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Bidault-Jourdainne V, Botto N, Peycelon M, Carricaburu E, Lopez P, Bonnard A, Blanc T, El-Ghoneimi A, Paye-Jaouen A. Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study. J Pediatr Urol 2024; 20:498.e1-498.e8. [PMID: 38310033 DOI: 10.1016/j.jpurol.2024.01.017] [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] [Received: 08/01/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques. OBJECTIVE To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS). STUDY DESIGN Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared. RESULTS A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques. DISCUSSION Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view. CONCLUSIONS This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.
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Affiliation(s)
- Valeska Bidault-Jourdainne
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France.
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Sorbonne Université, INSERM, Maladies génétiques d'expression pédiatrique, APHP, Hôpital d'Enfants Armand Trousseau, Paris, France; UMR INSERM 1141 NEURODEV, Paris, France
| | - Elisabeth Carricaburu
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Arnaud Bonnard
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France; Department of Pediatric Surgery and Urology, Necker Children Hospital, APHP, Paris, France
| | - Alaa El-Ghoneimi
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Université Paris Cité, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
| | - Annabel Paye-Jaouen
- Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, APHP, Paris, France; Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRESCENDO), Paris, France
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Mostafa MS, Shalaby MS, Woodward M. Outcome of redo orchidopexy after previous laparoscopic orchidopexy. Pediatr Surg Int 2023; 39:109. [PMID: 36763163 DOI: 10.1007/s00383-023-05392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Testicular reascent is a recognised complication of orchidopexy, and redo surgery may be required. In this report, we present our experience of redo orchidopexy after initial laparoscopic surgery. METHODS Patients who had undergone redo orchidopexy following an initial vessel-sparing (VS) or non-vessel sparing (NVS) laparoscopic orchidopexy between 2005 and 2019 were identified. Outcome data, including complications and testicular size, were recorded. RESULTS The series comprised 23 patients (5: initial bilateral surgery with reascent on one side only; 18: unilateral surgery) with a mean age at original surgery of 3.5 years (range 8 months-6 years) and at redo surgery, 4 years (range 1.5-7 years). VS surgery had been undertaken in 15 and NVS in 8. A tension-free scrotal position was achieved in all cases. There were no complications and no patient required orchidectomy. At a minimum of 6-month follow-up after redo surgery, there were no cases of reascent and there was no change in testicular size/volume (based on clinical examination). CONCLUSION Redo orchidopexy is an effective treatment following failed laparoscopic orchidopexy and a scrotal testis can be achieved in all cases. Complete testicular atrophy did not occur, but the risk of partial atrophy could not be accurately quantified.
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Affiliation(s)
- Mohamed Saber Mostafa
- Department of Paediatric Urology, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS2 8BJ, UK.,Department of Paediatric Surgery, Ain Shams University, Cairo, Egypt
| | - Mohamed Sameh Shalaby
- Department of Paediatric Urology, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS2 8BJ, UK
| | - Mark Woodward
- Department of Paediatric Urology, Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, BS2 8BJ, UK.
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Papparella A, Umano GR, Romano M, Delehaye G, Cascone S, Trotta L, Noviello C. In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis? Minim Invasive Surg 2022; 2022:1564830. [PMID: 36249585 PMCID: PMC9553680 DOI: 10.1155/2022/1564830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients' mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler-Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient.
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Affiliation(s)
- Alfonso Papparella
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppina Rosaria Umano
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Mercedes Romano
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Giulia Delehaye
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Salvatore Cascone
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Letizia Trotta
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
| | - Carmine Noviello
- Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy
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Papparella A, De Rosa L, Noviello C. Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 42. [PMID: 33522214 DOI: 10.4081/pmc.2020.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 10/24/2020] [Indexed: 11/22/2022] Open
Abstract
Fowler-Stephens Laparoscopic Orchiopexy (FSLO) permits the mobilization of Intra-Abdominal Testis (IAT) to the scrotal position after spermatic vessel ligation. We reported our experience of FSLO for IAT. The charts of all boys who underwent a FSLO were retrospectively reviewed. Data were analysed for demographic data, procedure, complications and follow-up results. From January 2008 to June 2016, 160 laparoscopies for Non Palpable Testis (NPT) were performed at a mean age of 3,2 years. 61% of patients had a right NPT, while 6% were bilateral. In 64 cases, an IAT was found: 20 were managed by FSLO with a two-stage procedure in 11 patients. There were no differences in hospitalisations; one patient had a prolonged ileus. Follow-up ranged from 1 to 8 years. Of the 20 patients who underwent FSLO, testicular atrophy developed in three; the remaining testes were in the scrotal position, with normal consistency. FSLO was applied in 31% of IAT. The overall success rate of the technique was 85 %. The percentage of atrophy associated after spermatic vessels interruption appears to provide a good chance of testicular survival.
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Affiliation(s)
- Alfonso Papparella
- Pediatric Surgery, Department of Women, Children, General, and Specialist Surgery, Campania University "Luigi Vanvitelli", Napoli.
| | - Laura De Rosa
- Pediatric Surgery, Department of Women, Children, General, and Specialist Surgery, Campania University "Luigi Vanvitelli", Napoli.
