Summary
Introduction
Ascending testis (AT) is a rare complication after repair of an inguinal hernia/hydrocele.
However, there has been some controversy concerning the AT following laparoscopic
and open procedures.
Objective
To review the experience of, and discuss the associated mechanisms with, testicular
ascent after pediatric inguinal hernia/hydrocele surgery.
Study design
A retrospective review of the medical records of male children who underwent inguinal
hernia/hydrocele repair at the present hospital between January 2000 and December
2014. Those who underwent subsequent orchiopexies due to ipsilateral cryptorchidism
were identified. The ATs that were misdiagnosed, caused by improper operation, and
retractile testes were excluded. The Poisson distribution evaluated the incidences
of subgroups.
Results
A total of 17,295 inguinal hernias and hydroceles were repaired on 12,849 males; of
whom, 10 testes (0.058%) developed ATs on nine individuals postoperatively (Summary
Table). The difference of AT incidences between subgroups was insignificant (P > 0.05), except for that grouped by the age at initial operation (cutoff = 1 year,
P = 0.008; cutoff = 2 years, P = 0.012). During orchiopexy, extensive adhesions were found in the inguinal canal
only in the two cases following open repair. The hernia sac/processus vaginalis remained
intact in the canal of AT after laparoscopic repair, and partial after open herniotomy.
Discussion
It was generally assumed that testicular ascent after repair of an inguinal hernia/hydrocele
was caused by adhesion of the spermatic cord. However, the cord was not dissected
during laparoscopic procedure, so adhesion was not the major reason for AT following
laparoscopic surgery. The sac/processus were partially excised during open repair,
but kept intact in laparoscopic procedure. Therefore, remnants of the sac/processus
might play a greater role in postoperative testicular ascent than adhesions. Furthermore,
it was found that AT incidence after the repair was not higher than that in ‘normal’
males. Ascending testis was probably not an operative complication, but a natural
descent process of testis independent of the operation. Moreover, the testis descended
further due to dissection of the cord and excision of the sac/processus, so the AT
incidence was extremely low following open operation. From this point of view, open
repair of an inguinal hernia/hydrocele was probably a protective factor for preventing
testicular ascent.
Conclusion
Summary TableGeneral characteristics of patients with inguinal hernia/hydrocele repairs and ascending
testis after the repairs.
| Patients underwent repair of an inguinal hernia/hydrocele | Patients with ascending testis after the repairs | |
|---|---|---|
| Age, median (range) | 3.19 years (10 days–12 years) | 4.33 years (1–8 years) |
| Birth weight, median (range) | 3.4 kg (1.5–5.0) | 3.02 kg (1.6–3.7) |
| Number of patients | 12,849 | 9 |
| Open/laparoscopic | 6500/6379 | 2/7 |
| Inguinal hernia/hydrocele | 9388/3461 | 8/1 |
| Right/left/bilateral | 7793/3118/1968 | 3/5/1 |
| Preterm/full-term | 462/12,387 | 2/7 |
| Age ≤1 year/>1 years | 7180/5669 | 1/8 |
| Age ≤2 years/>2 years | 9336/3513 | 2/7 |
| Birth weight <2.5 kg/≥2.5 kg | 319/12,530 | 1/8 |
Keywords
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Article info
Publication history
Published online: September 28, 2016
Accepted:
August 11,
2016
Received:
April 27,
2016
Identification
Copyright
© 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
