Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery.

Background: Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable.

Methods: This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor.

Results: Out of 11 boys included in the study, 7 (63.63%) had failed orchidopexy. Another 3 (27.27%) were opened for 2nd stage orchidopexy and 1 (9.09%) had iatrogenic ascent of testis after herniotomy. On clinical examination 4 (36.36%) had a palpable testicle at the superficial ring, 2 (18.18%) were in inguinal canal (1 doubtful!), and no testicle could be palpated in 5 (45.45%). Ultrasonography picked up 2 testicles (18.18%) at the superficial Inguinal ring, 1 (9.09%) in Inguinal canal and 1 (9.09%) testicle in the abdominal cavity. On reexploration, 10 (90.9%) testicles were found and brought down, 7 (63.63%) being considered of reasonable consistency and size. Another 3 (27.27%) were considered soft or small in size, and in 1 (9.09%)), no testicle was found. In 5 patients (45.45%), the testicle was at superficial ring, in 3 (27.27%) in the inguinal canal, and in 2 (18.18%) in the abdominal cavity. Results were considered good in 6 (54.54%), fair in 3 (27.27%)) and poor in 2 (18.18%).

Conclusion: Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent