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Abbasion R, Mottaghi M, Saeidi Sharifabad P, Mahdavi Rashed M, Mehrad-Majd H, Mohammadzadeh Rezaei M. Gubernaculum-sparing orchiopexy versus gubernaculum excision; A randomized trial on success and atrophy rates. J Pediatr Urol 2024:S1477-5131(24)00350-4. [PMID: 39034198 DOI: 10.1016/j.jpurol.2024.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/26/2024] [Accepted: 06/29/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION AND OBJECTIVE Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy. STUDY DESIGN This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman's tests were used where appropriate. RESULTS Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6-84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p = 0.002). CONCLUSION Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint. TRIAL REGISTRATION https://irct.ir/trial/58842.
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Affiliation(s)
- Reza Abbasion
- Department of Pediatric Urology, Faculty of Medicine, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahdi Mottaghi
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Parisa Saeidi Sharifabad
- Department of Urology, Ghaem Medical Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Masoud Mahdavi Rashed
- Department of Radiology, Akbar and Dr. Sheikh Hospitals, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hassan Mehrad-Majd
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
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Benzi TSCG, Gallo CM, Fortuna A, Costa WS, Sampaio FJ, Favorito LA. Abdominal testicular vessel distribution in human fetuses - basis for fowler-Stephens surgery. Int Braz J Urol 2023; 49:749-756. [PMID: 37338817 PMCID: PMC10947616 DOI: 10.1590/s1677-5538.ibju.2023.9909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To analyze the histology and distribution of abdominal testicular vessels in human fetuses Patients and Methods: We studied 19 fetuses (34 testes) ranging in age from 12 to 19 weeks post-conception. The fetuses were evaluated regarding crown-rump length (CRL), total length (TL) and body weight immediately before dissection. Each testis was dissected and embedded in paraffin, from which 5 μm thick sections were obtained and stained with Masson's trichrome and Anti-CD31 antibody to quantify the vessels. The stereological analysis was carried out with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the unpaired T-test (p<0.05). RESULTS The fetuses presented mean weight of 222.5g, mean CRL of 15.3 cm and mean TL of 23.2 cm. All testes were in the abdominal position. The mean percentage of vessels (Vv) in the upper portion of the testis was 7.6% (4.6 to 15%) and in the lower portion the mean was 5.11% (2.3 to 9.8%), with a significant difference (p=0.0001). In the analysis between the upper portion of the right and left testes (p=0.99) and in the analysis of the lower portion of the right and left testes (p=0.83), we did not observe significant differences. CONCLUSION The upper portion of the abdominal testis in human fetuses had a higher concentration of vessels than the lower portion. These results suggest that manipulation of the lower end of the testis during Fowler-Stephens surgery should be avoided in order to preserve the collateral circulation.
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Affiliation(s)
- Tatiana S. C. G. Benzi
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
| | - Carla M. Gallo
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
| | - Anneliese Fortuna
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
| | - Waldemar S. Costa
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
| | - Francisco J.B. Sampaio
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital – Universidade do Estado do Rio de Janeiro – Uerj, Rio de Janeiro, RJ, Brasil
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Tian Q, Zhao X, Zhang C, Yu K, Fang E, Zhou X, Yuan J, Li N. Compared outcomes of high-level cryptorchidism managed by Fowler-Stephens orchiopexy versus the Shehata technique: A systematic review and meta-analysis. J Pediatr Urol 2023:S1477-5131(23)00075-X. [PMID: 36966014 DOI: 10.1016/j.jpurol.2023.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The surgical approach for high-level intra-abdominal testis (IAT) is variable. While most pediatric urologists prefer staged Fowler-Stephens orchiopexy (FSO), Shehata publicized a novel approach-known as staged laparoscopic traction orchiopexy (SLTO) or the Shehata technique-to better manage IATs. OBJECTIVE This study compares the overall success rates, atrophy rates, retraction rates, and operation times of the two procedures to assist surgeons with developing procedure strategies. METHODS Databases were searched for relevant literature involving these two approaches, and studies meeting the eligibility criteria were involved; RevMan 5.4 was used to conduct this meta-analysis. The relative risk (RR), weighted mean difference, 95% confidence interval (CI), p-value, publication bias, and heterogeneity were calculated. RESULTS The Shehata technique demonstrated better performance than staged FSO regarding the overall success and atrophy rate, while the retraction rate and operation time had no statistical difference. CONCLUSIONS This study revealed that the Shehata technique may be an alternative to staged FSO for managing high-level IATs. Additional high-quality studies regarding the Shehata technique, as well as a long-term follow-up, are required for further and more credible analysis.
