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Morizawa Y, Aoki K, Fukui S, Tomizawa M, Shimizu T, Onishi K, Hori S, Gotoh D, Nakai Y, Miyake M, Torimoto K, Fujimoto K, Otani T, Fujimoto K. Assessment of diagnostic accuracy for cryptorchidism and risk factors for delayed orchidopexy. Int J Urol 2024; 31:170-176. [PMID: 37934938 DOI: 10.1111/iju.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Cryptorchidism (CO) diagnosis by palpation is challenging. Patients with suspected CO are primarily referred to pediatric urologists by general pediatricians and urologists. Currently, surgical treatment for CO is recommended earlier than in previous guidelines. In this study, we evaluated factors that lead to diagnosis discordance and delayed orchidopexy in patients referred with suspected CO in addition to timing of initial screening. METHODS In total, 731 patients (1052 testes) with suspected CO were included. Risk factors for diagnostic discrepancy in CO diagnosis by pediatric urologists and risk of delayed orchiopexy were evaluated. RESULTS Herein, 659 (90%) patients were diagnosed during routine public health checkups for infants and young children, and 419 (57%) patients were referred by pediatric practitioners. Of 1052 testes, 374 (36%) were diagnosed with CO by pediatric urologists. In multivariate analysis, risk factors of diagnostic discrepancy for CO diagnosis by pediatric urologists were bilateral testis (odds ratio [OR] = 9.17, p < 0.0001), >6 months old at initial diagnosis (OR = 1.036, p < 0.0001), and pediatric referral (OR = 4.60, p < 0.0001). In total, 296 patients underwent orchiopexy for CO. In multivariate analysis, risk factors for delayed orchiopexy were presence of comorbidities (OR = 3.43, p = 0.003) and >10 months old at referral (OR = 12.62, p < 0.0001). CONCLUSIONS Pediatric referral is a risk factor for discordant CO diagnostics, and late age at referral brings a risk of delayed orchiopexy. It is necessary to enlighten pediatricians, who are mainly responsible for routine health checkups, in teaching CO diagnostic techniques to ensure early referral.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Katsuya Aoki
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
| | - Takeshi Otani
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Fan L, Shi L, Liu S, Zhang Z, Shi J. Bilateral versus unilateral orchidopexy: IVF/ICSI-ET outcomes. Front Endocrinol (Lausanne) 2024; 15:1294884. [PMID: 38362278 PMCID: PMC10867241 DOI: 10.3389/fendo.2024.1294884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Cryptorchidism is a common genital disorder. Approximately 20% of azoospermic or infertile men reported having histories of cryptorchidism. Bilateral cryptorchidism may have been more condemned than unilateral cryptorchidism. Early treatment by orchidopexy is the definitive procedure for cryptorchid patients with cryptorchidism. However, fertility potency after orchidopexy may be adversely affected and assisted reproduction techniques will be required for infertile patients. Objective To compare the reproductive outcomes between unilateral and bilateral orchidopexy groups. Methods A retrospective cohort study at a tertiary hospital, including a total of 99 infertile men who underwent orchidopexy to treat cryptorchidism and subsequently underwent their first IVF/ICSI-ET cycle. Men were grouped according to the laterality of their cryptorchidism and orchidopexy surgeries they received. Fertilization rate and live birth rate were chosen as parameters for evaluating outcomes. Results The sperm concentration and viability were significantly higher in unilateral orchidopexy group than in bilateral orchidopexy group (28.09 ± 27.99 vs 7.99 ± 14.68, P=0.001; 33.34 ± 22.52 vs 11.95 ± 17.85, P=0.001). Unilateral orchidopexy group showed lower demand for ICSI (66.07% vs 95.35%, P<0.001). Interestingly, both groups exhibited similar rates of fertilization, clinical pregnancy, live birth and birth defect. Boy birth ratio was lower in bilateral orchidopexy group as compared to unilateral orchidopexy group (27.27% vs 58.62%, P=0.026). Conclusion A history of bilateral orchidopexy surgery correlates with a worsened sperm parameter and a higher demand for ICSI as compared to patients with history of unilateral orchidopexy. However, this does not influence the final live birth rate.
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Affiliation(s)
- Lijuan Fan
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Lin Shi
- Department of Immunology and Microbiology, Xi’an Jiaotong University College of Medicine, Xi’an, China
| | - Shan Liu
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Zhou Zhang
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women’s and Children’s Hospital, Xi’an, China
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Yang Z, He Y, Chen P, Zhang T, Ke Z, Sun F, Zhou G, Zhao W, Li S. Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study. Pediatr Surg Int 2024; 40:34. [PMID: 38214758 PMCID: PMC10786978 DOI: 10.1007/s00383-023-05630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children. METHODS We prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus. RESULTS No differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen. CONCLUSION Single-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.
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Affiliation(s)
- Zhilin Yang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Yingying He
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, 518000, P.R. China
| | - Pengyu Chen
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Tiejun Zhang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Zhicong Ke
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Fenghao Sun
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Weiguang Zhao
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China.
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Han H, Li J, Lei HE, Yin H, Tian L. Laparoscopic orchidopexy for the treatment of cryptorchidism in adults: a description of the technique and outcomes. BMC Urol 2024; 24:1. [PMID: 38166868 PMCID: PMC10763021 DOI: 10.1186/s12894-023-01386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There are few studies on cryptorchidism in adults, and its treatment is still controversial. METHODS To summarize the surgical strategy and clinical efficacy of laparoscopic orchidopexy for the treatment of cryptorchidism in adults, 37 adult cryptorchidism patients were retrospectively analyzed between September 2017 and February 2022. All 37 patients underwent laparoscopic orchidopexy, of whom 33 underwent inguinal hernia repair without tension. The intraoperative procedures and surgical techniques were recorded in detail. Preoperative examination and regular postoperative review of color Doppler ultrasound, and reproductive hormone, alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels were performed. RESULTS All testes descended successfully into the scrotum, including 25 through the inguinal route and 12 through Hesselbach's triangle route. No intraoperative or postoperative complications were observed. The follow-up time was 38.6 (± 19.4) months, and no evidence of testicular malignancy was found during the follow-up period. After analyzing the reproductive hormone levels at 1 year postoperatively in 28 patients with more than 1 year of follow-up, it was found that the patients had a significant increase in testosterone levels and a decrease in follicle-stimulating hormone levels after surgery. None of the patients showed any significant improvement in semen quality after surgery. CONCLUSION Our study suggests that laparoscopic orchidopexy is a safe and feasible surgical procedure for the treatment of cryptorchidism in adults, especially high cryptorchidism, which is difficult to treat. After comprehensive consideration, preserving the testis should be preferred for treating cryptorchidism in adults to maximize the protection of the patient's reproductive hormone secretion function.
