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Selin C, Hallabro N, Anderberg M, Börjesson A, Salö M. Orchidopexy for undescended testis-rate and predictors of re-ascent. Pediatr Surg Int 2024; 40:139. [PMID: 38806810 PMCID: PMC11133083 DOI: 10.1007/s00383-024-05729-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. METHODS A retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent. RESULTS A total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis. CONCLUSION The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias.
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Affiliation(s)
- Caroline Selin
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Nilla Hallabro
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
| | - Magnus Anderberg
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden
| | - Anna Börjesson
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden
| | - Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden.
- Department of Pediatric Surgery, Skåne University Hospital, 221 85, Lund, Sweden.
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2
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Wahyudi I, Raharja PAR, Situmorang GR, Rodjani A. Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials. Pediatr Surg Int 2024; 40:74. [PMID: 38451346 DOI: 10.1007/s00383-024-05655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making. MATERIALS AND METHODS A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study's quality was conducted by utilizing the revised Cochrane risk-of-bias tool. RESULTS Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges. CONCLUSION Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.
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Affiliation(s)
- Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia.
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
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Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
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BAWAZIR OA, ALSAEGH MO. Orchidopexy during inguinoscrotal hydrocele repair: is it necessary? Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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5
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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]
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Zhao W, Su C, Li S, Mo Z. Comparison of the Detection and Ligation of Patent Processus Vaginalis Between Laparoscopy-Assisted Transscrotal Orchiopexy and Single Scrotal Incision Orchiopexy. Front Surg 2022; 8:819057. [PMID: 35174204 PMCID: PMC8841425 DOI: 10.3389/fsurg.2021.819057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to compare the detection and ligation of patent processus vaginalis (PPV) between laparoscopy-assisted transscrotal orchidopexy (LATO) and single scrotal incision orchiopexy (SSIO) for low palpable undescended testis (UDT). We performed a retrospective medical record review of transscrotal orchidopexies performed for low palpable UDT at our institution from 2017 to 2019; 33 and 39 boys underwent LATO and SSIO, respectively. Data collection included patient demographics, incidence of PPV, operative time, and clinical outcomes. All 95 testes were delivered into the scrotum. There was no significant difference between the two groups with respect to patients' age, side, and mean operative time. The incidence of PPV in the LATO group was significantly higher than that in the SSIO group (56.52 vs. 34.69%, P = 0.04). The incidence of contralateral PPV in the LATO group was 45%. One patient in the SSIO group underwent unilateral PV ligation and laparoscopic exploration revealed bilateral PPV owing to metachronous contralateral hydrocele. One patient in the LATO group demonstrated obliterated PV in the initial transscrotal procedure, but an ipsilateral PPV was found in the latter laparoscopic procedure. In conclusion, LATO has a higher detection rate and higher ligation of the PPV than SSIO, suggesting that, LATO may help reduce recurrent PPV-related issues. However, long-term follow-up results are needed to evaluate the advantages and disadvantages in a larger case series.
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Affiliation(s)
- Weiguang Zhao
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Department of Pediatric Urology, Shenzhen Children's Hospital, Shenzhen, China
- Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Cheng Su
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
| | - Shoulin Li
- Department of Pediatric Urology, Shenzhen Children's Hospital, Shenzhen, China
- Shoulin Li
| | - Zengnan Mo
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China
- *Correspondence: Zengnan Mo
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7
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Yu C, Hu Y, Wang L, Kang L, Zhao J, Lu J, Lin T, He D, Wu S, Wei G. Comparison of Single-Incision Scrotal Orchiopexy and Traditional Two-Incision Inguinal Orchiopexy for Primary Palpable Undescended Testis in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:805579. [PMID: 35372152 PMCID: PMC8964791 DOI: 10.3389/fped.2022.805579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To compare the safety, efficacy, and cosmetic results of single-incision scrotal orchiopexy (SISO) and traditional two-incision inguinal orchiopexy (TTIO) for primary palpable undescended testes (PUDTs) in children. MATERIALS AND METHODS A systematic literature search of all relevant studies published on PubMed, Embase, Medline, Cochrane Library, Web of Science database, and Wanfang data until July 2021 was conducted. The operative time, hospitalization duration, conversion rate, wound infection or dehiscence, scrotal hematoma or swelling, testicular atrophy, reascent, hernia or hydrocele, analgesics needs, and cosmetic results were compared between SISO and TTIO using the Mantel-Haenszel or inverse-variance method. RESULTS A total of 17 studies involving 2,627 children (1,362 SISOs and 1,265 TTIOs) were included in the final analysis. The conversion rate of SISO was 3.6%. The SISO approach had a statistically significant shorter operative time than the TTIO approach for PUDT (weighted mean difference-11.96, 95% confidence interval -14.33 to -9.59, I2 = 79%, P < 0.00001) and a shorter hospital stay (weighted mean difference-1.05, 95% confidence interval -2.07 to -0.03, P = 0.04). SISO needed fewer analgesics and had better cosmetic results than TTIO. SISO had a similar total, short-term, or long-term complication rate with TTIO. CONCLUSION Compared with TTIO, SISO has the advantages of shorter operative time, shorter hospitalization duration, less postoperative pain, and better cosmetic appealing results. SISO is a safe, effective, promising, and potential minimal invasive surgical approach for PUDT. SISO is an alternative to TTIO in selected cryptorchid patients, especially for lower positioned ones. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021268562.
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Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yang Hu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Ling Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Lian Kang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jie Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Jiandong Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
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8
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Jan IA, Hassan M, Shalaan I, Alshehhi MA. Single Median Raphe Scrotal incision Orchiopexy: A safe & feasible approach for fixation of Palpable Undescended testes. Pak J Med Sci 2021; 37:1930-1934. [PMID: 34912420 PMCID: PMC8613038 DOI: 10.12669/pjms.37.7.4261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/05/2021] [Accepted: 07/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background: We wish to share our outcome of single median raphe scrotal incision orchiopexy (SMRSO) regarding safety & feasibility of technique by evaluating ease of access, conversion rate, duration of surgery, success rate, complications, and the need for redo-surgery. Methods: We retrospectively analyzed data of 277 orchiopexies performed in our department on 224 patients operated on between June 2016 to June 2019. SMRSO was considered for palpable testes that can be brought to the upper limit of the scrotum under anesthesia. The conventional inguinoscrotal approach was used for high lying testes. A median raphe incision was made to access & mobilize the testis on either side, ligation of processus vaginalis performed, and the testes secured in the scrotal pouch. The approach was utilized for both unilateral and bilateral orchiopexies. Follow-up done at one week, one month & six months to evaluate the outcome. Results: A total of 277 orchiopexies were performed in 224 patients. 237 (86%) orchiopexies were via the median raphe scrotal approach in 184 patients. Out of these, 53 cases had bilateral orchiopexies. 30 (11%) performed via a conventional inguinoscrotal approach and 10 (4%) by laparoscopic approach. The mean duration of surgery for SMRSO was 24 minutes for unilateral and 42 minutes for bilateral cases. Immediate postoperative complications included scrotal hematoma in three (1.6%) cases, Hematoma of the abdominal wall in one case, and scrotal edema in 4 (2 %) patients. All complications were treated conservatively & resolved. No wound infection or testicular atrophy was reported. Long-term complications included testicular ascend in three cases [1.6%]. Conclusion: Single-incision Median Raphe Scrotal orchiopexy is an attractive alternative to the standard inguinoscrotal orchiopexy for palpable low lying undescended testes with a better cosmetic outcome.
