Orchiopexy without Transparenchymal Fixation Suturing: A 29-Year Experience

Area of Science:

• Urology
• Pediatric Surgery

Background:

• Orchiopexy is a surgical procedure to correct undescended testes or testicular torsion.
• Traditional orchiopexy techniques may involve sutures that penetrate the tunica albuginea, potentially impacting testicular function.
• Assessing outcomes of orchiopexy techniques that avoid tunical invasion is crucial for optimizing surgical practice.

Purpose of the Study:

• To evaluate the efficacy of nontunical orchiopexy, a technique that avoids sutures piercing the tunica albuginea.
• To determine the success rates of elective and emergent orchiopexies performed without transparenchymal fixation.
• To provide insights into the long-term outcomes of this specific orchiopexy method.

Main Methods:

• Retrospective analysis of 1,104 orchiopexy procedures performed between 1985 and 2014 by a single urologist.
• Inclusion of patients aged 1 day to 25 years, encompassing cases of testicular torsion and undescended testes.
• Evaluation of operative notes, follow-up appointments, and long-term testicular condition, defining success by appropriate testicular size and position.

Main Results:

• A high success rate of 98.7% (1,090 out of 1,104 cases) was observed, characterized by normal postoperative testicular size and position.
• Undesired outcomes occurred in only 14 testes (1.3%) across 8 patients, including postoperative atrophy, long-term pain, and failure to maintain position.
• The orchiopexy technique consistently involved no transparenchymal fixation suture.

Conclusions:

• Orchiopexy without transparenchymal suturing through the tunica albuginea is a highly successful surgical approach for testicular fixation.
• The technique demonstrates a favorable outcome rate, supporting the hypothesis that avoiding tunical invasion is beneficial.
• Tunical sutures are deemed unnecessary given the high success rates and potential negative impact of tunical invasion on spermatogenesis.