201:
the testes through a shorter pathway medial to the inferior epigastric vessels (called the “Prentiss maneuver”) for a more favorable scrotal position. The benefits of both techniques is debated, with neither showing a difference in success rates. For palpable undescended testes, multi-study analysis has shown that there is no significant difference in safety or success rates between standard open inguinal and laparoscopic approaches, with the latter being more expensive and associated with a higher rate of complications (extensive high retroperitoneal dissection with scrotal hematomas and wound infection, Prentiss maneuvers with hemorrhage from epigastric vessels and wound infection).
29:
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is another option for patients with intra-abdominal testes, particularly in those with bilateral undescended testes. This technique uses microvascular anastomosis to maximize testicular blood supply after mobilization of the testicles (to get around the high variability in blood supply can complicate
200:
is best used for abdominal testis, while mobile/peeping testis distal to the inguinal ring should be approached with the standard one-stage laparoscopic or open orchiopexy. The major proposed benefits of laparoscopic orchiopexy are the possibility of high retroperitoneal dissection and/or rerouting
132:
Twisting of the spermatic cord results in obstruction of the testicular venous drainage. Intense vascular engorgement and infarction may lead to testicular injury and sterility. If the cord is manually untwisted within approximately six hours the testis has a high chance of remaining viable. One in
313:
further contributed to the current techniques for orchiopexy between the late 1800s and early 1900s, with the steps for standard orchiopexy being established before the 1960s. At this point, the standard orchiopexy applied to most undescended testes had a high success rate ranging from 89% to 92%-
207:
is a two-stage procedure applied for high intra-abdominal testes (often with short vascular pedicle) or non-mobile testis. This method makes use of collateral blood supply to maintain testicular blood flow, allowed the testis to be brought down further to reach the scrotum without tension. Stage 1
317:
In 1979, Jones and Bagley suggested a high inguinal incision for high canalicular or intra-abdominal testes. Fowler and
Stephens devised a means to preserve the blood supply of high undescended testes through collateral circulation. Their technique was modified into a two-staged operation. Later,
224:
arteries), with a period of 6 months to allow for collateral blood supply to develop. Stage 2 involved testicular mobilization and fixation within the dartos pouch, which is often performed with laparoscopy. The two-staged Fowler-Stephens is now performed as routine management for intra-abdominal
291:
The first recorded attempt for surgical correction of an undescended testis was performed by James Adams in the London
Hospital in 1871, although there are reports of attempts by several German doctors (J. F. Rosenmerkel in 1820 and M.J. von Chelius in 1837). The patient died due to infectious
264:
Overall, there is considerable variation in surgical practice for testicular fixation for testicular torsion, with no significant difference in effectiveness between sutured and
Jaboulay fixation in emergency re-presentations, post-operative complications, or returns to operation.
97:
Cryptorchidism is definitively diagnosed after 1 year of age, as testicular descent may occur after birth. Surgical placement into the scrotum is recommended by 18 months to decrease the likelihood of testicular cancer, testicular atrophy, and sterility.
140:
Surgical fixation in the form of orchiopexy is indicated to prevent the reoccurrence of torsion, and is usually performed bilaterally, even if only one testicle is affected by torsion. The procedure has a high success rate in preventing reoccurrence.
382:
Moore, Sacha L.; Chebbout, Ryad; Cumberbatch, Marcus; Bondad, Jasper; Forster, Luke; Hendry, Jane; Lamb, Ben; MacLennan, Steven; Nambiar, Arjun; Shah, Taimur T.; Stavrinides, Vasilis; Thurtle, David; Pearce, Ian; Kasivisvanathan, Veeru (2020-08-27).
241:
Two distinct techniques used for surgical fixation are the sutured point-fixation and
Jaboulay tunica plication. Multiple studies have shown that both are effective techniques for fixation with limited evidence favoring either in acute torsion.
