Editing Undescended Testicle (section)

==== Surgical Approach to the Palpable Testis ====
* '''<span style="color:#ff0000">Options (2):</span>'''
*#'''<span style="color:#ff0000">Inguinal</span>''' (with repair of an associated hernia if present)
*#*Traditional approach
*#'''<span style="color:#ff0000">Pre-scrotal/scrotal orchidopexy</span>'''
* '''High (proximal) ligation of the processus vaginalis is an essential surgical step to allow placement of the testis in a sub-dartos pouch within the hemi-scrotum, without tension'''
* '''<span style="color:#ff0000">Inguinal'''
** '''<span style="color:#ff0000">Maneuvers to provide spermatic cord length include (4):'''
**# '''<span style="color:#ff0000">Divide lateral fascial bands along the cord and at the internal inguinal ring'''
**# '''<span style="color:#ff0000">Blunt dissection of the cranial retroperitoneal spermatic vessels'''
**# '''<span style="color:#ff0000">Medial transposition of the testis beneath the epigastric vessels (Prentiss maneuver)'''
**# '''<span style="color:#ff0000">Cranial extension of the incision'''
*** '''Very rarely, the testis cannot be brought to dependent scrotal position after these maneuvers and a''' '''Fowler-Stephens (FS) orchidopexy''' '''may be considered''' as an alternative to orchiectomy, which is preferentially reserved for visibly abnormal or atrophic testes, postpubertal patients, or cases associated with insufficient vasal length.
**'''Complications'''
*** '''Uncommon'''
*** '''Serious complications include testicular retraction and atrophy'''
** '''A minimum of 6 months’ follow-up is recommended to determine postoperative testis position and size.'''
*** Long-term follow-up should be considered for counseling of the patient regarding fertility issues, risk of testicular malignancy, and self-examination.
** Torsion of a scrotal testis after orchidopexy has been reported but is very rare, and the risk may be minimized by routine extravaginal testicular fixation in a subdartos pouch.
** If complete intrascrotal testicular atrophy occurs postoperatively, further intervention is not needed, but the option of testicular prosthesis placement should be offered to the patient and family.
*** Implantation of a testicular prosthesis should occur at least 6 months after any scrotal procedure or after puberty and is best performed through an inguinal approach.
*** Fixation of the prosthesis to the dartos and closure of the scrotal fascia above the implant using purse-string nonabsorbable suture are required.
*** Complications including displacement, pain, or infection occur in < 5% of cases.
* '''Scrotal'''
** Used selectively in many series; '''efficacy and complication rates are similar to those of standard inguinal orchidopexy'''