Outcome Analysis of Redo Orchiopexy: Scrotal vs Inguinal.

Abstract

Redo orchiopexy after previous surgery is technically challenging and requires skills and care to ensure preservation of cord structures. We report our experience with redo orchiopexy in children. We retrospectively reviewed patients who had undergone redo orchiopexy between January 2004 and May 2015. Variables evaluated included primary procedure, type of redo procedure, operative time, shift of surgical route, operative and postoperative complications, and testicular location at last followup. A total of 3,384 orchiopexies were performed during the study period, with 61 children (1.8%) requiring redo orchiopexy. Mean ± SD patient age at redo orchiopexy was 6.4 ± 3.6 years (range 1.5 to 17.1) and average followup was 24.9 months (2.1 to 99.6). The primary surgical procedure preceding redo surgery was inguinal orchiopexy in 45.9% of the patients, scrotal orchiopexy in 13.1% and laparoscopy in 13.1%, and 27.9% of patients were status post inguinal surgery (hernia/hydrocele repair). Redo surgery was performed by inguinal approach in 33 patients, while 28 children underwent a scrotal approach. There was no statistical difference in intraoperative and postoperative complication rates for the 2 approaches (p = 0.52 and p = 0.26, respectively). However, there was a statistically significant difference in overall operative time between approaches (p = 0.003) with scrotal orchiopexy being significantly shorter (53.1 minutes) compared to inguinal orchiopexy (84.6). Scrotal and inguinal orchiopexy appear to be viable in managing secondarily ascending testes, with the scrotal approach offering some advantage in terms of length of procedure.