Spermatic Cord Torsion After Testicular Fixation - A Different Surgical Approach and a Revision of Current Techniques -

Abstract

We present a technique for testicular fixation, based on the development of a new anatomical structure formed exclusively by the visceral and the parietal tunica vaginalis; our pre-clinical experience with this technique performed in guinea pigs and a clinical casuistic of 100 operations in 69 patients (age range: newborns to 25 years, mean 101.43 months) where the principal indications were unilateral torsion, testicular descent and contralateral fixation after orchiectomy. Postoperative follow-up ranged between 4 months and 204 months with a mean of 14.304 months. At their final follow-up, all patients presented normal testicular size, shape, consistency, sensitivity, mobility and intrascrotal position; no patient complained of symptoms related to the operation. The discussion also includes 48 cases of failed testicular fixation which were performed with sutures, vaginal adhesions or dartos-pouch techniques, as reported by 30 different authors. Ages of patients at the primary operation ranged from 3 years to 34 years (mean 14.381 years), at the secondary operation from 10 years to 40 years (mean 19.298 years) and the interval between them ranged from 5 days to 27 years (mean 53.773 months). The causes of the failures, which led us to consider them as unreliable, were absorption of cicatricial tissue, serosal regeneration and loosening of sutures. The sequelae included testicular atrophies, orchiectomies and severely damaged testicles.

A novel method of scrotal orchidopexy: description of the technique and short‐term outcomes

“…In at least 50 cases reported over the last 40 years testicular torsion has recurred after previous bilateral orchidopexy . Absorbable sutures were used in the vast majority of these cases of re‐torsion .…”

Misdiagnosed Adult Testicular Torsion: Case Report

“…This may present the clinician with the diagnostic dilemma where prompt action is required. Therefore, for the good outcome of the scrotal procedures, the fixation must be such that one should aim at avoiding recurrent testicular torsion and possibility of increasing the risk of infertility and/or malignancy (12) as a result of wrong choice of sutures. Such reports have appeared in the literature and therefore prompted the incorporation of suture less fixations, in the form of dartos pouch orchidopexy (6,13).…”

Hodentorsion nach prophylaktischer Orchidopexie

“…Wiederholt wurden operative Verfahren beschrieben, die der verbreiteten Methode der Fixierung mittels Nähten durch die Tunica albuginea und der seitlichen Skrotalwand beziehungsweise dem medianen Septum [3], hinsichtlich der Verhinderung von Re-Torsionen überlegen sein sollen. Zu den genannten Verfahren zählen die Fenestrierung der Tunica vaginalis [4], die Eversion der Tunica vaginalis ohne zusätzliche Fixation [5], die Schaffung eines subkutanen Tunica-dartos-Pouches [6], die transseptale axiale Fixation beider Hoden [7] sowie die Naht von Tunica vaginalis viszeralis und parietalis [8]. Die Schaffung einer großflächigen Adhäsionszone zwischen Tunica albuginea und der Skrotalwand ist die übereinstimmende Grundüberlegung der genannten Verfahren [9].…”

“…Die Schaffung einer großflächigen Adhäsionszone zwischen Tunica albuginea und der Skrotalwand ist die übereinstimmende Grundüberlegung der genannten Verfahren [9]. Aufgrund geringer Fallzahlen (10 [7], 35 [5], 69 [8]) und der Seltenheit der Re-Torsion lässt sich eine verlässliche Aussage, welcher OP-Methode der Vorzug zu geben ist, nicht ableiten [10]. Kontrollierte klinische Studien hierzu fehlen.…”