fistula with meconium filled chamber between the two hemiscrotum. Two boys had associated anomalies. Five boys had primary procedure with anterior sagittal approach-anoplasty (ASAP) and anorectoplasty (ASARP). Two patients had pelvic colostomy and ASARP in one and PSARP in one. One patient died postoperatively. One boy developed anal stenosis and needed redo. Five children have regular bowel movements and they are growing well. Thorough clinical examination may identify the anatomical variations of male H-type ARM, and for the treatment of which primary ASAP or ASARP gives good results.

Novel FGFR2 deletion in a patient with Beare–Stevenson‐like syndrome

Novel <i>FGFR2</i> deletion in a patient with Beare–Stevenson‐like syndrome

Surgical Approach to Concealed Penis: Technical Refinements and Outcome

A concealed penis is defined as a phallus of normal size buried in prepubic tissue (buried penis), enclosed in scrotal tissue (webbed penis), or trapped by scar tissue after penile surgery (trapped penis). We report our results using a standardized surgical approach that was highly effective in both functional and cosmetic terms. From January 2002 to December 2005, 56 patients (median age 7 years) underwent surgery for a buried penis, 11 (median age 5 years) for a webbed penis, and 20 (median age 8 years) for a trapped penis. All 20 patients with a trapped penis had previously undergone circumcision for phimosis, except for 3 (1 for multioperated lymphangioma, 1 for repaired hypospadias, and 1 for corrected glanular epispadia). All webbed penises were phimotic, requiring circumcision. The surgical technique consisted of complete exteriorization of the shaft and reconstruction of the penopubic and penoscrotal angles. These maneuvers, however, proved extremely straightforward, with the addition of an incision along the scrotal raphe without any incision of the penile skin. All the patients were observed for at least 1 year after repair. Recurrence was observed in 3 boys with a buried penis (5.3%); all 3 boys were obese. Two cases of a trapped penis (10.0%) recurred, but no case of a webbed penis recurred. Regarding complications, 2 patients with a buried penis presented with mild lymphatic stasis of distal shaft that spontaneously subsided within a few months. The scrotal approach we have described has simplified the complete exteriorization of the penile shaft, with easy bleeding control, avoiding the use of flaps, grafts, and additional ventral Z-plasty often described in published reports. In addition, the cosmetic results were judged to be good by the parents.

SURGICAL TREATMENT OF LYMPHEDEMA OF THE PENIS AND SCROTUM

Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.

Tratamiento quirúrgico del rectocele y el enterocele: una visión integrada de las afecciones del compartimiento vaginal posterior

Genital prolapse, whether associated or not with urinary, anal or sexual dysfunction, should be evaluated globally to select the appropriate treatment. Rectocele and enterocele are defects of the posterior vaginal compartment, although they can be secondary to abnormalities of the central compartment, since lesions of the perineal raphe and rectovaginal septum can occur in isolation or accompanied by others that also affect the tissues involved in pelvic support. The various surgical approaches to rectocele alone or associated with other defects are reviewed. Likewise, the distinct pathogenic types of enterocele are discussed. Laparoscopic sacrocolpoperineopexy is a promising intervention for the simultaneous correction of defects of the posterior and central compartments. New and better designed studies are required to evaluate the distinct surgical approaches and interventions for genital prolapse.

SUPERFICIAL SKIN INFECTION CAUSED BY STREPTOCOCCUS PNEUMONIAE IN CHILDREN

Pneumococcal superficial skin infections are rarely described. We present 3 cases of Streptococcus pneumoniae superficial skin infections in previously healthy children. In 2 cases, lesions occurred on facial skin; in the third case they occurred on the scrotal raphe. One isolate was fully penicillin-resistant.

Granuloma de silicona en el pene "siliconoma"

To report our experience with one case of penile silicone granuloma, that has clinical interest for its unfrequent presentation. We report the case of a patient with sexual dysfunction secondary to subcutaneous injection of liquid silicone in the penis resulting in a penile granuloma and migration of the particles to the penile root and midline scrotal raphe. We proceeded to the surgical excision of the granuloma and migrated particles, repairing the penile defect with scrotal skin. Subcutaneous injection of liquid silicone is a practice that does not have any justification because of its devastating effects and requires major perations for the elimination of the injected material.

