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Inguinal Orchidopexy for Cryptorchidism

Indications

Cryptorchidism with inguinal or high scrotal localization of the testis. The therapeutic goal in cryptorchism is the tension-free fixation of the testis to the lowest point of the scrotum before the end of the first year of life.

Contraindications

Coagulation disorders. Increased surgical risk due to comorbidity. Suspected abdominal testis, nonpalpable testicular location. In post-pubertal patients with unilateral cryptorchism and a small testis, an orchiectomy is preferable.

Surgical Technique of Inguinal Orchidopexy

Preoperative preparation:

Supine positioning, general anesthesia, perioperative antibiotic prophylaxis if risk factors for surgical site infections are present.

Surgical approach:

Inguinal incision. Transect the aponeurosis of the abdominal external oblique muscle to open the inguinal canal. Search and identify the testis, which can be located above the aponeurosis. Divide the gubernaculum testis and mobilize the spermatic cord to the inner inguinal ring. Resect the cremaster muscle circularly to achieve additional mobility of the testis. Rule out a patent processus vaginalis. If the spermatic cord is too short, transection of the inferior epigastric vessels and medialization of the spermatic cord may help (Prentiss, 1960).

Dartos Pouch:

Palpate the deepest part of the hemiscrotum with the index finger through the inguinal incision. Incise the scrotal skin across the palpating finger without cutting the tunica dartos. Create a pouch with blunt scissor dissection between the cutis and the tunica dartos, large enough to accommodate the testis. Open the tunica dartos with a small incision, advance an overholt clamp to the inguinal incision, grab the testis, and guide it into the Dartos pouch. Fix the testis to the Dartos pouch's wall and close the tunica dartos opening with fine (4-0) monofilament stitches.

Wound closure:

Close the aponeurosis of the abdominal external oblique muscle with a running suture. Close the skin of the Dartos pouch and the inguinal incision with fines sutures.

Technical Modification:

A scrotal orchidopexy is possible for conveniently located testes and avoids the inguinal incision (Wahyudi et al., 2024).

Complications of Orchidopexy

Early complications are bleeding, hematoma, wound infection, and testicular atrophy (2–10%). Late complications are recurrence of cryptorchidism, hernia or hydrocele due to incomplete closure of the processus vaginalis, infertility, and testicular cancer despite the surgical treatment.

References

C. Radmayr, G. Bogaert, H. S. Dogan, and Tekg&uuml, “EAU Guidelines: Paediatric Urology,” 2022. [Online]. Available: https://uroweb.org/guidelines/paediatric-urology/.

Prentiss, R. J.; WEICKGENANT, C. J.; MOSES, J. J. & FRAZIER, D. B. Undescended testis: surgical anatomy of spermatic vessels, spermatic surgical triangles and lateral spermatic ligament.
The Journal of urology, 1960, 83, 686-692.

I. Wahyudi, P. A. R. Raharja, G. R. Situmorang, and A. Rodjani, “Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials.,” Pediatr Surg Int., vol. 40, no. 1, p. 74, 2024, doi: 10.1007/s00383-024-05655-7.

  Deutsche Version: Inguinale Orchidopexie