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Affiliation(s)
- Hu Han
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Beijing, 100020, China
- Institute of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiaxing Li
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Beijing, 100020, China
- Institute of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hong-En Lei
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Beijing, 100020, China
- Institute of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hang Yin
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Beijing, 100020, China.
- Institute of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Long Tian
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Beijing, 100020, China.
- Institute of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Ramsey WA, Huerta CT, Jones AK, O'Neil CF, Saberi RA, Gilna GP, Lyons NB, Collie BL, Parreco JP, Thorson CM, Sola JE, Perez EA. Immediate Versus Delayed Surgical Management of Infant Cryptorchidism With Inguinal Hernia. J Pediatr Surg 2024; 59:134-137. [PMID: 37858390 DOI: 10.1016/j.jpedsurg.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Cryptorchidism is commonly treated with orchiopexy at 6-12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT. METHODS The Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates. RESULTS We analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration. CONCLUSION In newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6-12 months of age to reassess for surgery. LEVEL OF EVIDENCE Level III TYPE OF STUDY: Retrospective Comparative Study.
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Affiliation(s)
- Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Carlos T Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexis K Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher F O'Neil
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicole B Lyons
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brianna L Collie
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Parreco
- Memorial Regional Hospital, Division of Trauma and Surgical Critical Care, Hollywood, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Weiner H, Solomon JR, Thinnes R, Pinsky B, Ferreri C, Singleterry M, Bahamonde A, Awadh S, Tran J, Paradis AG, Vetter J, Brooks A, Lund S, Kuwaya D, Juhr D, Wendt L, Eyck PT, Traxel E, Kraft KH, Ellison JS, Storm DW. How Effective Was the 2014 AUA Cryptorchidism Guideline? A Multi-institutional Evaluation. Urol Pract 2023; 10:605-610. [PMID: 37498314 DOI: 10.1097/upj.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION In 2014, the AUA published guidelines regarding the evaluation of cryptorchidism. This multi-institutional study aims to determine if these guidelines reduced the age of referral and the utilization of ultrasound in boys with cryptorchidism. We hypothesize that delayed referral continues, and utilization of ultrasound remains unchanged. METHODS A retrospective review of boys referred for the evaluation of cryptorchidism was performed at 4 academic institutions, collecting data for 1 year prior (2013) and 2 nonconsecutive years following guideline creation (2015 and 2019). Across these time frames, we compared median ages at evaluation and surgery, and rates of patient comorbidities, orchiopexy, and preevaluation ultrasound. RESULTS A total of 3,293 patients were included. The median age at initial pediatric urology evaluation in all cohorts was 39 months (IQR: 14-92 months). Following publication of the AUA Guidelines, there was no difference (P = .08) in the median age at first evaluation by a pediatric urologist between 2013 and 2015, and an increase (P = .03) between 2013 and 2019. Overall, 21.2% of patients received an ultrasound evaluation prior to referral, with no significant difference between 2013 and 2015 (P = .9) or 2019 (P = .5) cohorts. CONCLUSIONS Our data suggest that, despite publication of the AUA Guidelines on evaluation and treatment of cryptorchidism, there has been no reduction in the age of urological evaluation or the utilization of imaging in boys with undescended testis. Finding alternative avenues to disseminate these evidence-based recommendations to referring providers and exploring barriers to guideline adherence is necessary to improve care for patients with cryptorchidism.
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Affiliation(s)
| | | | - Robert Thinnes
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | | | | | - Sami Awadh
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | | | - Daren Kuwaya
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Denise Juhr
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Linder Wendt
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | | | - Jonathan S Ellison
- Medical College of Wisconsin, Milwaukee, Wisconsin
- Children's Wisconsin, Milwaukee, Wisconsin
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Varga A, Kardos D, Radványi Á, Vajda P, Sasi Szabó L, Kovács T. Medium-Term Results of Staged Laparoscopic Traction Orchiopexy for Intra-abdominal Testes: A Multicenter Analysis. J Pediatr Surg 2023; 58:2020-2026. [PMID: 37202294 DOI: 10.1016/j.jpedsurg.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/02/2023] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Staged laparoscopic traction orchiopexy (SLTO) is a novel technique for the intra-abdominal testis (IAT) based on elongation of the testicular vessels without separating them. This multicenter study evaluated the medium-term results of this technique. METHODS Data of SLTO performed in three pediatric surgical centers between 2013 and 2020 were analyzed retrospectively. In 2021, physical and Doppler ultrasound examinations were performed to determine the position and viability of testes. Success was defined as an intra-scrotal testicle without atrophy. RESULTS SLTO was performed on 48 cases (55 testes, 7 bilateral). Mean age at first stage was 2.9 (0.8-12.6) years. High intra-abdominal testes were found in 16.4% and in 60% morphological abnormalities were observed. To fix the testes to the abdominal wall monofilament suture was used in 67.3%, braided in 29.1%. Mean time between the two stages was 16.4 weeks; three testes required redo traction. Perioperative complications occurred in 21 patients (38.2%) including insufficient fixation (11), testicular atrophy (4), wound complications (4), adhesion of the spermatic cords (1) and hydrocele (1). In case of insufficient fixation monofilament sutures were used in 90.9%. In 2021 38 patients (43 testes) had physical and 36 patients (41 testes) had ultrasound examinations. Mean follow-up was 2.7 (0.34-7.9) years. Altogether five atrophies were identified, and three testicular ascents (7.0%) occurred. The overall success rate was 82.2%. CONCLUSIONS SLTO may be a feasible alternative to conventional treatments of IATs. Additionally, braided suture seems to be a better option to fix the testicle to the abdominal wall. LEVEL OF EVIDENCE LEVEL IV.
