Role of ultrasound in the follow-up of intra-abdominal testes post Fowler-Stephens orchiopexy

Medium-Term Results of Staged Laparoscopic Traction Orchiopexy for Intra-abdominal Testes: A Multicenter Analysis

BACKGROUND

Staged laparoscopic traction orchiopexy (SLTO) is a novel technique for the intra-abdominal testis (IAT) based on elongation of the testicular vessels without separating them. This multicenter study evaluated the medium-term results of this technique.

METHODS

Data of SLTO performed in three pediatric surgical centers between 2013 and 2020 were analyzed retrospectively. In 2021, physical and Doppler ultrasound examinations were performed to determine the position and viability of testes. Success was defined as an intra-scrotal testicle without atrophy.

RESULTS

SLTO was performed on 48 cases (55 testes, 7 bilateral). Mean age at first stage was 2.9 (0.8-12.6) years. High intra-abdominal testes were found in 16.4% and in 60% morphological abnormalities were observed. To fix the testes to the abdominal wall monofilament suture was used in 67.3%, braided in 29.1%. Mean time between the two stages was 16.4 weeks; three testes required redo traction. Perioperative complications occurred in 21 patients (38.2%) including insufficient fixation (11), testicular atrophy (4), wound complications (4), adhesion of the spermatic cords (1) and hydrocele (1). In case of insufficient fixation monofilament sutures were used in 90.9%. In 2021 38 patients (43 testes) had physical and 36 patients (41 testes) had ultrasound examinations. Mean follow-up was 2.7 (0.34-7.9) years. Altogether five atrophies were identified, and three testicular ascents (7.0%) occurred. The overall success rate was 82.2%.

CONCLUSIONS

SLTO may be a feasible alternative to conventional treatments of IATs. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall.

LEVEL OF EVIDENCE

LEVEL IV.

The role of the resistive index in predicting testicular atrophy after orchiopexy in unilateral undescended testis

PURPOSE

One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT.

METHODS

The data of 215 patients aged < 15 years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded.

RESULTS

TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy.

CONCLUSION

Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.

Diagnostic value of ultrasound in children with transverse testicular ectopia

OBJECTIVE

The study aimed to investigate the diagnostic value of ultrasound in children's transverse testicular ectopia (TTE).

MATERIALS AND METHODS

We retrospectively studies all TTE cases diagnosed in our hospital from January 2017 to December 2021. All cases were evaluated by ultrasound examination and compared to physical examination and diagnostic laparoscopy results.

RESULTS

This study included 14 TTE patients in total, with a median age was 1.08 years. In the 14 TTE, physical examination found 10 TTE cases, of which nine testes were located in the opposite scrotum, one testis was located in the opposite groin, and the other four testes were not observed by physical examination. All cases were diagnosed by preoperative ultrasound, and nine testes were located in the opposite scrotum, two testes were located in the opposite groin, and three testes were located next to the opposite iliac vessel in the abdominal cavity. Preoperative ultrasound showed the ectopic spermatic cord in six cases (6/14, 42.8%) and persistent Müllerian duct syndrome (PMDS) in one case (1/14, 7%). Diagnostic laparoscopy finally confirmed 14 cases of TTE, which was consistent with preoperative ultrasound, and the coincidence rate was 100% (14/14). Among the 14 cases of TTE, diagnostic laparoscopy showed that 12 cases had ectopic spermatic vessels and vas deferens (12/14, 85.7%), and six cases were associated with PMDS (6/14, 42.8%). When TTE was associated with the ectopic spermatic cord and PMDS, the diagnostic performance of diagnostic laparoscopy was better than that of preoperative ultrasound (P < 0.05). The testis volume of the affected side of TTE was less than that of the contralateral testis (P < 0.05).

CONCLUSION

Ultrasonography is very helpful for the preoperative diagnosis of TTE in children, and it is suitable as a non-surgical method for locating ectopictestis. Preoperative assessment of the exact presence of PMDS is difficult and unclear. This may be related to factors such as pelvic developmental stages in infancy, examination techniques, and atypical imaging findings of PMDS.