indicated because of cancer, trauma, or infection of the testis. In benign conditions, a
prosthesis may be implanted for cosmetic or psychological reasons. Prostheses are
usually made of silicone rubber.
b. Operative Procedure.
(1) The upper anterior surface of the scrotum is incised over the testicle.
The incision is carried through the skin and fascial layers to expose the tunica vaginalis.
Retractors are placed and bleeding vessels clamped and tied.
(2) The tunica vaginalis is grasped and mobilized. The spermatic cord is
dissected free up to the external abdominal ring, clamped, and ligated. The testis is
removed. Bleeding is controlled. A small Penrose drain may be placed in the wound.
Fine sutures of plain gut number 3-0 or nylon number 4-0 are used to close the wound.
a. General. This operation involves the suspension of the testis within the
scrotum. An undescended (cryptorchid) testis is one that has failed to move properly
into the normal intrascrotal position. A retractile testis is one that has descended
through the inguinal canal but lies either within or superficial to the external ring. An
ectopic testis is one that has descended through the canal and rests in an abnormal
position (the perineal femoral area or lateral to the canal). When this operation is done
on young boys, the primary goal is to obtain adequate length of the spermatic vessels
and the vas to allow the testis to lie in the scrotum.
b. Operative Procedure (Transverse Inguinal Approach).
(1) An incision is made at the internal inguinal ring, the inguinal canal is
opened, and the testis and cord freed. Another incision is made at the external inguinal
ring and the testis is brought through the incision and into the scrotum to the proper
(2) The reconstruction of the muscle closure of both the internal ring and the
external oblique is accomplished, using fine interrupted silk or chromic sutures.
The subcutaneous tissue and skin are closed with fine sutures, as
3-38. HYPOSPADIAS REPAIR
a. General. This surgery involves penile straightening and urethral
reconstruction. Because the deformities are usually multiple, correction is usually
accomplished in several stages, allowing several months to elapse between operations.
The various techniques employed are for the purpose of providing a straight penis and
establishing an effective urethral orifice.