A Novel Technique of Circumcision Incision Orchidopexy
Condition: Cryptorchidism; Undescended Testis
MeSH terms: Cryptorchidism
Study type: Observational

Summary: 
      Given that both circumcision and orchidopexy are commonly done in a single setting, the
      investigators adopted the technique of orchidopexy via circumcision incision, particularly
      for palpable low inguinal cryptorchidism. In this paper, the investigators aim to present a
      novel technique and discuss our preliminary outcome of such procedure compared to the
      traditional inguinal-scrotal double incision technique. Specifically, the investigators aimed
      to determine the differences in operative time, testicular size changes, peri-operative
      complications, pain score and parent's satisfaction of both novel technique and conventional
      orchidopexy.
    

Detailed description: 
      Cryptorchidism is the most common disorder of the male endocrine gland in children.. 1
      According to the latest guideline by European Association of Urology in the Pediatric Urology
      for the treatment of cryptorchidism, both inguinal and scrotal approaches orchidopexy are
      accepted standard treatment options. 2 In the local setting, circumcision is another common
      surgical procedure among the children, particularly under the same instance of anesthesia for
      other procedure. Not only due to religious and sociocultural reasons, male circumcision has
      been recently considered having a protective effect against acquisition of various sexually
      transmitted infections (STIs). 3 This benefit is one of many that have led to many
      affirmative evidence-based policy statements by medical bodies in support of the procedure.

      Given that both procedures are commonly done in a single setting, we adopted the technique of
      orchidopexy via circumcision incision, particularly for palpable low inguinal cryptorchidism.
      In this paper, we aim to present a novel technique and discuss our preliminary outcome of
      such procedure compared to the traditional inguinal-scrotal double incision technique.
      Specifically, we aimed to determine the differences in operative time, testicular size
      changes, peri-operative complications, pain score and parent's satisfaction of both novel
      technique and conventional orchidopexy.
    

Intervention name(s): Novel technique Circumcision Incision Orchidopexy
Intervention type(s): Procedure
Intervention description(s): The novel technique starts with retraction of the prepucial skin off the glans penis and double incision circumcision done with mucosal sparing, then degloving of the penis on the side of the undescended testis. Dissection via Dartos' layer into the inguinal area until the palpable testicle was identified and extracted with mobilization of the spermatic cord. Hernia sac was then separated and suture ligated as high as the area of internal ring opening. Spematic cord lengthening was done until adequate length achieved for fixation into the inferior aspect of the scrotum. Then development of the Dartos' pouch via the circumcision site was done. A double or single suture testicular fixation using Vicryl 3-0 simple interrupted sutures on the everted Dartos' pouch inner surface was done. Subsequent placement of the testicle into the Dartos' pouch was done as the inner surface was inverted. The last step was the completion of the circumcision closure using Chromic 4-0 interrupted sutures.
Other intervention name(s): Chua's Procedure
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Children diagnosed with palpable cryptorchidism with pre-operative inguino-scrotal
        ultrasound to confirm the location of the testis on the low inguinal canal and its
        viability. Recruited from September 2013- September 2014