One Stage Rotation Flap Scrotoplasty and Orchidopexy For the Correction of Ectopic Scrotum

Urology Case Reports
13 Apr, 2019 ,

A 2-year-old boy presented with ectopic scrotum, low lesion imperforate anus, spina bifida, and pubic diastasis since birth. Correction of the ectopic scrotum and concomitant bilateral orchidopexy in one stage of surgery was performed. This procedure is relatively simpler to perform and gives out a favorable cosmetic result.

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A 2-year-old boy was presented with ectopic scrotum, anal atresia, spina bifida and pubic diastasis since birth. The child underwent posterior sagittal anorectoplasty in June 2016, followed by spina bifida closure in February 2017. Upon clinical examination, right hemiscrotum was normal in size and location with normal testicle located in the high scrotal position. The left hemiscrotum was present in the left inguinal region, with the left testicle located below the superficial inguinal ring. Scrotal raphe and the phallus developed normally. The sizes of both testicles were approximately 30 × 20 mm. Pelvic X-ray revealed pubic diatheses which were decided in a conference with pediatric orthopedics to be left alone due to the risk of surgery outweighing the benefits. We performed correction of the ectopic scrotum and bilateral orchidopexy in one stage of surgery.

An inguinal incision was first performed on the left side to mobilize the funiculus until the left testis was able to be moved down to the anatomical position of the scrotum. This was followed by correction of the ectopic scrotum that was initiated with a Y incision that extends from the right hemiscrotum until it reached the ectopic scrotal sac. An inguinal rotational scrotal skin flap was used to relocate the scrotal sac. The median raphe and two hemiscrotum sacs were constructed inferiorly to the penis, where the scrotal sac should have formed. Bilateral orchidopexy was performed afterwards, started with positioning the left testis in the left hemiscrotum sac with the fixation of tunica vaginalis using Vicryl® 4.0 with anchoring suture in the 6 0′clock direction. The fixation of the right testis to the right hemiscrotal sac was also performed afterwards followed by adequate skin closure.