1
|
Arena L, Szklarz T, Costabel M, Maguiña P, De Carli C. A Case of Conservative Management of Intra-abdominal Polyorchidism in a Child. Urology 2023; 176:187-189. [PMID: 36948361 DOI: 10.1016/j.urology.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
Polyorchidism is defined as the presence of 2 or more testes on the same side. A 7-year-old boy (46 XY) with multiple congenital abnormalities and nonpalpable bilateral gonads is presented. He underwent diagnostic laparoscopic surgery at 8 months old which revealed duplicated right testes and contralateral presence of persistent left Mullerian duct structures. A successful Fowler-Stephens orchidopexy in 2 stages was performed on both testicles. Postoperative ultrasonography showed orthotopic right testes of 0.15 and 0.28 cc. We propose testicular preservation in these patients to prevent early anorchia.
Collapse
Affiliation(s)
- Luciano Arena
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina.
| | - Tatiana Szklarz
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Macarena Costabel
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Pamela Maguiña
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Claudio De Carli
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| |
Collapse
|
2
|
Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
Collapse
Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
| |
Collapse
|
3
|
Abdelhalim A, Chamberlin JD, Young I, Fahim M, Chuang KW, McAleer IM, Wehbi E, Stephany HA, Khoury AE. Testicular Volume Changes in Laparoscopic Staged Fowler-Stephens Orchiopexy: Studying the Impact of Testicular Vessel Division. Urology 2019; 127:113-118. [DOI: 10.1016/j.urology.2019.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/16/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
|
4
|
Bipolar diathermy as another method for testicular vascular division in laparoscopic two-stage Fowler–Stephens orchidopexy. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000544637.78778.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
5
|
Bagga D, Prasad A, Grover SB, Sugandhi N, Tekchandani N, Acharya SK, Samie A. Evaluation of two-staged Fowler-Stephens laparoscopic orchidopexy (FSLO) for intra-abdominal testes (IAT). Pediatr Surg Int 2018; 34:97-103. [PMID: 28980063 DOI: 10.1007/s00383-017-4170-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The best operative intervention for intrabdominal testis (IAT) has not been standardized as yet. The question of whether to bring down an IAT with a single-staged vessel-intact laparoscopic orchidopexy (VILO) or a two-staged laparoscopic Fowler-Stephens orchidopexy (FSLO) is still undergoing debate, with both the procedures being popular. The present study has been designed to evaluate the factors predicting the success or failure of two-staged FSLO for (IAT). METHODS 43 boys with 49 non-palpable testes underwent diagnostic laparoscopy out of which 35 underwent two-staged FSLO. Size of the testis was measured with a graduated probe in both stages. Independent variables such as age, height, testis-to-internal ring distance (T-IR), neo internal ring-to-midscrotal distance (NIR-MS), and mobility-to-contralateral ring (MCIR) were analysed. Postoperatively 34 IATs were followed up clinically as well as ultrasonologically after 6 months, to see for the size, position, and vascularity. Based on this, the patients were divided into two groups, Group A (successful) and Group B (Failed). RESULTS 24 IATs had a successful outcome (Group A) and 11 were failure (Group B). The overall success rate of the study was 68.6%. The difference in mean age of patients in both groups was insignificant (p = 0.89) (Fig. 1), and similarly, the difference in mean height was insignificant (p = 0.61). The difference in mean T-IR in both the groups was insignificant (1.85 versus 2.77 cm; p = 0.09) and mean NIR-MS was 5.41 cm in Group A and 5.10 cm in Group B, and the difference again was insignificant (p = 0.23). CONCLUSION The success rate of FSLO was 68.6%. None of the above-described independent variables have any effect on the outcome of two-staged FSLO. While VILO remains the treatment of choice for IAT located at or near the ring, but IAT higher than this, two-staged FSLO gives a better chance for achieving intra-scrotal orchidopexy.