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Affiliation(s)
- Alexandra Varga
- Division of Pediatric Surgery, Department of Pediatrics, Albert Szent-Györgyi Clinical Center, University of Szeged, 14-15 Korányi Fasor, Szeged, H-6725, Hungary.
| | - Dániel Kardos
- Division of Pediatric Surgery, Department of Pediatrics, Medical School, University of Pécs, 7 József Attila út, Pécs, H-7623, Hungary
| | - Ádám Radványi
- Division of Pediatric Surgery, Department of Pediatrics, University of Debrecen, 98 Nagyerdei Körút, Debrecen, H-4032, Hungary
| | - Péter Vajda
- Division of Pediatric Surgery, Department of Pediatrics, Medical School, University of Pécs, 7 József Attila út, Pécs, H-7623, Hungary
| | - László Sasi Szabó
- Division of Pediatric Surgery, Department of Pediatrics, University of Debrecen, 98 Nagyerdei Körút, Debrecen, H-4032, Hungary
| | - Tamás Kovács
- Division of Pediatric Surgery, Department of Pediatrics, Albert Szent-Györgyi Clinical Center, University of Szeged, 14-15 Korányi Fasor, Szeged, H-6725, Hungary
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Schmedding A, van Wasen F, Lippert R. Are we still too late? Timing of orchidopexy. Eur J Pediatr 2023; 182:1221-1227. [PMID: 36622430 PMCID: PMC10023762 DOI: 10.1007/s00431-022-04769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/06/2022] [Accepted: 12/17/2022] [Indexed: 01/10/2023]
Abstract
An undescended testis is the most common genitourinary disease in boys. The German guidelines, first published in 2009, proposed the timing of orchidopexy to be before 12 months of age. The aim of the study was to analyze the implementation of these guidelines 10 years after publication. The national cumulative statistics of hospital admissions, provided by the Institute for the Remuneration System in Hospitals (InEK), and the statistics concerning procedures performed in private pediatric surgical practices of the professional association of pediatric surgeons (BNKD) regarding the time of surgeries for the year 2019 were analyzed. Data from InEK included all German hospital admissions. Data from BNKD included data from 48 private pediatric surgical practices. The hospitals treated 6476 inpatients with undescended testis, and 3255 patients were operated in private practices. Regarding the age at treatment, 15% of the hospital patients and 5% of the private practice patients were younger than 1 year and fulfilled the guideline recommendations. Forty percent of the hospital patients and 29% of the private practice patients were 1 or 2 years of age. All other patients were 3 years of age or older at the time of orchidopexy. Conclusions: The rate of orchidopexy within the first 12 months of life is remarkably low even 10 years after the publication of the guidelines. Awareness of the existing guideline must be increased for both referring pediatric and general practitioners. What is Known: • In Germany, orchidopexy is performed by pediatric surgeons and urologists either in hospital settings or in private practices. • Most international guidelines set the age for surgical treatment of undescended testis between 12 and 18 months of age. The German guidelines, published in 2009, sets the time-limit at one year of age. Until five years after publication of the German guidelines, the number of patients treated before the first year of life was low; studies show an orchidopexy ratebetween 8% and 19% during this time. What is New: • This study the first to cover all administered hospital patients in Germany and a large group of patients treated in private practices. It contains the largest group of German patients with undescended testis. • Although almost all children participate in the routine check-up at the age of seven months, which includes investigation for undescended testis, adherence to the orchidopexy guidelines is still low. Only 15% of the hospital patients and 5% of the patients in private practice were treated before their first birthdays.
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Affiliation(s)
- Andrea Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Germany.
| | | | - Ralf Lippert
- Private Practice of Pediatric Surgery, Bremen, Germany
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Stark EM, Beasley SW, Campbell A. How electronically available referral guidelines for primary medical practitioners can improve the timeliness of orchidopexy. N Z Med J 2021; 134:89-94. [PMID: 34855737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM This study determined whether easily used guidelines and an electronic referral process could decrease the age of referral of suspected undescended testes (UDT). An online resource for primary medical practitioners was introduced for which the UDT guideline advises referral to paediatric surgery for testes not sitting spontaneously in the scrotum at three-months corrected age. METHOD Data were collected prospectively for boys referred with UDT over a seven-year period (2012-2018), during which time agreed GP guidelines on the Community HealthPathways website for referral were introduced. Trends in the age at referral and age at orchidopexy were analysed. RESULTS Complete data were obtained for 212 boys. Referral before age six months increased from 13% to 61%, and before 12 months from 48% to 78%. Orchidopexy by 12 months increased from 16% to 39%, and by 18 months from 48% to 74%, during the same period. Median age at orchidopexy for this 2012-2018 cohort was 21.6 months compared with 31.1 months from 1997-2007. DISCUSSION These data demonstrate earlier referral of boys with UDT and earlier orchidopexy corresponded to the introduction of the GP Community HealthPathways website. A similar resource available in other regions or countries also might be expected to reduce the age of referral of suspected UDT from primary care providers.
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Affiliation(s)
- Erika M Stark
- Resident Medical Officer, Canterbury District Health Board
| | - Spencer W Beasley
- Clinical Director, Department of Paediatric Surgery, Christchurch Hospital, and Professor of Paediatric Surgery, University of Otago, Christchurch
| | - Alison Campbell
- Senior Registrar Paediatric Surgery, Sheffield Chrildren's NHS Foundation Trust
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Obayashi J, Wakisaka M, Tanaka K, Furuta S, Ohyama K, Kitagawa H. Risk factors influencing ascending testis after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele. Pediatr Surg Int 2021; 37:293-297. [PMID: 33388952 DOI: 10.1007/s00383-020-04789-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the risk factors influencing ascending testis following laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia or hydrocele. METHODS Boys undergoing LPEC between 2014 and 2018 had their medical records and operative movies reviewed. Group A patients required orchiopexy after LPEC. Group B patients did not. Their baseline characteristics were reviewed. The path of the LPEC needle (not crossing the spermatic duct at first circuit [Not Crossing]), whether the second entry of the LPEC needle was different from the first hole (Different Hole), peritoneal injury requiring re-ligation (Re-ligation), and hematoma (Hematoma) were evaluated. The quantitative factors of significant difference were set as a cut-off value. RESULTS There were 5 patients (7 sides) in Group A and 162 patients (237 sides) in Group B. Birth weight was lower in Group A (p = 0.035). Not Crossing was 7 sides (100%) in Group A and 97 sides (41%) in Group B (p = 0.002). Hematoma was 2 sides (29%) in Group A and 11 sides (5%) in Group B (p = 0.047). Cut-off value of birth weight was 932 g (AUC 0.78). CONCLUSION Birth weight < 932 g and operative findings (not crossing over the spermatic duct on the first circuit and hematoma) indicated an increased risk of ascending testis after LPEC.
