Potential complications with the prescrotal approach for the palpable undescended testis? A comparison of single prescrotal incision to the traditional inguinal approach

Purpose: Prescrotal orchiopexy is emerging as an alternative surgical approach to undescended testicles. We compare operative times, success rates and complications of single incision prescrotal orchiopexy and the traditional inguinal approach. Materials and Methods: During a 3-year period all patients who underwent prescrotal orchiopexy were retrospectively reviewed and compared to age matched controls operated on via the traditional inguinal approach. Data collected included preoperative and postoperative testicular positioning, operative time and complications, including testicular atrophy and ascent. Exclusion criteria were retractile or ectopic testis, incomplete data, including lack of followup, and a concurrent procedure at the time of orchiopexy. Results: A total of 63 orchiopexies were performed using the prescrotal approach (mean patient age 4.6 years) and the inguinal approach (4.7 years). Average surgical times for the prescrotal and inguinal groups were 34 and 64 minutes, respectively (p = 0.002). Followup ranged from 6 to 42 months. Complication rates between the groups were similar. However, 2 hernias (3%) occurred in the prescrotal group, of which 1 was incarcerated and associated with Meckel's diverticulum, and I was a late recurrence. Conclusions: With the paucity of literature on prescrotal orchiopexy potential complications may be underreported. Despite the limitations of sample size, prescrotal orchiopexy may be associated with a 3% risk of postoperative hernia. A single incision prescrotal orchiopexy is still a viable approach for patients with primary palpable undescended testicles. Advantages include shorter operative time, a cosmetically appealing single incision and possibly less pain.