67th Annual Meeting Abstracts
Belt and Suspenders: Division of the Cremaster During Orchiopexy is Safe and Effective
*RAYMOND M BERNAL, MARK R ZAONTZ
TEMPLE UNIVERSITY SCHOOL OF MEDICINE, Philadelphia, PA
Introduction: It has been shown that suture fixation of the testicle can be associated with severe parenchymal damage. We describe an alternate technique that blunts the Cremaster reflex, eliminating a mechanism that can contribute to failed fixation.
Methods: Depending on the exam, we utilize a transverse inguinal and/or high scrotal incision. The underlying tissues are opened with cautery and the testicle is delivered into the wound. The spermatic cord is skeletonized, addressing any hernias. Using cauterization, cremaster fibers are divided superior to the testicle, and stripped to the external ring. The tunica vaginalis is opened widely and everted. A subdartos pocket is created, and absorbable sutures are used to affix the everted tunica to the dartos, keeping the testicle dependent. The scrotum is then closed.
Results: A retrospective review identified 77 patients over one year for which 5 year follow-up was possible. 92 testicles were operated upon. Average age was 69 months, with an average follow-up of 9.25 months. No patients experienced subsequent torsion, recurrence of retractile testis, or testicular ascent. There were no major complications. The modified technique was used to address a variety of indications.
Conclusions: We present a modified orchiopexy technique that is safe, effective, and blunts the Cremaster reflex. The testicles remained in their dependent positions during follow-up. Our technique may provide an alternative to those still utilizing suture fixation techniques.