Scrotal skin replacement for extramammary Paget's disease—a technique

We describe a new method of ‘silk hat skin replacement’ for extramammary Paget's disease in the scrotum. This method takes only a short time, and a scrotal raphe can be reconstructed.

A congenital scrotal mass consistent with an adnexal polyp of neonatal skin

Anewborn male was evaluated for an extratesticular scrotal wall mass. The infant was noted to have a solid, nontender, pedunculated mass originating at the scrotal raphe measuring 0.5 × 0.5 × 0.4 cm (Fig. 1). No other genitourinary abnormalities or congenital malformations were appreciated.

PENILE AGENESIS WITH A SEPARATED SCROTUM AND NORMAL RENAL FUNCTION IN AN IDENTICAL TWIN

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Feb 2002PENILE AGENESIS WITH A SEPARATED SCROTUM AND NORMAL RENAL FUNCTION IN AN IDENTICAL TWIN JUSTIN E. WITTKOPF, CHRISTOPHER S. COOPER, and CHARLES E. HAWTREY JUSTIN E. WITTKOPFJUSTIN E. WITTKOPF More articles by this author , CHRISTOPHER S. COOPERCHRISTOPHER S. COOPER More articles by this author , and CHARLES E. HAWTREYCHARLES E. HAWTREY More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)69126-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PENILE AGENESIS WITH A SEPARATED SCROTUM AND NORMAL RENAL FUNCTION IN AN IDENTICAL TWIN." The Journal of Urology, 167(2 Part 1), pp. 687–688 References 1 : Diagnosis and current management of penile agenesis. J Pediatr Surg1998; 33: 628. Crossref, Medline, Google Scholar 2 : Agenesis of the penis, scrotal raphe and anus in one of monoamniotic twins. Teratology1984; 29: 173. Crossref, Medline, Google Scholar 3 : Agenesis of the penis: patterns of associated malformations. Am J Med Genet1999; 84: 47. Crossref, Medline, Google Scholar 4 : Persistent cloaca with absent penis and anal atresia in one of identical twins. J Pediatr1978; 93: 821. Crossref, Medline, Google Scholar From the Children's Hospital of Iowa, Division of Pediatric Urology, Iowa City, Iowa© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited by Luo S, Yang Z, Ma N, Wang W, Chen S, Wu Q, Qu S and Li Y (2022) Congenital aphallia associated with congenital urethrorectal fistulaMedicine, 10.1097/MD.0000000000028878, VOL. 101, NO. 7, (e28878) Demirer Z, Aip B, Uguz S, Guragac A and Irkilata H (2015) A rare case of penis agenesis (Aphallia) with associated multiple urogenital anomaliesInternational Journal of Surgery Case Reports, 10.1016/j.ijscr.2015.08.004, VOL. 15, (10-12), . Nakano Y, Aizawa M, Honma S and Osa Y (2009) Completely Separated Scrotum and Vesicointestinal Fistula Without Exstrophy as a Novel Manifestation of Aphallia: A Case ReportUrology, 10.1016/j.urology.2009.04.055, VOL. 74, NO. 6, (1303-1305), Online publication date: 1-Dec-2009. Goenka A, Jain V, Sharma R, Gupta A and Bajpai M (2008) MR diagnosis of penile agenesis: is it just absence of a phallus?Pediatric Radiology, 10.1007/s00247-008-0910-1, VOL. 38, NO. 10, (1109-1112), Online publication date: 1-Oct-2008. Srinivasan J, McDougall P and Hutson J (2003) When is 'intersex' not intersex? A case of penile agenesis demonstrates how to distinguish non-endocrine disorders in neonates with genital anomalyJournal of Paediatrics and Child Health, 10.1046/j.1440-1754.2003.00249.x, VOL. 39, NO. 8, (629-631), Online publication date: 1-Nov-2003. Volume 167Issue 2 Part 1February 2002Page: 687-688 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.KeywordsabnormalitiesscrotumpenistwinsMetricsAuthor Information JUSTIN E. WITTKOPF More articles by this author CHRISTOPHER S. COOPER More articles by this author CHARLES E. HAWTREY More articles by this author Expand All Advertisement PDF downloadLoading ...

