History of Orchiopexy for Cryptorchidism derstanding the disease were accepted, such as the preva- lence of hernias, the possibility of torsion, the malignant potential of the ‘‘arrested’’ testis, and functional limi- tations of cryptorchid testis, both in terms of spermato- genesis and hormone production. These were well sum- marized by Eccles in a lecture named “The Anatomy, Physiology, and Pathology of the Imperfectly Descended Testis’’ [27,28]. 　Some surgeons tried to overcome the problem of a short length of spermatic cord. They fixed the testis to another site, such as the fascia lata or contralateral testis, for the purpose of possible lengthening of the cord. Torek in Newyork and Keetley in England independently reported the technique of fixation in the fascia lata in a similar period [29,30]. The testis was recommended to be kept in situ for 3 to 6 months and then detached carefully and repositioned in the scrotum. Torek also reported 64 cases of successful staged operation, which did not need to divide the sper- matic vessels [29]. 　The concepts of continuous traction were revisited by Cabot and Nesbit of Michigan University again with the use of a rubber band and wire cage for approximately 12 days [31]. 　Although there is enthusiasm for one stage repair of or- chiopexy, some difficult cases with short testicular cord will benefit by the judicious use of staged operations with trac- tion of the testicular cord for the time being. This concept is still valid and is applied to some staged operations. Robert J. Prentiss of San Diego County Hospital added ad- ditional technical insight with his detailed depiction of the surgical anatomy of the spermatic vessels and the anatom- ic proof that relative lengthening of the spermatic cord could be achieved by division of the inferior epigastric ves- sels and medial displacement of the spermatic vessels [32]. 　The current method of testicular fixation within the sub- dartos pouch was first described by Schoemaker [33] in 1932 but was popularized by John K. Lattimer [34], at Columbia University, in 1957. He also worked out a way to implement gentle traction via an elastic band anchored in the vicinity of the patient’s knee for 10 days. 　With the inclusion of the subdartos pouch technique, the four key steps of standard orchiopexy were established just before the 1960s. The standard orchiopexy can be applied to almost all undescended testes with the exception of high undescended testes. The success rate ranges from 89% to 92%. Therefore, attention has turned to the treatment of high undescended testes which were not adequately treat- ed by standard orchiopexy. ESTABLISHMENT OF CURRENT ORCHIOPEXY In 1979, Jones and Bagley suggested a high inguinal in- cision as the open surgical alternative for high canalicular or intraabdominal testes [35]. A transverse incision is made medial to the anterior superior iliac spine and carried down to the external oblique fascia just superior to the in- ternal ring. This incision made it possible to approach the 159 peritoneal cavity easier than through a standard inguinal incision. The point is the preservation of the spermatic ves- sels, high retroperitoneal mobilization of the spermatic vessels, and passage of the testis directly through the ab- dominal wall at the pubic tubercle (Prentiss maneuver). This procedure shares similar indications and surgical principles with laparoscopic orchiopexy and was the popu- lar surgical approach before the advent of laparoscopic management of an intra-abdominal testis. 　In case of a high undescended testis, the testicular artery and veins often limit the distal mobility of these testes. As mentioned earlier, attempts to divide the testicular artery were made well before the 20th century. However, a high atrophy rate precluded wide application. In 1959, Fowler and Stephens [36] studied the vascular anatomy of the tes- tis and devised a means to repair a high undescended testis and preserve its blood supply via collateral circulation. Children with a long, looping vas that extends down the in- guinal canal are the ideal candidates for this surgery, but less than one third of the children with intraabdominal testes were found to have this condition. Originally, Fowler and Stephens orchiopexy was known as a staged technique but it was further modified into a 2-staged operation with a better success rate (77% vs. 67%). 　Prior to 1976, the non-palpable testis was only located by inguinal exploration. However Cortesi et al [37] first de- scribed the laparoscopy as a modality that could reveal the location of non-palpable testis. With increased experience, its indication was further expanded to therapeutic pur- poses. Bloom in 1991 described a procedure for staged pel- viscopic orchiopexy [38]. The pure one-stage laparoscopic orchiopexy was first reported by Jordan and Winslow [39]. Therapeutic laparoscopy has the advantage of 1) high mag- nification and improved visualization 2) capability of ex- tensive vascular dissection up to the origin of gonadal ves- sels, 3) minimal morbidity, and 4) the ability of creating a new internal ring medial to inferior epigastric vessels to achieve the straight vascular course to the scrotum. 　Laparoscopic orchiopexy can be conducted as either one-stage orchiopexy with preservation of spermatic ves- sels or Fowler and Stephens orchiopexy. While current or- chiopexy includes a variety of methods, all methods stem from the basic concepts of standard orchiopexy. CONCLUSIONS More than 200 years ago, the discussion of cryptorchidism began and the surgical techniques and philosophies have continued to evolve. The current technique of standard or- chiopexy is the end result of evolved concepts. A study of the history of surgical management of the undescended tes- tis sheds light on the rationale behind the current management. Conflicts of Interest The authors have nothing to disclose. Korean J Urol 2010;51:155-160