260:
was developed later as a non-suture fixation method that avoids trans-parenchymal sutures and instead utilizes eversion, loose plication, and adhesion formation. this technique is criticized for potential security inadequacy.
248:
may be performed using either absorbable or non-absorbable sutures, with 3 point fixation sites being preferred. There are concerns regarding potential complications arising from suture fixation (and required breach of the
108:
There are multiple different orchiopexy techniques used to correct an undescended testicle due to the large variation in location where the testes may present. The procedures have a high overall success rate.
124:
While neonatal torsion occurs with no anatomic defect to account for its occurrence (occurring in utero or shortly after birth), adult torsion results from a bilateral congenital anomaly often called a
105:(germ cell neoplasia in situ within the atrophic tubules). Patients are at increased risk for the development of cancer and atrophy in the contralateral, normally descended testes as well.
87:
Undescended testicles affect 1% of males and are 10% bilateral. The cause is unknown, with a small percentage associated with developmental abnormalities or chromosomal aberrations.
306:, and practiced antiseptic techniques that had been absent from previous attempts by other physicians. The postoperative course was reported to be “satisfactory in every way”.
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is often used for low inguinal testes, reducing surgical time and patient discomfort as compared to other methods, while also reducing the risk of complications. Additionally,
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crediting Thomas
Curling (who had worked with James Adams) with the idea of anchoring the testis to the bottom of the scrotum. Notably, Annadale was a close acquaintance of
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can be easily corrected. This approach requires a second incision to secure the testicle within the scrotum (as compared to the prescrotal approach).
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The first attempts at surgical correction of cryptorchidism began in the early 1800s. Before this, inguinal testis were managed with the use of
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For the management of palpable undescended testes (over 80% of undescended testes) the standard inguinal approach is the appropriate procedure.
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Cryptorchidism is associated with tubular atrophy and sterility. In addition, cryptorchid testes carry a three to five times higher risk for
232:
the Fowler-Stephens procedure). It takes a lot of microvascular surgical skill, specialized instrumentation, and is a much longer procedure.
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one-stage laparoscopic orchiopexy was reported first to reveal the location of non-palpable testes and then as a therapeutic treatment.
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can be successfully repaired during this procedure. This approach maintains the high success rate seen in other surgical methods.
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Attention was then turned to the treatment of high undescended testes, which the standard orchiopexy did not adequately treat.
70:. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve
663:"Testicular Autotransplantation: A 17-Year Review of an Effective Approach to the Management of the Intra-Abdominal Testis"
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213:
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completed the first successful orchiopexy in 1887 on a three-year-old boy. He discussed the care of this patient in
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852:
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608:"Retrospective analysis of testicular outcomes following laparoscopic two-stage Fowler Stephens orchidopexy"
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922:
701:
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Bukowski
Timothy P.; Wacksman Jeffrey; Billmire David A.; Lewis Alfor G.; Sheldon Curtis A. (1995-08-01).
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455:"Laparoscopic versus open orchiopexy for palpable undescended testes: Systematic review and meta-analysis"
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Koh, Yu Han; Granger, Jeremy; Cundy, Thomas P.; Boucaut, Hilary AP; Goh, Day Way (2019-12-01).
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or abdominal, while the other 50% are atrophic, and usually located in the scrotum. Diagnostic
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129:", where the testis is abnormally anchored in the scrotal sac, leading to increased mobility.
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702:"Sutured point-fixation versus Jaboulay fixation for salvaged testicular torsion in children"
569:"Prescrotal Orchiopexy: An Alternative Surgical Approach for the Palpable Undescended Testis"
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The theory of orchiopexy is attributed to the observations of Baron
Albrecht von Haller and
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Russinko Paul J.; Siddiq
Farjaad M.; Tackett Leslie D.; Caldamone Anthony A. (2003-12-01).
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in the 1700s, who began to elucidate the anatomy and mechanism of testicular descent.
