Efficacy of the transscrotal approach in cord lengthening for palpable undescended testes in children.

BACKGROUND

The transscrotal approach has been considered a promising alternative for the management of palpable undescended testes in children; however, it has not been widely adopted. One major concern is whether this approach provides sufficient cord length to allow tension-free descent of the testis into the scrotum. This study aimed to evaluate the cord-lengthening efficacy of the transscrotal approach by comparing the pubo-testicular distance after high ligation of the patent processus vaginalis (PTd1) with the pubo-scrotal distance (PSd) in children with low palpable undescended testes.

METHODS

This prospective longitudinal study included patients with low palpable undescended testes who underwent orchidopexy via the transscrotal approach from October 2022 to February 2023 at Children's Hospital 2, Ho Chi Minh City, Vietnam. Variables recorded included PSd, PTd1, preoperative testicular position, clinical inguinal hernia, presence of a patent processus vaginalis (PPV), level of PPV ligation, operative time, and surgical success indicators.

RESULTS

A total of 53 undescended testes in 47 patients were included, with a median age of 24 months (IQR 14-45) and a median follow-up of 33 months (IQR 31.5-34). PTd1 was greater than PSd in 98 % of cases (6.2 ± 1.0 cm vs. 5.3 ± 0.7 cm; 95 % CI: 0.7-1.1; p < 0.05). There was no difference in PTd1 between inguinal and extra-inguinal testes (6.2 ± 0.9 cm vs. 6.2 ± 1.0 cm; 95 % CI: -0.6 to 0.7; p = 0.9). High ligation of the PPV near the internal ring was achieved in 88 % of cases, providing an average gain of 2.8 ± 1.3 cm in cord length. Postoperative testicular volume increased significantly compared to preoperative measurements [301 mm3 (IQR 204.7-354.3) vs. 224.6 mm3 (IQR 143-338.2); p < 0.05]. The overall success rate was 98 %.

CONCLUSION

In cases of low palpable undescended testes, the transscrotal approach consistently provides adequate cord length for tension-free testicular descent after high PPV ligation. Moreover, this approach enables high ligation of the PPV near the internal inguinal ring in the majority of cases.