Testicular volume in adult patients undergoing cryptorchidism surgery in childhood, and impact on paternity

OBJECTIVE

To determine the impact of orchiopexy on testicular volume. To determine whether age at surgery impacts testicular volume. To determine whether paternity is associated with testicular volume.

METHODS

Patients born between 1961 and 1985 who had undergone cryptorchidism surgery at the Pediatric Surgery Department of Miguel Servet University Hospital were included. Testis location and macroscopic appearance data were collected. Control testicular ultrasonographies and paternity surveys were carried out. Initially, the study was descriptive, and subsequently, inferential.

RESULTS

Ultrasonography was performed in 216 testicular units a mean of 14.9 years following surgery, whereas the paternity survey was conducted among 157 respondents a mean of 41.9 years following surgery. There were significant differences (p = 0.0038) in testicular volume distribution according to epididymal dissociation. There was a linear correlation between older age at surgery and lower testicular volume, but without statistical significance. Significant differences (p < 0.0001) in testicular volume according to groups - operated and non-operated -, as well as between unilateral and bilateral cases, were found. No differences in paternity rates according to testicular volume were noted.

CONCLUSION

Operated testes have lower volumes than normally descended testes. Older age at surgery may contribute to lower final volumes. Testes with full epididymal-testicular dissociation have lower total volumes. No relation between testicular volume and paternity rates was found. Further long-term studies are required.

What's up with my neck? Ultrasound and surgical findings in cervical midline tumors

OBJECTIVE

Evaluate ultrasound (US) sensitivity and specificity in suspected thyroglossal duct cysts (TGDC) undergoing surgery in our hospital, and their correlation with surgical findings.

MATERIAL AND METHODS

Retrospective study of 150 patients undergoing surgery for midline neck mass suggestive of TGDC (2008-2018). We analyzed epidemiological variables and compared the correlation between diagnostic ultrasound imaging and surgical findings, considering previous episodes of local infection.

RESULTS

Mean age at surgery was 3.96 years (0.75-12.58 years). Of the 150 patients, 81 were male and 69 were female. Following ultrasound examination, 110 were suspected to have TGDC, and diagnosis was confirmed after surgery in 80 cases. Of the remaining 40 cases without TGDC-compatible US examination, TGDC was confirmed in 15 cases. The rest were diagnosed with dermoid cyst (49), lymphadenopathy (4), and vascular malformation (2). US sensitivity was 84%, while specificity was 45%, with a positive predictive value of 73%, and a negative predictive value of 62%. In 62.1% (59) of TGDCs, a previous infection episode had been described, with 16.7% of cases requiring surgical drainage. 13.6% had recurrence after Sistrunk technique. There was no statistically significant relationship between previous infection episodes and postsurgical recurrence, or between surgical or spontaneous drainage and cyst recurrence.

CONCLUSIONS

Even though US role in eutopic thyroid gland identification cannot be doubted, it provides with low specificity in the study of midline neck masses. Therefore, the physician's opinion should be prioritized.

[Hypertrophy of labia minora. A growing problem in adolescence]

OBJECIVE

Hypertrophy of labia minora in adolescence is a little known disease. However, the growing demand for the solution of this problem pushes us to include it in our clinical practice. We evaluated the aesthetic and functional results of labiaplasty using straight amputation of the protuberant tissue of the labial edges.

METHODS

Patients treated by hypertrophy of labia minora were reviewed. We evaluated the results of aesthetic, functional and surgical complications. A survey on the degree of satisfaction was also conducted.

RESULTS

We collected 16 patients with 28 labioplasty, indicated by discomfort with the clothing and exercise. They were performed at a median age of 13.43 years (range 11.25-14.31). Bilateral 11 (64.7%), left 4 (23.5%) and rights 2 (11.8%). The median hospital stay was 1 day (range 1-3). There was evidence of immediate complications (partial dehiscence of the scar) in 1 (3.57%) patient and late complications in 2 (7.14%) patients (granuloma in the scar and recurrence), in a median follow up time of 1.58 years (range 0.19-7.76). The survey was answered by 13 patients. All of them said that preoperative discomfort was resolved. Postoperative discomfort (pain or straps) were nothing or very few in 61.54% and the median time of inconvenience was 5 days (range 1-30). They felt an improvement in self-esteem 69.23% and the 30.77% remaining never presented a problem about that. Median overall satisfaction was 8 (range 7-10) over 10, and the 100% of patients would repeat surgery.