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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: 41] [Impact Index Per Article: 5.9] [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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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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Alagaratnam S, Nathaniel C, Cuckow P, Duffy P, Mushtaq I, Cherian A, Desai D, Kiely E, Pierro A, Drake D, De Coppi P, Cross K, Curry J, Smeulders N. Testicular outcome following laparoscopic second stage Fowler-Stephens orchidopexy. J Pediatr Urol 2014; 10:186-92. [PMID: 24045121 DOI: 10.1016/j.jpurol.2013.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess outcome after laparoscopic second-stage Fowler-Stephens orchidopexy (L2(nd)FSO). PATIENTS AND METHODS Retrospective review of 94 children (aged 0.75-16 years, median 2.75 years), who underwent L2(nd)FSO for 113 intra-abdominal testes between January 2000 and May 2009: 75 unilateral, 19 bilateral (11 synchronous; 8 metachronous). Follow-up (range 3 months-10.9 years, median 2.1 years) was available for 88 children (102 testes: 71 unilateral, 31 bilateral). RESULTS Testicular atrophy occurred in 9 out of 102 (8.8%), including 8 out of 71 (11.3%) unilateral and 1 out of 31 (3.2%) bilateral intra-abdominal testes (multivariate analysis: p = 0.59). Testicular ascent ensued in 9 out of 102 (8.8%), comprising four (5.6%) unilateral and five (16.1%) bilateral testicles (multivariate analysis: p = 0.11). Of the 18 bilateral testes brought to the scrotum synchronously none atrophied and four (22.2%) ascended, compared to one (7.7%) atrophy and one (7.7%) ascent among the 13 testes brought to the scrotum on separate occasions (Fisher exact test: p = 0.42 and p = 0.37, respectively). Mobilization of the testis through the conjoint tendon tended towards less ascent (multivariate analysis p = 0.08) but similar atrophy (p = 0.56) compared to mobilization through the deep-ring/inguinal canal. Logistical regression analysis identified no other patient or surgical factors influencing outcome. CONCLUSIONS This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.
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Affiliation(s)
- Swethan Alagaratnam
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Calvin Nathaniel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Peter Cuckow
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Patrick Duffy
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Abraham Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Divyesh Desai
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
| | - Edward Kiely
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Agostino Pierro
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - David Drake
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Kate Cross
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
| | - Naima Smeulders
- Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK; Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, Euston Road, London, UK.
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Laparoscopic Orchiopexy for Intra-abdominal Testes—A Single Institution Review. J Laparoendosc Adv Surg Tech A 2013; 23:481-3. [DOI: 10.1089/lap.2012.0578] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Laparoscopic management of intra-abdominal testis: 5-year single-centre experience-a retrospective descriptive study. Minim Invasive Surg 2012; 2012:878509. [PMID: 22474586 PMCID: PMC3306959 DOI: 10.1155/2012/878509] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 11/15/2011] [Indexed: 12/29/2022] Open
Abstract
Background. Undescended testis is one of the most common urological problems in children, affecting about 1% of boys at age of 1 year. Of these, about 20% have a nonpalpable testis with a very high probability that the testis is absent. This may have a significant impact on the possibility of malignancy in these testes, as well as on the later fertility of these subjects. Methods. We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6-month outcomes, in 91 patients diagnosed with impalpable undescended testes between January 2006 and December 2010. Results. Of the 91 patients, 9 had bilateral and 82 had unilateral impalpable testes. All 100 testes were managed laparoscopically. The largest group of intra-abdominal testes in this series, 42 testes, was entering the internal ring; in these, laparoscopic exploration and standard open orchiopexy resulted in a 66% success rate. The total success rate was 63.3%. Conclusion. Laparoscopy is extremely useful in both the diagnosis and treatment of impalpable testes. Objectively measured mobility of the testis towards the contralateral internal inguinal ring is an excellent intraoperative indicator for type of orchiopexy. Standardization of management may increase the success rate of orchiopexy.
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Papparella A, Romano M, Noviello C, Cobellis G, Nino F, Del Monaco C, Parmeggiani P. The value of laparoscopy in the management of non-palpable testis. J Pediatr Urol 2010; 6:550-4. [PMID: 20106723 DOI: 10.1016/j.jpurol.2009.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 12/22/2009] [Indexed: 01/01/2023]
Abstract
OBJECT To retrospectively review the value of laparoscopy in the management of impalpable testis. MATERIALS AND METHODS In 1993-2006, 182 laparoscopies for impalpable testis were performed for a total of 194 testicular units. Five laparoscopic findings were considered: testicular ectopia, intra-abdominal testis, and cord structures that are blind ending, completely absent (agenesis) or entering the internal inguinal ring. RESULTS In 62 cases an intra-abdominal testis was found; 18 were classified as high and managed by a laparoscopic Fowler-Stephens procedure. Cord structures entering the inguinal ring were observed in 77 patients and 45 underwent an inguinal exploration: a testis was found in 12 cases and in 33 a remnant was excised. In 35 cases, intra-abdominal blind ending vas and vessels were observed and eight showed testicular agenesis. No major surgical complications were recorded. Follow up ranged from 1 to 3 years. CONCLUSIONS Our study confirms the value of laparoscopy in the management of non-palpable testis, providing a definitive diagnosis by the direct view of spermatic bundle and testis. Ninety-three patients were managed by laparoscopy only, and in 44 it was essential for the subsequent surgical approach. When the internal inguinal ring is patent and/or normal spermatic vessels are present an inguinal exploration is mandatory.
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Affiliation(s)
- A Papparella
- Division of Pediatric Surgery, Second University of Naples, Via S. Pansini 5, 80131 Naples, Italy.
