ESPU Congress 2017 - Abstract book

102

CONGRESS OF THE ESPU

14:17–14:20

S9-6 (PP)

SCROTAL INCISION AS INITIAL APPROACH

FOR THE MANAGEMENT OF BOTH PALPABLE

AND NONPALPABLE UNDESCENDED TESTICLES:

RESULTS OF FIRST 500 CONSECUTIVE CASES

Juan PRIETO

, Jeffrey WHITE

and Maria Veronica RODRIGUEZ

1) University of Texas Health Science Center San Antonio, Methodist Children’s Hospital and Children’s, Urology,

San Antonio, USA - 2) University of Texas Health Science Center, Urology, Houston, USA - 3) University of Texas Health

Science Center San Antonio, Urology, San Antonio, USA

PURPOSE

To present the outcomes of the use of a scrotal incision as the first line approach for the management

of all undescended testicles (UDT) including both palpable and unilateral nonpalpable testicles.

MATERIAL AND METHODS

From 2009 to 2015, 459 consecutive patients underwent 500 scrotal approaches for the manage-

ment of all palpable and unilateral nonpalpable UDT. The scrotal approach was the initial selected

approach irrespective of the location of the UDT, the patency of the processus vaginalis or size of

the contralateral descended testis. If there was neither a nubbin nor a testicle, laparoscopy was

performed. All procedures were performed by a single pediatric urologist (JCP) in three different

institutions. Minimum follow-up was 6 months. Secondary orchiopexies and inadequate follow-up

were exclusion criteria.

RESULTS

Out of the 500 UDT, 432 (86%) were palpable and 68 (14%) were nonpalpable as determined by

examination under anesthesia. A scrotal approach was the definitive treatment in 98% of these

patients with a success rate for scrotal orchiopexy of 97.4%. Among the nonpalpable UDT (n=68),

46 were either nubbins or testicles located extra-abdominally and the remaining 22 testes were

intra-abdominal. Scrotal approach was the definitive treatment in 68% of these patients with a suc-

cess rate of 100% for those extra-abdominal testes or nubbins. The remaining 22 intra-abdominal

testes were managed laparoscopically. In six of these intra-abdominal testes, the initial scrotal ap-

proach facilitated the dissection of a looping vas. Three complications were documented (excluding

laparoscopic procedures): suture dehiscence (n=1), bleeding (n=1), and persistent high location

(n=2).

CONCLUSIONS

The majority of patients with UDT, whether palpable or nonpalpable, can be initially approached via

a scrotal incision. Initial scrotal approach was the definitive treatment in 98% of the palpable UDT

and prevented unnecessary laparoscopy in 68% of the nonpalpable UDT.