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The edges of the cremaster are grasped with hemostats and dissected off the internal spermatic fascia medially and laterally. This is best accomplished by gently pulling the internal spermatic fascia downward off the underside of the cremaster until the medial and lateral flaps are fully developed. The base of the cephalad cremaster flap is attached to the internal oblique muscle above the cord, and the lateral flap is attached to transversalis just above inguinal ligament.