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Dave S, Manaboriboon N, Braga LHP, Lorenzo AJ, Farhat WA, Bägli DJ, Khoury AE, Salle JLP. Open versus laparoscopic staged Fowler-Stephens orchiopexy: impact of long loop vas. J Urol 2009; 182:2435-9. [PMID: 19765743 DOI: 10.1016/j.juro.2009.07.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy. MATERIALS AND METHODS Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12). The presence of a long looping vas was noted from the first stage operative notes. Doppler ultrasound was performed postoperatively to confirm testicular atrophy. RESULTS Atrophy rate at a mean followup of 13.5 months was 20.5% (15 of 61 in laparoscopic and 0 of 12 in open orchiopexy). None of the 5 long looping vas testes atrophied following open orchiopexy, compared to 5 of 6 (83%) following laparoscopic orchiopexy (p = 0.03). Analyzing the laparoscopic group alone, a long looping vas was significantly associated with risk of atrophy (p <0.01). CONCLUSIONS The presence of a long looping vas was associated with a higher atrophy rate following laparoscopic second stage Fowler-Stephens orchiopexy. Laparoscopic management of the long looping vas may be more challenging and, therefore, in such cases open Fowler-Stephens orchiopexy may result in better success rates by preserving the integrity of the collateral vessels.
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Affiliation(s)
- Sumit Dave
- Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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12
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Esposito C, Vallone G, Savanelli A, Settimi A. Long-Term Outcome of Laparoscopic Fowler-Stephens Orchiopexy in Boys With Intra-Abdominal Testis. J Urol 2009; 181:1851-6. [PMID: 19233407 DOI: 10.1016/j.juro.2008.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 10/21/2022]
Affiliation(s)
- C. Esposito
- Department of Pediatrics, “Federico II” University of Naples, Naples, Italy
| | - G. Vallone
- Department of Pediatrics, “Federico II” University of Naples, Naples, Italy
| | - A. Savanelli
- Department of Pediatrics, “Federico II” University of Naples, Naples, Italy
| | - A. Settimi
- Department of Pediatrics, “Federico II” University of Naples, Naples, Italy
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13
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Lintula H, Kokki H, Eskelinen M, Vanamo K. Laparoscopic Versus Open Orchidopexy in Children with Intra-abdominal Testes. J Laparoendosc Adv Surg Tech A 2008; 18:449-56. [DOI: 10.1089/lap.2007.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Hannu Lintula
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Kokki
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
| | - Matti Eskelinen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Kari Vanamo
- Department of Pediatric Surgery, Kuopio University Hospital, Kuopio, Finland
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14
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Management of boys with nonpalpable undescended testis. ACTA ACUST UNITED AC 2008; 5:252-60. [PMID: 18414455 DOI: 10.1038/ncpuro1102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 02/15/2008] [Indexed: 11/08/2022]
Abstract
Cryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys with palpable testis is standardized, there are no formal guidelines for the management of boys with nonpalpable testis. In this Review we look at the current trends in the diagnosis and treatment of this disorder, as well as the indications for therapy and surgical procedures. On the basis of current evidence, we find that there is no optimum orchidopexy technique for the treatment of intra-abdominal testis, although it is preferable to adopt techniques that preserve the spermatic vessels. We also briefly examine the follow-up of patients with this disorder and its common complications. As yet, there are no data that assess the potential of laparoscopic orchidopexy being a risk factor for impaired fertility later in life.
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15
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Abstract
The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re-implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome.
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Affiliation(s)
- Marc C Smaldone
- Urology, University of Pittsburgh Medical Center, 3471 5th Avenue, Pittsburgh, PA 15213, USA.
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16
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Sweeney DD, Smaldone MC, Docimo SG. Minimally invasive surgery for urologic disease in children. ACTA ACUST UNITED AC 2007; 4:26-38. [PMID: 17211423 DOI: 10.1038/ncpuro0677] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/03/2006] [Indexed: 11/09/2022]
Abstract
This article is a comprehensive review of the current indications and recent literature pertaining to laparoscopic techniques in pediatric urology. Basic concepts such as instrumentation, anesthetic considerations, and complications are reviewed. Specific techniques and indications are also explored. As the field of pediatric urology continues to expand, it still lags behind adult urology. With improvements in technology, however, and with new surgeons entering the field with a basic laparoscopic background, pediatric urologic laparoscopy continues to progress. Currently, procedures such as laparoscopic exploration for undescended testicles and laparoscopic nephrectomy are accepted as the 'gold standard', and are performed at most institutions. Other procedures, such as laparoscopic pyeloplasty and laparoscopic reconstructive surgery, have only recently been introduced and are primarily available at centers with surgeons experienced in laparoscopy. It is our hope that minimally invasive surgical approaches to urologic conditions will become available to all children and become commonplace at most institutions.
