1
|
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.
Collapse
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
| |
Collapse
|
2
|
Zhou G, Chen J, Yin J, Liu X, Su J, Li S. Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler-Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study. J Laparoendosc Adv Surg Tech A 2022; 32:920-924. [PMID: 35442805 PMCID: PMC9416541 DOI: 10.1089/lap.2021.0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The benefits of performing open versus laparoscopic gubernaculum-sparing second-stage Fowler–Stephens orchiopexy (FSO) remain unclear. We compared the two techniques to answer this question. Methods: We retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO at our institution between September 2004 and June 2020 (all patients underwent surgery by a single surgeon). We evaluated both procedures based on the incidence of testicular atrophy, testicular ascent, and other complications. Results: The age at initial surgery was 45.7 ± 28.2 months (median, 39). One hundred nine cases were treated with open second-stage gubernaculum-sparing FSO (OFSO), and 96 cases were treated with laparoscopic second-stage gubernaculum-sparing FSO (LFSO). The mean follow-up period was 59.8 months (median, 54; standard deviation, +35). The overall testicular atrophy rate was 1.5%. Atrophy was observed in 2 and 1 patient in the OFSO and LFSO groups, respectively (1.8% versus 1.0%, P > .05). There was no significant difference in the incidence of testicular ascent between both groups (2.8% versus 3.1%). Five and four complications were noted in the OFSO and LFSO groups, respectively (P > .05). Conclusions: Second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions. Neither the open nor laparoscopic approach appeared superior, because the overall testicular survival rates and incidence of testicular ascent and other complications were equivalent between both groups.
Collapse
Affiliation(s)
- Guanglun Zhou
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jinjun Chen
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jianchun Yin
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Xiaodong Liu
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Jiahong Su
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| | - Shoulin Li
- Laboratory of Pelvic Floor Muscle Function, Department of Urology, Shenzhen Children's Hospital, Shenzhen, P.R. China
| |
Collapse
|
3
|
La cryptorchidie chez l’enfant : facteurs prédictifs d’atrophie et de réascension testiculaires postopératoires. Prog Urol 2022; 32:332-340. [DOI: 10.1016/j.purol.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/23/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022]
|
4
|
Laparoscopic Ist stage orchiopexy using antiadherent sheet for high abdominal testis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
5
|
Wu CQ, Kirsch AJ. Revisiting the success rate of one-stage Fowler-Stephens orchiopexy with postoperative Doppler ultrasound and long-term follow-up: a 15-year single-surgeon experience. J Pediatr Urol 2020; 16:48-54. [PMID: 31784377 DOI: 10.1016/j.jpurol.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The optimal management of a high undescended testicle (UDT) remains debated. When tethering is due to shortened spermatic vessels, a one-stage or two-stage Fowler-Stephens Orchiopexy (FSO) can be performed. Published series suggest a higher success rate with a two-stage FSO, though its superiority has not been ascertained. The authors examine patient and surgical factors associated with success of one-stage FSO and compare our outcomes with the established literature. METHODS We retrospectively reviewed the charts of 43 boys who underwent one-stage FSO for 45 testes from 2003 to 2018 by a single surgeon at our institution. Patient factors, surgical approach, and postoperative results were reviewed. Radiographic success was a testis with intact vascular flow or normal echotexture on scrotal ultrasound. Clinical success was a non-atrophic, intrascrotal testis at postoperative follow-up. Radiographic and clinical success was compared. Data analysis was performed with Fisher's exact test and t-test for categorical and continuous variables respectively. RESULTS Follow-up (mean 29 months; 0.5 months-14.5 years) was available for 40 patients (42 testes; 21 bilateral, 21 unilateral). Average age at surgery was 21.8 months (4 months-10.4 years). Associated conditions were seen in 14 patients. Twenty-nine patients had postoperative scrotal Doppler ultrasound with radiographic success in 25/29 (86.2%). Overall clinical success was 34/42 (81%) with 4 (9.5%) each of atrophy and ascent. A second surgery to address ascent in four patients allowed correction in three for a success rate of 88%. Radiographic and clinical success was significantly associated (P = 0.01). Clinical success was also significantly associated with inguinal rather than laparoscopic testis mobilization (P = 0.03) but not to patient's age, associated conditions, unilaterality/bilaterality, or pre-operative hypoplasia or location. Greater than 3 years of follow-up was available in 11 (26.2%) cases, of which seven had successful results. All adverse outcomes occurred within 8 months after surgery. Success was otherwise durable. CONCLUSION This is the largest series of one-stage FSO to date. The success rate of one-stage FSO in this series matches that published in the literature for two-stage FSO; equal success is achieved with fewer surgeries. Postoperative Doppler ultrasound demonstrating intact vascular flow or normal testis echotexture is significantly associated with clinical success and highlights the utility of postoperative ultrasound in patients with an equivocal exam.
