Modified Scrotal (Bianchi) Mid Raphe Single Incision Orchiopexy for Low Palpable Undescended Testis: Early Outcomes
Abstract
Purpose:
We compared the results of low transscrotal mid raphe orchiopexy, high scrotal incision (Bianchi) and conventional inguinal approach in patients with palpable undescended testes.
Materials and Methods:
Orchiopexies performed between January 2003 and September 2009 with a minimum 3-month followup were included. Low scrotal incision (group 1) and high scrotal incision (group 2) were compared to the traditional inguinal 2-incision technique (group 3). We retrospectively reviewed operative time, success as defined by mid or lower scrotal position of the testis, and complications at 12 weeks and 1 year postoperatively.
Results:
A total of 286 orchiopexies were performed in 214 patients with palpable undescended testes. Group 1 included 81 patients with 125 undescended testes. Group 2 consisted of 44 patients with 60 undescended testes. Group 3 included 89 patients with 101 undescended testes. Postoperatively the testes were located in a good position within the scrotum in 99% of patients in group 1, 98% in group 2 and 100% in group 3. Mean ± SD operative time for unilateral undescended testes was significantly shorter for low transscrotal compared to inguinal orchiopexy (28 ± 10 vs 37 ± 12 minutes, p <0.0001) but equivalent to a high scrotal incision (27 ± 10 minutes, p = 0.59). For all 160 children followed for 1 year no long-term atrophy or secondary reascent was observed.
Conclusions:
Low transscrotal mid raphe orchiopexy appears to be an excellent alternative to high scrotal incision or standard inguinal orchiopexy for low palpable undescended testes, especially bilateral cases.
References
- 1 : Prevalence and natural history of cryptorchidism. Pediatrics1993; 92: 44. Google Scholar
- 2 : On inguinal testicle and its operative treatment by transplanting into the scrotum. Ann Anat Surg1881; 4: 89. Google Scholar
- 3 : Operation on undescended testicle and congenital inguinal hernia. JAMA1899; 33: 773. Google Scholar
- 4 : A review of surgical treatment of undescended testes with emphasis on anatomical position. J Urol1988; 140: 125. Link, Google Scholar
- 5 : Scrotal fixation: a different surgical approach in the management of the low undescended testes. Urology1997; 49: 762. Google Scholar
- 6 : Trans-scrotal orchidopexy: orchidopexy revised. Pediatr Surg Int1989; 4: 189. Google Scholar
- 7 : High scrotal (Bianchi) single-incision orchidopexy: a tailored approach to the palpable undescended testis. Pediatr Surg Int2004; 20: 618. Google Scholar
- 8 : The scrotal approach. Pediatr Surg Int1995; 10: 58. Google Scholar
- 9 : Scrotal (Bianchi) approach to patent processus vaginalis in children. Tech Urol1999; 5: 95. Google Scholar
- 10 : Long-term outcome of scrotal incision orchiopexy for undescended testis. Urology2007; 70: 786. Google Scholar
- 11 : Trans-scrotal approach for surgical correction of cryptorchidism and congenital anomalies of the processus vaginalis. Eur Urol1996; 29: 235. Google Scholar
- 12 : A new clinical classification for undescended testis. Scand J Urol Nephrol2003; 37: 43. Google Scholar
- 13 : Single scrotal incision orchiopexy for the palpable undescended testicle. J Urol2000; 164: 156. Link, Google Scholar
- 14 : Prescrotal orchiopexy: an alternative surgical approach for the palpable undescended testis. J Urol2003; 170: 2436. Link, Google Scholar
- 15 : The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis. J Urol2003; 169: 1832. Link, Google Scholar
- 16 : Scrotal incision orchiopexy for undescended testis. Urology2004; 64: 1216. Google Scholar
- 17 : Scrotal incision orchiopexy for undescended testes with or without a patent processus vaginalis. J Urol2007; 177: 1516. Link, Google Scholar
Division of Urology, Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, Quebec, Canada