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Leung MWY, Chao NSY, Wong BPY, Chung KW, Kwok WK, Liu KKW. Laparoscopic mobilization of testicular vessels: an adjunctive step in orchidopexy for impalpable and redo undescended testis in children. Pediatr Surg Int 2005; 21:767-9. [PMID: 16096794 DOI: 10.1007/s00383-005-1495-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2005] [Indexed: 10/25/2022]
Abstract
The testicular position after conventional inguinal orchidopexy for canalicular, "peeping" and redo undescended testes may not be satisfactory despite retroperitoneal dissection. Laparoscopy allows extensive mobilization of testicular vessels to gain additional length. We review our experience of using laparoscopic mobilization of testicular vessels (LMTV) in orchidopexy for these difficult undescended testes. From January 2003 to May 2004, LMTV was performed in 18 boys. The testicular vessels were mobilized from just proximal to the internal inguinal ring to the level of caecum and sigmoid colon respectively. Fifteen patients had clinically impalpable testes. Diagnostic laparoscopy revealed 13 "peeping" and 2 canalicular testes. LMTV was performed together with inguinal orchidopexy. There were three cases of redo orchidopexies because of unfavourable testicular position after previous surgery. LMTV was performed following inguinal dissection. The median follow-up period is 11.7 months. Sixteen testes are located at the base of scrotum, and two at mid-scrotum. The size is normal in 17 testes, whereas 1 testis is smaller than the contralateral one. LMTV is a safe and efficient adjunctive step in orchidopexy for impalpable and redo undescended testes.
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Affiliation(s)
- M W Y Leung
- Kowloon Central & East Cluster, Hospital Authority, Paediatric Surgical Centre, Hong Kong SAR, China
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18
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Srinivas M, Kilmartin B, Das SN, Puri P. Prepubertal unilateral spermatic vessel ligation decreases haploid cell population of ipsilateral testis postpubertally in rats. Pediatr Surg Int 2005; 21:360-3. [PMID: 15834729 DOI: 10.1007/s00383-005-1431-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
DNA flow cytometry is a sensitive and rapid technique to evaluate the germ cell maturation of testis. The haploid cell population of testis specifically denotes testicular maturation. High ligation of spermatic vessels (HLSV) and low ligation of spermatic vessels (LLSV) have been described in the surgical treatment of high undescended testis. Estimation of germ cell population of testis after these maneuvers has not been performed so far by DNA flow cytometry; hence this study was designed. Thirty male rats, aged 30 days, were randomized into three groups. Group I underwent sham surgery; group II underwent unilateral HLSV-ligation and division of main spermatic vessels, similar to the Fowler-Stephens technique; and group III underwent unilateral LLSV-ligation and division of main spermatic vessels close to the testis, similar to the Koff and Sethi technique. Thirty days later, the ipsilateral testes were harvested, and haploid, diploid, and tetraploid cells were counted by DNA flow cytometry. The mean (+/-SD) percentage of the haploid cell population was 68.7+/-4.8, 49.3+/-6.5, and 50.8+/-6.4 in groups I, II, and III, respectively. There was a significant (p<0.05) decrease in haploid cell population between groups I and II and between groups I and III. However, there was no significant difference between groups II and III. In conclusion, prepubertal HLSV as well as LLSV decreases the haploid cell population of ipsilateral testis in rats. LLSV has no advantage over HLSV.
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Affiliation(s)
- M Srinivas
- Children's Research Center, Our Lady's Hospital for Sick Children, Crumlin, Dublin, 12, Ireland
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19
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Laparoscopic management of nonpalpable testes: a multicenter study of the Italian Society of Video Surgery in Infancy. J Pediatr Surg 2005; 40:696-700. [PMID: 15852282 DOI: 10.1016/j.jpedsurg.2005.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Diagnostic laparoscopy has changed the surgical approach to nonpalpable testes (NPT). The aim of this study was to determine the value of laparoscopy in managing patients with NPT and to suggest guidelines for the interpretation of laparoscopic findings. The authors report the results of a multicenter study of the Italian Society of Video Surgery in Infancy on laparoscopic management of NPT. METHODS Between 1993 and 2001, the authors collected records of 364 patients with NPT who underwent laparoscopy, for a total of 388 testicular units. RESULTS Intraabdominal testes were found in 124 (34%) cases, for a total of 137 testes; 83 testicular units were classified as low and 54 as high. A total of 155 (43%) patients had cord structures entering the internal inguinal ring, 79 (22%) had intraabdominal blind-ending cord structures, and 6 (1%) had testicular agenesia. CONCLUSIONS Laparoscopy is a valuable tool in diagnosing and treating more than 50% of cases of NPT. The laparoscopic evaluation of abdominal testes can provide indications for the most suitable surgical technique; moreover, in 23% of patients, it makes abdominal exploration unnecessary. The value of laparoscopy is even greater if the anatomical aspect of the internal ring and spermatic cord structures is carefully evaluated.
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Bittencourt DG, Miranda ML, Moreira APP, Miyabara S, Bustorff-Silva JM. The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis. Int Braz J Urol 2005; 29:345-51; discussion 351-2. [PMID: 15745560 DOI: 10.1590/s1677-55382003000400011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 07/29/2003] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes. MATERIALS AND METHODS Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47%) patients presented nonpalpable testes bilaterally, 7 (14%) only at the right side and 20 (39%) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume. RESULTS Nine (12%) testes were not localized, but their vessels and deferent duct were atrophic. Two (3%) testes were intra-abdominal and atrophic, and 2 (3%) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25%) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29%) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10%) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17%) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54%) cases, reaching a surgical success of 89%. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12%) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89%. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17%) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77% of good results. CONCLUSION Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.