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Affiliation(s)
- Iftikhar A Jan
- Iftikhar A. Jan, Department of Pediatric Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Mokhtar Hassan
- Mokhtar Hassan, Department of Pediatric Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Ikram Shalaan
- Ikram Shalaan, Department of Pediatric Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Muna Ahmed Alshehhi
- Muna Alshehhi, Department of Pediatric Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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9
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Hayes M, Patel A, Seideman C. Staged Fowler Stephens, Who Requires a Third Procedure? Curr Urol Rep 2021; 22:32. [PMID: 34009488 DOI: 10.1007/s11934-021-01049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The two-stage Fowler-Stephens orchiopexy is a well-described surgical approach for most pediatric urologists tackling the high intra-abdominal testis. Testicular ascent is a well-reported outcome of the surgery and a problem that could be fixed with a repeat procedure. The purpose of this review is to determine the rate of subsequent testicular ascent and repeat surgery after a two-stage Fowler-Stephens using best available evidence. RECENT FINDINGS/RESULT We selected 16 studies that pertained to our topic. 0-13% of testicles were deemed to be in an inappropriate position on follow-up (6-37 months). The definition of appropriate postoperative position varied between studies and rates of repeat procedures were sparsely available. Available data reports a repeat orchiopexy rate of 2.6-7.5% after two-stage Fowler-Stephens. Two-stage Fowler-Stephens orchiopexy is a highly successful surgical technique to manage high intra-abdominal testes. Rates of testicular ascent are difficult to ascertain due to varying definitions and small sample sizes. While repeat procedures are typically indicated, the actual rate of repeat orchiopexy is rarely reported and long-term outcomes following a third procedure is sparse.
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Affiliation(s)
- Mitchell Hayes
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
| | - Amir Patel
- Department of Urology, Oregon Health & Science University, Portland, OR, USA. .,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA.
| | - Casey Seideman
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
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10
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Zhao T, Deng F, Jia W, Gao X, Li Z, Tang X, Li D, Zhou R, Shu F, Zhang J, Zhang Z, Fu W, Liu G. Ambulatory Orchidopexy Is a Potential Solution to Improve the Rate of Timely Repair in Cryptorchid Boys: An 8 Year Retrospective Study of 4,972 Cases. Front Pediatr 2021; 9:671578. [PMID: 34017811 PMCID: PMC8129512 DOI: 10.3389/fped.2021.671578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cryptorchidism is the most common congenital anomaly in pediatric urology. Although early surgery on cryptorchid boys is recommended by pediatric urologists worldwide, the actual age at orchidopexy is often older than the recommended age. Our medical center has started performing ambulatory orchidopexy since March 2016 at the ambulatory surgery center. We aimed to investigate whether ambulatory orchidopexy can improve the timely repair rate. Methods: A retrospective analysis was conducted from 2012 to 2019 at our medical center. Ambulatory orchidopexy was started at our medical center on March 24, 2016. Boys born on or after September 24, 2015 were classified into the "with ambulatory medical resource" group, and boys born before September 24, 2014, were classified into the "without ambulatory medical resource" group. The timely repair rates were calculated and compared. Results: A total of 4,972 cryptorchidism cases were included in the final study. Approximately 33.0% of cryptorchid boys received timely surgery (orchidopexy by the age of 18 months), and only 6.8% of all cryptorchid boys underwent surgery before the age of 1 year. After the performance of ambulatory orchidopexy, the timely repair rate increased from 25.7 to 37.0% (P < 0.001), and the percentage of patients receiving surgery before the age of 1 year increased significantly from 3.5 to 8.6% (P < 0.001). The proportion of timely repair in patients with ambulatory medical resources was significantly higher than that in patients without ambulatory medical resources (15.6% vs. 58.2%, P < 0.001). Significant changes in the rate of surgery before 12 months of age were also found between the two groups (2.4% vs. 14.8%, P < 0.001). Conclusions: After the performance of ambulatory orchidopexy in our medical center, the rates of both timely repair and receiving surgery before the age of 1 year increased significantly. Ambulatory orchidopexy is a potential solution to improve the rate of timely repair in cryptorchid boys, and it is worthy of promotion in developing countries and regions.
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Affiliation(s)
- Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fuming Deng
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Jia
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Gao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhongmin Li
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiangliang Tang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dian Li
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhou
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fangpeng Shu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhengtao Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Fu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guochang Liu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Zhao TX, Liu B, Wei YX, Wei Y, Tang XL, Shen LJ, Long CL, Lin T, Wu SD, Wei GH. Clinical and socioeconomic factors associated with delayed orchidopexy in cryptorchid boys in China: a retrospective study of 2423 cases. Asian J Androl 2020; 21:304-308. [PMID: 30632485 PMCID: PMC6498732 DOI: 10.4103/aja.aja_106_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR] = 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.
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Affiliation(s)
- Tian-Xin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Bin Liu
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yue-Xin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiang-Liang Tang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Lian-Ju Shen
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Chun-Lan Long
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
| | - Sheng-De Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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12
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Neheman A, Levitt M, Steiner Z. A tailored surgical approach to the palpable undescended testis. J Pediatr Urol 2019; 15:59.e1-59.e5. [PMID: 30563750 DOI: 10.1016/j.jpurol.2018.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Orchiopexy for a palpable undescended testis can be approached through a traditional inguinal incision or trans-scrotally. Despite the possible advantages of the scrotal approach, including reduced postoperative pain and shorter recovery, it is not consistently advocated. OBJECTIVE The objective of this study was to present the experience with a tailored approach to orchiopexy based on physical findings. STUDY DESIGN This is an extended case series. MATERIALS AND METHODS The mobility of the testis as described at examination under anesthesia informs the choice of surgical approach. If a 'low' palpable testis (defined as testis that can be manipulated to the scrotum) was found, a scrotal approach was used. In cases of 'high' palpable testis (testis that cannot be manipulated to scrotum), the inguinal approach was used. Success was defined by location and size of the testis 3 months after surgery. RESULTS A total of 259 orchiopexies were performed in 181 boys (78 bilateral). Scrotal approach was used in 125 (48%) and inguinal in 134 (52%) orchiopexies. Operative time was significantly shorter for the scrotal approach, 25 min vs. 40 min for inguinal orchiopexy (P < 0.05). The overall success rate was 98% with no statistical difference between the groups. Three children from the inguinal group and two from the scrotal group required an additional procedure for persistent undescended testis. The rates of testicular atrophy and hypotrophic testis were higher in the inguinal group than the scrotal group (5/134 vs. 0/125; P < 0.05 and 17/134 vs. 6/126; P < 0.05, respectively). DISCUSSION The substantial cohort of patients selected for trans-scrotal orchiopexy experienced success rates and rates of atrophic and hypotrophic testis comparable with those found in the published literature. Furthermore, trans-scrotal operative times were significantly lower than those of inguinal procedures, and less patients required re-operation in the trans-scrotal group. Limitations of this study include significantly higher age at operation in trans-scrotal patients and a difficulty accurately classifying hypotrophic testes. Furthermore, the higher atrophic rate in the inguinal group vs. the scrotal group likely reflects the vulnerability of a testis that is located higher and not the superiority of the scrotal approach. CONCLUSION This tailored approach to a palpable undescended testis appears simple, safe, and effective, providing high success rate with marginal complications. It is considered a preference in cases of low undescended testis, whereas the standard two-incision inguinal orchiopexy may better serve those with high undescended testis.
