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Scrotal fixation: a different surgical approach in the management of the low undescended testes
1Department of Paediatric Surgery, University Hospital, Nottingham, United Kingdom.
Objectives:
To evaluate the feasibility of using the scrotal approach in patients with undescended testes.
Methods:
Over an 18-month period, 165 patients were diagnosed to have 208 undescended testes. Of these, 28 were nonpalpable.
Results:
At exploration, 7 testes were abdominal, 33 were canalicular, 165 were in the region of the external ring/pubic tubercle, and 1 was perineal. There were 2 cases of unilateral monorchism. The operative procedure performed was as follows: orchiectomy for 6 abnormal testes, orchiopexy for 142, and scrotal fixation (SF) for 58. (In this series, 9 patients were converted from SF to an orchiopexy at the time of the initial operative procedure.) SF involves a scrotal incision extending down to the tunica vaginalus. The cord is then mobilized from below, after which the testis is placed in an extra-dartos pouch.
Conclusions:
Our study has shown that there are a significant number of undescended testes that lie in the region of the pubic tubercle, lack a hernial sac, and can be managed by a scrotal mobilization alone. Based on our experience with SF, we have used a simple classification of undescended testis that has therapeutic and prognostic justifications.