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Affiliation(s)
- Daniel G Bittencourt
- Section of Pediatric Surgery, School of Medicine, State University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
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21
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Radmayr C, Oswald J, Schwentner C, Neururer R, Peschel R, Bartsch G. Long-Term Outcome of Laparoscopically Managed Nonpalpable Testes. J Urol 2003; 170:2409-11. [PMID: 14634439 DOI: 10.1097/01.ju.0000090024.02762.3d] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE We evaluated laparoscopic diagnostic findings in 108 impalpable testes, and analyzed the success rate and long-term outcome of either direct laparoscopic orchiopexy or the 2-stage Fowler-Stephens procedure. MATERIALS AND METHODS A total of 84 children with 108 impalpable testes and a mean age of 1.9 years underwent laparoscopy between 1992 and September 2000. Long-term outcome with regard to viability and location of the testes was evaluated. RESULTS Of the 108 testes 72 were located intra-abdominally, of which 28 were managed by direct laparoscopic orchiopexy, 29 were managed by a 2-stage laparoscopic Fowler-Stephens procedure and 15 were vanishing. The remaining 36 testes were inguinally located during exploration and orchiopexy, except for 5 vanishing testes. In all cases the operation proceeded as planned. After a mean followup of 6.2 years all laparoscopically managed testicles were in a normal scrotal position with normal perfusion as revealed by color flow Doppler sonography. Two testicles became atrophic after a 2-stage Fowler-Stephens procedure. Morbidity was low in all children. CONCLUSIONS The laparoscopic approach allows not only diagnosis, but also adequate therapy regardless of whether direct orchiopexy or a 2-stage procedure is performed. Our long-term results clearly demonstrate that even in the patients undergoing the 2-stage procedure the laparoscopic approach is safe and efficient, and leads to excellent results concerning viability of the affected testicles. Progress and experience gained during recent years are encouraging in continuing laparoscopic procedures in children.
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22
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Abstract
PURPOSE Laparoscopy is now considered integral to the management of nonpalpable testes, although its benefits are not clearly documented. The authors prospectively determined the value of laparoscopy in patients with nonpalpable testes. METHODS Between December 1997 and October 2001, 37 patients with 40 nonpalpable testes were scheduled for laparoscopy followed by definitive treatment. Laparoscopy was cancelled in 4 patients (5 testes) because their testes became palpable under anesthesia. In the remaining 33 patients (35 testes), it was determined at the time of surgery whether, as a consequence of laparoscopy: (1) retroperitoneal exploration was avoided (2) definitive treatment was facilitated. RESULTS Laparoscopy did not alter the management of 27 testes (77%) that were treated through an inguinal incision with orchiopexy for 17 testes (6 intraabdominal and 9 at the deep ring) and removal of 10 atrophic nubbins. It was only useful in avoiding retroperitoneal dissection for 5 (14%) vanishing testes, and it may have been of benefit for 3 testes treated with a 2-stage Fowler-Stephens orchiopexy. CONCLUSIONS The majority of our patients with nonpalpable testes could have been treated through an inguinal incision with laparoscopy being reserved for situations in which the testis was not identified on inguinal exploration.
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Affiliation(s)
- Shumyle Alam
- Department of Surgery, University of Illinois, Chicago, IL 60561, USA
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23
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Esposito C, Damiano R, Gonzalez Sabin MA, Savanelli A, Centonze A, Settimi A, Sacco R. Laparoscopy-assisted orchidopexy: an ideal treatment for children with intra-abdominal testes. J Endourol 2002; 16:659-62. [PMID: 12490019 DOI: 10.1089/089277902761403005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE The investigation of a child with a nonpalpable testis is probably the most frequent indication for laparoscopy in pediatric patients. The objective of this study was to evaluate the results and advantages of laparoscopy-assisted orchidopexy performed without dividing the spermatic vessels. PATIENTS AND METHODS During a 3-year period, 85 boys with nonpalpable testes (NPT) (91 testes overall) underwent laparoscopic diagnostic exploration. Twenty-five patients (27.4%) showed an intra-abdominal testis (IAT): 24 underwent a laparoscopy-assisted orchidopexy (LAO) without sectioning of the spermatic vessels, and one, whose inner spermatic vessels were not adequately long for LAO without tension, underwent a two-step Fowler-Stephens (FS) procedure. The technique consists of dissection and mobilization of the inner spermatic vessels and the vas deferens from the posterior peritoneum, sectioning of the gubernaculum attachments, and bringing down of the testis into the scrotum through the internal inguinal ring, if open, or through a neo-inguinal ring created medial to the epigastric vessels. RESULTS Surgery lasted between 40 and 80 minutes (median 60 minutes). All the testes were brought down into the scrotum. There was only 1 (4%) intraoperative complication, which occurred in the second patient operated on with this procedure. He experienced an iatrogenic rupture of the spermatic vessels secondary to excessive traction. CONCLUSION Laparoscopic orchidopexy is the logical extension of diagnostic laparoscopy for the evaluation of NPT. Concerning the technique, we believe that LAO with intact spermatic vessels could be considered the treatment of choice in the patient with IAT, as it does not affect normal testicular vascularization. Alternatively, in the case of very high IAT (more than 3 cm from IIR), an FS procedure may be considered.
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Affiliation(s)
- Ciro Esposito
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.
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Touiti D, Ameur A, Beddouch A, Oukheira H, Taobane H. [Role of celioscopy in the assessment and treatment of non-palpable testis in adults. Report of 2 cases]. ANNALES D'UROLOGIE 2001; 35:353-5. [PMID: 11774770 DOI: 10.1016/s0003-4401(01)00059-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors reported two cases of impalpable testis in young mens. Laparoscopy is useful in both the diagnosis and the management of impalpable testes. Intraabdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. A second-stage vasal-based orchidopexy can then be performed once adequate testicular reperfusion via the the defferential pedicle is believed to have occurred.
