Failed Orchiopexy

Abstract

Introduction: Failure after orchiopexy or cryptorchidism after inguinal surgery are not so rarely encountered conditions. Reoperative orchiopexies are technically demanding procedures. In our study, we aimed to examine the causes of failures and outcomes of reorchiopexies. Patients and Methods: Between 1993 and 2003, a total of 28 children who underwent reoperative orchiopexy were included into the study. Undescended testes was detected as unilateral in 24 and bilateral in 4 cases. The mean age of patients at the time of second operation was 6.8 years. The mean period of time between the first and the second operations was 3.2 (1–13 years) years. Results: The first operations were orchiopexies in all patients. After the first operations, 15 testes were found to be localized at the high scrotal position, 8 at the level of the external ring and 9 within the inguinal canal. Overall, reorchiopexies were performed on 32 testes in 28 patients. During the second operation, patent processus vaginalis was detected in 11 (34.4%), and unsuccessful hernia repair in 9 (28.1%) cases. After reorchiopexies, two testes with preoperative inguinal location could only be brought to high scrotal position and in another case orchiectomy was performed to an atrophic testis. Overall, after a mean follow-up period of 3.8 (1–7 years) years following the second operations, 29 (93.5%) testes were scrotal without evidence of atrophy. Conclusion: In our series, inadequate repair of inguinal hernia or patent processus vaginalis, as noted in 62.5% of the cases, was determined as an important factor leading to failure after surgical treatment of undescended testis. Adequate dissection and correction of inguinal hernia increase the success rate after orchiopexies.

Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines

“…The patent processus vaginalis needs to be ligated proximally at the level of the internal ring, because an unidentified or inadequately repaired patent processus vaginalis is an important factor leading to failure of orchidopexy [42]. Any additional pathology must be dealt with, such as removal of an appendix testis (hydatid of Morgagni).…”

Surgical treatment of undescended testes

“…Recurrent cryptorchidism after orcihopexy is a well‐known complication. Most often inadequate repair of inguinal hernia or patent processus vaginalis and the lack of adequate retroperitoneal dissection is determined as an important factor leading to failure after surgical treatment of undescended testis (58). In surgical treatment of recurrent cryptorchidism, scarring from the previous procedure makes dissection difficult.…”

Torsion of cryptorchid testis after primary orchiopexy failure: An overlooked cause of abdominal pain in children

“…The failure rate of primary inguinal orchiopexy has been reported to be from 7.5 to 13% 4 . McIntosh et al…”

“…Testicular torsion as a cause of acute abdominal pain is well known but torsion of the cryptorchid testes continues to elude the clinicians from making a timely diagnosis 3 . It may be noted that failure of orchiopexy and subsequent return of the testis from the scrotum to the intra-abdominal position is well documented in the literature 4 . We report the case of young boy with a history of orchiopexy one year back, who presented with intense abdominal pain.…”