The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis

The scrotal approach to undescended testis has been described using a high scrotal incision and including hernia repair. We describe an approach that uses a low scrotal incision with an inguinal incision if a patent processus is identified. We retrospectively reviewed the likelihood of a patent processus in children selected to undergo this technique.

A total of 56 consecutive patients determined by history and physical examination to have ectopic or ascended testes underwent orchiopexy using an initial scrotal approach for a total of 71 undescended testes. Inguinal surgery had previously been done in 5 testes, which were not included in patent processus analysis. Charts were reviewed for testicular position, need for inguinal incision and demographic data.

Of the patients 16 (19 testes) were younger than 2 years, 19 (26 testes) were 2 to 6 years old and 17 (21 testes) were older than 6 years. In 20% of the patients an inguinal incision was made for a patent processus vaginalis. The incidence of a patent processus was 26% in those younger than 2 years, 15% in those 2 to 6 years old and 19% in those older than 6 years (p = 0.17). All patients had satisfactory scrotal placement with at least 1 followup examination.

Children with ectopic or ascended testes on physical examination findings may be treated successfully via a low scrotal approach with only 20% requiring concomitant inguinal hernia repair through a standard inguinal incision. Overall 80% of the children avoided an inguinal incision. This technique has become our standard approach to these testes.