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Introduction Cryptorchidism is the most common congenital anomaly of male genitalia, with incidence of about 3, 4% full-term babies and 30 % of premature babies. Retractile testicles is a related condition where the testes can be at times found within the scrotum and at times not. The primary management of cryptorchidism and retractile testicles is surgery and its purpose is not only to produce a good cosmetic appearance or positive psychological effect, but to reduce the risk of infertility. It is usually performed in infancy, if inguinal testes have not descended after 4-6 months. Hormonal therapy is sometimes attempted and occasionally successful. The aim of this retrospective study was to present our results of cryptorchidism and retractile testicles surgery, with emphasis on operative technique, age of the patient at the time of surgery, anatomic position of cryptorchid testes, were the testes palpable upon physical examination and presence of associated anomalies and conditions. Patients and Methods In a ten-year span (1999-2009) a total of 490 patients were operated upon for maldescent of testes. Median patient age at first orchyopexy was 7, 5 years (range 13 months to 44 years). Maldescent had been unilateral in 401 patients (227 on the right side, 174 on the left), bilateral in 81, retractile testicles were found in 82, nonpalpable in 73, canalicular in 376, beyond the external ring in 21 and atrophic or absent in 20 patients. Of associated anomalies and conditions most common were cardiovascular anomalies (5), neurological anomalies (4), hypospadia (3), ipsilateral inguinal hernias (150), adhesions of the foreskin (104), phimosis (15). Of techniques Schoemaker type procedure was most commonly used with 479 procedures. Nine patients underwent exploration of the inguinal canal due to the finding of unilateral absent testicle, eleven patients underwent semicastration due to the finding of atrophic testicle. Results Out of 490 operated patients 485 had excellent results and were released to house care after 3 to 7 days. Complications were noted in 5 patients, including hematoma and/or oedema in 2 and other complications in 3 patients. Success was defined as scrotal position and lack of atrophy. Success rates by anatomical testicular position were 86, 4 percent for peeping and 98 percent for canalicular testes and for those located beyond the external ring. Success rate for Schoemaker orchiopexy procedure was 95, 7 percent. Discussion Diagnosis of cryptorchidism should usually be made at birth and treatment optimally performed between 6 to 18 months of age. Our data suggest that the majority of cryptorchidism are diagnosed at pre-puberty physical examination. Surgery success rates found in this study were similar to previously publicized data. Combining our experience in Schoemaker procedure with education of population will result in further increase of success rate after orchiopexy. |