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Affiliation(s)
- Juma Obayashi
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Munechika Wakisaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Kunihide Tanaka
- Department of Pediatric Surgery, St. Marianna University Yokohama-City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
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Ferragut Cardoso AP, Gomide LMM, Souza NP, de Jesus CMN, Arnold LL, Cohen SM, de Camargo JLV, Nascimento e Pontes MG. Time response of rat testicular alterations induced by cryptorchidism and orchiopexy. Int J Exp Pathol 2021; 102:57-69. [PMID: 33502821 PMCID: PMC7839953 DOI: 10.1111/iep.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/03/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022] Open
Abstract
Cryptorchidism is one of the main risk factors for infertility and testicular cancer. Orchiopexy surgery corrects cryptorchidism effects. Different models of cryptorchidism developed in the rat include surgery. We assessed testicular alterations in rats submitted to surgical cryptorchidism and examined their potential for reversibility at different time points in order to verify time dependency effect(s) on the recovery of the undescended testes. Cryptorchidism was induced in 3-week-old rats. Animals were euthanized 3, 6 or 11 weeks after surgery to evaluate the morphological progression of cryptorchidism-induced germinative epithelial alterations. Other groups underwent orchiopexy 3, 5 or 9 weeks after surgical cryptorchidism, before or after puberty. Animals were euthanized 3 or 8 weeks after orchiopexy. Controls underwent sham surgery at the same time points as the surgical groups. Cryptorchid testes showed decreased weight, germinative epithelial degeneration, apoptosis and vacuolation, corresponding to impairment of spermatogenesis and of Sertoli cells. Some tubules has a Sertoli cell-only pattern and atrophy. The intensity of damage was related to the duration of cryptorchidism. After orchiopexy, spermatogenesis completely recovered only when testicular relocation occurred before puberty and the interval for recovery was extended. These results indicate that age, sexual maturity and extension of germ cell damage were relevant for producing germ cell restoration and normal spermatogenesis. We provide original observations on the time dependency of testicular alterations induced by cryptorchidism and their restoration using morphologic, morphometric and immunohistochemical approaches. It may be useful to study germ cell impairment, progression and recovery in different experimental settings, including exposure to exogenous chemicals.
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Affiliation(s)
- Ana P. Ferragut Cardoso
- Center for the Evaluation of the Environmental Impact on Humans Health (TOXICAM)Department of PathologyBotucatu Medical SchoolSão Paulo State University (UNESP)BotucatuBrazil
- Present address:
Department of Pharmacology and ToxicologyUniversity of LouisvilleLouisvilleKYUSA
| | - Lígia M. M. Gomide
- Center for the Evaluation of the Environmental Impact on Humans Health (TOXICAM)Department of PathologyBotucatu Medical SchoolSão Paulo State University (UNESP)BotucatuBrazil
- Present address:
Southwestern University Center of São PauloItapetiningaBrazil
| | - Nathalia P. Souza
- Center for the Evaluation of the Environmental Impact on Humans Health (TOXICAM)Department of PathologyBotucatu Medical SchoolSão Paulo State University (UNESP)BotucatuBrazil
| | | | - Lora L. Arnold
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Samuel M. Cohen
- Department of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNEUSA
- Havlik‐Wall Professor of OncologyDepartment of Pathology and MicrobiologyUniversity of Nebraska Medical CenterOmahaNEUSA‘Sertoli cells
| | - João Lauro V. de Camargo
- Center for the Evaluation of the Environmental Impact on Humans Health (TOXICAM)Department of PathologyBotucatu Medical SchoolSão Paulo State University (UNESP)BotucatuBrazil
| | - Merielen G. Nascimento e Pontes
- Center for the Evaluation of the Environmental Impact on Humans Health (TOXICAM)Department of PathologyBotucatu Medical SchoolSão Paulo State University (UNESP)BotucatuBrazil
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12
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Iqbal N, Hasan A, Saghir S, Iqbal S, Saif UB, Choudhry AM, Choudhry AM, Gill BS, Hussain I, Iqbal D, Khan F, Akhter S. Laparoscopic Orchiopexy For Management Of Bilateral Non-Palpable Testes. J Ayub Med Coll Abbottabad 2020; 32:445-449. [PMID: 33225641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite numerous clinical studies regarding the management of unilateral impalpable testes by laparoscopy, there is a paucity of such studies regarding the management of bilateral 'non-palpable' testes. We shared the outcome of the laparoscopic management of bilateral 'non-palpable' testes in terms of successful orchiopexy and complications in children. METHODS A total of 22 children underwent bilateral diagnostic laparoscopy for undescended testes who presented to our department from January 2010 till March 2018. We did chart review for variables such as the age of children, operative time, hospital stay, single-stage or 2 stage procedure, and operative complications. Preoperatively history and physical examination were done along with baseline investigations and Ultrasound abdomen and scrotum before surgery for general anaesthesia fitness. They were managed by single or two steps laparoscopic orchiopexy according to suitability for each case. RESULTS We performed bilateral laparoscopic orchidopexies in 22 children having a mean age of 4.1±1.98 years (49.2 months) Mean operative time for single setting bilateral single-stage orchiopexy was 136±32 minutes. Out of twenty-two children with bilateral impalpable testes, 12 boys (54.5%) were managed with a single-stage Bilateral Laparoscopic technique while the other 10 (45.45%) were managed in 2 staged laparoscopic intervention using Fowler-Stephens technique. Testicular atrophy was seen in 2/44 testes (4.54%). While 1 /44 (2.27%) testis had ascended to the inguinal region requiring redo surgery. CONCLUSIONS Laparoscopic management of bilateral 'non-palpable' testes in a single or double setting is a safe and effective method of bringing testes down to the scrotum. It has no major morbidities.
