Comparative evaluation of the effectiveness of the use of inguinal and scrotal approaches in the treatment of recurrent cryptorchidism.

Abstract

Introduction. The average recurrence rate after inguinal orchiopexy is 1%, and with scrotal access – 3%. The high incidence of cryptorchidism determines a relatively large number of patients who need redo orchiopexy, which explains the interest in studying the results of the use of inguinal and scrotal approaches in the surgical treatment of recurrent cryptorchidism. Materials and methods. In the period from 2016 to 2021, 36 operations were performed for relapses of cryptorchidism. Right-sided cryptorchidism was in 22 (61.1%) patients, left-sided – 14 (38.9%) boys. The average age of patients was 6.4 ± 3.6 years (1.5-17.1 years). The study included patients whose entire testicular volume was located outside the scrotum. The patients were divided into two groups: group I, 21 (58.3%) children who had relapse eliminated by scrotal access, group II, 15 (41.7%) who used inguinal access. The duration of the operation and the time spent in the hospital, the frequency of repeated malposition and testicular atrophy, the duration of the use of analgesics were studied. Results. In group I patients, the median time of the operation was 35 minutes [25;100], the average length of hospital stay was 2.5 days, and the average duration of anesthesia was 0.4 days. In group II, the median time of the operation was is 90 minutes [60;130], which is significantly longer than in group I (p=0.002), the average length of stay in the hospital is 4 days, the average time of anesthesia is 1.4 days. In 2 (12.5%) patients of group I, there was a need for conversion and the use of inguinal access. 7 (19.4%) patients did not come for a follow-up examination. Group I included 16 (55.2%), group II 13 (44.8%) boys. Testicular atrophy was in group I in 1 (6.25%) patient, there was no malposition, in group II 2 (15.3%) there was atrophy, malposition in 1 (7.6%) case. Conclusion. Both scrotal and inguinal access during repeated orchiopexy are highly effective in the treatment of recurrent cryptorchidism, while scrotal access reduces the time of surgery and the extent of injury