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Inguinal Orchidopexy for Cryptorchidism

The therapeutic goal in cryptorchism is the tension-free fixation of the testis to the lowest point of the scrotum. International guidelines recommend to achieve the goal before the end of the first year of life.

Contraindications

In post-pubertal patients with unilateral cryptorchism and 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. For preoperative diagnostic details see section diagnosis of cryptorchidism.

Surgical approach:

Inguinal incision. Incision of 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 up to the inner inguinal ring. Circular resection of the cremaster muscle is done to achieve additional mobility of the testis. Rule out a patent processus vaginalis.

Creation of the Dartos Pouch:

The deepest part of the hemiscrotum is palpated with the index finger through the inguinal incision. A small incision is done across the palpating finger without cutting the tunica dartos. With the help of a scissor a pouch is established between the cutis and the tunica dartos; large enough to accommodate the testis.

Now a small incision of the tunica dartos is done and an overholt clamp is brought up to the inguinal incision, the testis is grabbed and guided into the dartos pouch. The testis is fixed to the wall of the Dartos pouch with fine (4-0) monofilament stitches.

Wound closure:

Skin closure of the Dartos pouch. Closure of the aponeurosis of the abdominal external oblique muscle. Skin closure of the inguinal incision.

Complications of Orchidopexy

Bleeding, wound infection, testicular atrophy, recurrence of cryptorchidism.

References

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

  Deutsche Version: Inguinale Orchidopexie