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Affiliation(s)
- Nadeem Iqbal
- Shifa International hospital Islamabad, Pakistan
| | - Aisha Hasan
- Riphah International University, Rawalpindi, Pakistan
| | | | - Sidra Iqbal
- Ayub Teaching Hospital, Abbottabad, Pakistan
| | | | | | | | | | - Ijaz Hussain
- Shifa International hospital Islamabad, Pakistan
| | - Daud Iqbal
- Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan
| | | | - Saeed Akhter
- Shifa International hospital Islamabad, Pakistan
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13
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Sommer-Jörgensen V, Künzli M, Holland-Cunz SG, Gros S, Frech M. A CARE-compliant article successful salvage of bilateral perinatal testicular torsion after delivery out of breech presentation: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e21763. [PMID: 32899004 PMCID: PMC7478688 DOI: 10.1097/md.0000000000021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Neonatal testicular torsion is a rare condition. There is no consensus about the optimal surgical treatment of neonatal testicular torsions. The salvage rate reported in literature remains poor. Discrimination of the onset of a neonatal testicular torsion seems to have an important impact of the salvage rate. Deliveries out of breech presentation have a risk for neonatal complications including neonatal genital birthtrauma. PATIENT CONCERNS A newborn boy, who was delivered at 40 weeks of gestation out of breech presentation, showed shortly after birth, a painful discoloration and swelling of the scrotum. DIAGNOSIS Clinical examination and ultrasound were highly suspicious for testicular torsion. INTERVENTION Emergency surgery revealed a bilateral testicular torsion with dark coloration of both testicles. The testicles were detorted and left in situ. A bilateral orchidopexy was performed. OUTCOMES Postoperative ultrasound showed reperfusion of both testicles and the boy was discharged from hospital. Follow-up after 2 months showed normal clinical examination and sonographically persistent perfusion of both testicles. Endocrinological investigations during minipuberty revealed normal hormonal values. LESSONS We present this rare case in regard to the current literature and recommend close observation of newborns for genital trauma after delivery out of breech position. We encourage surgeons to carefully consider leaving the testicles in situ.
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14
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Abstract
Undescended testis is the most common genitourinary disorder during childhood. The traditional inguinal approach still represents the standard technique to correct undescended testis. However, over the last decades a large number of studies have shown that the scrotal approach has a lower morbidity rate and significantly shorter operation times and offers a good cosmetic result as well as an equal surgical treatment result, which makes it a good alternative to the traditional inguinal approach in gliding and low palpable testis.
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Affiliation(s)
- Nina Friederike Younsi
- Universitätsmedizin Mannheim, Zentrum für Kinder-, Jugend- und rekonstruktive Urologie, Mannheim
| | - Katrin Zahn
- Universitätsmedizin Mannheim, Zentrum für Kinder-, Jugend- und rekonstruktive Urologie, Mannheim
| | - Raimund Stein
- Universitätsmedizin Mannheim, Zentrum für Kinder-, Jugend- und rekonstruktive Urologie, Mannheim
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15
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Wu CQ, Kirsch AJ. Revisiting the success rate of one-stage Fowler-Stephens orchiopexy with postoperative Doppler ultrasound and long-term follow-up: a 15-year single-surgeon experience. J Pediatr Urol 2020; 16:48-54. [PMID: 31784377 DOI: 10.1016/j.jpurol.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/15/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The optimal management of a high undescended testicle (UDT) remains debated. When tethering is due to shortened spermatic vessels, a one-stage or two-stage Fowler-Stephens Orchiopexy (FSO) can be performed. Published series suggest a higher success rate with a two-stage FSO, though its superiority has not been ascertained. The authors examine patient and surgical factors associated with success of one-stage FSO and compare our outcomes with the established literature. METHODS We retrospectively reviewed the charts of 43 boys who underwent one-stage FSO for 45 testes from 2003 to 2018 by a single surgeon at our institution. Patient factors, surgical approach, and postoperative results were reviewed. Radiographic success was a testis with intact vascular flow or normal echotexture on scrotal ultrasound. Clinical success was a non-atrophic, intrascrotal testis at postoperative follow-up. Radiographic and clinical success was compared. Data analysis was performed with Fisher's exact test and t-test for categorical and continuous variables respectively. RESULTS Follow-up (mean 29 months; 0.5 months-14.5 years) was available for 40 patients (42 testes; 21 bilateral, 21 unilateral). Average age at surgery was 21.8 months (4 months-10.4 years). Associated conditions were seen in 14 patients. Twenty-nine patients had postoperative scrotal Doppler ultrasound with radiographic success in 25/29 (86.2%). Overall clinical success was 34/42 (81%) with 4 (9.5%) each of atrophy and ascent. A second surgery to address ascent in four patients allowed correction in three for a success rate of 88%. Radiographic and clinical success was significantly associated (P = 0.01). Clinical success was also significantly associated with inguinal rather than laparoscopic testis mobilization (P = 0.03) but not to patient's age, associated conditions, unilaterality/bilaterality, or pre-operative hypoplasia or location. Greater than 3 years of follow-up was available in 11 (26.2%) cases, of which seven had successful results. All adverse outcomes occurred within 8 months after surgery. Success was otherwise durable. CONCLUSION This is the largest series of one-stage FSO to date. The success rate of one-stage FSO in this series matches that published in the literature for two-stage FSO; equal success is achieved with fewer surgeries. Postoperative Doppler ultrasound demonstrating intact vascular flow or normal testis echotexture is significantly associated with clinical success and highlights the utility of postoperative ultrasound in patients with an equivocal exam.
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Affiliation(s)
- Charlotte Q Wu
- Children's Healthcare of Atlanta, Emory University School of Medicine, USA.
| | - Andrew J Kirsch
- Children's Healthcare of Atlanta, Emory University School of Medicine, USA
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16
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Hirata Y, Moriya K, Nakamura M, Kon M, Nishimura Y, Ujihashi K, Higuchi M, Matsumoto R, Kitta T, Shinohara N. [PUBERTAL TESTICULAR TORSION OF POLYORCHIDISM DIAGNOSED IN INFANCY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2020; 111:53-57. [PMID: 33883360 DOI: 10.5980/jpnjurol.111.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Left polyorchidism was found in a 2-month-old boy with a left scrotal mass. As he was asymptomatic and all testes were in the scrotum, he was conservatively followed up. At 17 years of age, he presented with left acute scrotum due to testicular torsion of the left supernumerary testis. Counterclockwise 720-degree rotation of the left supernumerary testis was noted during emergency surgery, and orchidopexy of the 3 testes (2 left testes and 1 right testis) was performed. Biopsy of the left supernumerary testis demonstrated spermatogenesis and no malignancy. One and a half years after surgery, all testes were viable without atrophy.Polyorchidism is a rare condition and there is no consensus on the management of asymptomatic cases detected early in life. The position of the supernumerary testis (intrascrotal or extrascrotal) is important when deciding the management strategy because of the risk of malignancy. If conservative management is selected initially, elective surgery, such as prophylactic orchiectomy or orchidopexy, may be needed because of the risk of malignancy and torsion.
