Trans-scrotal approach for surgical correction of cryptorchidism and congenital anomalies of the processus vaginalis

Objectives: Surgery of the inguinal canal is the most common practice in pediatric urology. Recently, the trans-scrotal approach has been described for orchidopexy of palpable undescended testes. The aim of this paper is to report our experience with this technique, emphasizing both the advantages and the disadvantages with respect to the usual approach. Methods: Over a period of 2 years, we used the trans-scrotal approach in 85 children with cryptorchidism, hydrocele and inguinal hernia. The scrotal incision was combined vertical and horizontal. Results: All children with hernia and hydrocele were cured without complications. Among the cryptorchids, 3 children required an additional groin incision to complete the procedure, 3 experienced postoperative hematoma, 2 had mild testicular hypotrophy, and 1 recurrent cryptorchidism at follow-up. Conclusion: Most palpable undescended testes can be successfully treated by this operation. However, the dissection of the processus vaginalis from the cord below the external ring is time-consuming, requires more skill, and exposes to more complications. Conversely, the results are excellent in hydroceles.