Editing AUA: Cryptorchidism (2018) (section)

=== Approach ===

==== <span style="color:#ff0000">Palpable</span> ====
*'''<span style="color:#ff0000">Standard technique: two-incision (inguinal and scrotal) orchiopexy'''
**The inguinal portion of the procedure is performed to mobilize the cord structures and gain adequate length for repositioning the testis in the scrotum, along with closure of a patent processus vaginalis, when present. The secondary scrotal incision is performed to create a subdartos pouch for placement and fixation of the testis.
*If low lying, single incision orchidopexy is also a viable option. 
**Potential advantages with respect to enhanced recovery and cosmesis, as well as reduced operative time. This technique can be effective even when there is a patent processus/hernia sac present
*If a palpable nubbin is present, in the scrotum, potentially representing a vanishing testis, then scrotal or inguinal exploration can safely be performed.
**Regardless of the approach, the specimen should be sent for pathologic confirmation, to confirm a vanishing testis and no presence of malignancy.

==== <span style="color:#ff0000">Non-palpable ====
*'''<span style="color:#ff0000">Perform examination under anesthesia to reassess for palpability of testes'''
**If the testis is palpable, open orchidopexy should be undertaken
*'''If nonpalpable, surgical exploration (laparoscopic or open) and, if indicated, abdominal orchidopexy should be performed.'''
**'''<span style="color:#ff0000">Surgical options if an intrabdominal testis is found with anatomy that is felt to be appropriate for salvage (3):'''
**#'''<span style="color:#ff0000">Orchidopexy'''
**#'''<span style="color:#ff0000">One-stage Fowler Stephens (FS) orchidopexy'''
**#'''<span style="color:#ff0000">Two-stage FS orchidopexy'''
**'''The identification of the testicular vessels should be the end point of any exploration for a nonpalpable testis.'''
**'''If the testicle warrants salvage and tesicular vessels are long enough to reach into the scrotum, then the vascular supply should be spared and a primary orchidopexy is performed in preference to FS orchidopexy'''
**In the FS approach, the testicular vessels are divided and the blood supply to the testis is maintained through collaterals, including the artery of the vas deferens. 
***When the FS orchidopexy is done in one stage, the testicular vessels are ligated and the testicle is immediately moved down into the scrotum;
***In the two-stage approach, only ligation is done at the time of the first stage, without mobilization of the testis. The patient is then followed for three to six months, to presumably allow for improved collateral circulation to develop. A second stage repair is then undertaken with repositioning of the testis in to the scrotum.
***When a primary orchidopexy cannot be performed in cases where the testicular vessels are too short, the decision to perform a one-stage or two-stage FS orchidopexy is left to the discretion for the surgeon based on the location of the testis, associated vascular supply to the testis, and the anatomy of the peritesticular structures.