Scrotal incision orchiopexy for undescended testes with or without a patent processus vaginalis

Bianchi and Squire first described scrotal incision orchiopexy as an alternative to the traditional inguinal approach in the 1980s. The goal of this study was to review our series of scrotal orchiopexies to evaluate operative times, success rates and complications in patients with and without a patent processus vaginalis.

A total of 121 scrotal incision orchiopexies were performed in 103 patients with palpable undescended testes between November 2002 and January 2006. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as fixation is performed. Charts were retrospectively reviewed to assess operative times as well as position and size of the testes at followup.

Patient age ranged from 6 months to 13 years (mean 4.5 years). The processus vaginalis was patent in 75 testes (62%). A total of 121 testes (100%) were successfully placed within the scrotum using a single incision. Operative times ranged from 7 to 36 minutes (mean 18.9). There were no cases of testicular atrophy or ascent, hernia or hydrocele formation with followup that ranged from 6 months to 1 year. The only complications were 4 wound infections (3.3%), which were successfully treated with antibiotics.

The scrotal incision technique is an underused method of orchiopexy regardless of patency of the processus vaginalis. Shorter operative times, comparable success and complication rates, and a more cosmetically appealing result compared to the traditional inguinal approach make scrotal orchiopexy an attractive alternative.