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Affiliation(s)
- D Touiti
- Service d'urologie, hôpital militaire Mohamed V, Rabat, Maroc
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25
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Baker LA, Docimo SG, Surer I, Peters C, Cisek L, Diamond DA, Caldamone A, Koyle M, Strand W, Moore R, Mevorach R, Brady J, Jordan G, Erhard M, Franco I. A multi-institutional analysis of laparoscopic orchidopexy. BJU Int 2001; 87:484-9. [PMID: 11298039 DOI: 10.1046/j.1464-410x.2001.00127.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To combine and analyse the results from centres with a large experience of laparoscopy for the impalpable testis with small series, to determine the expected success rate for laparoscopic orchidopexy. METHODS A questionnaire was distributed to participating paediatric urologists; each contributor retrospectively reviewed the clinical charts for their cases of therapeutic laparoscopy for an impalpable testis, detailing 36 variables for each patient. The data were collated centrally into a computerized database. For inclusion, the testis was intra-abdominal (including 'peeping' at the internal ring) at laparoscopic examination, was not managed through an open approach and did not undergo orchidectomy. Three surgical groups were assessed, with success defined as lack of atrophy and intrascrotal position: group 1, primary laparoscopic orchidopexy; group 2, a one-stage Fowler-Stephens (F-S) orchidopexy; and group 3, a two-stage F-S orchidopexy. RESULTS Data were gathered from 10 centres in the USA, covering the period 1990-1999; 252 patients representing 310 testes were included and overall, 15.2% were lost to follow-up. There was no significant difference between success rates in the larger and smaller series. Atrophy occurred in 2.2% of 178 testes, 22.2% of 27 testes and 10.3% of 58 testes in groups 1-3, respectively. Testes were not in a satisfactory scrotal position in 0.6%, 7.4% and 1.7% of groups 1-3, respectively. The mean follow-up for each group was 7.7, 8.6 and 20.0 months, respectively. The overall success for all groups was 92.8% (97.2% group 1; 74.1% group 2; 87.9% group 3), with an atrophy rate of 6.1%. CONCLUSION Laparoscopic orchidopexy for the intra-abdominal testis, in both large and small series, can be expected to have a success rate higher than that historically ascribed to open orchidopexy. Within this series, single-stage F-S laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the two-stage repair. However, when considering both F-S approaches, the laparoscopic approach gave greater success than previously reported for the same open approaches. Despite the weaknesses inherent in a retrospective unrandomized study, we conclude that laparoscopic orchidopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testicle.
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Affiliation(s)
- L A Baker
- Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
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26
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Abstract
OBJECTIVE To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures. PATIENTS AND METHODS The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one-stage and staged Fowler-Stephens (F-S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery. RESULTS From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra-abdominal in 46, iliac in 14, in the internal ring in 22, 'peeping' in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one-stage F-S in 20 and a two-stage F-S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5-12 years); the mean (range) follow-up was 5 (1-36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow-up available). Four patients (4%) had testicular atrophy from failed F-S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow-up, was 96% (90 of 94). Of the 20 one-stage F-S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F-S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy. CONCLUSION The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra-abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.
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Affiliation(s)
- B Chang
- Long Island Jewish Medical Center/Schneider Children's Hospital, New Hyde Park, NY, USA
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27
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Abstract
PURPOSE The aim of this study is to report the initial experience with needlescopic surgery (2-mm optics and instrumentation exclusively) for the cryptorchid testicle. METHODS Ten patients (age 8 months to 37 years) underwent 12 needlescopic procedures: orchiopexy (n = 8), orchiectomy (n = 2), and diagnostic exploration with attempted excision of testicular remnant (n = 2). Two patients underwent bilateral needlescopic orchiopexy. Needlescopic (2 mm) optics and instrumentation were used exclusively in the pediatric patients. RESULTS All procedures were completed successfully by needlescopic techniques. Mean surgical time was 110 minutes (range, 60 to 180 minutes), and blood loss was 6 mL (range, 0 to 20 mL). There were no intraoperative complications. All procedures were performed on an outpatient basis. In all 8 orchidopexies, the testis was successfully brought to a scrotal position. CONCLUSIONS Needlescopic techniques allow safe performance of various procedures for a cryptorchid testicle. The cosmetic result is excellent.
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Affiliation(s)
- I S Gill
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA
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Thorup JM, Cortes D, Visfeldt J. Germ cells may survive clipping and division of the spermatic vessels in surgery for intra-abdominal testes. J Urol 1999; 162:872-4. [PMID: 10458398 DOI: 10.1097/00005392-199909010-00080] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis. However, it is uncertain whether the more sensitive germ cells survive this procedure in addition to the Sertoli and interstitial cells of the human testis. Survival of germ cells is a prerequisite of later fertility potential. MATERIALS AND METHODS We studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13(1/2) years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. RESULTS Median number of spermatogonia per tubular cross section of the biopsies taken at stage 2 was slightly lower (0.03) compared to the median number at stage 1 (0.06) of the operation but this difference was not significant (p = 0.2031). CONCLUSIONS Our study shows that the spermatogonia may survive clipping and division of the spermatic vessels, although the number of spermatogonia per tubular transverse section decreases slightly.
