Scrotal Approach to Both Palpable and Impalpable Undescended Testes: Should It Become Our First Choice?

A tailored surgical approach to the palpable undescended testis

“…Since it was first conceived 26 years ago, there have been only 16 related reports [11]. Almost all testes can be dissected through a scrotal incision; however, operating on HPT from below requires meticulous, sometimes traumatic, dissection and at times requires an additional inguinal incision [12]. An upfront inguinal orchiopexy is generally perceived as a straightforward approach and potentially allows better management of concomitant inguinal pathology such as hernia.…”

Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present?

“…Proponents of this approach have argued that the incision provides easier detection of testicular remnants and that laparoscopy can be "avoided" since only 14 to 32% had an IAT. 13,14 In contrast to these single-surgeon retrospective series, the majority of participants chose laparoscopy as the first step which is in concert with contemporary literature. This may be a philosophical shift in strategy.…”

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

“…42 In comparison to standard inguinal orchidopexy, recent evidence from observational studies has suggested that the scrotal approach has equivalent success rates and complications, with advantage of a significantly shorter operative time. 38,39,43 At least two randomized, controlled trials comparing the two techniques (inguinal vs. scrotal) have been attempted and essentially confirmed those findings; 44,45 however, in one of the studies the authors also report mean length of stay above two days for both procedures, which questions the generalizability of the conclusions to our environment, where these procedures are almost universally undertaken on an outpatient basis. 44 Furthermore, none of these randomized, controlled trials prespecified the minimal clinically important difference in operative time to justify sample size calculation; therefore, their conclusions should be interpreted with caution.…”

“…[37][38][39][40][41] Evidence suggests that most palpable testicles can be successfully managed through this incision. 37,38 According to a recent review that analyzed 1558 scrotal orchidopexies, recurrence was observed in only nine cases, testicular hypo/atrophy in five, and surgical site infections in 13. A secondary inguinal incision was needed in 3.5% of the boys to facilitate high (proximal) testicular dissection.…”