Scrotal fixation in the management of low undescended testes

Scrotal fixation (SF) is a known technique for the management of low undescended testes (UDT). SF assumes that most low UDT have no patent processus vaginalis (PPV) and can be managed via scrotal mobilization alone. We report our experience of the role of SF in the management of low UDT.

A retrospective review of all palpable UDT operated on by the senior author between 1998 and 2008 was undertaken. Children diagnosed with palpable UDT were examined under general anesthesia; if the whole testis could be manipulated into the upper part of the scrotum, low UDT was assumed and SF was performed. Attempts to identify a PPV intraoperatively were made in all and, if found, the procedure was converted to standard inguinal incision orchidopexy.

One hundred and thirteen children with 134 UDT were identified. SF was performed in 55 testes; inguinal orchidopexy (IO) in 75 and four testes were excised. The median (IQR) age at SF was 5.5 [4.7-6.3] years. Three SF were converted to an IO when a PPV was discovered. The complications in SF were scrotal hematoma (n = 1) and superficial wound infection (n = 1). No post-operative herniae or atrophied testis were seen and none required a redo operation. The mean (SD) operative times for SF and IO were 29.5 (18.1) and 42.7 (16.6) min, respectively (P = 0.04).

In our study, 52 of 55 (94.5%) patients with low UDT lacked a hernial sac and were successfully fixed by SF. SF is a viable, simple, quick and safe alternative to IO in the management of low UDT.