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Mentessidou, Anastasia; Gargano, Tommaso; Lima, Mario; Mirilas, Petros (2021-07-06).
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253:) like infarction and abscess formation, however this is not supported by data.
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385:"Orchidopexy for Testicular Torsion: A Systematic Review of Surgical Technique"
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is most appropriate procedure for palpable testes. With this technique, the
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Roy, Chloe; Cullis, Paul S.; Clark, Claire; Munro, Fraser D. (2020-02-01).
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Early orchiopexy reduces the risks for cancer and sterility in males with
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Hutcheson Joel C.; Cooper
Christopher S.; Snyder Howard M. (2000-11-01).
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41:
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is often advised to determine the location of non-palpable testis.
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and testicular vessels can be easily visualized and a patent
344:. Elsevier - Health Sciences Division. pp. 692–694.
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Approximately 50% of non-palpable testis are high in the
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Kumar, V., Abbas, A. K., & Aster, J. C. (2017).
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527:"The anatomical approach to inguinal orchiopexy"
757:"An Evolution of Orchiopexy: Historical Aspect"
133:three cases results in dead testes, requiring
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16:Surgery to fix a testicle into the scrotum
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755:Park, Kwanjin; Choi, Hwang (March 2010).
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117:Orchiopexy is performed in the event of
896:Transurethral resection of the prostate
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869:Transurethral incision of the prostate
816:Extensive WebMDHealth information page
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150:For fixation of the undescended testes
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908:Transurethral microwave thermotherapy
309:Max SchĂĽller, Arthur Dean Bevan, and
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342:Robbins Basic Pathology 10th Edition
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851:Tests and procedures involving the
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237:For fixation of testicular torsion
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1068:Frenuloplasty of prepuce of penis
585:10.1097/01.ju.0000097160.15802.23
229:Microvascular autotransplantation
184:Standard open inguinal orchiopexy
62:to move and/or permanently fix a
901:Radical retropubic prostatectomy
292:complications of the procedure.
718:10.1016/j.jpedsurg.2019.08.018
624:10.1016/j.jpedsurg.2019.10.030
471:10.1016/j.jpedsurg.2021.07.003
1:
679:10.1016/S0022-5347(01)67110-6
543:10.1016/S0022-5347(05)67088-7
706:Journal of Pediatric Surgery
612:Journal of Pediatric Surgery
459:Journal of Pediatric Surgery
300:The British Medical Journal,
225:testes at many institutions.
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208:involved vessel ligation (
205:Fowler-Stephens orchiopexy
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773:10.4111/kju.2010.51.3.155
761:Korean Journal of Urology
401:10.1016/j.euf.2020.07.006
94:, or undescended testes.
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26:
853:male reproductive system
198:Laparoscopic orchiopexy
33:Evolution of orchiopexy
1078:Penile plethysmography
923:Prostate brachytherapy
389:European Urology Focus
127:bell-clapper deformity
170:Prescrotal orchiopexy
1129:Male genital surgery
1063:Foreskin restoration
884:Transurethral biopsy
83:Undescended testicle
1073:Penile Frenulectomy
214:inferior epigastric
192:processus vaginalis
145:Surgical techniques
1108:Scrotal ultrasound
1083:Postage stamp test
981:Vasoepididymostomy
971:Vasectomy reversal
879:Transrectal biopsy
667:Journal of Urology
573:Journal of Urology
531:Journal of Urology
258:Jaboulay procedure
210:spermatic arteries
119:testicular torsion
113:Testicular torsion
72:testicular torsion
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948:Spermatocelectomy
712:(12): 2631–2635.
351:978-0-323-35317-5
103:testicular cancer
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930:Prostate massage
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135:orchiectomy
78:Indications
56:orchidopexy
1123:Categories
1013:Orchiopexy
1006:Castration
410:2164/17006
322:References
279:castration
178:hydroceles
52:Orchiopexy
22:Orchiopexy
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