Collapse
Affiliation(s)
- Charlotte Q Wu
- Children's Healthcare of Atlanta, Emory University School of Medicine, USA.
| | - Andrew J Kirsch
- Children's Healthcare of Atlanta, Emory University School of Medicine, USA
| |
Collapse
|
6
|
Evaluation of Fowler–Stephens orchiopexy for high-level intra-abdominal cryptorchidism: A systematic review and meta-analysis. Int J Surg 2018; 60:74-87. [DOI: 10.1016/j.ijsu.2018.10.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 12/21/2022]
|
7
|
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
|
8
|
Erdoğan C, Bahadır B, Taşkınlar H, Naycı A. Laparoscopic management and its outcomes in cases with nonpalpable testis. Turk J Urol 2017; 43:196-201. [PMID: 28717546 PMCID: PMC5503441 DOI: 10.5152/tud.2017.63625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 10/18/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Diagnostic laparoscopy is the gold standard in the algorithm of nonpalpable testis. Testicular tissue is examined and treatment is planned accordingly. In this study we reviewed the place of diagnostic laparoscopy, and evaluated the results and effectiveness of laparoscopy in the diagnosis and management of nonpalpable testis. MATERIAL AND METHODS Children who had diagnostic laparoscopy for nonpalpable testes were included in the study. Physical examination results, ultrasonography (USG) reports, age at surgery, laparoscopic and inguinal exploration findings, surgical procedures, orchiopexy results, early and late-term complications were evaluated. Follow-up visits were performed at 3-month intervals for the first, at 6-month intervals for the 2. year, then at yearly intervals. Testicular size and location was evaluated by during control examination. RESULTS Overall 58 boys, and 68 testes (26 left: 44.8%; 22 right: 37.9%, and 10 bilateral: 17.2%) were included in the study. Mean age at surgery was 5.5 years (10 months-17 years). Diagnostic value of USG was 15.7%. Diagnostic laparoscopy findings were as follows: Group 1: blind-ended vessels, n=7 (10.2%); Group 2: intraabdominal testes, n=8 (11.7%); Group 3: vas and vessels entering internal ring, n=53 (77.9%). Overall 43 testes underwent orchiopexy, which were normal (n=8) or hypoplastic (n=35). Mean follow-up period was 19 months (1-12 years), and on an average 7 visits were performed (5-14). On follow-up, 5 testes were normal-sized and located in the scrotum, while 4 testes were atrophic and underwent orchiectomy. Two testes were found in the inguinal canal and redo orchiopexy was performed. Control USG revealed reduced testicular blood supply and volume. CONCLUSION Laparoscopic surgery is safe and effective in the management of nonpalpable testes. In the majority, routine use of diagnostic laparoscopy in the algorithma does not confer any additional contributions in many patients.
Collapse
Affiliation(s)
- Cankat Erdoğan
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Berktuğ Bahadır
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Hakan Taşkınlar
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Naycı
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| |
Collapse
|
9
|
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
|
10
|
Naycı A, Bahadır GB, Erdoğan C, Taşkınlar H. Laparoscopic one-stage Fowler-Stephens orchiopexy preserving gubernaculum. Turk J Urol 2017; 43:75-78. [PMID: 28270955 DOI: 10.5152/tud.2016.32392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess gubernaculum-sparing laparoscopic one-stage Fowler-Stephens orchiopexy (FSO), in the management of high intrapelvic testis. MATERIAL AND METHODS Medical reports of boys who underwent laparoscopic one-stage FSO were retrospectively reviewed. High intrapelvic testis was defined as testis ≥3 cm away from ipsilateral internal ring. Testes were evaluated on physical examination at 3rd, 6th and 18th months after surgery. Children were evaluated as for their demographic data, operative findings, interventional details and outcomes. RESULTS Seven patients met inclusion criteria of the study. Six of 7 testis were small and had abnormal appearance, compared with the contralateral testis. Average distance of the testes from the internal ring was 4.2±1.1 cm (3 to 6). Average age at surgery was 6.1±4.2 years (2 to 12). Average follow-up period was 14±5.8 months (8 to 20), and 5 testis (71.4%) were considered to be normal in volume and scrotal location. Two testes were relatively atrophic and underwent orchiectomy. CONCLUSION Our preliminary results shows a good testicular survival rate for one-stage laparoscopic FSO. Sparing collateral vasculature of the gubernaculum is important.