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Affiliation(s)
- A Neheman
- Department of Urology, Division of Pediatric Urology, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Levitt
- Department of Urology, Division of Pediatric Urology, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Z Steiner
- Department of Urology, Meir Medical Center, Kefar Sava, Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Oh JH, Chung HS, Yu HS, Kang TW, Kwon D, Kim SO. Hydrocelectomy via scrotal incision is a valuable alternative to the traditional inguinal approach for hydrocele treatment in boys. Investig Clin Urol 2018; 59:416-421. [PMID: 30402575 PMCID: PMC6215779 DOI: 10.4111/icu.2018.59.6.416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Few studies have explored the treatment of isolated communicating hydroceles via scrotal incision. We prospectively evaluated the surgical outcomes of such treatment in boys with hydroceles compared with that using traditional, inguinal incision hydrocelectomy. Materials and Methods Of 347 boys aged 0–12 years who were diagnosed as hydrocele on ultrasonography, 173 boys were assigned to the scrotal incision hydrocelectomy group (group I, n=173) and 172 boys were assigned to the traditional inguinal incision hydrocelectomy group (group II, n=172), and finally 156 boys in group I and 156 boys in group II were included in this study. Surgical outcomes, including postoperative complications and hydrocele relapse rates, were compared between groups. Results The overall success rates were similar in both groups (group I, 96.8%; group II, 89.1%; p=0.740). The operation time and hospital stay were significantly shorter in group I (30.94±3.95 minutes and 3.94±0.30 days) than in group II (38.02±7.12 minutes and 4.24±0.99 days; p<0.001 and p=0.009, respectively). The postoperative complication rate was lower in group I than in group II (3.2% vs. 10.9%, p=0.740). Conclusions Scrotal incision hydrocelectomy in boys was associated with shorter operative time and hospital stay, and a lower postoperative complication rate, than was the inguinal incision approach. The scrotal incision technique might be an easy and effective alternative treatment when used to treat hydroceles in boys as well as inguinal incision approach.
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Affiliation(s)
- Jeong Hoon Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dongdeuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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14
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Talabi A, Sownde O, Adejuyigbe O. High (trans) scrotal orchidopexy for palpable undescended testes in children: Influence of age and testicular position. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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15
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Braga LH, Lorenzo AJ, Romao RLP. Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism. Can Urol Assoc J 2017; 11:E251-E260. [PMID: 28761584 DOI: 10.5489/cuaj.4585] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cryptorchidism is one of the most common congenital anomalies in males, characterized by inability to palpate the testicle in the expected normal anatomical position (i.e., within its respective hemi-scrotum). It represents an abnormality of testicular descent and development associated with long-term concerns, including infertility, hypogonadism, and development of neoplasms.
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Affiliation(s)
- Luis H Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON; Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON; Canada
| | - Rodrigo L P Romao
- Division of Urology, IWK Health Centre and Dalhousie University, Halifax, NS; Canada
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16
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Savoie KB, Bachier-Rodriguez M, Schurtz E, Tolley EA, Giel D, Feliz A. Health Disparities in the Appropriate Management of Cryptorchidism. J Pediatr 2017; 185:187-192.e1. [PMID: 28408128 DOI: 10.1016/j.jpeds.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/09/2017] [Accepted: 03/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess regional practices in management of cryptorchidism with regard to timely fixation by the current recommended age of 18 months. STUDY DESIGN A retrospective study was performed. Charts of all patients who underwent surgical correction for cryptorchidism by a pediatric general surgeon or urologist within a tertiary pediatric hospital in an urban setting were systematically reviewed. RESULTS We identified 1209 patients with cryptorchidism. The median age of surgical correction was 3.7 years (IQR: 1.4, 7.7); only 27% of patients had surgical correction before 18 months of age. Forty-six percent of our patients were white, 40% were African American, and 8% were Hispanic. African American and Hispanic patients were less likely to undergo timely repair (P?=?.01), as were those with public or no insurance (P?<?.0001). A majority (72%) of patients had no diagnostic imaging prior to surgery. A majority of patients had palpable testes at operation (85%) and underwent inguinal orchiopexy (76%); 82% were operated on by a pediatric urologist. Only 35 patients (3%) experienced a complication; those repaired late were significantly less likely to develop a complication (P?=?.03). There were no differences in age at time of surgery by surgeon type. CONCLUSIONS A majority of our patients were not referred for surgical intervention in a timely manner, which may reflect poor access to care in our region. Public and self-pay insurance status was associated with delayed repair. Education of community physicians and families could be potentially beneficial.
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Affiliation(s)
- Kate B Savoie
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN; Le Bonheur Foundation, Le Bonheur Children's Hospital, Memphis, TN.
| | - Marielena Bachier-Rodriguez
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN; Le Bonheur Foundation, Le Bonheur Children's Hospital, Memphis, TN
| | - Elleson Schurtz
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN
| | - Elizabeth A Tolley
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Dana Giel
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN
| | - Alexander Feliz
- Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN
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Arena S, Impellizzeri P, Perrone P, Scalfari G, Centorrino A, Turiaco N, Parisi S, Antonuccio P, Romeo C. Is inguinal orchidopexy still a current procedure in the treatment of intraabdominal testis in the era of laparoscopic surgery? J Pediatr Surg 2017; 52:650-652. [PMID: 27629799 DOI: 10.1016/j.jpedsurg.2016.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To report our experience in surgical management of nonpalpable intraabdominal testis (NPIT) by inguinal orchidopexy without division of the spermatic vessels. METHODS We reviewed the records of NPIT patients who underwent orchidopexy between 2012 and 2015. All patients were evaluated ultrasonographically. When the testis was not detected ultrasonographically, a laparoscopic exploration was performed. If the testis was found on laparoscopy, surgery was resumed through an inguinal incision. A follow-up was performed at 1week, 1, 3 and 6months. RESULTS Twenty-one NPIT patients were treated, mean age 21.0±11.7months. Ultrasound identified 15 cases of NPIT (71%); diagnostic laparoscopy was performed in 6 (29%). All patients underwent an inguinal orchidopexy. At 1week, four testes were in a high scrotal position. At 6months follow-up, one testis was in a high scrotal position and one retracted up to the external inguinal ring. No atrophy was recorded. CONCLUSIONS Despite several attempts to find a surgical technique without any significant complications, all described procedures failed to meet the target. In our experience, inguinal orchidopexy is a safe, reliable and successful surgical procedure for the management of NPIT. It should be preferred to a technique requiring vascular division, burdened with a higher incidence of atrophy. TYPE OF STUDY Treatment study. LEVELS OF EVIDENCE Case series with no comparison group.
