J C Hutcheson1, C S Cooper, H M Snyder. 1. Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Abstract
PURPOSE: Achieving a scrotally positioned testis with no iatrogenic atrophy is the primary goal of the surgical treatment of cryptorchidism. The success rate is associated with preoperative testicular position and the technique used. Our success rate with inguinal orchiopexy for abdominal testis is higher than those previously published and may be due to our anatomical approach to retroperitoneal dissection. We review the relevant anatomy and discuss the surgical technique of inguinal orchiopexy. MATERIALS AND METHODS: We researched and reviewed the relevant technical and anatomical literature on inguinal orchiopexy, and describe the anatomical approach to orchiopexy in detail. RESULTS: An understanding of the retroperitoneal fascial layers is the key to understanding surgery of the retroperitoneum. Dividing the internal spermatic fascia is required for the surgeon to separate the processus vaginalis from the vas and vessels. CONCLUSIONS: The average age of children undergoing cryptorchid surgery has decreased dramatically during the last 40 years. In such young patients extensive mobilization of the vas and vessels may be accomplished through a relatively small incision. We believe that our success rate with inguinal orchiopexy for abdominal testis is associated with our anatomical approach to retroperitoneal dissection.
PURPOSE: Achieving a scrotally positioned testis with no iatrogenic atrophy is the primary goal of the surgical treatment of cryptorchidism. The success rate is associated with preoperative testicular position and the technique used. Our success rate with inguinal orchiopexy for abdominal testis is higher than those previously published and may be due to our anatomical approach to retroperitoneal dissection. We review the relevant anatomy and discuss the surgical technique of inguinal orchiopexy. MATERIALS AND METHODS: We researched and reviewed the relevant technical and anatomical literature on inguinal orchiopexy, and describe the anatomical approach to orchiopexy in detail. RESULTS: An understanding of the retroperitoneal fascial layers is the key to understanding surgery of the retroperitoneum. Dividing the internal spermatic fascia is required for the surgeon to separate the processus vaginalis from the vas and vessels. CONCLUSIONS: The average age of children undergoing cryptorchid surgery has decreased dramatically during the last 40 years. In such young patients extensive mobilization of the vas and vessels may be accomplished through a relatively small incision. We believe that our success rate with inguinal orchiopexy for abdominal testis is associated with our anatomical approach to retroperitoneal dissection.