Collapse
Affiliation(s)
- Ali Naycı
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | | | - Cankat Erdoğan
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Hakan Taşkınlar
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| |
Collapse
|
11
|
Sepúlveda X, Egaña PJL. Current management of non-palpable testes: a literature review and clinical results. Transl Pediatr 2016; 5:233-239. [PMID: 27867845 PMCID: PMC5107370 DOI: 10.21037/tp.2016.10.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cryptorchidism is a common pathology that occurs in 3% in full term newborns, and it decreases to 0.8-1.2% at 1 year of age. Nearly a 20% of undescended testes are non-palpable. Various surgical treatments have been described, but its management is still controversial. A literature review was made of non-palpable testes, analysing diagnostic tools, treatment and its results. Additionally we reviewed non-palpable testes cases treated in our centre in the last 20 years. Different techniques are described for the management of non-palpable testes; with or without section of the spermatic vessels and/or in 1 or 2 stages. Nowadays, literature supports the laparoscopic management in two stages. In our experience, we have better results in two-stage Fowler-Stephens than one-stage, with lower rates of testicular atrophy. Non-palpable testes are a common pathology in paediatric urology. Analysing the literature and our experience we recommend a two-stage surgery for intra-abdominal testes, which has demonstrated good results and lower percentage of atrophic testis.
Collapse
Affiliation(s)
- Ximena Sepúlveda
- Department of Pediatric Surgery, University of Valparaíso, Dr. Gustavo Fricke Hospital, Viña del Mar, Chile
| | - Pedro-José López Egaña
- Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Santiago, Chile;; Department of Pediatrics and Pediatric Surgery, School of Medicine, University of Chile, Santiago, Chile;; Clínica Alemana, Santiago, Chile
| |
Collapse
|
12
|
Wayne C, Chan E, Nasr A. What is the ideal surgical approach for intra-abdominal testes? A systematic review. Pediatr Surg Int 2015; 31:327-38. [PMID: 25663531 DOI: 10.1007/s00383-015-3676-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 01/08/2023]
Abstract
There is controversy regarding the ideal surgical management of intra-abdominal testes (IAT) to preserve fertility; we conducted a systematic review to address this problem. We performed a comprehensive electronic search of CENTRAL, MEDLINE, EMBASE, and CINAHL from 2008 to September 2014 (the date range was limited due to an abundance of literature), as well as reference lists of included studies. Two researchers screened all studies for inclusion, and quality assessed each relevant study using AMSTAR for systematic reviews (SRs), Cochrane 'Risk of bias' tool for randomized controlled trials (RCTs), and MINORS for non-randomized studies. We identified two relevant SRs and 29 non-randomized studies. Due to the heterogeneity of the data, meta-analysis was not possible. Ultrasound and magnetic resonance imaging are insufficient for identification or localization of IAT; laparoscopic or surgical exploration is necessary. Primary orchiopexy is effective for low IAT, and Fowler-Stephens orchiopexy (FSO) is effective for high IAT. There is no clear benefit of one- vs. two-stage FSO, or of open vs. laparoscopic technique. Several alternative or modified techniques also show promise. RCTs are needed to confirm the validity of these findings, and to assess long-term outcomes.
Collapse
Affiliation(s)
- Carolyn Wayne
- Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada,
| | | | | | | |
Collapse
|
13
|
Carson JS, Cusick R, Mercer A, Ashley A, Abdessalam S, Raynor S, Lyden E, Azarow K. Undescended testes: does age at orchiopexy affect survival of the testis? J Pediatr Surg 2014; 49:770-3. [PMID: 24851767 DOI: 10.1016/j.jpedsurg.2014.02.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 02/13/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The optimal age at which to perform orchiopexy for cryptorchidism has long been debated. The aim of this study was to determine if age at orchiopexy affected testicular atrophy. METHODS A retrospective review of patients undergoing orchiopexy from 2000 to 2010 was conducted. An individual testis, rather than patient, was used as the dependent variable. A total of 349 testicles from 1126 charts (ICD-9=752.51) were identified. Primary study outcome was testicular survival without atrophy. RESULTS Mean follow up for the study was 25 months. There was postoperative atrophy in 27 testes (7.7%). Intraabdominal testicle was independently associated with increased postsurgical atrophy (p<0.0001). The odds of postsurgical atrophy were 15.66 times higher for an abdominal vs. inguinal location (95% CI: 5.5-44.6). Testicular atrophy was highest for orchiopexy at ages 13-24 months (n=16 of 133, 12%) vs. those less than 13 months (n=3 of 64, 5%), and those greater than 24 months (n=8 of 152, 5%) (p=0.0024). After adjusting for location, age was not statistically significant with postsurgical atrophy (p=0.055). CONCLUSIONS From this study we conclude that there is no increase in testicular atrophy in patients less than 13 months.