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Affiliation(s)
- Salvatore Arena
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy.
| | - Pietro Impellizzeri
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Patrizia Perrone
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Gianfranco Scalfari
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Antonio Centorrino
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Nunzio Turiaco
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Saveria Parisi
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Pietro Antonuccio
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
| | - Carmelo Romeo
- Department of human pathology in adult and developmental age "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Italy
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Braga LH, Lorenzo AJ. Cryptorchidism: A practical review for all community healthcare providers. Can Urol Assoc J 2017; 11:S26-S32. [PMID: 28265313 DOI: 10.5489/cuaj.4343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cryptorchidism is one of the most common congenital anomalies of the male genitalia, occurring in 1% of boys by the age of one year. Even though the etiology of cryptorchidism is multifactorial, management has evolved with the clear recognition that hormonal treatment is not effective and surgery between 6-18 months of age leads to better testicular outcomes. Diagnostic laparoscopy is considered the standard approach for management of non-palpable testes, and can be combined with one or two-stage orchidopexy, with up to 80-90% success rates. This review discusses the natural history of retractile testicles, indications for hormonal treatment and orchidectomy, ultrasound's role as a diagnostic tool, risks of infertility and testicular cancer, and surgical techniques for inguinal and intra-abdominal testes.
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Affiliation(s)
- Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
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19
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Bey E, Gaget O, Jund J, Overs C, Skowron O. [Congenital undescended testis: Should open processus vaginalis have any impact on the elected surgical approach?]. Prog Urol 2016; 26:1185-1190. [PMID: 28029537 DOI: 10.1016/j.purol.2016.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 09/17/2016] [Accepted: 09/26/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Compare the position of the undescended testis at clinical examination and under general anesthesia with the patency of an open processus vaginalis. PATIENTS AND METHODS We included children from 2 to 18 years of age operated for a unilateral or bilateral undescended testis between January 2006 and April 2014 at the Annecy Genevois hospital, France. The analysis was conducted considering that the individual was the testis. Testicular position before surgery, under general anesthesia and patency of open processus vaginalis as a surgical finding were prospectively recorded. RESULTS Three hundred and six children were included. The analysis was conducted over 401 testes. The position at clinical examination was significantly linked to a persistent open processus vaginalis (P=0.0045). Over the 282 testes considered as candidate for Bianchi's procedure, as to say intra- or supra-scrotal under general anesthesia, 154 had a persistent processus vaginalis (55%). CONCLUSION There is a link between a persistent processus vaginalis and the location of the undescended testis which should encourage us not to neglect the inguinal approach, and eventually to question the relevance of Bianchi's procedure. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E Bey
- Département de chirurgie urologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - O Gaget
- Département de santé publique, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - J Jund
- Département de santé publique, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - C Overs
- Département de chirurgie urologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - O Skowron
- Département de chirurgie urologie, centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
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20
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Feng S, Yang H, Li X, Yang J, Zhang J, Wang A, Lai XH, Qiu Y. Single scrotal incision orchiopexy versus the inguinal approach in children with palpable undescended testis: a systematic review and meta-analysis. Pediatr Surg Int 2016; 32:989-95. [PMID: 27510940 DOI: 10.1007/s00383-016-3956-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We performed a systematic review and meta-analysis to compare the efficacy and safety between single-incision, transscrotal orchidopexy, and the traditional inguinal orchidopexy in children. METHODS A systematic search of the electronic databases was conducted to identify studies compared the transscrotal orchidopexy (SO) and inguinal orchidopexy (IO) for children. Parameters, such as operative time, the incidence of patent processus vaginalis, and postoperative complications, including wound infection, testicular atrophy, testicular reascent, hernia, or hydrocele, were pooled and compared by meta-analysis. RESULTS Among the 1376 children with palpable undescended testes (UDTs) included in the eight studies, 697 had received SO and 679 IO. There were shorter operative times with the SO approach compared with IO. However, no significant difference was found between SO and IO in the incidence of patent processus vaginalis and postoperative complications, including wound infection, testicular atrophy, testicular reascent, and hernia. CONCLUSION SO is a safe and effective surgical approach alternative to IO for pediatric UDTs. Compared with IO, SO has the advantage of shorter operative times. Besides, the incidence of postoperative wound infection may be slightly lower in SO. We suggest that SO should be considered as an acceptable option for children with UDTs.
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Affiliation(s)
- Shaoguang Feng
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Huajun Yang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Xiang Li
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Junjia Yang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Jie Zhang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Aihe Wang
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China
| | - Xin-He Lai
- Institute of Inflammation and Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuhui Qiu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, No. 195 Wenhui Rd, Xiacheng district, Hangzhou, 310015, China.
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Lopes RI, Naoum NK, Chua ME, Canil T, Dos Santos J, Farhat WA. Outcome Analysis of Redo Orchiopexy: Scrotal vs Inguinal. J Urol 2016; 196:869-74. [PMID: 27157374 DOI: 10.1016/j.juro.2016.04.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Redo orchiopexy after previous surgery is technically challenging and requires skills and care to ensure preservation of cord structures. We report our experience with redo orchiopexy in children. MATERIALS AND METHODS We retrospectively reviewed patients who had undergone redo orchiopexy between January 2004 and May 2015. Variables evaluated included primary procedure, type of redo procedure, operative time, shift of surgical route, operative and postoperative complications, and testicular location at last followup. RESULTS A total of 3,384 orchiopexies were performed during the study period, with 61 children (1.8%) requiring redo orchiopexy. Mean ± SD patient age at redo orchiopexy was 6.4 ± 3.6 years (range 1.5 to 17.1) and average followup was 24.9 months (2.1 to 99.6). The primary surgical procedure preceding redo surgery was inguinal orchiopexy in 45.9% of the patients, scrotal orchiopexy in 13.1% and laparoscopy in 13.1%, and 27.9% of patients were status post inguinal surgery (hernia/hydrocele repair). Redo surgery was performed by inguinal approach in 33 patients, while 28 children underwent a scrotal approach. There was no statistical difference in intraoperative and postoperative complication rates for the 2 approaches (p = 0.52 and p = 0.26, respectively). However, there was a statistically significant difference in overall operative time between approaches (p = 0.003) with scrotal orchiopexy being significantly shorter (53.1 minutes) compared to inguinal orchiopexy (84.6). CONCLUSIONS Scrotal and inguinal orchiopexy appear to be viable in managing secondarily ascending testes, with the scrotal approach offering some advantage in terms of length of procedure.
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Affiliation(s)
- Roberto Iglesias Lopes
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Naimet Kamal Naoum
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Erlano Chua
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Canil
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Walid A Farhat
- Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Hyuga T, Kawai S, Nakamura S, Kubo T, Nakai H. Long-Term Outcome of Low Scrotal Approach Orchiopexy without Ligation of the Processus Vaginalis. J Urol 2016; 196:542-7. [PMID: 26944301 DOI: 10.1016/j.juro.2016.02.2962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We performed low scrotal approach orchiopexy in patients with prescrotal cryptorchidism. The processus vaginalis was not ligated if it was not widely patent. We retrospectively evaluated the long-term outcomes of low scrotal approach orchiopexy without processus vaginalis ligation. MATERIALS AND METHODS A total of 137 patients (227 testes) were diagnosed with prescrotal cryptorchidism between October 2009 and April 2014. All patients underwent low scrotal approach orchiopexy. Mean age at surgery was 34.9 months. The processus vaginalis was deemed to be not widely patent when a sound could not be passed into the abdominal cavity through the internal inguinal ring, and the processus vaginalis was not ligated in such cases. RESULTS Intraoperative findings revealed that the processus vaginalis was widely patent in 10 testes and was not widely patent in 217. A widely patent processus vaginalis was closed via scrotal approach in 5 testes, while an inguinal approach was necessary in 5. Median followup was 44 months (range 20 to 73). Postoperative complications included reascending testis in 1 case where an inguinal approach was necessary. No patient manifested testicular atrophy or inguinal hernia. CONCLUSIONS Low scrotal approach orchiopexy is a useful and safe procedure for treating patients with prescrotal cryptorchidism. Ligation is unnecessary when the processus vaginalis is not widely patent.
