The gold-standard orchidopexy procedure in boys with an undescended testis (UDT) involves inguinal exploration with a subsequent scrotal incision to allow placement of the mobilized testis. Alternative procedures have been proposed, including laparoscopic approaches and single-incision techniques, which aim to provide minimal invasiveness, reduced morbidity and improved cosmetic outcomes. The Bianchi procedure was the first technique to be described that used an initial single scrotal incision in children with a palpable UDT. It is considered more technically demanding than the standard approach, and its applicability in cases of impalpable UDT has been a topic of debate. Urologic surgeon Piet Callewaert at the Maastricht University Medical Centre, The Netherlands, has now reported his experience of this technique in cases of both palpable and impalpable UDT.

...initial scrotal incision can be recommended as a safe and effective orchidopexy technique...

All orchidopexy procedures performed during 2003–2008 were included in this analysis. A total of 194 procedures were performed in 154 children (mean age 71 months, range 4–229 months). 40 patients had bilateral, palpable UDT. Impalpable UDT was present in 46 patients.

All 148 procedures in boys with palpable UDT were completed successfully using the single-incision technique, with none requiring additional laparoscopy or conversion to an inguinal approach. Of the 46 procedures in boys with unilateral, impalpable UDT, 36 were successfully completed via the single scrotal incision. 15 of these 36 boys had an abdominal UDT, 11 of which were successfully corrected via the initial scrotal incision (the remaining 4 required additional laparoscopy).

An additional inguinal incision was required in 2 cases of impalpable, high-inguinal UDT because of difficulty managing the open processus vaginalis through the scrotal incision; however, these cases occurred early in the series, and similar cases were manageable through the initial scrotal incision as the surgeon gained experience.

Complications occurred in 4 (2%) of 194 procedures, and all testes remained in the scrotum after a mean follow-up of 10 months. The authors conclude that the use of an initial scrotal incision can be recommended as a safe and effective orchidopexy technique in patients with either palpable or impalpable UDT.