Collapse
Affiliation(s)
- Jeffrey S Carson
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE.
| | - Robert Cusick
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE; Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| | - Andrea Mercer
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE; Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| | - Adrienne Ashley
- Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| | - Shahab Abdessalam
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE; Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| | - Stephen Raynor
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE; Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| | - Elizabeth Lyden
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, NE
| | - Kenneth Azarow
- Department of Surgery, University of Nebraska Medical Center College of Medicine, Omaha, NE; Pediatric Surgery, Children's Hospital and Medical Center, Omaha, NE
| |
Collapse
|
14
|
Penson D, Krishnaswami S, Jules A, McPheeters ML. Effectiveness of hormonal and surgical therapies for cryptorchidism: a systematic review. Pediatrics 2013; 131:e1897-907. [PMID: 23690511 PMCID: PMC4074661 DOI: 10.1542/peds.2013-0072] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Controversy remains concerning the optimal treatment approach for cryptorchidism. The objective of this study was to assess effectiveness of hormone therapy or surgery for cryptorchidism. METHODS We searched Medline and other databases from 1980 to February 2012. Two reviewers independently assessed studies against predetermined criteria. Two reviewers independently extracted data and assigned overall quality and strength of evidence ratings using predetermined criteria. RESULTS Fourteen studies addressed effectiveness of hormonal treatments, and 26 studies addressed surgical intervention outcomes. Hormonal treatment is associated with testicular descent in some children, but rates generally do not exceed those seen with placebo by >10%. Surgical treatment is associated with success rates of testicular descent ranging from 33% to 100%, depending on surgery. Weighted success averages were 78.7% for 1-stage Fowler-Stephens (FS), 86% for 2-stage FS, and 96.4% for primary orchiopexy. Descent rates were similar among studies comparing laparoscopic and open surgeries. Reported harms of hormonal treatments were mild and transient. Adverse effects specifically associated with surgical repair were rare. CONCLUSIONS The body of the reviewed literature comprises primarily fair- and poor-quality studies, limiting our ability to draw definitive conclusions. Hormonal treatment is marginally effective relative to placebo but is successful in some children and with minimal harms, suggesting that it may be an appropriate trial of care for some patients. Surgical options are effective, with high rates of testicular descent (moderate strength of evidence for FS procedures, high for primary orchiopexy). Comparable outcomes occur with laparoscopic and open approaches.
Collapse
Affiliation(s)
- David Penson
- Center for Surgical Quality and Outcomes Research, Nashville, TN 37203-1738, USA.
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health
| | | | - Melissa L. McPheeters
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health,,Obstetrics and Gynecology, Vanderbilt Medical Center, Nashville, Tennessee
| |
Collapse
|
15
|
Mahomed A, Adams S, Islam S. Initial Success with Gubernacular-Sparing Laparoscopic-Assisted Fowler-Stephens Orchidopexy for Intra-abdominal Testes. J Laparoendosc Adv Surg Tech A 2012; 22:192-4. [DOI: 10.1089/lap.2011.0130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anies Mahomed
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Stephen Adams
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| | - Saidul Islam
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, United Kingdom
| |
Collapse
|
16
|
Abstract
Cryptorchidism is a common genital anomaly diagnosed at birth or during childhood. Genetic and/or environmental factors that alter expression or function of hormones crucial for testicular descent, insulin-like 3, and testosterone, may contribute to cryptorchidism. When identified at birth, surgical treatment is indicated by 6 months of age if testes fail to descend, or at the time of diagnosis in older children. A laparoscopic approach is preferred for abdominal testes. Early surgical therapy may reduce the risk of subfertility and/or malignancy.