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Affiliation(s)
- Taiju Hyuga
- Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Tochigi, Japan.
| | - Shina Kawai
- Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Tochigi, Japan
| | - Shigeru Nakamura
- Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Tochigi, Japan
| | - Taro Kubo
- Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Tochigi, Japan
| | - Hideo Nakai
- Department of Pediatric Urology, Jichi Medical University, Children's Medical Center Tochigi, Tochigi, Japan
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Soualili Z, Achouri D, Haif A, Touabti S, Yahia SA, Benmahmoud M, Choutri H, Nedjar S, Mimoune M, Chouaib S. The interscrotal approach to inguinoscrotal pathologies. Arab J Urol 2015; 13:176-8. [PMID: 26413342 PMCID: PMC4563009 DOI: 10.1016/j.aju.2015.05.002] [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: 01/12/2015] [Revised: 05/05/2015] [Accepted: 05/09/2015] [Indexed: 11/03/2022] Open
Abstract
Objective To determine the efficiency of the interscrotal approach to inguinoscrotal pathologies. Patients and methods We report the use of the interscrotal approach in 21 boys, from September 2012 to November 2013, operated using an interscrotal access through a vertical incision on the median raphe. Results The approach was used for bilateral inguinal hernia (48%), bilateral ectopic testis (19%), torsion of the spermatic cord (19%), testicular biopsy (10%) and webbing of the penis (5%). Conclusion Inter-scrotal access is an option for inguinoscrotal pathologies, with the advantages of a single incision, much less dissection and disruption of tissue, and greater comfort for the ‘day-case’ child.
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Affiliation(s)
- Zineddine Soualili
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Djelloul Achouri
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Assia Haif
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Souhem Touabti
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Smain Ait Yahia
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Mahmoud Benmahmoud
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Hichem Choutri
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Sameh Nedjar
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Malika Mimoune
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
| | - Sayah Chouaib
- University of Farhat Abbas, Institute of Medical Sciences of Setif, Algeria
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Ben Dhaou M, Zouari M, Zitouni H, Jallouli M, Mhiri R. [Comparison of the inguinal and scrotal approaches for the treatment of cryptorchidism in children]. Prog Urol 2015; 25:598-602. [PMID: 26094098 DOI: 10.1016/j.purol.2015.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/29/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The single scrotal incision orchidopexy was described by Bianchi in 1989. Despite its popularity, the place of this technique in the treatment of cryptorchidism in children is still unclear. AIM OF THE STUDY To evaluate and compare the outcomes of the conventional inguinal approach and the scrotal approach for the treatment of palpable undescended testis in children. METHODS A prospective study for all patients with palpable undescended testis undergoing orchidopexy between January 2011 and December 2013 was conducted. Totally 200 patients were randomly divided into two groups: group 1: two incisions inguinal approach (80 patients, 100 testis); group 2: single scrotal incision approach (89 patients, 100 testis). MAIN RESULTS The patients' mean age was 53.9±13 months in group 1 and 45.8±9 months in group 2. There was no statistical difference between the two groups in terms of patient age (P=0.8) and location of the undescended testis (P=0.359). Operative time was statistically significantly lower in the scrotal group (P<0.05). There was a significant difference in the complications rates between the two groups. CONCLUSION The single scrotal incision orchidopexy is safe and effective for undescended testicles palpable in the inguinal canal or in high scrotal position.
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Affiliation(s)
- M Ben Dhaou
- Service de chirurgie pédiatrique, CHU Hédi-Chaker, route El Ain Km 0,5, 3029, Sfax, Tunisie
| | - M Zouari
- Service de chirurgie pédiatrique, CHU Hédi-Chaker, route El Ain Km 0,5, 3029, Sfax, Tunisie.
| | - H Zitouni
- Service de chirurgie pédiatrique, CHU Hédi-Chaker, route El Ain Km 0,5, 3029, Sfax, Tunisie
| | - M Jallouli
- Service de chirurgie pédiatrique, CHU Hédi-Chaker, route El Ain Km 0,5, 3029, Sfax, Tunisie
| | - R Mhiri
- Service de chirurgie pédiatrique, CHU Hédi-Chaker, route El Ain Km 0,5, 3029, Sfax, Tunisie
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Ibrahim M, Getso KI, Mohammad MA, Akhparov NN, Aipov RR. Herniotomy in resource-scarce environment: Comparison of incisions and techniques. Afr J Paediatr Surg 2015; 12:45-50. [PMID: 25659550 PMCID: PMC4955508 DOI: 10.4103/0189-6725.150980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are various methods for surgical treatment of hernia and hydrocele in children with variable cost-effectiveness, recovery and cosmetic outcomes. This study analyses our experience with mini-incision/invasive herniotomy in children in resource-limited centre. MATERIALS AND METHODS Seven hundred and eighty-four n = 784 patients underwent herniotomy via conventional and mini-invasive methods were assigned into Group A and Group B. Three hundred and seventy-six n = 376 (47.95%) in Group A while four hundred and eight n = 408 (52.04%) in Group B. Eight hundred and seventeen (817) herniotomy was performed. Demographic data, hernia/hydrocele sides, volume of surgical suture used, surgery duration, and complications analysed. RESULTS Right side hernia and/or hydrocele were 464 (59.18%). 287 (36.60%) had left sided while 33 (4.21%) had bilateral hernia and/or hydrocele. There were 14 bilateral hernia repair in Group A and 19 in Group B. The lengths of operation time for unilateral repair ranged from 14 to 54 min in Group A (median, 23 min) and 7-44 min in Group B (median, 15 min) with a mean surgical duration of 15.48 ± 4.16 min in Group B versus 23.41 ± 5.94 min in Group A (P < 0.001) while the range of the lengths of operation time for bilateral repair in Group A was 20-54 min (median, 36) and 12-30 min (median, 21) in Group B with a mean duration of 36.35 ± 9.89 min in Group A versus 20.42 ± 4.83 min in Group B P = 0.00563. 376 sachets of 45 cm suture material were used in Group A versus 137 in Group B. There were total of 87 (23.13%) complications in Group A versus 3 (1.47%) in Group B P = 0.000513. Superficial wound infection and abscess were 9 (2.36%) and 16 (4.25%) in Group A versus none (0) in Group B. CONCLUSION Mini-incision/invasive herniotomy in children and adolescents is fast, cost-effective with satisfactory cosmetic outcome and limited complications.