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Affiliation(s)
- Qingqing Tian
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Zhao
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chu Zhang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kechi Yu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Erhu Fang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Zhou
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiyan Yuan
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Li
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Neheman A, Shumaker A, Grazi J, Kord E, Bondarenko S, Stav K, Zisman A, Noh P. Standardized single-stage laparoscopic Fowler-Stephens orchiopexy regardless of testis position: Modification of technique eliminates the need for intra-operative decision-making. J Minim Access Surg 2022; 18:591-595. [PMID: 36204939 PMCID: PMC9632696 DOI: 10.4103/jmas.jmas_312_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background/Purpose: It is generally perceived that a primary laparoscopic orchiopexy has superior outcomes due to preservation of the testicular artery, and thus should be the choice when achievable. The two-stage laparoscopic Fowler-Stephens orchiopexy (LFSO) is considered superior regarding success rate compared to the one-stage procedure when the artery must be transected. Outcomes can be jeopardized when a primary orchiopexy is ultimately realized to be the incorrect procedure due to insufficient testicular artery length. It is preferable to decide the approach before initiating dissection, however, in reality, this does not always occur. Purpose: It is generally perceived that a primary laparoscopic orchiopexy has superior outcomes due to preservation of the testicular artery, and thus should be the choice when achievable. The two-stage laparoscopic Fowler-Stephens orchiopexy (LFSO) is considered superior regarding success rate compared to the one-stage procedure when the artery must be transected. Outcomes can be jeopardized when a primary orchiopexy is ultimately realized to be the incorrect procedure due to insufficient testicular artery length. It is preferable to decide the approach before initiating dissection, however, in reality, this does not always occur. Materials and Methods: Key surgical maneuvers implicated in the modified one-stage LFSO (M-LFSO) include preservation of a wide peritoneal flap between the vessels and the vas deferens, dissecting the vessels as proximal as possible and avoiding manipulation of the epididymis and vessels between the vas and epididymis when transferring the testis to the scrotum. Results: Our cohort included 55 boys (59 testes). Median age and weight at surgery were 13.3 months (interquartile range [IQR] 9.2–32.4) and 10.4 kg (IQR 9.2–12.6). The mean operative time was 70 min (IQR 60–85). The median follow-up was 11 months (IQR 7–12). There was one case of testicular atrophy (2%) and two cases of suboptimal testicular position in the scrotum at 6 months. Conclusions: M-LFSO is a standardized approach for all cases of IAT regardless of testicular position. Preservation of a wide peritoneal flap and proximal dissection of the vessels may contribute to the adequate testicular blood supply. The proposed approach eliminates the need for intra-operative decision-making and for ancillary procedures.
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Affiliation(s)
- Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Shumaker
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Grazi
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Kord
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergey Bondarenko
- Department of Pediatric Urology, Municipal Hospital, Volgograd, Russia
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Noh
- Department of Urology, Children's Hospital of Illinois, Peoria, Illinois, USA
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Logsdon NT, Favorito LA. Editorial Comment: Anatomy of testicular artery: A proposal for a classification with MDCT angiography. Int Braz J Urol 2022; 48:594-595. [PMID: 35373952 PMCID: PMC9060165 DOI: 10.1590/s1677-5538.ibju.2022.03.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Natasha T Logsdon
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Logsdon NT, Favorito LA. Editorial Comment: Ascending testis: A congenital predetermined condition. Int Braz J Urol 2021; 48:184-185. [PMID: 34735090 PMCID: PMC8691237 DOI: 10.1590/s1677-5538.ibju.2022.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Natasha T Logsdon
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Favorito LA. Editorial Comment: Image-guided study of swine anatomy as a tool for urologic surgery research and training. Int Braz J Urol 2021; 47:1266-1267. [PMID: 34469677 PMCID: PMC8486439 DOI: 10.1590/s1677-5538.ibju.2021.06.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Favorito LA. Editorial Comment: Translational research in urology: nu-tricion and prostate. Int Braz J Urol 2021; 47:1030-1031. [PMID: 34260179 PMCID: PMC8321447 DOI: 10.1590/s1677-5538.ibju.2020.1114.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Favorito LA. Editorial Comment: Gubernaculum Testis and Cremasteric Vessel Preservation during Laparoscopic Orchiopexy for Intra-Abdominal Testes: Effect on Testicular Atrophy Rates. Int Braz J Urol 2021; 47:1067-1068. [PMID: 34260185 PMCID: PMC8321453 DOI: 10.1590/s1677-5538.ibju.2021.05.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janei-ro, RJ, Brasil
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Benzi TC, Logsdon NT, Sampaio FJB, Favorito LA. Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis - a narrative review. Int Braz J Urol 2021; 48:8-17. [PMID: 34003614 PMCID: PMC8691233 DOI: 10.1590/s1677-5538.ibju.2021.99.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/10/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.
