Orchiopexy for impalpable testis: high spermatic vessel division is a safe maneuver

This review was performed to assess the effect of protecting the collateral circulation between spermatic and vasal vessels by leaving a strip of peritoneum attached to the lower spermatic cord in patients in whom the spermatic vessels needed to be divided to bring the testis into good scrotal position.

Between 1983 and 1994, 22 boys were encountered in whom 1 testis was always normal in size and position, and the other was intra-abdominal and would not be in normal scrotal position after complete cord straightening. A strip of peritoneum had been left attached to the spermatic cord before full mobilization. After high division of the spermatic vessels the testes were brought in the mid scrotum during the same operation.

All testes remained in scrotal position except 1 which retracted and was subsequently removed. None became atrophic.

Division of the spermatic vessels, the Fowler-Stephens maneuver, can safely be performed during an initial operation as long as its possible need is anticipated, and the collateral circulation between the vasal vessels and spermatics is not disrupted. Secondary orchiopexy for inadequate cord length is now rarely required. This type of open orchiopexy for high impalpable testis is safe, is easy to learn, has no increased morbidity and is generally less expensive than a laparoscopic approach.