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Affiliation(s)
- Musa Ibrahim
- Department of Surgery, Murtala Mohammad Specialist Hospital, Children Surgical Unit, Kano, Nigeria
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Khirallah MG, Elafifi MA, Elbatarny AM, Elsharaby AM. Orchiopexy through a single high transverse scrotal incision. Afr J Paediatr Surg 2015; 12:61-5. [PMID: 25659553 PMCID: PMC4955503 DOI: 10.4103/0189-6725.150986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Palpable Undescended Testis (PUT) represents a common paediatric problem in many premature and some mature infants. There are several surgical techniques to correct PUT either through combined inguinal and scrotal incision or single transverse scrotal incision. This study assessed single high transverse scrotal incision for the management of PUT as regards to feasibility, postoperative success and final cosmetic results. MATERIALS AND METHODS One hundred twenty patients were managed at the Paediatric Surgery Department of Tanta University Hospital with PUT during the period from March 2010 to March 2014. They were all operated at the age of 6-12 months. We excluded recurrent cases, and cases older than 12 months. Through high transverse scrotal incision, the layers were divided, and the canal entered through the external ring, dissecting the PUT and bringing it through the incision. Hernia sac, if present, was ligated at the neck. Creation of the dartos pouch was then made through the same incision. All infants were followed-up at 1 month, 2 months and 6 months to detect any re-ascended cases, testicular atrophy and the final cosmetic appearance. RESULTS A total of 140 PUTs were operated upon in 120 patients. PUT was bilateral in 20 patients, right-sided in 65 cases and left-sided in 35 cases. Thirty testes were located at the external ring; the others were located within the inguinal canal. No cases needed a redo operation, and there was no case of postoperative testicular atrophy. CONCLUSION Single high transverse incision was sufficient to deal with PUT especially, in young infants (age 6 months) with no need for conversion in most cases to the traditional two incisions technique, and good long term follow-up and a better cosmetic results.
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Affiliation(s)
- Mohammad G Khirallah
- Department of Paediatric Surgery, Tanta Faculty of Medicine, Tanta University Hospitals, Tanta, El Gharbeya, Egypt
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Single scrotal-incision orchidopexy for palpable undescended testis in children. Arab J Urol 2014; 13:112-5. [PMID: 26413331 PMCID: PMC4561924 DOI: 10.1016/j.aju.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/02/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the single scrotal-incision orchidopexy (SSIO) technique in patients with an undescended testis palpable in the inguinal canal or below the external inguinal ring. PATIENTS AND METHODS Between January 2011 and December 2013 we performed 100 SSIOs in 89 patients. The mean (range) follow-up was 9 (3-36) months. RESULTS In 88 testes the SSIO was performed with no difficulties. In four patients an additional dissection by opening the external ring and canal was necessary; none of these patients developed an inguinal hernia after surgery. In eight patients conversion to an inguinal approach was necessary because of difficulty in controlling the hernial sacs and inadequate mobilisation. At the follow-up assessment, of the 89 patients, none developed testicular atrophy, one (1%) had wound dehiscence and four (5%) had a scrotal haematoma. There was no statistically significant difference between the testicular size at baseline and that during the follow-up. At 3 months after surgery the overall cosmetic result was excellent. CONCLUSION The SSIO is minimal-access surgery allowing less dissection, less discomfort for the patient, rapid healing, excellent cosmetic results and a good success rate. This technique is safe and effective for undescended testes palpable in the inguinal canal or below the external inguinal ring.
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Primary new-onset hydroceles presenting in late childhood and pre-adolescent patients resemble the adult type hydrocele pathology. J Pediatr Surg 2014; 49:1656-8. [PMID: 25475813 DOI: 10.1016/j.jpedsurg.2014.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 11/22/2022]
Abstract
AIM The aim of this study was to investigate the presence of a patent processus vaginalis (PPV) in children of late childhood and pre-adolescence presenting with new onset hydrocele. MATERIAL AND METHODS All males with hydrocele presenting at our department from January 2011 to January 2013 were followed. Patients with secondary hydroceles were excluded. Demographic data, medical history, clinical symptoms and signs relative to their pathology and U/S findings were recorded. According to their indications, patients were either operated or followed up. Patients surgically treated, consisted our study group. RESULTS Sixty patients were identified. Thirteen were followed until resolution of their hydrocele. Forty-seven patients were surgically treated. Twenty-seven had right sided hydrocele (57.44%), 13 had left sided hydrocele (27.66%) whereas in 7 patients the hydroceles were bilateral (14.9%). All patients were operated by an inguinal approach. In all 9 patients (19.14%) presenting with new-onset hydrocele at the age >10 years (range: 10-15 years), intraoperative exploration did not reveal a PPV. All patients were followed at least for 6 months post-operatively. CONCLUSION Early evidence shows that primary new onset hydroceles presenting in late childhood and pre-adolescence seem to be non-communicating and resemble the adult type hydrocele pathology.
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Castillo-Ortiz J, Muñiz-Colon L, Escudero K, Perez-Brayfield M. Laparoscopy in the surgical management of the non-palpable testis. Front Pediatr 2014; 2:28. [PMID: 24783184 PMCID: PMC3986523 DOI: 10.3389/fped.2014.00028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/24/2014] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). METHODS From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient's age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher's exact test for two independent proportions was used for statistical analysis and reported our results. RESULTS One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. CONCLUSION Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings.
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Affiliation(s)
| | - Luis Muñiz-Colon
- Division of Urology, University of Puerto Rico , San Juan, PR , USA
| | - Karina Escudero
- Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
| | - Marcos Perez-Brayfield
- Division of Urology, University of Puerto Rico , San Juan, PR , USA ; Division of Urology, Inter-American Hospital for Advanced Medicine , Caguas, PR , USA
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Alp BF, Irkilata HC, Kibar Y, Zorba U, Sancaktutar AA, Kaya E, Dayanc M. Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children. Kaohsiung J Med Sci 2013; 30:200-5. [PMID: 24656161 DOI: 10.1016/j.kjms.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022] Open
Abstract
The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment.
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Affiliation(s)
| | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Unal Zorba
- School of Medicine, Rize University, Rize, Turkey
| | | | - Engin Kaya
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Murat Dayanc
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
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Novaes HFF, Carneiro Neto JA, Macedo Jr A, Barroso Junior U. Single scrotal incision orchiopexy - a systematic review. Int Braz J Urol 2013; 39:305-11. [DOI: 10.1590/s1677-5538.ibju.2013.03.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/27/2013] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Jose Abraao Carneiro Neto
- Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of Sao Paulo
| | - Antonio Macedo Jr
- Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of Sao Paulo
| | - Ubirajara Barroso Junior
- Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of Sao Paulo
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Aggarwal H, Kogan BA, Feustel PJ. One third of patients with a unilateral palpable undescended testis have a contralateral patent processus. J Pediatr Surg 2012; 47:1711-5. [PMID: 22974611 DOI: 10.1016/j.jpedsurg.2012.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/01/2012] [Accepted: 01/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence and predictive factors associated with a contralateral patent processus vaginalis in boys with a unilateral palpable undescended testis. METHODS We retrospectively reviewed the records of 77 consecutive boys (median age, 15 months; range, 5 months to 17.7 years) who had undergone orchiopexy for a unilateral palpable testis. At inguinal orchiopexy, an 8F feeding tube and a 70° adult cystoscope lens were placed into the peritoneum through the hernia sac, and the contralateral internal ring was inspected. The clinical factors that might predict the presence of a contralateral patent processus vaginalis were determined. RESULTS The overall rate of a contralateral patent processus vaginalis was 34% in those with a significant ipsilateral hernia sac. After considering age, side, prematurity, location, and volume of the undescended testis, only the boys with a testis distal to the external ring compared with those with testes lying within the inguinal canal had statistically increased odds of a patent contralateral processus vaginalis (odds ratio, 3.1; 95% confidence interval, 1.08-9.08). CONCLUSION Approximately one third of boys with a unilateral palpable undescended testis will have a contralateral patent processus vaginalis as determined by transinguinal laparoscopy. The rate is higher (52%) if the undescended testis was distal to the external ring. Both the etiology and significance of this contralateral finding are unknown.