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Affiliation(s)
- Tatiana C Benzi
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Natasha T Logsdon
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Francisco J B Sampaio
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital - Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Favorito LA. Translational research in testicular migration. Int Braz J Urol 2020; 47:45. [PMID: 33047911 PMCID: PMC7712685 DOI: 10.1590/s1677-5538.ibju.2021.99.03.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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Multiple variations of the renal and testicular vessels: possible embryological basis and clinical importance. Surg Radiol Anat 2015; 38:729-33. [PMID: 26507071 DOI: 10.1007/s00276-015-1584-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
During routine dissection of the abdominal cavity of a 55-year-old African male cadaver, multiple anomalies including renal and testicular vessels were encountered. The right kidney was supplied by three right hilar renal arteries arising from the abdominal aorta at different vertebral levels whereas only one left renal artery supplied the left kidney. On the right three renal veins drained the kidney into the inferior vena cava. In contrast, the left kidney was drained by a single renal vein which received a large primary posterior tributary. The primary posterior tributary had three tributaries from the posterior lumbar region. The right testis had two sources of arterial supply; one from the subcostal artery and another from the abdominal aorta. The left testis was supplied normally by a single testicular artery. The right testis was drained by four testicular veins as follows: one drained into the subcostal vein, the other two drained separately for a longer course and joined shortly before draining into the right main renal vein, the fourth one drained into the anterior aspect of the inferior vena cava at the level of the second lumbar vertebra. On the left, the testicle was drained by two testicular veins which travelled separately from the deep inguinal ring and joined shortly before they drain into the left renal vein. This variation may represent an immature form of complicated development of kidneys and testes. Additionally, emphasis must be put on preoperative vascular examination to avoid surgical complications from variant vessels in this region.
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in pediatric pathology, chapter 1. Normal development of testicular structures: from the bipotential gonad to the fetal testis. Pediatr Dev Pathol 2015; 18:88-102. [PMID: 25119266 DOI: 10.2350/12-04-1184-pb.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Nistal
- 1 Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
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Ellis R, Lahiri R, Mahomed A. Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler–Stephens procedure. Surg Endosc 2014; 28:3158-61. [DOI: 10.1007/s00464-014-3574-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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Filipovic B, Stijak L, Filipovic B. An unusual origin of the double left testicular artery in a male cadaver: a case report. J Med Case Rep 2012; 6:267. [PMID: 22938096 PMCID: PMC3441792 DOI: 10.1186/1752-1947-6-267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Variations in the number and course of the testicular arteries, often coexisting with variations of the other branches arising from the abdominal aorta, are still reported to be of interest to urology surgeons. CASE PRESENTATION During a routine dissection course, an unusual origin of the double left testicular artery was observed in the cadaver of a 68-year-old Caucasian man who donated his body to the Institute of Anatomy. CONCLUSIONS A deeper understanding of the variations of the testicular arteries is necessary for all physicians whose practice is related to the testicles and their vascular stalk.
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Affiliation(s)
- Branislav Filipovic
- Institute of Anatomy "Niko Miljanic", University of Belgrade, Faculty of Medicine, 4/2 Dr Subotica, 11000, Belgrade, Serbia.