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Affiliation(s)
- Yurie Hirata
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Kazuhiro Ujihashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
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17
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Ali MS, Khan N, Uddin MB, Hossain MS, Mushtabshirah L. High Transverse Scrotal Incision Orchiopexy for Undescended Testes. Mymensingh Med J 2019; 28:542-546. [PMID: 31391424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bianchi squire first described scrotal incision orchiopexy as an alternative to the traditional approach in the1980s. In maximum premature and some mature infants, palpable testis is a common surgical problem. There are several surgical technique applied to overcome this surgical problems like combined inguinal and scrotal incision or single high transverse scrotal incision. The goal of this study assessed single high transverse scrotal incision for the management of PUT as regards to evaluate operative time, postoperative success and final cosmetic results. One hundred twenty patients were managed at the Paediatric Surgery Department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh with PUT during the period from 2015 to March 2018. We operated all cases between 6 to 12 months and excluded more than 12 months of age and recurrent cases. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as a fixation is performed. After fixation of testis high transverse scrotal incision was given, all layers were separated. Then enter into inguinal cannel by cutting of external ring. After dissecting the testis come down through the incision. After making dartos pouch through the same incision and orchidopexy done. All infants were followed-up at 1 month, 2 months and 6 months to detect operative times as well as position, testicular atrophy and the final cosmetic appearance. Patient age ranged from 6 months to 12 months. A total of 120 PUTs were operated upon in 100 patients. PUT was bilateral in 15 patients, right-sided in 55 cases and left-sided in 30 cases. Among 120 testes 40 testes were located distal to external inguinal ring (EIR), 70 testes were at internal inguinal ring (IIR) and 10 testes were in between EIR and IIR. A total of 100 patients were successfully placed within scrotum using a single incision. Operative time ranged from 20-36 minutes. There were no cases of testicular atrophy or ascent. The only complications were 3 wound infections (3%), which were successfully treated with antibiotics. Single high transverse scrotal incision was sufficient to deal with PUT especially, in young infants (age 6 months). The procedure results in shorter operative times, similar success and complication rates, and a more cosmetically appealing outcome compared to inguinal orchiopexy.
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Affiliation(s)
- M S Ali
- Dr Mohammad Showkot Ali, Assistant Professor, Department of Paediatric Surgery, Mymensingh Medical College (MMC), Mymensingh, Bangladesh
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18
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Grijalba Ipiñazar I, Tuduri Limousin I, Reguera Fernández M, Najarro Ajuria G, Martínez Ruiz A. Anesthetic management of a child with congenital Steiner syndrome scheduled for laparoscopic bilateral orchidopexy. ACTA ACUST UNITED AC 2019; 66:381-384. [PMID: 31027758 DOI: 10.1016/j.redar.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 11/18/2022]
Abstract
Congenital Steinert syndrome is a severe form of myotonic dystrophy, characterized by general hypotonia, facial diplegia, respiratory difficulty and sucking and swallowing problems presented since birth. This syndrome has an estimated incidence of 1 per 10.000 births. Mortality is close to 50% during the neonatal period. It represents a challenge for the anesthesiologist due to the great variety of intraoperative and postoperative adverse events, given by both the evolution of the disease and the susceptibility to the vast majority of the anesthetic agents. A report of a 3-year-old boy with congenital myotonic dystrophy is presented, scheduled for laparoscopic bilateral orchidopexy, performed under general anesthesia without muscular relaxation, combined with ecoguide bilateral TAP block.
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Affiliation(s)
- I Grijalba Ipiñazar
- Servicio de Anestesiología, Reanimación y Terapeútica del Dolor, Hospital Universitario de Cruces, Barakaldo (Vizcaya), España.
| | - I Tuduri Limousin
- Servicio de Cirugía Pediátrica, Hospital Universitario Cruces, Barakaldo (Vizcaya), España
| | - M Reguera Fernández
- Servicio de Anestesiología, Reanimación y Terapeútica del Dolor, Hospital Universitario de Cruces, Barakaldo (Vizcaya), España
| | - G Najarro Ajuria
- Servicio de Anestesiología, Reanimación y Terapeútica del Dolor, Hospital Universitario de Cruces, Barakaldo (Vizcaya), España
| | - A Martínez Ruiz
- Servicio de Anestesiología, Reanimación y Terapeútica del Dolor, Hospital Universitario de Cruces, Barakaldo (Vizcaya), España
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19
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Boyle TA, Perez EA, Diez R, Sola JE, Sanz EE, Garcia A, Fuentes EJ. Transverse testicular ectopia discovered following reduction of an inguinal hernia. J Pediatr Surg 2019; 54:608-611. [PMID: 30409476 DOI: 10.1016/j.jpedsurg.2018.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/07/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022]
Abstract
Transverse testicular ectopia is a rare condition in which both testicles occupy a single hemiscrotum. The aberrant positioning may lead to vascular compromise or impaired temperature regulation, which elevate the risks for torsion, infertility and testicular cancer. Definitive therapy consists of orchiectomy or orchiopexy. We report a case of a 10-month-old boy with an incarcerated inguinal hernia who was discovered to have transverse testicular ectopia following hernia reduction. The patient was treated with herniorrhaphy and open transseptal orchiopexy.
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Affiliation(s)
- Thomas A Boyle
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Ricardo Diez
- Department of Surgery, Division of Pediatric Surgery, Hospital Quironsalud Sur, Madrid, Spain
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Eva E Sanz
- Department of Surgery, Division of Pediatric Surgery, Hospital Quironsalud Sur, Madrid, Spain
| | - Ana Garcia
- Department of Surgery, Division of Pediatric Surgery, Hospital Quironsalud Sur, Madrid, Spain
| | - Ennio J Fuentes
- Department of Surgery, Division of Pediatric Surgery, Hospital Quironsalud Sur, Madrid, Spain.