Avoidance of inguinal incision in laparoscopically confirmed vanishing testis syndrome.

Nonpalpable testicles may be due to the vanishing testis syndrome, intra-abdominal position, examination obscured by obesity or scar tissue and rarely testicular agenesis. Laparoscopy is an excellent means of distinguishing these entities without the need for open abdominal exploration. We investigated whether laparoscopy affects the need for an inguinal incision and exploration when no testicle is palpable and the vas and vas deferens are visualized exiting the internal inguinal ring on laparoscopy. In 34 boys 6 to 18 months old (mean age 41) physical examination demonstrated a nonpalpable testicle, including on the right side in 12, on the left side in 17 and bilaterally in 5. The vanishing testis syndrome was diagnosed after laparoscopy when no testicle was palpable despite physical examination done with the patient under anesthesia, spermatic vessels were visualized exiting the internal inguinal ring or spermatic vessels were visualized in the abdomen with or without an identifiable intra-abdominal testicular nubbin. Laparoscopy confirmed the vanishing testis syndrome in 16 patients, intra-abdominal testicles in 13 and peeping testes in 1. Adequate examination using anesthesia was not possible in 4 patients with obesity, or previous inguinal or lower abdominal surgery. These boys underwent inguinal exploration after laparoscopy showed the vas and vessels exiting a closed internal inguinal ring. Of the 16 cases of the vanishing testis syndrome orchiectomy with contralateral scrotal orchiopexy was performed in 14 through a median raphe scrotal incision and in 1 through an inguinal incision for an associated inguinal hernia. In the remaining patient who underwent laparoscopy only a blind ending vas and vessels were visualized in the abdomen without an identifiable nubbin. The infraumbilical and median raphe incisions healed without obvious scars. Followup was at least 1 year. When spermatic vessels are visualized exiting the internal inguinal ring on laparoscopy in the setting of a nonpalpable testicle, a median raphe scrotal incision can be made to remove the testicular nubbin associated with the vanishing testicle syndrome. Orchiectomy is possible through this median raphe incision even when the testicle is in the inguinal canal because this distance in young children is small. Cosmesis is excellent since 1 incision is within the umbilicus and the other is on the median scrotal raphe.

SINGLE SCROTAL INCISION ORCHIOPEXY FOR THE PALPABLE UNDESCENDED TESTICLE

We prospectively evaluated the Bianchi single high scrotal incision technique for orchiopexy in boys with palpable undescended testis distal to the external inguinal ring. A total of 60 Bianchi orchiopexies were performed in 48 patients. We identified a group with primary undescended and secondary ascended testis, and a trapped testicle associated with previous inguinal surgery, respectively. Testicular position and size were assessed at 6 weeks of followup. We evaluated group 1-34 patients with bilateral (8), right (17) and left (9) primary undescended testis, group 2-3 with secondary ascended testis and group 3-11 with bilateral (4), right (4) and left (3) trapped testis. Average surgical time was 15, 35 and 35 minutes, respectively. Four patients required conversion to a traditional inguinal incision to achieve adequate cord length. All but 2 patients had a palpable testicle of acceptable size compared with the contralateral mate in the dependent scrotum at the end of the operation and 6 weeks postoperatively. Those returning for 1-year followup had identical findings. In groups 1 and 2 a single testicle normal to palpation resided in a high scrotal position and 1 testis required secondary orchiectomy for infarction, respectively. Scrotal hematoma resolved spontaneously without injury to the testis in 1 case. No hernias were evident. A single high scrotal incision for palpable primary, secondary ascended or even trapped testis is well tolerated, cosmetically pleasing and associated with a short operative time. The complication rate is acceptably low.