Collapse
Affiliation(s)
- Deepak Bagga
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Ashish Prasad
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
| | - Shabnam Bhandari Grover
- Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Nidhi Sugandhi
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Narender Tekchandani
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Samir Kant Acharya
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Amat Samie
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| |
Collapse
|
6
|
Treatment of impalpable testis - one clinic's experience. Wideochir Inne Tech Maloinwazyjne 2017; 12:166-171. [PMID: 28694903 PMCID: PMC5502339 DOI: 10.5114/wiitm.2017.67482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/26/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Undescended testes are recognised in 1% to 2% of boys during the first year of life, and about 20% of them are impalpable. Ultrasonography (US) may establish the localisation of the testis but the final diagnosis is usually determined laparoscopically. Aim To evaluate long-term results of laparoscopic treatment of boys with impalpable testes and sensitivity of preoperative ultrasound. Material and methods Between 2011 and 2015, we operated on 545 boys with undescended testes. Sixty-two of them with 65 impalpable testes were treated laparoscopically – the study group. Mean age was 3.5 years. The study group was divided into 5 groups according to type of treatment. The volume and position of the operated gonad were assessed manually and by ultrasound. Results In group 1 testicular agenesis was observed in 19 patients. In group 2 revision of the inguinal canal revealed testicular agenesis in 7 and atrophy in 4 patients. In group 3 conversion to classic orchiopexy was performed in 10 patients. In group 4 one-stage orchiopexy was performed in 9 patients on 12 testes. In group 5 a two-stage F-S procedure was performed in 13 patients. Ten testes in group 4 had a volume in the normal range (84%) and also 10 testes in group 5 (77%). Conclusions Laparoscopy in impalpable testes is the procedure of choice and allows definitive management, even when conversion to open procedure is necessary. Sensitivity of preoperative ultrasound is generally about 60% for true intra-abdominal testes, so diagnostic laparoscopy is necessary.
Collapse
|
7
|
Abstract
PURPOSE While the nonpalpable testis represents a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Controversy exists surrounding the best evaluation and management of this entity. In this review we update what is known about the nonpalpable testis, including the etiology, preoperative evaluation and best surgical management as well as novel techniques and ongoing controversies. MATERIALS AND METHODS We searched PubMed® and MEDLINE® from January 2000 to January 2017 using relevant key terms. Of 367 articles 115 were considered for inclusion based on a priori design. Using a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. RESULTS The nonpalpable testis should be evaluated by physical examination only. Imaging is not indicated for routine cases. The optimal surgical approach and technique remain debatable but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trials and other quality comparisons are difficult. Therefore, management remains controversial. CONCLUSIONS Evaluation and management of the nonpalpable testis remain difficult, and some aspects are still debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.
Collapse
Affiliation(s)
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
8
|
Abstract
The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.
Collapse
Affiliation(s)
- Himanshu Aggarwal
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| | - Barry A Kogan
- Albany Medical College and The Urological Institute of Northeastern New York, Albany, NY 12208, USA
| |
Collapse
|
9
|
Hamidi N, Telli O, Bagci U, Esen B, Karagoz MA, Hascicek AM, Soygur T, Burgu B. Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes. Front Pediatr 2016; 4:13. [PMID: 26973822 PMCID: PMC4778551 DOI: 10.3389/fped.2016.00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/15/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To date, laparoscopy has gradually become the gold standard for treatment of non-palpable testicles (NPT) with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT. MATERIALS AND METHODS We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy (LAO) and two-stage Fowler-Stephens technique (FST) was performed for 45 and 37 patients, respectively. Age (at surgery), follow-up time, laterality of testes, and postoperative complications were analyzed. Modified Clavien classification system (MCCS) was used for evaluating complications. RESULTS The median age (at surgery) and median follow-up time were 18 (range: 6-56) and 60 (range: 9-130) months, respectively. Overall success rate for two laparoscopy techniques was 87.8% during the maximal follow-up time. We observed wound infection in two, hematoma in one, testicular atrophy in five, testicular re-ascending in two patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade I (five vs. two patients, p = 0.14) and grade IIIb MCCS complications (five vs. two patients, p = 0.44). CONCLUSION Our results have shown that two laparoscopic approaches have low complication rates.
