Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials

Introduction: Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making. Materials and methods: A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study’s quality was conducted by utilizing the revised Cochrane risk-of-bias tool. Results: Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: − 15.06 min; 95% CI: − 21.04 to − 9.08). However, there was no significant difference in hospitalization duration (WMD: − 0.72 days; 95% CI: − 1.89–0.45), total complications (OR: 1.08; 95% CI: 0.70–1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27–1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38–2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67–3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges. Conclusion: Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.