Reoperative orchiopexy: surgical aspects and functional outcome

Over a 14-year period, a total of 40 patients underwent surgical revision a fter an unsuccessful orchiopexy attempt. Overall, 34 reorchiopexies (I bila teral) and 7 orchiectomies were performed. All reorchiopexies were carried out using extensive mobilization of the testis and spermatic cord. This app roach was sufficient for scrotal placement of the testis in 23 instances; h owever, it was necessary to transpose the spermatic vessels medially in the remaining 11 (incision of the transversalis fascia in 5, incision of the t ransversalis fascia and division of the inferior epigastric vessels in 6). Only 1 prepuberal boy developed testicular atrophy (2%). Functional long-te rm assessment was done in 20 postpuberal patients using testicular ultrasou nd and sperm analysis. The reoperated cryptorchid testes were significantly smaller than the controls (P < 0.005), but decreased fertility was only no ted in 3 patients (18.7%). We conclude that testicular volume in adulthood is not directly related to fertility, so that accurate reorchiopexy seems t o be the best way to preserve fertility in this special group of cryptorchi d patients.