Collapse
Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Onur Telli
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Uygar Bagci
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Baris Esen
- Department of Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital , Ankara , Turkey
| | | | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine , Ankara , Turkey
| |
Collapse
|
10
|
The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study. Can J Anaesth 2015; 62:798-806. [DOI: 10.1007/s12630-015-0369-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022] Open
|
11
|
Alagaratnam S, Nathaniel C, Cuckow P, Duffy P, Mushtaq I, Cherian A, Desai D, Kiely E, Pierro A, Drake D, De Coppi P, Cross K, Curry J, Smeulders N. Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy. J Pediatr Urol 2014; 10:186-92. [PMID: 24045121 DOI: 10.1016/j.jpurol.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO). PATIENTS AND METHODS Retrospective review of 94 children (aged 0.75-16 years, median 2.75 years), who underwent L2(nd)FSO for 113 intra-abdominal testes between January 2000 and May 2009: 75 unilateral, 19 bilateral (11 synchronous; 8 metachronous). Follow-up (range 3 months-10.9 years, median 2.1 years) was available for 88 children (102 testes: 71 unilateral, 31 bilateral). RESULTS Testicular atrophy occurred in 9 out of 102 (8.8%), including 8 out of 71 (11.3%) unilateral and 1 out of 31 (3.2%) bilateral intra-abdominal testes (multivariate analysis: p = 0.59). Testicular ascent ensued in 9 out of 102 (8.8%), comprising four (5.6%) unilateral and five (16.1%) bilateral testicles (multivariate analysis: p = 0.11). Of the 18 bilateral testes brought to the scrotum synchronously none atrophied and four (22.2%) ascended, compared to one (7.7%) atrophy and one (7.7%) ascent among the 13 testes brought to the scrotum on separate occasions (Fisher exact test: p = 0.42 and p = 0.37, respectively). Mobilization of the testis through the conjoint tendon tended towards less ascent (multivariate analysis p = 0.08) but similar atrophy (p = 0.56) compared to mobilization through the deep-ring/inguinal canal. Logistical regression analysis identified no other patient or surgical factors influencing outcome. CONCLUSIONS This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.
Collapse
Affiliation(s)
- Swethan Alagaratnam
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Calvin Nathaniel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Peter Cuckow
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Patrick Duffy
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Abraham Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Divyesh Desai
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Edward Kiely
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Agostino Pierro
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - David Drake
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Kate Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| |
Collapse
|
12
|
Castillo-Ortiz J, Muñiz-Colon L, Escudero K, Perez-Brayfield M. Laparoscopy in the surgical management of the non-palpable testis. Front Pediatr 2014; 2:28. [PMID: 24783184 PMCID: PMC3986523 DOI: 10.3389/fped.2014.00028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/24/2014] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). METHODS From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient's age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher's exact test for two independent proportions was used for statistical analysis and reported our results. RESULTS One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. CONCLUSION Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings.
Collapse
Affiliation(s)
| | - Luis Muñiz-Colon
- Division of Urology, University of Puerto Rico , San Juan, PR , USA
| | - Karina Escudero
- Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
| | - Marcos Perez-Brayfield
- Division of Urology, University of Puerto Rico , San Juan, PR , USA ; Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
| |
Collapse
|
13
|
Mehendale VG, Shenoy SN, Shah RS, Chaudhari NC, Mehendale AV. Laparoscopic management of impalpable undescended testes: 20 years' experience. J Minim Access Surg 2013; 9:149-53. [PMID: 24250059 PMCID: PMC3830132 DOI: 10.4103/0972-9941.118822] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/28/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years. MATERIALS AND METHODS From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler - Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite. RESULTS None of the testis atrophied after two-stage Fowler - Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy. CONCLUSIONS Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler - Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler - Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.
Collapse
Affiliation(s)
- Vinay G Mehendale
- Medico Surgical Clinic and Hospital, Seth VC Gandhi and MA Vora Municipal General Hospital, Rajawadi, Ghatkopar, Mumbai, Maharashtra, India
| | | | | | | | | |
Collapse
|
14
|
Bagga D, Teckchandani N, Kumar V, Grover SB, Yadav DK, Acharya SK. Predictive factors for successful vessel-intact laparoscopic orchiopexy for intra-abdominal testes. J Pediatr Urol 2013; 9:453-7. [PMID: 23269107 DOI: 10.1016/j.jpurol.2012.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/26/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify the predictive factors for successful vessel-intact laparoscopic orchiopexy (VILO) for nonpalpable intra-abdominal testes (NPIT). MATERIALS AND METHODS 25 boys with 28 NPITs within 2 cm of the internal ring underwent VILO. They were divided into two groups based upon outcome, for statistical comparison. Group A (successful VILO): patients with testes pexed in scrotum during surgery, and maintained viability and scrotal position of testes at 3-month & 6-month postoperative follow up. Group B: failed VILO. RESULTS Intrascrotal fixation at VILO was achievable for 17/28 NPITs. Postoperative follow up and final outcome data were available for 25/28 NPITs, of which 14 were successful (A) while 11 had failed VILO (B). The mean age of patients in group A differed significantly from that of patients in group B (4.16 years versus 6.64 years; p = 0.035). The mean testis-to-internal ring distance was 0.50 cm for group A and 1.05 cm for group B, but this was not statistically significant (p = 0.141). There was statistically a highly significant difference (p = 0.002) with respect to the mean internal ring-to-midscrotum distances in groups A and B: 5.56 cm and 7.05 cm, respectively. A scatter-plot of age or height against internal ring-to-midscrotum distance showed a fairly linear relationship. CONCLUSIONS Age or height of the patient at surgery is an independent factor predicting the success of VILO for intra-abdominal testis. The internal ring-to-midscrotum distance increases with age/height, resulting in increased testis-to-midscrotum distance and higher failure rate of VILO in older children.
