Back to 2016 Fall Congress

BACKGROUND: To present the outcomes of the use of a scrotal incision as the first line approach for the management of all undescended testicles (UDT) including both palpable and unilateral nonpalpable testicles.
METHODS: From 2009 to 2015, 459 consecutive patients underwent 500 scrotal approaches for the management of all palpable and unilateral nonpalpable UDT. The scrotal approach was the initial selected approach irrespective of the location of the UDT or the patency of the processus vaginalis or size of the contralateral descended testis. If there was neither a nubbin nor a testicle, laparoscopy was performed. All procedures were performed by a single pediatric urologist (JCP) in three different institutions. Minimum follow-up was 6 months. Secondary orchiopexies and inadequate follow-up were exclusion criteria.
RESULTS: Patient age ranged from 6 months to 13 years (mean 3.4 years). Mean follow up was 12.5 months. Out of the 500 UDT, 432 (86%) were palpable and 68 (14%) were nonpalpable as determined by examination under anesthesia. Within the palpable group (n=432), the location of the testes was as follows: retractile/high scrotum (n=74), ectopic (n=3), subinguinal (n=189), and canalicular (n=166). A scrotal approach was the definitive treatment in 98% of these patients with a success rate for scrotal orchiopexy of 97.4%. Among the nonpalpable UDT (n=68), 46 were either nubbins or testicles located extra-abdominally and the remaining 22 testes were intra-abdominal. Scrotal approach was the definitive treatment in 68% of these patients with a success rate of 100% for those extra-abdominal testes or nubbins. The remaining 22 intra-abdominal testes were managed laparoscopically. In six of these intra-abdominal testes, the initial scrotal approach facilitated the dissection of a looping vas. Mean operative time for scrotal orchiopexy was 23.4 minutes. Three complications were documented (excluding laparoscopic procedures): suture dehiscence (n=1), bleeding (n=1), and persistent high location (n=2).
CONCLUSIONS: The vast majority of patients with UDT, whether palpable or nonpalpable, can be initially approached via a scrotal incision. The low morbidity and high success rate associated with the scrotal approach makes it a very attractive technique not only for the initial approach of all palpable and nonpalpable UDT but for the definitive management of all extra-abdominal UDT. Initial scrotal approach was the definitive treatment in 98% of the palpable UDT and prevented unnecessary laparoscopy in 68% of the nonpalpable UDT.

UDT	n	Extra-abdominal	Intra-abdominal	Scrotal Orchiectomy (nubbins)	Scrotal Orchiopexy (viable testes) Success rate	Definitive treatment Scrotal Incision (viable and nonviable)
Palpable	432	432	0	2	97.4% (419/430)	98% (423/432)
Non-palpable	68	46 (34 nubbins and 12 extraabdominal testes)	22	34	100% (12/12 viable extra-abdominal)	68% (46/68)
Total	500	478	22	36	97.5% (431/442)	94% (469/500)

Table 1. Outcomes Initial Scrotal Approach for all palpable and nonpalpable UDT