The low scrotal approach to the ectopic or ascended testicle: prevalence of a patent processus vaginalis.

PURPOSE: The scrotal approach to undescended testis has been described using a high scrotal incision and including hernia repair. We describe an approach that uses a low scrotal incision with an inguinal incision if a patent processus is identified. We retrospectively reviewed the likelihood of a patent processus in children selected to undergo this technique.

MATERIALS AND

METHODS

A total of 56 consecutive patients determined by history and physical examination to have ectopic or ascended testes underwent orchiopexy using an initial scrotal approach for a total of 71 undescended testes. Inguinal surgery had previously been done in 5 testes, which were not included in patent processus analysis. Charts were reviewed for testicular position, need for inguinal incision and demographic data.

RESULTS

Of the patients 16 (19 testes) were younger than 2 years, 19 (26 testes) were 2 to 6 years old and 17 (21 testes) were older than 6 years. In 20% of the patients an inguinal incision was made for a patent processus vaginalis. The incidence of a patent processus was 26% in those younger than 2 years, 15% in those 2 to 6 years old and 19% in those older than 6 years (p = 0.17). All patients had satisfactory scrotal placement with at least 1 followup examination.

CONCLUSIONS

Children with ectopic or ascended testes on physical examination findings may be treated successfully via a low scrotal approach with only 20% requiring concomitant inguinal hernia repair through a standard inguinal incision. Overall 80% of the children avoided an inguinal incision. This technique has become our standard approach to these testes.