Collapse
|
17
|
Kim J, Min GE, Kim KS. Laparoscopic orchiopexy for a nonpalpable testis. Korean J Urol 2010; 51:106-10. [PMID: 20414422 PMCID: PMC2855483 DOI: 10.4111/kju.2010.51.2.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 01/26/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose We evaluated the efficacy and the availability of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied outcomes including the testicular survival rate and associated complications. Materials and Methods We retrospectively reviewed the medical records of 67 children (86 testicular units) who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis between 1996 and 2008. The mean patient age was 2.4 years (median, 1 year; range, 0.5-9 years), and the mean follow-up period was 21.8 months (range, 0.3-138.4 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months. Results Of 86 testes, 69 testes were treated with primary laparoscopic orchiopexy (PLO) sparing the internal spermatic vessel, 14 testes were treated with one-stage Fowler-Stephens laparoscopic orchiopexy 1, and 3 testes were treated with two-stage Fowler-Stephens laparoscopic orchiopexy 2. The testicular survival rates were 97.7% (84/86) within 1 month and 93.7% (59/63) beyond 3 months. Of 59 viable testes followed up beyond 3 months, 48 (81.4%) testes were positioned in the lower scrotum and 11 (18.6%) testes in the mid to high scrotum. Conclusions Laparoscopic orchiopexy was successful for a nonpalpable intra-abdominal testis with a high testicular survival rate irrespective of the location from the internal ring. However, atrophy of the testis or upward migration of the testis can occur during follow-up, so we suggest watchful, periodic follow-up evaluating the viability and location of orchiopexed testes that are located in the lower scrotum in the immediate postoperative period or during short-term follow-up.
Collapse
Affiliation(s)
- Jongwon Kim
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
18
|
Daher P, Nabbout P, Feghali J, Riachy E. Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis? J Pediatr Surg 2009; 44:1999-2003. [PMID: 19853762 DOI: 10.1016/j.jpedsurg.2009.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/05/2009] [Accepted: 06/05/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE There are no formal guidelines for the management of boys with nonpalpable testis. In this article, we report our experience in treating all nonpalpable intraabdominal testis (NPIT) with standard inguinal orchidopexy without dividing the spermatic vessels stating that the Fowler-Stephens technique is no longer indicated for the treatment of the intraabdominal testis. METHODS Between June 2003 and April 2008, we treated 23 boys with NPIT confirmed by ultrasound or laparoscopy. All cases were treated through an inguinal orchidopexy without division of the spermatic vessels by fixing the testis to the scrotum by 2 absorbable stitches even if there was an upward retraction of the scrotal skin. Location and size of testis were reported at 1 week, 1 month, 3 months, and 6 months through physical examination. RESULTS Average age at presentation was 24 months. Ten patients (43%) had the NPIT on the right side, 8 (35%) on the left side, and 5 (22%) were bilateral. We had no intraoperative complications. All patients were discharged on the same day. In all cases, the testis was normal in size and found in the scrotum after 6 months of follow-up. CONCLUSION On the basis of our experience, we believe that the Fowler-Stephens procedure is not indicated anymore in the management of NPIT. Orchidopexy without division of the spermatic vessels should be the treatment of choice even for the cases of very high intraabdominal testis because it does not affect normal testicular vascularization and is minimally invasive.
Collapse
Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Faculty of Medicine, Hotel-Dieu de France University Hospital, Saint Jospeh University, Beirut, Lebanon
| | | | | | | |
Collapse
|
19
|
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
|
20
|
Dessanti A, Falchetti D, Iannuccelli M, Milianti S, Altana C, Tanca A, Ubertazzi M, Strusi G, Fusillo M. Cryptorchidism With Short Spermatic Vessels: Staged Orchiopexy Preserving Spermatic Vessels. J Urol 2009; 182:1163-7. [DOI: 10.1016/j.juro.2009.05.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Indexed: 10/20/2022]
Affiliation(s)
- A. Dessanti
- Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy
| | - D. Falchetti
- Department of Pediatric Surgery, Spedali Civili, Brescia, Italy
| | - M. Iannuccelli
- Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy
| | - S. Milianti
- Department of Pediatric Surgery, Spedali Civili, Brescia, Italy
| | - C. Altana
- Department of Pediatric Surgery, Spedali Civili, Brescia, Italy
| | - A.R. Tanca
- Department of Pediatric Surgery, Spedali Civili, Brescia, Italy
| | - M. Ubertazzi
- Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy
| | - G.P. Strusi
- Institute of Radiology, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy
| | - M. Fusillo
- Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University of Sassari, Sassari, Italy
| |
Collapse
|