Collapse
Affiliation(s)
- Deepak Bagga
- Department of Pediatric Surgery, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
| | | | | | | | | | | |
Collapse
|
15
|
Laparoscopic management of intra-abdominal testis: 5-year single-centre experience-a retrospective descriptive study. Minim Invasive Surg 2012; 2012:878509. [PMID: 22474586 PMCID: PMC3306959 DOI: 10.1155/2012/878509] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 11/15/2011] [Indexed: 12/29/2022] Open
Abstract
Background. Undescended testis is one of the most common urological problems in children, affecting about 1% of boys at age of 1 year. Of these, about 20% have a nonpalpable testis with a very high probability that the testis is absent. This may have a significant impact on the possibility of malignancy in these testes, as well as on the later fertility of these subjects. Methods. We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6-month outcomes, in 91 patients diagnosed with impalpable undescended testes between January 2006 and December 2010. Results. Of the 91 patients, 9 had bilateral and 82 had unilateral impalpable testes. All 100 testes were managed laparoscopically. The largest group of intra-abdominal testes in this series, 42 testes, was entering the internal ring; in these, laparoscopic exploration and standard open orchiopexy resulted in a 66% success rate. The total success rate was 63.3%. Conclusion. Laparoscopy is extremely useful in both the diagnosis and treatment of impalpable testes. Objectively measured mobility of the testis towards the contralateral internal inguinal ring is an excellent intraoperative indicator for type of orchiopexy. Standardization of management may increase the success rate of orchiopexy.
Collapse
|
16
|
Guo J, Liang Z, Zhang H, Yang C, Pu J, Mei H, Zheng L, Zeng F, Tong Q. Laparoscopic versus open orchiopexy for non-palpable undescended testes in children: a systemic review and meta-analysis. Pediatr Surg Int 2011; 27:943-52. [PMID: 21476074 DOI: 10.1007/s00383-011-2889-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Laparoscopic orchidopexy (LO) has been widespread used in the management of non-palpable testis (NPT) in children. However, the real advantages of LO over traditional open orchidopexy (OO) still remain exclusive. METHODS Published studies until August 31, 2010 were searched from Medline, Embase, Ovid, Web of Science, and Cochrane databases. Randomized controlled trials (RCTs) and observational clinical studies (OCSs) with a comparison of LO and OO were included for a systemic review and meta-analysis. RESULTS Out of 226 studies, 2 RCTs and 5 OCSs were eligible for inclusion criteria, comprising 176 cases of LO and 263 cases of OO. The hospital stay of LO was significantly shorter than that of OO (WMD = -0.66; 95% confidence interval [CI] = -0.95 to -0.37; P < 0.00001). However, no significant difference was observed between LO and OO in operative time (WMD = 4.02; 95% CI = -9.89 to 17.93; P = 0.57), time to resume feeding (WMD = -2.29; 95% CI = -6.78 to 2.20; P = 0.32) or full activity (WMD = -9.71; 95% CI = -27.84 to 8.42; P = 0.29), recurrence (OR = 0.60; 95% CI = 0.13 to 2.72; P = 0.51), viable testis rate (OR = 1.61; 95% CI = 0.30 to 8.52; P = 0.58), success rate (OR = 1.41; 95% CI = 0.44 to 4.46; P = 0.56), and testicular atrophy (OR = 1.70; 95% CI = 0.49 to 5.98; P = 0.40). CONCLUSION Although shorter hospital stay is noted in LO, it does not provide significant advantage over open surgery for treating NPT. However, due to the publishing bias, a series of RCTs are necessary to explore the efficiencies of LO in the management of NPT in children.