CONCLUSION

The labiaplasty by straight amputation in adolescence is an effective technique with few complications, and with a high degree of satisfaction for patients.

[Esophageal atresia type I. Is impossible possible?]

INTRODUCTION

Treatment of esophageal atresia with "long gap" remains difficult and controversial. According to the idea that esophageal anastomosis is imposible in most cases, several esophageal substitution methods have been proposed, as esophagocoloplasty, gastric transposition or reversed gastric tube. Nevertheless reconstruction of native esophagus is accepted as the best option if posible. "Long gap" definition is imprecise, expressed by variability in percent of these cases in total esophageal atresias reported in different series in literature. We report our experience in seven cases type I esophageal atresia with long gap and the different therapeutic options used, with attention to delayed or early esophageal anastomosis feasibility and outcome.

MATERIAL AND METHODS

We have treated 121 patients with esophageal atresia from whom we analized 7 cases with pure esophageal atresia with "long gap" (5.8%). Six patients underwent gastrostomy and two gastrostomy and esophagostomy. Five patient underwent primary repair with esophageal anastomosis, delayed between 14 days and 4 months in 4 cases. One patient underwent esophageal anastomosis in the first day without gastrostomy. Retroesternal esophagocoloplasty was performed in 2 patients about their first year of life. Esophagogram was done in first month after surgery and pH monitoring of gastroesophageal reflux. Follow-up ranged from 6 months to 28 years.

RESULTS

Esophageal anastomosis was feasible in all 5 patients in whom it was tried. Stricture occurred in two patients, one patient underwent anastomotic resection and new esophageal anastomosis. Esophageal reflux was present in two patients, one of them required funduplication. One patient was dead by complications of cardiac malformation. Remaining patients have normal swallowing and are in normal growth curves. Patients with esophagocoloplasty had not relevant early or late complications.

CONCLUSIONS

In most pure esophageal atresia, delayed or even early esophageal anastomosis is feasible, making use of surgical and anesthesic sources that favour it. Esophageal substitution techniques can be reserved if this approach fails.

[Prenatal diagnosis of ovarian cysts. The ultrasonographic course and therapeutic importance]

Before of the implantation of ultrasound there were few cases of ovarian cysts reported in literature because only the very large ones or those which result in mechanical complications produce symptoms. The authors report 17 cases of neonatal ovarian cysts diagnosed by prenatal ultrasound. All of the infants were asymptomatic after birth despite their size or being twisted. The diameter of the cysts varied from 2.5 to 10 cm. Five neonates were treated conservatively and the cysts resolved spontaneously. 12 infants underwent surgery following postnatal confirmation, 9 of these patients had complex ovarian cysts and at laparotomy all of them had torsion of the ovary, three of them were autoamputated, and 3 uncomplicated cysts because their large size or their association to a nephroblastoma. Simple cysts of the ovary tend to resolve spontaneously and therefore, must be treated conservatively. Complex cysts or simple ones larger than 4 cm that do not disappear should undergo surgical removal.

[Results of biofeedback on incontinence caused by anorectal atresia]

Eight patients with anorectal incontinence because of anorectal atresia, aged between seven and seventeen years, following surgical treatment with Romualdi-Soave procedure in seven cases and with PSARP in one case, have received biofeedback training to improve their continence. Clinical evaluation has been performed with a new numeric punctuation method that allows a quantitative and precise appraisal of incontinence (Incontinence Punctuation: IP). From a clinical point of view, biofeedback training has increased 4.16 points IP in patients in whom the method has been effective. It has prolonged the mean duration of voluntary contraction in 5.9 sec. and elevated in 13.6 mm. Hg. the maximal pressure contraction. In two patients, clinical evolution and manometry measurements indicated surgical treatment and PSARP was performed, improving IP in 5.5 points. We considered biofeedback training, when indicated, an adequate and innocuous technique to achieve an important clinical continence improvement in these patients.

[Ingestion of batteries: treatment with water overload. Review of 175 cases]

The authors have treated 6 cases of childhood ingestion of disk batteries with bowel irrigation by nasogastric sonde. The disk was expeled with faeces in less than 12 hours without complications. The world literature (169 cases) on this subject is reviewed.