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Sahin C, Kalkan M, Yalcinkaya S. Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes. Int Braz J Urol 2011; 37:727-32. [DOI: 10.1590/s1677-55382011000600007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2011] [Indexed: 11/21/2022] Open
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Simultaneous Penile Gangrene and Testicular Infarction Secondary to Calciphylaxis in a Uremic Patient. UROLOGICAL SCIENCE 2010. [DOI: 10.1016/s1879-5226(10)60021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Elyas R, Guerra LA, Pike J, DeCarli C, Betolli M, Bass J, Chou S, Sweeney B, Rubin S, Barrowman N, Moher D, Leonard M. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol 2010; 183:2012-8. [PMID: 20303527 DOI: 10.1016/j.juro.2010.01.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Fowler and Stephens showed that by dividing the spermatic vessels a high intra-abdominal testis could be placed in the scrotum. Testicular atrophy is a potential complication of this technique. We conducted a systematic review to determine whether single or 2-stage Fowler-Stephens orchiopexy results in better testicular viability. MATERIALS AND METHODS We searched electronic databases, clinical trial registries and gray literature. We included reports describing boys younger than 18 years with a primary outcome of "testicular viability and position." We performed a meta-analysis using random effects models. Heterogeneity was assessed using forest plot and I(2) statistic. RESULTS We identified 1,807 citations and included 61 articles. Single stage Fowler-Stephens orchiopexy was discussed in 9 articles, a 2-stage procedure in 36 and both approaches in 16. There were no randomized controlled trials, and most studies were cohort or case series. The pooled estimate of success rates was 80% for single stage Fowler-Stephens orchiopexy (95% CI 75 to 86) and 85% for 2-stage Fowler-Stephens orchiopexy (95% CI 81 to 90). The pooled odds ratio of single stage vs 2-stage Fowler-Stephens orchiopexy was 2.0 (95% CI 1.1 to 3.9) favoring the 2-stage procedure. There was no difference in the success rate between laparoscopic and open techniques in either single or 2-stage Fowler-Stephens orchiopexy. There was no evidence of asymmetry on the funnel plot. There were no complications reported with single stage, while ileus, hematoma and infection were the most common complications with 2-stage Fowler-Stephens orchiopexy. CONCLUSIONS Both techniques have a fairly high success rate but 2-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach (85% vs 80%, OR 2 in favor of 2-stage). Laparoscopic and open techniques had the same success rate. However, the level of evidence of the studies was low, and a study of a more robust design, such as a randomized controlled trial, should be performed.
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Affiliation(s)
- R Elyas
- Queens University, Kingston, Ontario, Canada
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De Carli C, Bettolli M, Leonard M, Jauregui E, Guerra L. Laparoscopic manoeuvre for orchidopexy in high intra-abdominal testes when cremasteric artery is present. J Pediatr Urol 2010; 6:2-5. [PMID: 19926341 DOI: 10.1016/j.jpurol.2009.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/08/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We report a case of high intra-abdominal testes (HIT) associated with the presence of the cremasteric artery (CA). The aim was to correlate the normal anatomy of the CA with the clinical finding in our patient and discuss its surgical implication. METHODS Left primary laparoscopic testicular descent by the Prentiss manoeuvre was performed in a 2 year-old boy with bilateral HIT. Cadaveric dissection was carried out focusing on the anatomical origin of the CA. Data obtained from cadavers and the clinical findings were analyzed. RESULTS During laparoscopic orchiopexy a left HIT was found in the presence of the CA. Primary tension-free orchiopexy was achieved preserving the CA. Our cadaver study revealed that the CA arose more frequently (68%) from the medial aspect of the inferior epigastric artery. CONCLUSION In the presence of HIT, surgeons should be aware of the CA as part of the testicular collateral circulation. Acquaintance with the normal anatomy of the CA is important to determine the most appropriate laparoscopic manoeuvre in orchiopexy when this artery is present. We believe that the Prentiss manoeuvre avoids compression and strangulation of the CA around the epigastric vessels while allowing testicular placement in the scrotum.
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Affiliation(s)
- Claudio De Carli
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario, Canada.
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Dave S, Manaboriboon N, Braga LHP, Lorenzo AJ, Farhat WA, Bägli DJ, Khoury AE, Salle JLP. Open versus laparoscopic staged Fowler-Stephens orchiopexy: impact of long loop vas. J Urol 2009; 182:2435-9. [PMID: 19765743 DOI: 10.1016/j.juro.2009.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy. MATERIALS AND METHODS Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12). The presence of a long looping vas was noted from the first stage operative notes. Doppler ultrasound was performed postoperatively to confirm testicular atrophy. RESULTS Atrophy rate at a mean followup of 13.5 months was 20.5% (15 of 61 in laparoscopic and 0 of 12 in open orchiopexy). None of the 5 long looping vas testes atrophied following open orchiopexy, compared to 5 of 6 (83%) following laparoscopic orchiopexy (p = 0.03). Analyzing the laparoscopic group alone, a long looping vas was significantly associated with risk of atrophy (p <0.01). CONCLUSIONS The presence of a long looping vas was associated with a higher atrophy rate following laparoscopic second stage Fowler-Stephens orchiopexy. Laparoscopic management of the long looping vas may be more challenging and, therefore, in such cases open Fowler-Stephens orchiopexy may result in better success rates by preserving the integrity of the collateral vessels.