Collapse
Affiliation(s)
- Ju Guo
- Department of Urology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Park JH, Park YH, Park K, Choi H. Diagnostic laparoscopy for the management of impalpable testes. Korean J Urol 2011; 52:355-8. [PMID: 21687397 PMCID: PMC3106170 DOI: 10.4111/kju.2011.52.5.355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 04/27/2011] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes. MATERIALS AND METHODS Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end. RESULTS The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy. CONCLUSIONS Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.
Collapse
Affiliation(s)
- Ji Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
18
|
Shalaby MM, Shoma AM, Elanany FG, Elganainy EO, El-Akkad MA. Management of the looping vas deferens during laparoscopic orchiopexy. J Urol 2011; 185:2455-7. [PMID: 21555012 DOI: 10.1016/j.juro.2011.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE A number of variables should be assessed during laparoscopic orchiopexy, including vas anatomy. A looping vas deferens enters the inguinal canal and loops back to the abdominal cavity. This anatomical variant is not uncommonly encountered. Some groups considered this condition in their laparoscopic classification of nonpalpable testis. We present our experience with managing the looping vas during laparoscopic orchiopexy. MATERIALS AND METHODS We identified this condition in 18 procedures. In 14 cases it was possible to bring the vas back to the abdominal cavity. In 3 cases the loop could not be brought back laparoscopically and an inguinal incision was used. After the vas was dissected free and dropped into the abdominal cavity pneumoperitoneum was resumed and the procedure was completed laparoscopically. A Web based survey was done to test the value of this method. RESULTS A total of 17 procedures were completed successfully with preservation of the vas deferens while in 1 the vas was inadvertently cut. A looping vas did not significantly affect operative time. All 18 testes were viable and retained the scrotal position on followup scrotal Doppler ultrasound. CONCLUSIONS Verification of vasal anatomy is a crucial step that should be completed before any dissection. Bringing a looping vas back to the abdominal cavity is usually feasible laparoscopically but in a few cases this may require a small incision to dissect the vasal loop from its inguinal attachments.
Collapse
Affiliation(s)
- Mahmoud M Shalaby
- Urology Department, Assiut University, Asyut and Mansoura Urology and Nephrology Center (AMS), Mansoura, Egypt.
| | | | | | | | | |
Collapse
|
19
|
Moursy EE, Gamal W, Hussein MM. Laparoscopic orchiopexy for non-palpable testes: outcome of two techniques. J Pediatr Urol 2011; 7:178-81. [PMID: 20541475 DOI: 10.1016/j.jpurol.2010.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 04/07/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the outcome of laparoscopic orchiopexy and the two-stage Fowler Stephens technique for managing patients with impalpable testis in terms of safety, feasibility and efficacy. PATIENTS AND METHODS This study included 78 patients who presented with 88 non-palpable testes to the outpatient clinic of Sohag university hospital in 2005-2009, and underwent laparoscopy by the same surgeon. Intra-abdominal testes were managed by laparoscopic orchiopexy if low, two-stage Fowler-Stephens technique if high, and orchiectomy if atrophic. Children were evaluated postoperatively to check the location and size of the testicle and to exclude any other complication. RESULTS Median age at presentation was 16 months (range 11-42 months). Four testes were absent while inguinal exploration was necessary for six testes with the vas entering the internal ring. Of the 78 intra-abdominal testes, 45 were identified as high (Fowler-Stephens in 43; orchiectomy in two atrophic testes) and 33 as low (orchiopexy). Follow up was 3-55 months (mean 34 months). Twelve patients (12 testes) were lost to follow up (7 Fowler-Stephens; 5 orchiopexy). On follow up, the testes were normal sized and well positioned in the scrotum in 28/28 and 32/36 testes in the orchiopexy and Fowler-Stephens groups with an overall success rate of 100% and 88.8%, respectively. Two testes showed testicular displacement and two showed testicular atrophy in patients of the Fowler-Stephens group. CONCLUSION Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with non-palpable testes, with excellent outcomes.