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20
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Siu Uribe A, Garrido Pérez JI, Vázquez Rueda F, Ibarra Rodrígue MR, Murcia Pascual FJ, Ramnarine Sánchez SD, Paredes Esteban RM. [Manual detorsion and elective orchiopexy as an alternative treatment for acute testicular torsion in children]. Cir Pediatr 2019; 32:17-21. [PMID: 30714696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To present our experience in pediatric patients with testicular torsion (TT) treated by manual detorsion (MD). PATIENTS AND METHODS Retrospective analysis of patients treated by MD in a 10-year period in a single center. Description of symptoms, detorsion technique, follow-up and complications. RESULTS 76 patients diagnosed with TT were studied in a 10-year period. 16 patients were treated by MD. Mean age was 12 years (Range: 10-13 years) and time from onset of pain was 5.25 hours (±4,2). Left testicle was affected in 75% (n=12). Detorsion maneuver was performed by a pediatric surgeon at the radiology room, in counter-clockwise direction in the right testicle and clockwise direction in the left testicle in all cases. The success was defined as the relief of pain, normal physical examination and was confirmed by Doppler ultrasound performed immediately after MD. MD was effective in 75% (n=12) and orchiopexy was performed under elective conditions at median time of 2 weeks (0-5 weeks). MD was unsuccessful in 3 patients and emergency orchiopexy was performed with no testicular loss. 1 patient had a second MD maneuver for incomplete detorsion. No short or long term complication nor testicular atrophy was observed. CONCLUSION MD and elective orchiopexy seems to be an efficient and reliable procedure in the treatment of TT in children. Further studies may be necessary to establish its safety and indications.
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Affiliation(s)
- A Siu Uribe
- UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
| | | | - F Vázquez Rueda
- UGC Cirugía Pediátrica. Hospital Universitario Reina Sofía. Córdoba
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21
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Iio K, Nomura O, Kinumaki A, Aoki Y, Satoh H, Sakakibara H, Hataya H. Testicular Torsion in an Infant with Undescended Testis. J Pediatr 2018; 197:312-312.e1. [PMID: 29429568 DOI: 10.1016/j.jpeds.2018.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | - Hiroshi Sakakibara
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics Tokyo Metropolitan Children's Medical Center Tokyo, Japan
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22
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Bagga D, Prasad A, Grover SB, Sugandhi N, Tekchandani N, Acharya SK, Samie A. Evaluation of two-staged Fowler-Stephens laparoscopic orchidopexy (FSLO) for intra-abdominal testes (IAT). Pediatr Surg Int 2018; 34:97-103. [PMID: 28980063 DOI: 10.1007/s00383-017-4170-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The best operative intervention for intrabdominal testis (IAT) has not been standardized as yet. The question of whether to bring down an IAT with a single-staged vessel-intact laparoscopic orchidopexy (VILO) or a two-staged laparoscopic Fowler-Stephens orchidopexy (FSLO) is still undergoing debate, with both the procedures being popular. The present study has been designed to evaluate the factors predicting the success or failure of two-staged FSLO for (IAT). METHODS 43 boys with 49 non-palpable testes underwent diagnostic laparoscopy out of which 35 underwent two-staged FSLO. Size of the testis was measured with a graduated probe in both stages. Independent variables such as age, height, testis-to-internal ring distance (T-IR), neo internal ring-to-midscrotal distance (NIR-MS), and mobility-to-contralateral ring (MCIR) were analysed. Postoperatively 34 IATs were followed up clinically as well as ultrasonologically after 6 months, to see for the size, position, and vascularity. Based on this, the patients were divided into two groups, Group A (successful) and Group B (Failed). RESULTS 24 IATs had a successful outcome (Group A) and 11 were failure (Group B). The overall success rate of the study was 68.6%. The difference in mean age of patients in both groups was insignificant (p = 0.89) (Fig. 1), and similarly, the difference in mean height was insignificant (p = 0.61). The difference in mean T-IR in both the groups was insignificant (1.85 versus 2.77 cm; p = 0.09) and mean NIR-MS was 5.41 cm in Group A and 5.10 cm in Group B, and the difference again was insignificant (p = 0.23). CONCLUSION The success rate of FSLO was 68.6%. None of the above-described independent variables have any effect on the outcome of two-staged FSLO. While VILO remains the treatment of choice for IAT located at or near the ring, but IAT higher than this, two-staged FSLO gives a better chance for achieving intra-scrotal orchidopexy.
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Affiliation(s)
- Deepak Bagga
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Ashish Prasad
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
| | - Shabnam Bhandari Grover
- Department of Radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Nidhi Sugandhi
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Narender Tekchandani
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Samir Kant Acharya
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Amat Samie
- Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
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Lauerman M, Kolesnik O, Park H, Buchanan LS, Chiu W, Tesoriero RB, Stein D, Scalea T, Henry S. Definitive Wound Closure Techniques in Fournier's Gangrene. Am Surg 2018; 84:86-92. [PMID: 29428033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885-11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727-0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.
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Chen Y, Zhao JF, Wang FR, Li Y, Shi Z, Zhong HJ, Zhu JM. [Single scrotal-incision orchidopexy without ligation of processus vaginalis for palpable undescended testis]. Zhonghua Nan Ke Xue 2017; 23:708-712. [PMID: 29726645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT). METHODS This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B. RESULTS The median age of the PUDT patients was 1.4 (0.6-11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele. CONCLUSIONS Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.
