Dartos pouch orchiopexy for adult testicular torsion and symptomatic retractile testis: Technique, early outcomes and critical appraisal of trans-tunical suture fixation

Abstract

Objectives

To describe a reproducible single-incision dartos pouch orchiopexy technique for adult patients requiring testicular fixation, report early outcomes from an initial adult series and critically appraise the evidence supporting conventional trans-tunical suture fixation.

Patients and Methods

A stepwise description is presented of a proximal-reflection dartos pouch orchiopexy performed through a single high transverse scrotal incision, in which the parietal tunica vaginalis is reflected proximally over the spermatic cord before dependent subdartos placement of the testis without trans-tunical or transparenchymal fixation sutures. Perioperative outcomes from an initial adult case series are reported.

Results

A total of 22 dartos pouch orchiopexies were performed in 12 adult patients with a median age of 23 years (range 18–31), including eight patients with intermittent testicular torsion, two with acute torsion and viable testes following detorsion and two with symptomatic retractile testis. Structured ultrasonographic follow-up ranged from 15 to 21 months (mean 19.2 months). Scrotal ultrasonography demonstrated preserved testicular vascularity and stable dependent positioning of all testes. There were no cases of recurrent torsion, testicular atrophy, chronic scrotal pain or scrotal complications.

Conclusion

Single-incision dartos pouch orchiopexy appears to be a safe, atraumatic and reproducible non-parenchymal technique for adult testicular fixation and may represent a viable alternative to conventional trans-tunical suture fixation.