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Affiliation(s)
- Sumit Dave
- Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Zomorrodi A, Buhluli A. Viable testis after retroperitoneal mass cord ligation in internal ring of inguinal canal in 15 kidney recipients: five years of experience. Transplant Proc 2008; 40:208-9. [PMID: 18261589 DOI: 10.1016/j.transproceed.2007.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sometimes in spermatic cord handling procedures like varicocelectomy, hernioraphy, and vasectomy, there is concern about perfusion of the testis. Herein we have presented our experience with retroperitoneal mass ligation of the cord in kidney recipients. Between 2001 and 2006, we performed mass ligation of the spermatic cord, including vas deferens and all spermatic vessels, in 15 kidney recipients (older than 55 years) who gave informed consent. During retroperitoneal preparation of the Iliac fossa for allografting, we performed this maneuver next to the internal ring of the inguinal canal. After performing a J incision in the right iliac fossa, separating fascia, and pushing the peritoneum medially, we isolated the spermatic cord at the internal ring of the inguinal canal for transfixation and placing the allografted kidney in retroperitoneal position with anastomoses of the iliac vessels. Posttransplantation the scrotum of patients was followed up by color Doppler ultrasound and physical examination. RESULT Normal circulation was detected in the testis postoperation using color Doppler ultrasound evaluation. Six patients returned with hydrocoeles between 4 and 8 months after transplantation and 3 of them underwent hydrocoelectomy. CONCLUSION Mass ligation of the spermatic cord (preinternal ring of inguinal canal) did not disturb the circulation to the testis severely nor did it induce ischemic problems (atrophy). This study suggested an unknown connection between vessels of the cord and other vessels that supply blood to the testis. This study questions the safety of cryo-biopsy of a testis mass by high clamping of the cord and also suggests that vasectomy may be safe in patients with a history of a standard Palomo varicocoelectomy.
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Affiliation(s)
- A Zomorrodi
- Urology & Kidney Transplantation Ward, Imam Hospital, Tabriz Medical Science University, Tbrize, Iran.
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Favorito LA, Costa WS, Sampaio FJB. Applied anatomic study of testicular veins in adult cadavers and in human fetuses. Int Braz J Urol 2008; 33:176-80. [PMID: 17488536 DOI: 10.1590/s1677-55382007000200007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Analyze the anatomic variations of the testicular veins in human cadavers and fetuses. MATERIALS AND METHODS One hundred male adult cadavers and 24 fetuses were studied. Four anatomic aspects were considered: 1) Number of testicular veins, 2) The local of vein termination, 3) Type and number of collaterals present and 4) Testicular vein termination angle. RESULTS Cadavers - Right side - One testicular vein occurred in 85% and 2 veins in 5% of the cases. There were communicating veins with the colon in 21% of the cases. Left side - One testicular vein occurred in 82%, two veins in 15%, three veins in 2% and four veins in 1% of the cases. There were communicating veins with the colon in 31% of the cases. Fetuses - Right side - One testicular vein occurred in all cases. This vein drained to the vena cava in 83.3% of the cases, to the junction of the vena cava with the renal vein in 12.5% and to the renal vein in 4.2%. There were communicating veins with the colon in 25% of the cases. Left side - One testicular vein occurred in 66.6% of the cases, and 2 veins in occurred 33.3%. Communicating veins with the colon were found in 41.6% of the cases. CONCLUSION The testicular vein presents numeric variations and also variations in its local of termination. In approximately 30% of the cases, there are collaterals that communicate the testicular vein with retroperitoneal veins. These anatomic findings can help understanding the origin of varicocele and its recurrence after surgical interventions.
