Cryptorchidism, or the undescended testis, is perhaps the most common genital anomaly in males. Historical success rates are approximately 90% depending on the preoperative location and technique used. Iatrogenic cryptorchidism can also occur in up to 2% of cases following hernia repair and 10% after primary inguinal orchidopexy, and is usually related to incomplete dissection of cord structures. Redo surgery is technically challenging and may involve a hazardous dissection inside the inguinal canal. Lopes et al. (Toronto) have reviewed 61 children undergoing redo orchidopexy at their institution (January 2001 - May 2015) using either an inguinal or scrotal approach for revisional surgery. A total of 3384 orchidopexies were undertaken during the study period. Sixty-one children (1.8%) required redo orchidopexy. Redo surgery was on the right side in 33 patients (54.1%), the left side in 24 (39.3%) and bilaterally in four (6.6%). Mean age at revisional surgery was 6.4 years (range 1.5 to 17.1 years). The majority of primary surgeries preceding redo surgery were inguinal orchidopexies (n=28; 45.9%). Eight patients (13.1%) had undergone scrotal orchidopexy, eight (13.1%) had laparoscopic procedures and 17 (27.9%) had undergone previous groin surgery (hernia / hydrocele). Redo surgery was by the inguinal approach in 33 and a scrotal approach in 28. The operative approach was based solely on surgeon preference (four attending surgeons). There was no difference in intra or postoperative complications between the two approaches. Scrotal orchidopexy was statistically significantly shorter (53.1 vs. 84.6 minutes). The authors suggest a scrotal approach for redo surgery following previous inguinal surgery; that both the scrotal approach and inguinal approach are valid options following previous inguinal orchidopexy (similarly hazardous, but less atrophy associated with the scrotal approach); and that when scrotal orchidopexy was the primary procedure, an inguinal approach for redo surgery is suggested.

Outcome analysis of redo orchiopexy: scrotal vs inguinal.
Lopes RL, Naoum NK, Chua ME, et al.
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Neil Featherstone

Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).

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