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18645

Surgical Management for the Palpable Undescended Testicle: Scrotal or Inguinal Approach?

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Sanjeet Panda, M.D.1, Lira Chowdhury2, Stephen Almond3, Mohammad Emran3, Haroon Patel3, Leon Smith-Harrison2 and Juan C. Prieto, M.D.2, (1)Pediatrics, Texas A& M University. Driscoll Children's Hospital, Corpus Christi, TX, (2)Urology, Driscoll Children's Hospital, Corpus Christi, TX, (3)Surgery, Driscoll Children's Hospital, Corpus Christi, TX

Purpose: Inguinal orchiopexy (IO) is the predominant surgical modality for the palpable undescended testicle (PUT), despite the introduction of scrotal orchiopexy (SO) in 1989 (Bianchi A). The purpose of this study is to compare a series of consecutive patients who underwent SO with an age matched control group who underwent IO for primary PUT.

Methods: From 2009 to 2011, 346 patients underwent SO or IO for PUT in our institution according to surgeon’s criteria. All the primary SO (n=90) performed by one pediatric urologist (JCP) were age matched to a control group of primary IO (n=157) performed by three pediatric surgeons (SA, ME, HP) and two pediatric urologists (LSH and JCP). Patients with incomplete data, ancillary procedures or lack of follow up were excluded from analysis. SO was performed through a transverse incision in the mid hemiscrotum and the dissection of the hernia sac was completed without disruption of the tunica vaginalis. IO was performed by opening the inguinal canal and completing a high ligation and division of the processus vaginalis. Results were analyzed by number of testicles treated, laterality, age at surgery, preoperative and postoperative testicular location and size, complications, and success rate (defined as mid or low scrotal testicular position and absence of postoperative hypotrophy or atrophy). Fisher’s exact test was used for statistical analysis.

Results: A total of 236 patients with primary PUT underwent orchiopexy at our institution between 2009 and 2011. The table below summarizes the findings.

 

GROUP A(SO)

GROUP B (IO)

NUMBER OF PATIENTS

89

146

NUMBER OF PEXIES

90

157

RIGHT SIDED

44

74

LEFT SIDED

46

83

PREOP location

Scrotal/retractile

30

2

PREOP location

High scrotum

41

10

PREOP location

inguinal

19

145

Mean Operative Time(min)

23.4

42.5

Postop atrophy/hypo

trophy

0

8

Postop position         ( high scrotum)

1

7

Success rate

 98.8%

 90.4%

All cases of postoperative testicular hypotrophy or ascent occurred in preoperative inguinal testes. The difference in postoperative hypotrophy was statistically significant between the two groups (p= 0.02) while the difference in postoperative testicular ascent was not statistically significant between the two approaches (p= 0.14). Two other complications were documented in group A: suture dehiscence (n=1) and bleeding (n=1), and 14 other complications were documented in group B: surgical site infection (n=5), bleeding (n=1), and prolonged pain/swelling (n=8). The higher complication rate in group B needs to be interpreted with caution since this group included a larger sample with more preoperative inguinal testicles. Median follow up was 6.7 months.

Conclusion: The success rate for the management of primary palpable undescended testicle remains high with SO and IO. The SO offers significant advantages such as avoiding injury to intra-abdominal organs, lower complication rate, shorter surgical times, less postoperative pain with faster recovery, and a cosmetically appealing incision concealed in the scrotum.