378 / 492
VR-17
(VS)
POSTERIOR APPROACH TO THE PROCESSUS VAGINALIS IN ORCHIDOPEXY
Patrick LEC
1
, Andrew TOMPKINS
2
, Katherine ROTKER
2
and Anthony CALDAMONE
2
1) Warren Alpert Medical School of Brown University, Providence, USA - 2) Warren Alpert Medical School of Brown
University, Urology, Providence, USA
PURPOSE
The most critical step in an orchiopexy in achieving spermatic cord length is the separation of the processus vaginalis
from the vas deferens and spermatic vessels. We report our experience with a posterior approach to the separation of
the processus vaginalis. Our hypothesis was that the posterior approach to the processus vaginalis is comparable in
surgical outcome measures to the more traditional anterior approach.
MATERIAL AND METHODS
Following internal review board approval, we retrospectively reviewed medical records of consecutive patients who
underwent orchidopexy at Hasbro Children’s Hospital between January 2006 and July 2012. Exclusion criteria included
previous ipsilateral inguinal surgery and laparoscopic orchidopexy. Only patients with 6-month follow up were included
in the study. Patients were divided into posterior and anterior surgical approach groups and operative outcomes were
compared. The major endpoints at 6-month follow up included ipsilateral testicular atrophy, secondary reascension, and
hernia recurrence. Additionally, a number of surgical variables were also considered, including gestational age, Tanner
stage, presence of co-morbidities at the time of procedure, pre-operative and intra-operative testis location, and
duration of procedure.
RESULTS
A total of 340 patients underwent orchidopexy who satisfied inclusion criteria within the time frame of our study. Of
these patients, 191 and 149 underwent posterior and anterior approach orchidopexies, respectively. Follow up at 6
months revealed 1 case of testicular atrophy and 2 cases of secondary reascension in the posterior and anterior
approach groups, respectively. Logistic regression analysis did not demonstrate significant difference in outcome
superiority between the two groups (P>0.2061).
CONCLUSIONS
In our study we have objectively determined that the posterior approach orchidopexy has the same surgical outcomes to
the anterior approach, and thus is a viable surgical alternative. We believe the posterior approach to be more
anatomical and easier to teach.