How I do it: "3-In-1" single incision bilateral scrotal orchiopexy and penile webbing repair with circumcision

Cryptorchidism and penoscrotal webbing are common pediatric urologic conditions that may coexist and require surgical correction. For palpable low-lying undescended testes, the scrotal approach to orchiopexy is well established and associated with excellent cosmetic outcomes and reduced operative time. In children undergoing circumcision, concurrent correction of penoscrotal webbing is important to avoid ventral penile skin deficiency and sinking of the penis in the suprapubic fat pad. We present a novel single-incision technique combining bilateral scrotal orchiopexy and penoscrotal webbing correction through a median scrotal raphe approach in addition to circumcision.

A diamond-shaped incision is created at the penoscrotal junction. Bilateral orchiopexies are performed through this incision with mobilization of the testes, release of cremasteric attachments, ligation of any patent processus vaginalis, and fixation of each testis to their respective dartos pouch. Following orchiopexy, reconstruction of the penoscrotal junction is completed and circumcision is performed using a Bainbridge clamp, mucosal collar tailoring and suturing to the shaft skin.

Between January 2025 and April 2026, this technique was performed in 20 boys with a mean age of 7.5 years. Mean operative time was 53 min (37-102 min). Complications included minor penoscrotal skin dehiscence in 25% of patients, all of which healed with conservative management using zinc oxide cream. One patient developed a scrotal hematoma and one developed a surgical site infection. Half of patients were discharged after two postoperative visits.

This single-incision technique safely combines bilateral scrotal orchiopexy, penoscrotal webbing correction, and circumcision while minimizing operative morbidity and additional incisions. Minor wound dehiscence heals favorably within the median raphe and cosmetic outcomes are very satisfactory.