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Affiliation(s)
- Luciano A Favorito
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Acar HI, Yazar F, Ozan H. Unusual origin and course of the testicular arteries. Surg Radiol Anat 2007; 29:601-3. [PMID: 17618401 DOI: 10.1007/s00276-007-0232-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 06/14/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The testicular arteries usually arise from the anterolateral aspect of the abdominal aorta just inferior to the renal arteries at the level of the second lumbar vertebra. However, they may also originate from the renal artery, middle suprarenal artery, one of the lumbar arteries, common or internal iliac artery, or the superior epigastric artery. METHODS An unusual origin of the right testicular artery and an unusual course of the left one were observed during routine dissection of the retroperitoneal space of a 43-year-old male cadaver. RESULTS The right testicular artery originated from the inferior segmental branch of the right renal artery. After the left testicular artery originated from the anterolateral surface of the abdominal aorta just inferior to the left renal artery it was located between the left renal vein and the left renal artery and descended anterior to the renal vein. Thereafter it coursed on its normal route distally with the testicular vein. CONCLUSIONS Awareness of variations of the testicular arteries, such as that shown in this case, is important during surgical and radiological procedures pertaining to kidney.
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Affiliation(s)
- Halil Ibrahim Acar
- Department of Anatomy, Ankara University School of Medicine, Sihhiye, 06100 Ankara, Turkey.
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Yalçin B, Komesli GH, Ozgök Y, Ozan H. Vascular anatomy of normal and undescended testes: surgical assessment of anastomotic channels between testicular and deferential arteries. Urology 2005; 66:854-7. [PMID: 16230152 DOI: 10.1016/j.urology.2005.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 03/29/2005] [Accepted: 04/19/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To demonstrate the vascular anatomy of the normal and undescended testes, emphasizing the surgical importance of the anastomotic channels between the testicular and deferential arteries in the undescended testis. METHODS This study was performed on four normal testes obtained from adult cadavers and the undescended testes taken from men undergoing unilateral orchiectomy. To show the arteries and their connections, we used the injection-corrosion casting technique. RESULTS The normal and undescended testes measured 36.3 +/- 9.2 mm x 21.2 +/- 4.3 mm x 14.3 +/- 5.4 mm and 19 x 16 x 9 mm, respectively. The testis and epididymis had an unusual shape in the undescended testes. The undescended testes were round, with a semilunar epididymis that was over the testis. All the testes, including the undescended testes, had testicular, deferential, and cremasteric arteries. The testicular, deferential, and cremasteric arterial diameter was 1.7 +/- 0.4, 1.1 +/- 0.3, and 0.5 +/- 0.3 mm in the normal testes and 1.5, 0.7, and 0.6 mm in the undescended testes, respectively. Communication among the three arteries was illustrated consistently by retrograde filling of the two noninjected arteries. Clearly visible anastomotic channels were present between the testicular and deferential arteries in the normal and undescended testes. CONCLUSIONS We suggest that the original Fowler and Stephans concept (high ligation of the testicular artery) is valid to preserve vascularity to the testis when vascular transection orchiopexy is performed, although the number of our specimens was not enough to prove this definitively.
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Affiliation(s)
- Bülent Yalçin
- Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey.
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Barqawi A, Furness P, Koyle M. Laparoscopic Palomo varicocelectomy in the adolescent is safe after previous ipsilateral inguinal surgery. BJU Int 2002; 89:269-72. [PMID: 11856109 DOI: 10.1046/j.1464-4096.2001.01623.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the outcome of laparoscopic Palomo varicocelectomy (LPV) in young boys who had undergone previous ipsilateral inguinal surgery (in whom potentially the arterial supply to the testicles may be compromised) in an attempt to assess its safety for the collateral vascular supply in such cases. PATIENTS AND METHODS Over a 5-year period (1995-2000) 44 patients underwent LPV, where both the spermatic artery and vein were ligated high above the internal ring. Thirteen patients had undergone previous ipsilateral inguinal surgery, which included inguinal hernia repairs in five, orchidopexy in two, communicating hydrocele repair in three and previous varicocele repair in three. All patients were followed clinically at 3 months and 1 year after surgery. RESULTS There were no complications related to laparoscopy or varicocele ligation. No patient developed ipsilateral testicular atrophy; moreover the testis size remained stable or was associated with compensatory growth in all patients. CONCLUSION Previous inguinal surgery involving the ipsilateral testicle does not appear to affect the collateral blood circulation to the affected testis in boys who undergo LPV mass ligation of the internal spermatic vein and artery. LPV for varicocele is safe in boys who have undergone previous inguinal surgery, suggesting that an adequate collateral blood supply is present.
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Affiliation(s)
- A Barqawi
- Department of Pediatric Urology, The Children's Hospital, University of Colorado School of Medicine, Denver, Colorado 80218, USA.
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