Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels.
OBJECTIVE
Patients with cryptorchidism can have such short spermatic vessels that it is impossible to place the testicle in a satisfactory scrotal position using conventional orchiopexy. In these cases the most commonly used operation is 1 to 2-stage Fowler-Stephens orchiopexy. We present our surgical experience using staged inguinal orchiopexy without section of the spermatic vessels in patients with short spermatic vessels.


METHODS
We used 2-stage inguinal orchiopexy in 38 children with intra-abdominal testis or testis peeping through the internal ring and short spermatic vessels (7 bilateral). Spermatic vessels were not sectioned, but were lengthened through progressive traction of the spermatic cord wrapped in polytetrafluoroethylene pericardial membrane (Preclude). In the first stage we mobilized the spermatic cord in the retroperitoneal space and then wrapped it in the polytetrafluoroethylene membrane. We subsequently attached the testis to the invaginated scrotal bottom. At 9 to 12 months we performed the second stage, which involved removing the polytetrafluoroethylene membrane.


RESULTS
From the first to the second stage we observed progressive descent of the testicle toward the scrotum. At 1 to 8-year followup after the second stage all 45 testicles were palpable in a satisfactory scrotal position with stable or increased testicular volume.


CONCLUSIONS
This technique represents an alternative to Fowler-Stephens orchiopexy, which can be associated with a greater risk of testicular ischemia.
Dessanti
A
A
Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy.
Falchetti
D
D
Iannuccelli
M
M
Milianti
S
S
Altana
C
C
Tanca
A R
AR
Ubertazzi
M
M
Strusi
G P
GP
Fusillo
M
M
D001672:Biocompatible Materials; D003456:Cryptorchidism / Q000601:surgery*; D005465:Fluorocarbon Polymers; D006801:Humans; D007223:Infant; D008297:Male; D013085:Spermatic Cord / Q000002:abnormalities* / Q000098:blood supply / Q000601:surgery*; D014143:Traction
D001672:Biocompatible Materials; D005465:Fluorocarbon Polymers; C010946:polytetrafluoroethane