Decision making during laparoscopic orchiopexy for intra-abdominal testes near the internal ring

We studied whether testicular proximity to the ipsilateral internal ring or ability to reach the contralateral ring predicted the likelihood that laparoscopic orchiopexy would deliver an intra-abdominal testis to the dependent scrotum.

Records of patients undergoing laparoscopic orchiopexy for testes within 2 cm of the internal ring were reviewed. Factors considered included patient age, mobility of the testis to the contralateral ring, intraoperative positioning in the upper vs lower scrotum, and postoperative findings of testicular viability and location.

Of 46 testes treated with laparoscopic orchiopexy 20 reached the low scrotum. The remaining 26 testes only reached the upper scrotum. Of these testes 14 were fixed to the most distal aspect of the scrotum that they would reach, while 12 were managed by vessel transection with 1-stage orchiopexy to the low scrotum in 10 and the upper scrotum in 2. Patient age at surgery, location within 2 cm of the internal ring and mobility to the contralateral ring did not predict ability of laparoscopic orchiopexy to bring the testis to the low scrotum. Followup was available in 42 testes at a mean of 6.8 months (range 1 to 25), with 25 (60%) in the low scrotum, 6 (14%) in the upper scrotum, 6 (14%) showing atrophy and 5 (12%) reoperated on for a position at or above the upper margin of the scrotum.

Factors evaluated did not indicate the likelihood that laparoscopic orchiopexy would result in a testis in the dependent scrotum. It is unclear whether a testis only reaching the upper scrotum should be fixed with vessels intact, or undergo 1-stage Fowler-Stephens orchiopexy to attempt to reach the low scrotum.