Collapse
|
20
|
Hassan ME, Mustafawi A. Laparoscopic management of impalpable testis in children, new classification, lessons learned, and rare anomalies. J Laparoendosc Adv Surg Tech A 2010; 20:265-9. [PMID: 20059389 DOI: 10.1089/lap.2009.0244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cryptorchidism is the most common genitourinary anomaly in male children. About 20% of cryptorchid testicles are impalpable. Laparoscopy has become one of the important diagnostic modalities for the management of impalpable testes. The aim of the present study was in highlighting the lessons and rare anomalies encountered during the management of impalpable testes in children over a period of 10 years in a single pediatric surgery center and to establish a new classification that better describes the anomalies. MATERIALS AND METHODS A retrospective review of 93 laparoscopic explorations for nonpalpable testes between 1998 and 2008 was conducted. Demographic data, intraoperative findings and management, associated anomalies, and postoperative follow-up were collected and analyzed. A new laparoscopic classification is described. RESULTS Age range was 7 months to 8 years. Twenty bilateral versus 73 unilateral impalpable testes were operated on. Four groups were established with subgroups in each group. Group 1 (vanishing syndrome) had 44 cases, group 2 (peeping testes) had 21 cases, group 3 (intra-abdominal testes) had 38 cases, and group 4 (disorders of sex development) had 10 cases. Associated anomalies included 4 cases of Down syndrome, 7 cases of neurologic impairment, 3 of renal anomalies, 3 of cardiac anomalies, and 1 case of eye anomalies. Follow-up range was 1-6 years. CONCLUSIONS A new laparoscopic classification is presented that better describes the anomalies and help-in planning the treatment of impalpable testes. Impalpable testes with Down syndrome are sometimes associated with bizarre anatomy. Parents should be well informed of all the possible findings, especially in bilateral cases.
Collapse
Affiliation(s)
- Mohamed E Hassan
- Pediatric Surgery Department, Alwasl Hospital, Dubai, United Arab Emirates.
| | | |
Collapse
|
21
|
Burjonrappa SC, Al Hazmi H, Barrieras D, Houle AM, Franc-Guimond J. Laparoscopic orchidopexy: the easy way to go. J Pediatr Surg 2009; 44:2168-72. [PMID: 19944228 DOI: 10.1016/j.jpedsurg.2009.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Intraabdominal testes represent less than 10% of cryptorchid testicles, and yet, they are the most challenging to correct. In the last 15 years, the two-stage Fowler-Stephens orchidopexy has gained popularity. The traditional approach includes laparoscopic or open clipping of the testicular vessels (first stage) and open inguinal orchidopexy (second stage). We present our experience with 2-stage orchidopexy with both stages done through a laparoscopic approach. MATERIALS AND METHODS Over a recent 5-year period, we reviewed patients operated for intraabdominal testis using a two-stage laparoscopic orchidopexy with a minimum of 1-year follow-up. In this study, success is defined as a nonatrophic, intrascrotal testis. Fifteen patients met the inclusion criteria, and none were lost to follow-up. RESULTS In the 15 patients, 11 had a unilateral intraabdominal testis, and 4 had bilateral cryptorchidism, with one of the 2 testes intraabdominal. The first stage was done at a mean age of 32 months, and the average time between the two stages was 9.7 months. All procedures (31) were done on an outpatient basis. Only 2 complications occurred, one scrotal hematoma and one redo first stage because of unsuccessful clipping noted at the time of planned second stage. The success rate is 93.3% (14/15). All testicles are intrascrotal, and all but 1 have maintained preoperative volume. CONCLUSION Two-stage laparoscopic orchidopexy is a fairly easy surgical procedure with minimum morbidity and high short term success rate. A larger cohort of patients with long-term follow-up is needed to substantiate these findings.