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Affiliation(s)
- J M Thorup
- Department of Paediatric Surgery, Rigshospitalet, University of Copenhagen, Denmark
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SAMPAIO FRANCISCOJB, FAVORITO LUCIANOA, FREITAS MARCELOA, DAMIAO RONALDO, GOUVEIA EDUARDO. ARTERIAL SUPPLY OF THE HUMAN FETAL TESTIS DURING ITS MIGRATION. J Urol 1999. [DOI: 10.1097/00005392-199905000-00076] [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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31
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Humke U, Siemer S, Bonnet L, Ziegler M. Pediatric laparoscopy for nonpalpable testes with new miniaturized instruments. J Endourol 1998; 12:445-50. [PMID: 9847068 DOI: 10.1089/end.1998.12.445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
New miniaturized pediatric telescopes (1.9 or 3.5 mm) and reusable instruments (3.5-mm trocars, scissors, graspers) were used for the first time in a prospective study to evaluate handling safety and efficacy in laparoscopic diagnosis of unilateral nonpalpable testes. The results were confirmed during the same anesthesia by open operation for either orchiopexy or removal of rudimentary spermatic cord structures. Laparoscopy in 13 boys revealed one abdominal testis, 5 vanishing testes, and 7 cases of inguinal retention associated with an open inner inguinal ring. The illumination and detail resolution of the minitelescope were excellent. The 3.5-mm instruments were fully functioning with regard to tissue dissection. No complications occurred. Without technical disadvantages but with increased safety for the patient, the new miniaturized pediatric laparocopic instruments indeed realize a step forward to minimal invasion in infants and children.
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Affiliation(s)
- U Humke
- Department of General and Pediatric Urology, University Hospital of Saarland, Homburg/Saar, Germany.
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32
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Abstract
The surgeon should be aware of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide surgical care in association with either outpatient or short-stay hospitalizations appear to be cost-effective and appropriate state-of-the-art medical care. Because the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.
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Affiliation(s)
- T E Lobe
- Section of Pediatric Surgery, University of Tennessee, Memphis, USA
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Merguerian PA, Mevorach RA, Shortliffe LD, Cendron M. Laparoscopy for the evaluation and management of the nonpalpable testicle. Urology 1998; 51:3-6. [PMID: 9610548 DOI: 10.1016/s0090-4295(98)00083-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of laparoscopy for the diagnosis and treatment of the nonpalpable testicle and to evaluate the results of laparoscopic orchidopexy. METHODS We retrospectively reviewed the charts of 91 laparoscopies performed over a period of 4 years. We reviewed the following parameters: findings, complications, patency of the processus vaginalis, appearance of the cord structures, and the success of the different procedures performed for the intra-abdominal testicle. RESULTS Fourteen patients had bilateral and 77 unilateral nonpalpable testicles. The mean age of the patients was 39.5 +/- 50.8 months. There were three laparoscopic complications (3.2%) one of which was a major bowel laceration. Laparoscopy defined the intra-abdominal anatomy accurately in 90 of the 91 cases Of the 26 intra-abdominal testicles above the ring, a one-stage laparoscopic orchidopexy was performed in five and a single-stage standard orchidopexy in seven. All of these testicles remain viable and are in good position. Eight patients underwent a staged Fowler-Stephens orchidopexy with laparoscopic clipping of the spermatic vessels as the first stage. Of these, a second-stage open orchidopexy was performed in five and a laparoscopic orchidopexy in three. Testicular atrophy occurred in two of the patients who underwent the second-stage open orchidopexy. Three one-stage Fowler-Stephens orchidopexies were performed with testicular atrophy occurring in two of these testicles. Laparoscopic orchiectomy was performed on two patients. CONCLUSIONS Laparoscopy is a valuable tool in the diagnosis and treatment of the nonpalpable testicle. Laparoscopic orchidopexy may decrease the rate of testicular atrophy since most of these can be performed laparoscopically in one stage, thus preserving the vascular supply.
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Affiliation(s)
- P A Merguerian
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
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Esposito C, Garipoli V. The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intra-abdominal testes. J Urol 1997; 158:1952-4; discussion 1954-5. [PMID: 9334647 DOI: 10.1016/s0022-5347(01)64189-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We report our experience in the treatment of high intra-abdominal testis with a complete laparoscopic 2-stage Fowler-Stephens procedure with associated transperitoneal closure of the internal ring in pediatric patients. MATERIALS AND METHODS Between 1990 and 1997, 100 boys with 105 nonpalpable testes underwent laparoscopy. Laparoscopy showed intra-abdominal testis in 40 cases. In 5 cases when the testis was just proximal to the internal ring, we performed standard orchiopexy. In 35 cases with the testis in the high intra-abdominal position, we performed the Fowler-Stephens procedure with the first stage performed laparoscopically. To date, all 35 testis have undergone the second phase after 6 to 12 months (2 by open technique, 33 by laparoscopy). The last 33 patients underwent the second phase of the 2-stage Fowler-Stephens procedure by laparoscopy with associated video surgical transperitoneal closure of internal ring. RESULTS All testes were successfully placed in the scrotum. At a mean 30 months of followup, with clinical examination, ultrasonography and comparative colorimetric echo Doppler study, all testes were viable in the scrotum, except for 1 that became atrophic 2 months after the second open phase of 2-stage Fowler-Stephens technique. CONCLUSIONS Our early results suggest that the 2-stage Fowler-Stephens procedure, performed completely using laparoscopy, is a feasible technique for treating high intra-abdominal testis.
