Surgical Treatment

Orchiopexy is one of the most frequent surgical procedures in males. Unpublished data from the National Hospital Discharge Survey by the National Center for Health Statistics indicate that there are approx 26,670 orchiopexies in the United States each year, with approx 75% (20,000) in males under 15 yr of age. Success after orchiopexy can be defined in various ways, such as a palpable testis in the scrotum, a normal-sized testis in the scrotum, normal testicular tissue on biopsy, normal semen analysis, or natural paternity. Success rates in achieving a palpable testis in the scrotum after surgery vary from 73 to 89% (116), depending, in part, on the procedure used. The inguinal procedure has the highest success rate (116,117), although the procedure is only appropriate for testes in this region. A meta-analysis has shown a relationship between anatomic location of the undescended testis and surgical success, with progressively better success rates, ranging from 74 to 92%, in association with a lower location of the testis (116).

Surgical techniques have been refined and have changed markedly over the years, with some testes requiring staged surgery (118). Recently, diagnostic laparoscopy has been used to determine the location of a nonpalpable testis (111). The diagnostic laparoscopy is used to plan the surgical approach, and, when no evidence for a testis or associated vasculature is found, it will prevent unnecessary open surgical exploration (112). Furthermore, the diagnostic laparoscopy can be converted to a laparoscopic orchiopexy when an intraabdominal testis is found (118).

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