Collapse
|
22
|
Hvistendahl GM, Poulsen EU. Laparoscopy for the impalpable testes: experience with 80 intra-abdominal testes. J Pediatr Urol 2009; 5:389-92. [PMID: 19457721 DOI: 10.1016/j.jpurol.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 04/06/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate two-stage laparoscopic Fowler-Stephens (FS) orchidopexy for intra-abdominal testes. MATERIALS AND METHODS A retrospective analysis was performed of the clinical findings, interventions and outcomes in 111 boys undergoing laparoscopy for 132 impalpable testes. RESULTS The median age was 5.7 years (1.1-14.6 years). Twenty-seven testes were absent. Eighty testes were intra-abdominal, of which 10 were removed laparoscopically due to anatomical anomalies (4), short spermatic cord (5) or atresia (1). Twenty-five testes were located in the groin. Laparoscopic FS procedure was performed for 65 intra-abdominal testes: 60 two-stage operations and five where the testes were removed during FS second stage due to short vas or testicular atrophy. Outcome was successful in 80%. One-stage laparoscopic orchidopexy without vessel division was performed in five intra-abdominal testes with satisfactory results in three. In general, the success rate is higher in boys with bilateral intra-abdominal testes, probably due to younger age at operation. CONCLUSIONS At our centre two-stage laparoscopic Fowler-Stephens orchidopexy for intra-abdominal testes showed results comparable to most other studies, but less satisfactory than a couple of recent studies. The median age at referral was higher than recommended. Operation at an earlier age may further improve the results.
Collapse
Affiliation(s)
- G M Hvistendahl
- Department of Urology, Aarhus University Hospital - Skejby, DK-8200 Aarhus N, Denmark.
| | | |
Collapse
|
23
|
Mir IS, Mohsin M, Kirmani O, Cheachek BA, Alam I, Wani M. Is laparoscospic orchidectomy the treatment of choice in adults with impalpable testis in rural hospitals in the developing world? Trop Doct 2009; 39:12-5. [PMID: 19211413 DOI: 10.1258/td.2008.080195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study was undertaken in order to evaluate the feasibility and safety of performing laparoscopic orchidectomy (LO) in men for unilateral impalpable testis in non-teaching rural hospitals in a developing country. We also investigated the possibility of reducing the cost and length of stay in hospital for patients undergoing LO. This is a prospective analysis of patients with impalpable testis undergoing LO in three non-teaching rural hospitals in the Kashmir Valley from January 2001 to March 2007. The cohort represented men requiring LO aged 15 to 62 (mean 36.2) years. The main outcome parameters assessed included mortality, conversion to an open procedure, complications, reduction in the costs and the length of the hospital stay. Forty-eight men with unilateral undescended testis on physical examination were studied. During laparoscopy the testis was identified near the deep ring in 30 patients, intra-abdominally in 16, and two had blind-ending vas and spermatic vessels near the deep ring. In 46 patients orchidectomy was performed. There were no deaths and none of the patients required conversion to an open procedure. Using reusable instruments, 00 degrees polyglactin sutures and self-made extraction bags, about US$ 300/patient was saved. There was no case of malignancy of the testis on histopathology examination. LO is one of the most satisfactory methods for the management of men with impalpable testis, having both a diagnostic and a therapeutic role especially for patients in the underdeveloped countries. These simple methods can reduce the cost and the length of the hospital stay.
Collapse
Affiliation(s)
- Iqbal Saleem Mir
- Department of Surgery, Government Gousia Hospital, Khanyar, Srinagar, J & K, India.
| | | | | | | | | | | |
Collapse
|
24
|
Laparoscopy-assisted orchiopexy for recurrent undescended testes in children. J Pediatr Surg 2009; 44:806-10. [PMID: 19361645 DOI: 10.1016/j.jpedsurg.2008.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Revised: 07/23/2008] [Accepted: 07/23/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Reoperative orchidopexy is a technical challenge to pediatric surgeons. The laparoscopy-assisted procedure is described for securing the testis in the scrotum in patients with a past history of open orchidopexy and testes in an unsatisfactory position. PATIENTS AND METHODS Thirty-one patients with 35 abnormally positioned testes (4 bilateral) were evaluated. All patients had a past history of inguinal surgery, and ages ranged between 2.5 and 13 years (mean, 5.5 years). Previous surgical procedures included 32 orchiopexies and 3 testicular detorsion of undescended testis. If needed, inguinal dissection was performed to loose the adherence between the cord and inguinal canal. Laparoscopic orchidopexy was applied to allow the testis to remain in the scrotum without tension. Patients underwent follow-up every 3 months after the operation with physical and ultrasound examinations. RESULTS Ten low inguinal testes were treated directly with open inguinal redo orchidopexy, whereas laparoscopy-assisted orchidopexy was possible in 23 (92%) of the remaining 25 reoperations. In 2 (8%) of these cases, severe scarring was present between the cord and the inguinal canal impeding the laparoscopy-assisted orchidopexy. For laparoscopy-assisted procedure, the operation time was 42 to 67 minutes (mean = 52 min). After the laparoscopy-assisted reoperations, 23 (92%) testes remain within the scrotum after a mean follow-up of 22 months (range, 6-32 months). CONCLUSION When feasible, laparoscopy-assisted orchiopexy is a simple and effective technique for securing testicles in reoperative orchiopexy procedures.