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Affiliation(s)
- C Esposito
- Division of Pediatric Surgery, Federico II, University of Naples, Italy
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Wiener JS, Jordan GH, Gonzales ET. Laparoscopic management of persistent Müllerian duct remnants associated with an abdominal testis. J Endourol 1997; 11:357-9. [PMID: 9355954 DOI: 10.1089/end.1997.11.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In recent years, laparoscopy has evolved from a purely diagnostic procedure in the management of nonpalpable testis to a definitive therapeutic intervention. Additional genital malformations occur in association with cryptorchidism, but reports of laparoscopic management of such entities do not exist. Herein, we describe the laparoscopic removal of persistent Müllerian duct remnants (uterus and round ligament) in combination with an orchiectomy of an abnormally small abdominal testis. This technique expands the versatility of laparoscopic management of cryptorchidism to include the resection of associated congenital anomalies.
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Affiliation(s)
- J S Wiener
- Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, USA
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Law GS, Pérez LM, Joseph DB. Two-stage Fowler-Stephens orchiopexy with laparoscopic clipping of the spermatic vessels. J Urol 1997; 158:1205-7. [PMID: 9258174 DOI: 10.1097/00005392-199709000-00136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We report the outcome of a staged approach to the intra-abdominal testicle and provide baseline data on operative time, postoperative course and testicular survival. MATERIALS AND METHODS We retrospectively reviewed the records of 441 boys (547 undescended testes). There were 105 boys (24%) with 124 nonpalpable testes (23%). All patients underwent laparoscopy. Ligation of spermatic vessels was performed as stage 1 on 20 abdominal testes (4%) in 18 boys (4%). Stage 2 orchiopexy was done using an open technique. RESULTS Two-stage orchiopexy in 18 boys included a bilateral procedure in 2, of which 1 was asynchronous and 1 was synchronous. Average operative time was 55 minutes for stage 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were performed on an outpatient basis in 18 and 17 (94%) boys, respectively. There were no complications after stage 1 and 1 wound infection developed after stage 2. One testis with no vas deferens was determined to be nonviable at stage 2. The remaining 19 testes (95%) were considered viable at a followup of 6 months or greater. Viability was based on testicular size and consistency similar to those of the contralateral testis. CONCLUSIONS Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis.
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Affiliation(s)
- G S Law
- Department of Pediatric Urology, University of Alabama, Birmingham Children's Hospital, USA
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Law GS, Perez LM, Joseph DB. Two-Stage Fowler-Stephens Orchiopexy With Laparoscopic Clipping of the Spermatic Vessels. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64428-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Stanford Law
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
| | - Luis M. Perez
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
| | - David B. Joseph
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
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Treatment of High Undescended Testes by Low Spermatic Vessel Ligation: An Alternative to the Fowler-Stephens Technique. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65820-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Koff SA, Sethi PS. Treatment of high undescended testes by low spermatic vessel ligation: an alternative to the Fowler-Stephens technique. J Urol 1996; 156:799-803; discussion 803. [PMID: 8683787 DOI: 10.1097/00005392-199608001-00067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We determined whether testis viability after a Fowler-Stephens orchiopexy depends on ligating the spermatic vessels high and far proximal to the undescended testis. MATERIALS AND METHODS Based on studies of testicular vascular anatomy we developed a technique of low spermatic vessel ligation and performed it on 39 high undescended testes in 33 patients. RESULTS Testis viability was 97% at 1 month and 93% (25 of 27) at 1 year. CONCLUSIONS Ligation of the spermatic vessels does not need to be performed high to ensure testis viability. Testicular vascular anatomy supports low spermatic vessel ligation and by decreasing tension on the testis low spermatic vessel ligation may enhance viability. A 2-stage laparoscopic approach to the high undescended testis is difficult to justify on the basis of cost or outcome analysis.
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Affiliation(s)
- S A Koff
- Section of Pediatric Urology, Children's Hospital, Columbus, Ohio, USA
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Wacksman J, Billmire DA, Lewis AG, Sheldon CA. Laparoscopically assisted testicular autotransplantation for management of the intraabdominal undescended testis. J Urol 1996; 156:772-4. [PMID: 8683780 DOI: 10.1097/00005392-199608001-00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The intra-abdominal testis continues to present a considerable urological challenge and the approach to its management continues to evolve. We report our initial experience with laparoscopically assisted testicular autotransplantation. MATERIALS AND METHODS An intra-abdominal testicle was identified laparoscopically in 5 patients who subsequently underwent testicular autotransplantation. RESULTS The success rate was 100% and median operative time was 5 hours. All patients were discharged home the day after surgery with no complications and a good result. CONCLUSIONS Because of success with this technique, this procedure offers significant advantages (decreased hospital stay and lower morbidity) than an open or 2-stage Fowler-Stephens approach.
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Affiliation(s)
- J Wacksman
- Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA
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Cain MP, Garra B, Gibbons M. Scrotal-inguinal Ultrasonography: A Technique for Identifying the Nonpalpable Inguinal Testis without Laparoscopy. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65817-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mark P. Cain
- From the Section of Pediatric Urology and Department of Radiology, Georgetown University Medical Center, Washington, D. C
| | - Brian Garra
- From the Section of Pediatric Urology and Department of Radiology, Georgetown University Medical Center, Washington, D. C
| | - M.David Gibbons
- From the Section of Pediatric Urology and Department of Radiology, Georgetown University Medical Center, Washington, D. C
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Wacksman J, Billmire DA, Lewis AG, Sheldon CA. Laparoscopically Assisted Testicular Autotransplantation for Management of the Intra-Abdominal Undescended Testis. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65811-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey Wacksman
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - David A. Billmire
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Alfor G. Lewis
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Curtis A. Sheldon
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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