Laparoscopic Versus Open Orchiopexy For Palpable Undescended Testes: Systematic Review And Meta-Analysis
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In brief
In brief
This systematic review and meta-analysis compares laparoscopic versus open orchiopexy for palpable undescended testes, finding no significant differences in success or complication rates between approaches. The evidence suggests open orchiopexy offers better cost-effectiveness and should remain first-line, though laparoscopic techniques are viable alternatives when high dissection and Prentiss maneuvers are avoided.
Written by the GCMD Library team from the article.
Background/Purpose
: Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO of palpable UDT in relation to high retroperitoneal dissection, Prentiss maneuver and intrascrotal testis fixation; also, to identify evidence for the safety, efficacy and cost of LO compared with OO in palpable UDT.
Methods
: Systematic search was performed for all studies on LO for palpable UDT, and for all comparative studies between LO and OO in palpable UDT. Fisher's test was used to assess associations between success/complications rates and different LO approaches and meta-analysis to compare LO and OO.
Results
: In LO, success rates were not affected by regular high dissection (p=1.0), Prentiss maneuver (p=1.0) or intrascrotal fixation (p=1.0); in fact, higher complications rates were noticed with regular high dissection (p=0.002) and Prentiss maneuver (p=0.01). Meta-analysis showed no significant differences between LO and OO in success (p=0.17) and complications (p=0.14) rates, while LO cost was higher in all comparative studies.
Conclusions
: Evidence shows higher benefit-cost ratio for OO and, therefore, the latter should remain the procedure of choice. LO can be alternatively used, as it shows comparable safety/efficacy, but it should not include high dissection, Prentiss maneuver and testis fixation, when unnecessary.
Type of study
: Systematic review and meta-analysis
Level of Evidence
: III