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Shih TY, Uen YH. Single scrotal incision for repair of bilateral inguinal hernias in boys. Pediatr Surg Int 2012; 28:417-20. [PMID: 22207457 DOI: 10.1007/s00383-011-3049-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Single scrotal incision for repair of bilateral inguinal hernias in boys is a new and attractive approach. However, the advantages and drawbacks of this approach have not been fully discussed in the literature and it has not been widely accepted as a standard procedure for repair of bilateral inguinal hernias. We develop the median raphe approach and this study is aimed to clarify the outcomes of this new technique. METHODS From January 2006 to December 2010, we studied 114 boys with bilateral inguinal hernias who underwent trans-scrotal repairs using median raphe incisions. The follow-up durations ranged from 12 to 36 months. The operation time and morbidity of this approach were compared to those of 91 boys who underwent conventional bilateral inguinal incision herniorrhaphy from January 2001 to December 2005. RESULTS The operation times were equal in both approaches. The incidence of stitch abscesses was a little higher in scrotal incision group. All the boys with the scrotal approach had excellent cosmetic results. CONCLUSION The median raphe approach for bilateral inguinal hernia repair is a good alternative to the conventional method for boys.
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Affiliation(s)
- Tune-Yih Shih
- Chi-Mei Medical Center, YongKang, Tainan, Taiwan, ROC
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Sutton PA, Greene OJ, Adamson L, Singh SJ. Scrotal fixation in the management of low undescended testes. J Indian Assoc Pediatr Surg 2011; 16:142-4. [PMID: 22121312 PMCID: PMC3221156 DOI: 10.4103/0971-9261.86871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aims: Scrotal fixation (SF) is a known technique for the management of low undescended testes (UDT). SF assumes that most low UDT have no patent processus vaginalis (PPV) and can be managed via scrotal mobilization alone. We report our experience of the role of SF in the management of low UDT. Materials and Methods: A retrospective review of all palpable UDT operated on by the senior author between 1998 and 2008 was undertaken. Children diagnosed with palpable UDT were examined under general anesthesia; if the whole testis could be manipulated into the upper part of the scrotum, low UDT was assumed and SF was performed. Attempts to identify a PPV intraoperatively were made in all and, if found, the procedure was converted to standard inguinal incision orchidopexy. Results: One hundred and thirteen children with 134 UDT were identified. SF was performed in 55 testes; inguinal orchidopexy (IO) in 75 and four testes were excised. The median (IQR) age at SF was 5.5 [4.7–6.3] years. Three SF were converted to an IO when a PPV was discovered. The complications in SF were scrotal hematoma (n = 1) and superficial wound infection (n = 1). No post-operative herniae or atrophied testis were seen and none required a redo operation. The mean (SD) operative times for SF and IO were 29.5 (18.1) and 42.7 (16.6) min, respectively (P = 0.04). Conclusion: In our study, 52 of 55 (94.5%) patients with low UDT lacked a hernial sac and were successfully fixed by SF. SF is a viable, simple, quick and safe alternative to IO in the management of low UDT.
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Affiliation(s)
- Paul A Sutton
- Department of Paediatric Surgery, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, United Kingdom
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Na SW, Kim SO, Hwang EC, Oh KJ, Jeong SI, Kang TW, Kwon DD, Park K, Ryu SB. Single scrotal incision orchiopexy for children with palpable low-lying undescended testis: early outcome of a prospective randomized controlled study. Korean J Urol 2011; 52:637-41. [PMID: 22025961 PMCID: PMC3198239 DOI: 10.4111/kju.2011.52.9.637] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/05/2011] [Indexed: 11/30/2022] Open
Abstract
Purpose We prospectively evaluated the surgical outcomes of single scrotal incision orchiopexy in children with a palpable undescended testis compared with the traditional two incision orchiopexy. Materials and Methods A total of 398 orchiopexies (292 children) were included and randomly assigned to the single scrotal incision orchiopexy group (Group I, 147 children, 201 testes) or the traditional inguinal incision orchiopexy group (Group II, 145 children, 197 testes). The final number of patients enrolled (excluding those lost to follow-up) was 107 children (146 testes) in group I and 105 children (141 testes) in group II. Success was defined as no complications, postoperative intrascrotal location of the testis, and no conversion to the traditional inguinal approach. Surgical outcomes and complications were compared between the two groups. Testicular location, complications, and subjective satisfaction rate were assessed at the follow-up evaluation at least 12 months postoperatively. Results The overall success rate in group I was 92.5% in 135 of 146 testes; the remaining 9 testes required conversion to traditional two incision orchiopexy. In group II, orchiopexy was successful in 136 of 141 testes (96.5%). The operation time and hospital stay were significantly shorter in group I (40.5±25.9 minutes, 2.1±0.8 days) than in group II (62.3±35.6 minutes, 2.5±0.7 days), respectively (p<0.001, p=0.03). Postoperative complications were found in two cases (hematoma, wound dehiscence) in group I and in one case (wound dehiscence) in group II; all cases with complications recovered with conservative care. The subjective rate of satisfaction with the cosmetic result was 96.6% in group I and 96.5% in group II (p=0.97). Conclusions We conclude that single scrotal incision orchiopexy is a simple technique that is associated with a shorter operation time and hospital stay than the traditional method and that is more feasible cosmetically.
