Survival of nonpalpable undescended testicles after orchiopexy

Among 496 boys who underwent operations for the preoperative diagnosis of undescended testicle, 41 patients had high undescended testicles that were not palpable preoperatively. Four of the 41 were bilateral, for a total of 45 high undescended testicles. Eight of the 45 were lost to long-term follow-up. Thirty-seven testicles were followed for over 1 year, and 30 (81%) of the 37 survived orchiopexy long term. No testicles atrophied later if they survived the first few postoperative months. Twenty-nine (64%) had vascular pedicles long enough to reach the scrotum without dividing the testicular artery. Our findings confirm long-standing impressions of most pediatric surgeons: (1) 81% survival warrants continuation of standard orchiopexy through a groin incision for nonpalpable undescended testicles in patients who will be able to ejaculate and engage in coitus; (2) most nonpalpable undescended testicles can be brought safely into the scrotum while preserving the testicular vasculature through a groin incision; (3) if it is necessary to divide the testicular artery in order to bring the testicle into the scrotum, our results confirm previous reports that preservation of the testicular collaterals will often allow the testicle to survive in a normal scrotal location; and (4) the need for testicular autotransplantation with microvascular anastomosis should rarely arise.