Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

ABSTRACT

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent