Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials

INTRODUCTION

Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making.

MATERIALS AND METHODS

A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study's quality was conducted by utilizing the revised Cochrane risk-of-bias tool.

RESULTS

Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges.

CONCLUSION

Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.

Trans-scrotal treatment of giant bilateral abdominoscrotal hydroceles in a 7-month-old boy

Abdominoscrotal hydrocele (ASH) is a rare condition characterized by a large scrotal and abdominal fluid-filled sac. An inguinal surgical approach is generally described in literature. We report the case of a 7-month-old child who underwent surgical repair of bilateral ASH through bilateral transverse scrotal incisions. The scrotal approach enabled optimal visibility and access to the hydrocele sacs. Separation of the sac from the testicular pedicle was possible with excellent control. Complete excision of the sac was performed. The postoperative course was uneventful. Follow-up after three years shows an excellent result. We recommend ASH repair through a transverse scrotal incision.

[Comparison of the inguinal and scrotal approaches for the treatment of cryptorchidism in children]

INTRODUCTION

The single scrotal incision orchidopexy was described by Bianchi in 1989. Despite its popularity, the place of this technique in the treatment of cryptorchidism in children is still unclear.

AIM OF THE STUDY

To evaluate and compare the outcomes of the conventional inguinal approach and the scrotal approach for the treatment of palpable undescended testis in children.

METHODS

A prospective study for all patients with palpable undescended testis undergoing orchidopexy between January 2011 and December 2013 was conducted. Totally 200 patients were randomly divided into two groups: group 1: two incisions inguinal approach (80 patients, 100 testis); group 2: single scrotal incision approach (89 patients, 100 testis).

MAIN RESULTS

The patients' mean age was 53.9±13 months in group 1 and 45.8±9 months in group 2. There was no statistical difference between the two groups in terms of patient age (P=0.8) and location of the undescended testis (P=0.359). Operative time was statistically significantly lower in the scrotal group (P<0.05). There was a significant difference in the complications rates between the two groups.

CONCLUSION

The single scrotal incision orchidopexy is safe and effective for undescended testicles palpable in the inguinal canal or in high scrotal position.