Transparenchymal testicular suture: A systematic review and meta-analysis highlighting the impact of additional fixation suture during routine orchiopexy

Published:December 18, 2020DOI:



      Orchiopexy for cryptorchidism is one of the common day-care surgeries performed by pediatric surgeons across the globe. Although majority of the surgeons reposition the testis into a sub-dartos pouch, the practice of taking an additional transparenchymal anchoring suture is often debated. The potential risks include impaired spermatogenesis and sub-fertility. Also, a consensus statement regarding the superiority of suture fixation over no suture fixation, in terms of prevention of recurrence of cryptorchidism, is lacking. This systematic review and meta-analysis aims to compare the outcomes of orchiopexy between the two groups i.e. without (Group A) and with the transparenchymal suture fixation (Group B).


      The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through October, 2020 for comparative studies. Statistical analysis was performed using a fixed-effects model; and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale.


      Five comparative studies, comprising a total of 734 and 1002 children within the groups A and B respectively, were recruited in this study. As compared to the children belonging to group A, a significantly higher incidence of recurrence of cryptorchidism (RR 1.75; 95% CI 1.10–2.80, p = 0.02) was observed among the children of group B. However, the difference in the incidence of testicular atrophy could not reach statistical significance (RR 1.56; 95% CI 0.23–10.50, p = 0.65). The average Downs and Black scale scores ranged from 15 to 21.5, with all the studies having moderate to high-risk of bias.


      The present meta-analysis revealed superiority of orchiopexy performed without transparenchymal suture fixation in terms of recurrence of cryptorchidism. Although, the incidence of testicular atrophy was higher among the children belonging to the suture group, no statistically significant difference was observed among the two groups. However, the level of evidence of the published comparative studies is limited. Therefore, it is recommended to focus on adequate mobilization of the testis and its positioning in the sub-dartos with minimal tension rather than over-reliance on futile adjuncts like taking transparenchymal testicular suture.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Koh Y.H.
        • Granger J.
        • Cundy T.P.
        • Boucaut H.A.
        • Goh D.W.
        Sutured point-fixation versus Jaboulay fixation for salvaged testicular torsion in children.
        J Pediatr Surg. 2019; 54: 2631-2635
        • Frank J.D.
        • O'Brien M.
        Fixation of the testis.
        Br J Urol Int. 2002; 89: 331-333
        • Hoseinpour M.
        • Memarzadeh M.
        • Sadeqi A.
        Comparative investigation of two surgical techniques of orchiopexy in the post-operative recurrence rate and testicular size in children in clinical trial study.
        Adv Biomed Res. 2015; 4: 171
        • Ritchey M.L.
        • Bloom D.A.
        Modified dartos pouch orchiopexy.
        Urology. 1995; 45: 136-138
        • Steinbecker K.M.
        • Teague J.L.
        • Wiltfong D.B.
        • Wakefield M.R.
        Testicular histology after transparenchymal fixation using polytetrefluoroethylene suture: an animal model.
        J Pediatr Surg. 1999; 34: 1822-1825
        • Coughlin M.T.
        • Bellinger M.F.
        • LaPorte R.E.
        • Lee P.A.
        Testicular suture: a significant risk factor for infertility among formerly cryptorchid men.
        J Pediatr Surg. 1998; 33: 1790-1793
        • Uijldert M.
        • Meißner A.
        • Kuijper C.F.
        • Repping S.
        • de Jong T.
        • Chrzan R.J.
        Orchidopexy for bilateral undescended testes: a multicentre study on its effects on fertility and comparison of two fixation techniques.
        Andrologia. 2019; 51e13194
        • Bellinger M.F.
        • Abromowitz H.
        • Brantley S.
        • Marshall G.
        Orchiopexy: an experimental study of the effect of surgical technique on testicular histology.
        J Urol. 1989; 142: 553-555
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of health care interventions.
        J Epidemiol Community Health. 1998; 52: 377-384
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Atici A.
        • Celikkaya M.E.
        • Akcora B.
        Is fixation suture necessary in undescended testicle surgery?.
        Ann Med Res. 2019; 26: 1275-1278
        • Hirner L.
        • Rübben I.
        • Lax H.
        • Hirner C.
        • Panic A.
        • Darr C.
        • et al.
        The value of an additional scrotal suture during orchidopexy.
        J Pediatr Urol. 2020; (In Press [Epub- October 21, 2020])
        • Meyer T.
        • Höcht B.
        Long term results of orchidopexy: transscrotal fixation versus Dartos-pouch.
        Zentralbl Chir. 2004; 129: 476-479
        • Ghnnam W.M.
        • Saed B.
        • Ghazy H.
        A modified technique for scrotal fixation during orchiopexy.
        Afr J Paediatr Surg. 2011; 8: 203-205
        • Elder J.S.
        Surgical management of the undescended testis: recent advances and controversies.
        Eur J Pediatr Surg. 2016; 26: 418-426
        • Welch K.J.
        Orchiopexy: a new anchoring technique, window septopexy.
        J Pediatr Surg. 1972; 7: 163-167
        • Williams C.
        Orchiolysis: correction of the undescended testicle without fixation.
        Br J Urol. 1973; 45: 437-440
        • Surer I.
        • Demirbag S.
        • Ozturk H.
        • Cetinkursun S.
        • Oğus E.
        • Surer H.
        Effects of testicular fixation on oxidative stress-related parameters in prepubertal rat testis.
        Arch Androl. 2006; 52: 71-78
        • Ribeiro C.T.
        • De Souza D.B.
        • Costa W.S.
        • Pereira-Sampaio M.A.
        • Sampaio F.J.B.
        Effects of testicular transfixation on seminiferous tubule morphology and sperm parameters of prepubertal, pubertal, and adult rats.
        Theriogenology. 2015; 84: 1142-1148
        • Kozminski D.J.
        • Kraft K.H.
        • Bloom D.A.
        Orchiopexy without transparenchymal fixation suturing: a 29-year experience.
        J Urol. 2015; 194: 1743-1747
        • Docimo S.G.
        The results of surgical therapy for cryptorchidism: a literature review and analysis.
        J Urol. 1995; 154: 1148-1152
        • Pedersen M.R.
        • Osther P.J.S.
        • Rafaelsen S.R.
        Ultrasound evaluation of testicular volume in patients with testicular microlithiasis.
        Ultrasound Int Open. 2018; 4: E99-e103
        • Condorelli R.
        • Calogero A.E.
        • La Vignera S.
        Relationship between testicular volume and conventional or nonconventional sperm parameters.
        Int J Endocrinol. 2013; 2013: 145792