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Affiliation(s)
- Seong Woong Na
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Cuda SP, Srinivasan AK, Kalisvaart J, Kirsch AJ. Evolution of Single Practice Trends in the Surgical Approach to the Undescended Testicle. J Urol 2011; 185:2451-4. [DOI: 10.1016/j.juro.2011.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Scott P. Cuda
- Department of Pediatric Urology, Children's Healthcare of Atlanta-Emory University School of Medicine, Atlanta, Georgia
| | - Arun K. Srinivasan
- Department of Pediatric Urology, Children's Healthcare of Atlanta-Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan Kalisvaart
- Department of Pediatric Urology, Children's Healthcare of Atlanta-Emory University School of Medicine, Atlanta, Georgia
| | - Andrew J. Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta-Emory University School of Medicine, Atlanta, Georgia
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Cloutier J, Moore K, Nadeau G, Bolduc S. Modified Scrotal (Bianchi) Mid Raphe Single Incision Orchiopexy for Low Palpable Undescended Testis: Early Outcomes. J Urol 2011; 185:1088-92. [DOI: 10.1016/j.juro.2010.10.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan Cloutier
- Division of Urology, Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, Quebec, Canada
| | - Katherine Moore
- Division of Urology, Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, Quebec, Canada
| | - Geneviève Nadeau
- Division of Urology, Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, Quebec, Canada
| | - Stéphane Bolduc
- Division of Urology, Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, Quebec, Canada
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Yucel S, Celik O, Kol A, Baykara M, Guntekin E. Initial Pre-Scrotal Approach for Palpable Cryptorchid Testis: Results During a 3-Year Period. J Urol 2011; 185:669-72. [DOI: 10.1016/j.juro.2010.09.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Selcuk Yucel
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Orcun Celik
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Arif Kol
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mehmet Baykara
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Erol Guntekin
- Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
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Mirilas P, Mentessidou A, Kontis E, Argyris I, Tsitouridis I, Petropoulos A. Sonographic evidence for patency of the processus vaginalis in children with acquired undescended testis. ACTA ACUST UNITED AC 2011; 34:49-54. [DOI: 10.1111/j.1365-2605.2010.01060.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20 years of transcrotal orchidopexy for undescended testis: results and outcomes. J Pediatr Urol 2010; 6:506-12. [PMID: 19942483 DOI: 10.1016/j.jpurol.2009.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 10/22/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND The role of the transcrotal approach to the undescended testis remains controversial despite its increasing popularity. The authors update their previous published series and review the literature on this subject, aiming to delineate the value of this technique. METHODS The authors performed a retrospective review of the transcrotal primary orchidopexy carried out to treat palpable undescended testis at Royal Manchester Children's Hospital between 1993 and 2005. A structured review of literature published since the proposal of this technique was also performed. RESULTS 122 procedures were included. The transcrotal approach was successfully completed in 119 (97.5%). Additional groin incision was needed in three (2.5%) to further mobilize the spermatic cord. No immediate complications were recorded and 8.4% required a reoperative procedure. On review of the literature, a total of 16 articles were discovered spanning 1695 transcrotal procedures, including the previously published authors' experience. On combining the data, the transcrotal approach required an additional groin incision in 4.4% of cases, 1.6% experienced immediate and/or early complications, and the overall recurrence rate was 2.0%. CONCLUSIONS Transcrotal orchidopexy for the treatment of palpable undescended testes is a safe procedure with a long-term success rate comparable to the two-incision approach.
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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.
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Scrotal Approach to Both Palpable and Impalpable Undescended Testes: Should It Become Our First Choice? Urology 2010; 76:73-6. [DOI: 10.1016/j.urology.2009.09.096] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/16/2009] [Accepted: 09/29/2009] [Indexed: 11/23/2022]
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Abstract
Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles. The second most common cause of hydrocele in adolescents is varicocelectomy. The risk of hydrocele formation is higher with non-artery-sparing procedures or those performed without microsurgical aid, and in surgery requiring cord dissection. If hydrocele occurs after varicocelectomy, initial management should include observation with or without hydrocele aspiration. Large persistent hydroceles are best served by open hydrocelectomy.
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Adult patients presenting with undescended testis in awareness-poor region. AFRICAN JOURNAL OF UROLOGY 2010. [DOI: 10.1007/s12301-010-0009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Uro-Onkologie – Update 2009. Urologe A 2009; 48:1056-8. [DOI: 10.1007/s00120-009-2083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Minimally invasive surgery (MIS) offers alternative operative approaches to standard open surgical techniques. However, MIS has been defined primarily as substituting laparoendoscopic alternatives for the traditional open surgical approach. The concept of MIS methodology may also be applied to open surgery in an effort to decrease incision size, potentially reduce morbidity and enhance convalescence, without compromising 'gold standard' outcomes. Pediatric urological applications of open MIS include pediatric renal surgery, ureteral reimplantation, ureteral surgery, inguinal-scrotal and genital surgery. A thorough review of the pediatric urology literature was performed and studies were identified describing open MIS, including outcomes and complications.
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Osifo DO, Osaigbovo EO. The prevalence, postnatal descent, and complications of undescended testes among children who underwent neonatal circumcision in Benin City, Nigeria. J Pediatr Surg 2009; 44:791-6. [PMID: 19361642 DOI: 10.1016/j.jpedsurg.2008.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE The prevalence, age at postnatal descent, and age at which complications set in and, therefore, prevented by orchidopexy in undescended testes are controversial. This study sought to determine the prevalence, age at postnatal descent, and age at which complications occurred in undescended testes. METHODS A prospective study was done on children who underwent neonatal circumcision at the University of Benin Teaching Hospital, Benin City, and Leadeks Medical Centre, both in Edo state, Nigeria, between January 2002 and December 2007. Those diagnosed with undescended testes were recruited for the study and followed up at the surgical outpatient clinic for 2 years; findings were documented on a structured proforma. RESULTS A total of 178 neonates aged between 5 and 28 days (mean, 7.6 +/- 4.2 days) and mean weight 3.9 +/- 1.8 kg among 6180 children circumcised had 186 undescended testes. On follow-up, 65 (34.9%) testes mainly among preterm neonates (P = .2450) fully descended within 7 months with no testicular descent recorded thereafter. Prevalence rates of 2.9% in neonates and 1.8% at 2 years old were recorded. Reduction in testicular volume, epididymoorchitis, and testicular torsion were recorded in 52 (28%) undescended testes between 12 and 24 months on follow-up. CONCLUSION Neonates with undescended testis should be observed for postnatal descent at least 7 months but may be offered orchidopexy before 1 year.
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Affiliation(s)
- David Osarumwense Osifo
- Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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Lee HR, Lee YS, Kim HS, Lee JY, Kim JC, Koh JS. A Comparison between Single Scrotal Incision Orchiopexy and the Inguinal Approach in Patients with Palpable Undescended Testes Distal to the External Inguinal Ring. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.11.1133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyun Rim Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Seok Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyo Sin Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Yeol Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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Wilson JM, Aaronson DS, Schrader R, Baskin LS. Hydrocele in the pediatric patient: inguinal or scrotal approach? J Urol 2008; 180:1724-7; discussion 1727-8. [PMID: 18721980 DOI: 10.1016/j.juro.2008.03.111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE The recommended approach for repairing hydrocele in children is inguinal to address a patent processus vaginalis. Hydrocele repair in adults is performed with a scrotal incision. We identified an age above which a significant percent of children had noncommunicating hydroceles, justifying a scrotal approach. MATERIALS AND METHODS A retrospective chart review was performed of children undergoing hydrocele repair at our institution between 1998 and 2006. Operative reports were reviewed by 2 investigators and intraoperative findings were recorded for statistical analysis relating age and findings at the time of the procedure using logistic regression and ROC analysis. Laterality and recurrence rates were also noted. RESULTS In this retrospective chart review 82.1% of hydroceles in children older than 10 years had intraoperative findings consistent with noncommunicating hydrocele and 86.4% in children older than 12 years were noncommunicating. One hydrocele in the age group older than 12 years was communicating and the history was suggestive of communication. Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001). CONCLUSIONS It is possible in children older than 12 years to repair hydroceles through a scrotal incision unless the clinical history is suggestive of a communication. Children younger than 12 years should undergo inguinal exploration for hydrocele repair.
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Affiliation(s)
- Jason M Wilson
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.
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