Redo orchiopexy following failed primary orchiopexy: indications, surgical strategy, and outcomes with a...

Redo orchiopexy after failed primary surgery is technically demanding due to postoperative fibrosis and distorted tissue planes. This study aimed to evaluate the indications, surgical strategies, and outcomes of redo orchiopexy, with specific focus on the safety and efficacy of a scrotal-first dissection technique and the role of 3-month postoperative assessment as a decision-making milestone.

A retrospective cohort study was conducted on 2672 orchiopexies performed at a single institution between January 2015 and March 2025. Patients who required redo orchiopexy were identified and their demographic, clinical, and surgical data were analyzed. Indications, surgical approaches, intraoperative findings, and postoperative outcomes were recorded. Statistical comparisons were performed using chi-square and Fisher's exact tests.

Redo orchiopexy was required in 32 of 2672 patients (1.2%), comprising 41 testes. Nine patients (28.1%) had bilateral involvement. The mean age at redo surgery was 67.8 months (range: 22-168 months) and mean follow-up was 36 months. Associated inguinal pathology was present in 32.0% and syndromic features in 21.9% of patients. Redo surgery was initiated via a scrotal incision in 96.9% of cases; scrotal dissection alone proved sufficient in 71.9%, whereas combined scrotal-inguinal dissection was necessary in 25.0%. The overall success rate was 90.2% (37/41 testes in stable scrotal position at final follow-up). Postoperative hematoma occurred in one case; one orchiectomy was required; and three patients needed further reintervention. No statistically significant difference in testicular location distribution was found between primary and redo cohorts (χ² = 3.113, p = 0.211).

Redo orchiopexy yields favorable outcomes when performed with appropriate technique. A scrotal-first approach is feasible in the vast majority of cases and avoids unnecessary inguinal re-exploration. The 3-month postoperative evaluation represents a structured early assessment milestone for identifying possible orchiopexy failure and guiding individualized follow-up or reintervention. It should not be interpreted as an automatic indication for reoperation in every testis that is not yet in a dependent scrotal position.