How important is the surgeon's experience in the success of orchiopexy? 15 years’ experience of a tertiary center

Year 2023, Volume: 16 Issue: 1, 17 - 20, 31.01.2023

Cemil Kutsal Kaya Horasanlı

Abstract

Objective: Cryptorchidism is one of the most common congenital anomalies in pediatric urology. Orchiopexy operation is performed to prevent testicular damage caused by cryptorchidism. However, orchiopexy is an operation that requires experience. Although re-orchiopexies are technically demanding procedures, often a secondary intervention may be required. Therefore, we examined the causes and outcomes of orchiopexy cases who had secondary intervention in our institute under a single investigator.
Method: Orchiopexy surgeries, performed by pediatric urologists in a tertiary hospital, between 2005 and 2020 were retrospectively reviewed. The cases which were required a secondary orchiopexy are included in the study. Perioperative findings, time of the primary surgery, and success rates were evaluated.
Results: Secondary orchiopexy was applied to 88 cases. Primary surgery was performed in 66 (75%) of these patients in the tertiary hospital by pediatric urologists, and in the remaining 22 (25%) patients in a state hospital by general urologists. It was observed that hernia repair was performed at significantly higher rates in patients whose first operation was performed by a pediatric urologist (79% vs. 32%, p<0.001).
Conclusion: According to the results of our study, inadequate hernia repair may be associated with the need for secondary orchiopexy. Also, we can say that pediatric urologists are more experienced in undescended testis and therefore the results of the first surgery are more satisfactory.

Keywords

undescended testis, orchiopexy, surgical failure, experience

References

• Wenzler DL, Bloom DA, Park JM. What is the rate of spontaneous testicular descent in infants with cryptorchidism? J Urol. 2004;171(2 Pt 1): 849–851.
• Ghirri P, Ciulli C, Vuerich M, Cuttano A, Faraoni M, Guerrini L, et al. Incidence at birth and natural history of cryptorchidism: a study of 10,730 consecutive male infants. J Endocrinol Invest. 2002;25(8):709–715.
• Bay K, Main KM, Toppari J, SkakkebÆk NE. Testicular descent: INSL3, testosterone, genes and the intrauterine milieu. Nat Rev Urol. 2011;8(4):187–196.
• Hutson JM. Journal of Pediatric Surgery-Sponsored Fred McLoed Lecture. Undescended testis: the underlying mechanisms and the effects on germ cells that cause infertility and cancer. J Pediatr Surg 2013;48(5):903–908.
• Gurney JK, Mcglynn KA, Stanley J, Merriman T, Signal V, Shaw C, et al. Risk factors for cryptorchidism. Nat Rev Urol. 2017;14(9):534–548.
• Zakaria M, Azab S, El Baz M, Fawaz L, Bahagat A. Cryptorchidism in Egyptian neonates. J Pediatr Urol. 2013;9(6 Pt A):815–819.
• Dave S, Liu K, Clark R, Garg AX, Shariff SZ. A retrospective population-based cohort study to evaluate the impact of an older sibling with undescended testis and hypospadias on the known maternal and fetal risk factors for undescended testis and hypospadias in Ontario, Canada, 1997-2007. J Pediatr Urol. 2019;15(1): 41.e1-41.e9.
• Redman JF. Inguinal reoperation for undescen-ded testis and hernia: approach to the spermatic cord through the cremaster fascia. J Urol. 2000;164(5):1705-1707.
• Ziylan O, Oktar T, Korgali E, Nane I, Ander H. Failed orchiopexy. Urol Int. 2004;73(4):313–315.
• Lattimer JK. Scrotal pouch technique for orchiopexy. J Urol. 1957;78(5):628–632.
• Ghnnam WM, Saed B, Ghazy H. A modified technique for scrotal fixation during orchiopexy. African J Paediatr Surg. 2011;8(2):203–205.
• Thorup J, Haugen S, Kollin C, Lindahl S, Läckgren G, Nordenskjold A, et al. Surgical treatment of undescended testes. Acta Paediatr 2007;96(5):631–637.
• Bassel YS, Scherz HC, Kirsch AJ. Scrotal incision orchiopexy for undescended testes with or without a patent processus vaginalis. J Urol. 2007;177(4):1516–1518.
• Noseworthy J. Recurrent undescended testes. Semin Pediatr Surg. 2003;12(2):90–93.
• Mirilas P, Mentessidou A. The secondary external inguinal ring and associated fascial planes: Surgical anatomy, embryology, applications. Hernia 2013;17(3):379–389.
• Feng S, Yang H, Li X, Yang J, Zhang J, Wang A, et al. Single scrotal incision orchiopexy versus the inguinal approach in children with palpable undescended testis: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(10): 989–995.