Collapse
|
25
|
Osifo DO, Osaigbovo EO. The prevalence, postnatal descent, and complications of undescended testes among children who underwent neonatal circumcision in Benin City, Nigeria. J Pediatr Surg 2009; 44:791-6. [PMID: 19361642 DOI: 10.1016/j.jpedsurg.2008.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE The prevalence, age at postnatal descent, and age at which complications set in and, therefore, prevented by orchidopexy in undescended testes are controversial. This study sought to determine the prevalence, age at postnatal descent, and age at which complications occurred in undescended testes. METHODS A prospective study was done on children who underwent neonatal circumcision at the University of Benin Teaching Hospital, Benin City, and Leadeks Medical Centre, both in Edo state, Nigeria, between January 2002 and December 2007. Those diagnosed with undescended testes were recruited for the study and followed up at the surgical outpatient clinic for 2 years; findings were documented on a structured proforma. RESULTS A total of 178 neonates aged between 5 and 28 days (mean, 7.6 +/- 4.2 days) and mean weight 3.9 +/- 1.8 kg among 6180 children circumcised had 186 undescended testes. On follow-up, 65 (34.9%) testes mainly among preterm neonates (P = .2450) fully descended within 7 months with no testicular descent recorded thereafter. Prevalence rates of 2.9% in neonates and 1.8% at 2 years old were recorded. Reduction in testicular volume, epididymoorchitis, and testicular torsion were recorded in 52 (28%) undescended testes between 12 and 24 months on follow-up. CONCLUSION Neonates with undescended testis should be observed for postnatal descent at least 7 months but may be offered orchidopexy before 1 year.
Collapse
Affiliation(s)
- David Osarumwense Osifo
- Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | | |
Collapse
|
26
|
Chang M, Franco I. Laparoscopic Fowler-Stephens Orchiopexy: The Westchester Medical Center Experience. J Endourol 2008; 22:1315-9. [DOI: 10.1089/end.2008.0158] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark Chang
- New York Medical College, Valhalla, New York
| | | |
Collapse
|
27
|
Management of boys with nonpalpable undescended testis. ACTA ACUST UNITED AC 2008; 5:252-60. [PMID: 18414455 DOI: 10.1038/ncpuro1102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 02/15/2008] [Indexed: 11/08/2022]
Abstract
Cryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys with palpable testis is standardized, there are no formal guidelines for the management of boys with nonpalpable testis. In this Review we look at the current trends in the diagnosis and treatment of this disorder, as well as the indications for therapy and surgical procedures. On the basis of current evidence, we find that there is no optimum orchidopexy technique for the treatment of intra-abdominal testis, although it is preferable to adopt techniques that preserve the spermatic vessels. We also briefly examine the follow-up of patients with this disorder and its common complications. As yet, there are no data that assess the potential of laparoscopic orchidopexy being a risk factor for impaired fertility later in life.
Collapse
|
28
|
Gad El-Moula M, Izaki H, El-Anany F, Abd El-Moneim A, El-Moneim El-Haggagy A, Abdelsalam Y, Abolyosr A, Kishimoto T, Oka N, Takahashi M, Fukumori T, Kanayama HO. Laparoscopy and intersex: report of 5 cases of male pseudohermaphroditism. THE JOURNAL OF MEDICAL INVESTIGATION 2008; 55:147-50. [DOI: 10.2152/jmi.55.147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohamed Gad El-Moula
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
- Department of Urology, Assiut University
| | - Hirofumi Izaki
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | | | | | | | | | | | - Tomoteru Kishimoto
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Natsuo Oka
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Masayuki Takahashi
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Tomoharu Fukumori
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| | - Hiro-omi Kanayama
- Department of Urology, Institute of Health Biosciences, The University of Tokushima Graduate School
| |
Collapse
|