158 tending upwards.’’ The importance of identifying and ligat- ing a patent processus vaginalis during orchiopexy was not recognized at that time [18]. 　In the 1870s even minor surgical procedures carried a high risk of morbidity from infection. Adams concluded that “no operation should be undertaken in early life” be- cause of the high likelihood of wound infection and sub- sequent peritonitis, unless the patient is “destined to be- come an equestrian.” Because most orchiopexies at that time were conducted for a perineal ectopic testis, which could have caused significant discomfort to the horseman, he seemed to suggest orchiopexy limited to this kind of occupation. ANNANDALE’S SUCCESS FOR 1st ORCHIOPEXY Thomas “Tommy” Annandale was born at Newcastle-on- Tyne on February 2, 1838. At the age of 15 years Tommy began work as an apprentice to his father, and at age 18 he matriculated at the University of Edinburgh, receiving a doctorate in medicine 4 years later in 1860. For his surgi- cal training, He remained in Edinburgh under the tutelage of James Syme. Then he served as private assistant for 10 years until Syme’s death in 1870. At that time, he became acquainted with Joseph Lister, who had already been the senior assistant under Syme. Besides, he also got the idea of antiseptics by using a carbolic acid wound dressing from Lister. The concept of an antiseptic wound dressing techni- que, first reported by Lister, was revolutionary at that time, significantly reducing the risk of wound infection. In 1877, he succeeded Joseph Lister as the regius professor (chair) of clinical surgery at the University of Edinburgh. He occupied the surgical chair at Edinburgh for 30 years, from 1877 to 1907, maintaining an active surgical practice in general surgery, orthopedics, otolaryngology, urology, and other subspecialties [19]. 　On June 1877, Annandale was referred a 3-year-old boy with pain in the perineum on walking and running. Annandale described the care of this patient in ‘The British Medical Journal’ in 1879, detailing the first recorded suc- cessful orchiopexy [20]. The patient had a right ectopic tes- tis palpated on ipsilateral perineum. On July 5, 1877, he did orchiopexy after freeing the testicle and gubernaculum from its attachment. Annandale credited Curling, who had attempted to perform orchiopexy with Adams, with the idea of anchoring the testis to the bottom of the scrotum, and his patient further benefited from the application of Lister’s antiseptic technique as a dressing of carbolic acid (phenyl alcohol) was applied to the wound. Unlike the cases of Adams, the postoperative course was ‘‘satisfactory in ev- ery way,’’ possibly due to the proper use of antiseptic techni- ques as Annandale has written ‘‘the whole of the operation was performed antiseptically.’’ 　Unquestionably, in the right place and at the right time, Annandale integrated the art and science of medicine. He recognized the importance of Lister’s work and Curling’s previous experiences, and fused their ideas into the first Korean J Urol 2010;51:155-160 Park and Choi successful orchiopexy. ESTABLISHMENT OF MODERN STANDARD ORCHIOPEXY: INTEGRATING MORE KNOWLEDGE INTO PRACTICE Following the successful orchiopexy by Annandale, several authors refined the techniques, which helped to give birth to the current technique. 　Max Schüller, in the 1881 Annals of Anatomy and Surgery, wrote an extensive treatise on undescended testis that included a description of the malignant potential of cryptorchidism [21]. In describing the surgical technique, he first advocated the division of the processus vaginalis to mobilize the spermatic cord in correction of the malposi- tioned testis. Additionally, he stressed the full division of cremaster upon the testicle and obstruction of the inguinal canal to reduce the re-ascent of testis. In contrast to Schüller’s technique, in 1893, Leonard Bidwell, assistant surgeon of the West London Hospital, described a techni- que for inverting the testis to gain approximately an inch and a half of length and anchoring the testis to an external wire cage to provide continuous traction [22]. 　Arthur Dean Bevan was Professor and Head of the Department of Surgery at Rush Medical College in Chicago and later President of the American Medical Association and the American Surgical Association. In 1899, He brought the Schüller’s concepts, such as division of the processus vaginalis, to the United States for the first time and took another step further, emphasizing the ten- sion-free mobilization of the testis to the scrotum by releas- ing the spermatic vessels to the retroperitoneum and possi- ble resection of them to gain further length [23]. He claimed that the need for spermatic vessel division would be less- ened after increased study and experience. He also de- scribed sewing the deep layer of the superficial fascia to the aponeurosis of the external oblique to prevent retraction of the testis, using a purse-string technique. With these kinds of modifications, he reported his results in over 400 cases with an overall success rate of approximately 95% [24]. 　Bevan also recommended the early correction of un- descended testis. His statement was further supported by Eisendrath, who showed a 90% occurrence of seminiferous tubule atrophy by 2 years of cryptorchidism [25]. This was followed by the landmark animal study by Carl Moore, who observed loss and recovery of testicular function after sur- gical cryptorchidism and orchiopexy, respectively [26]. 　From Bevan’s work, three main issues concerning the surgical treatment of the undescended testis became appa- rent: the requirement for mobilization of the cord, the ques- tionable necessity of division of the spermatic vessels to gain additional cord length, and the debate between trac- tion and tension-free repositioning of the testis within the scrotum. 　In the beginning of the 20th century, several concepts concerning cryptorchidism that are currently useful for un-