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Affiliation(s)
- Yi Chen
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Jun-Feng Zhao
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Fu-Ran Wang
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Yan Li
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Zhan Shi
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Hong-Ji Zhong
- Department of Pediatric Urology, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
| | - Jian-Ming Zhu
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China
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Wang F, Zhong H, Zhao J. Ascending testis after repair of pediatric inguinal hernia and hydrocele: A misunderstood operative complication. J Pediatr Urol 2017; 13:53.e1-53.e5. [PMID: 27727095 DOI: 10.1016/j.jpurol.2016.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ascending testis (AT) is a rare complication after repair of an inguinal hernia/hydrocele. However, there has been some controversy concerning the AT following laparoscopic and open procedures. OBJECTIVE To review the experience of, and discuss the associated mechanisms with, testicular ascent after pediatric inguinal hernia/hydrocele surgery. STUDY DESIGN A retrospective review of the medical records of male children who underwent inguinal hernia/hydrocele repair at the present hospital between January 2000 and December 2014. Those who underwent subsequent orchiopexies due to ipsilateral cryptorchidism were identified. The ATs that were misdiagnosed, caused by improper operation, and retractile testes were excluded. The Poisson distribution evaluated the incidences of subgroups. RESULTS A total of 17,295 inguinal hernias and hydroceles were repaired on 12,849 males; of whom, 10 testes (0.058%) developed ATs on nine individuals postoperatively (Summary Table). The difference of AT incidences between subgroups was insignificant (P > 0.05), except for that grouped by the age at initial operation (cutoff = 1 year, P = 0.008; cutoff = 2 years, P = 0.012). During orchiopexy, extensive adhesions were found in the inguinal canal only in the two cases following open repair. The hernia sac/processus vaginalis remained intact in the canal of AT after laparoscopic repair, and partial after open herniotomy. DISCUSSION It was generally assumed that testicular ascent after repair of an inguinal hernia/hydrocele was caused by adhesion of the spermatic cord. However, the cord was not dissected during laparoscopic procedure, so adhesion was not the major reason for AT following laparoscopic surgery. The sac/processus were partially excised during open repair, but kept intact in laparoscopic procedure. Therefore, remnants of the sac/processus might play a greater role in postoperative testicular ascent than adhesions. Furthermore, it was found that AT incidence after the repair was not higher than that in 'normal' males. Ascending testis was probably not an operative complication, but a natural descent process of testis independent of the operation. Moreover, the testis descended further due to dissection of the cord and excision of the sac/processus, so the AT incidence was extremely low following open operation. From this point of view, open repair of an inguinal hernia/hydrocele was probably a protective factor for preventing testicular ascent. CONCLUSION Ascending testis is rare in male pediatric patients who have had repair of an inguinal hernia/hydrocele. Currently, the mechanism of testicular ascent is still unclear, and should be further investigated in the future.
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Affiliation(s)
- Furan Wang
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China.
| | - Hongji Zhong
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China
| | - Junfeng Zhao
- Department of Pediatric Urology, Ningbo Women & Children's Hospital, Cicheng New Town, Jiangbei District, Ningbo, Zhejiang, China
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Marjanovic V, Budic I, Stevic M, Simic D. A Comparison of Three Different Volumes of Levobupivacaine for Caudal Block in Children Undergoing Orchidopexy and Inguinal Hernia Repair. Med Princ Pract 2017; 26:331-336. [PMID: 28437787 PMCID: PMC5768116 DOI: 10.1159/000475936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/22/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of 3 different volumes of 0.25% levobupivacaine caudally administered on the effect of intra- and postoperative analgesia in children undergoing orchidopexy and inguinal hernia repair. SUBJECTS AND METHODS Forty children, aged 1-7 years, American Society of Anesthesiologists (ASA) physical status I and II, were randomized into 3 different groups according to the applied volumes of 0.25% levobupivacaine: group 1 (n = 13): 0.6 mL∙kg-1; group 2 (n = 10): 0.8 mL∙kg-1; and group 3 (n = 17): 1.0 mL∙kg-1. The age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ2 test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. RESULTS Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of patients who required analgesics within 6 h (3/2/3), between 6 and 12 h (3/1/3), and between 12 and 24 h (1/0/2) after surgery were similar among the groups. CONCLUSION The 3 different volumes of 0.25% levobupivacaine provided the same quality of intra- and postoperative pain relief in pediatric patients undergoing orchidopexy and inguinal hernia repair.
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Affiliation(s)
- Vesna Marjanovic
- Center for Anesthesia and Resuscitation, Clinical Centre Nis, Nis, Serbia
- *Vesna Marjanovic, Center for Anesthesia and Resuscitation, Clinical Centre Nis, Bul. Zorana Djindjica 48, RS-18000 Nis (Serbia), E-Mail
| | - Ivana Budic
- Center for Anesthesia and Resuscitation, Clinical Centre Nis, Nis, Serbia
- Department of Anesthesiology, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marija Stevic
- Department of Anesthesia, University Children's Hospital Belgrade, Belgrade, Serbia
| | - Dusica Simic
- Department of Anesthesia, University Children's Hospital Belgrade, Belgrade, Serbia
- Department of Anesthesiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Yang ZL, Zhang G, Xu Q, Bai AS, Sun BP, Zhang XZ. [Modified Bianchi orchiopexy for median or low cryptorchidism]. Zhonghua Nan Ke Xue 2017; 23:39-42. [PMID: 29658235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of modified Bianchi (single incision in the midline of the scrotum) orchiopexy (MBO) versus that of traditional surgery in the treatment of median or low cryptorchidism. METHODS Eighty-two children with median or low cryptorchidism were treated from February 2013 to February 2014, 46 (53 testes) by MBO and the other 36 by the traditional method of inguinal incision (control, 40 testes). Comparisons were made in the operation time and postoperative complications between the two surgical strategies. RESULTS The mean operation time was significantly shorter in the MBO group than in the control ([25±6] vs [35±4] min, P<0.05). No testicular atrophy, hernias or hydrocele was found in either group during the 1-2 years of follow-up. Testis retraction was observed in 3 cases in the MBO group as compared with 2 in the control (P>0.05). The incision scar was obvious in all the controls, with 1 case of postoperative inguinal hematoma, but almost invisible in all the MBO cases. CONCLUSIONS Modified Bianchi orchiopexy is superior to traditional surgery in the treatment of median or low cryptorchidism for its advantages of short operation time, few complications, and satisfactory appearance of the healed incision.
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Affiliation(s)
- Zeng-Lei Yang
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - Gang Zhang
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - Quan Xu
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - An-Sheng Bai
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - Bai-Ping Sun
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
| | - Xiong-Zhou Zhang
- Department of Pediatric Surgery, Northwest Women and Children's Hospital, Xi'an, Shaanxi 710061, China
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Abstract
The aim of this study was to evaluate the testicular volume and structure using ultrasound (US) before and up to 3 years after orchidopexy in children with different age.A total of 128 patients underwent orchidopexy for undescended testes. Afterwards, patients were invited for annual follow-up and control scrotal US. The total number of analyzed testes after orchidopexy was 184. Patients were divided according to age at the time of surgery: group I (2-4 years old), group II (5-7), and group III (8-10). In all patients, the testicular volume ratio was calculated as the operated testes volume versus the control testes mean volume.There was an increase in the median ratio in all age groups, from 0.86 to 0.95 in group I, 0.82 to 0.92 in group II and 0.78 to 0.90 in group III. In group of the patients 2 to 4 years old the growth of the ratio 3 years after surgery was statistically significant.Abnormalities in the structure of the testes, which may indicate severe damage to the testis, were seen in approximately 20% of patients on initial exams. On follow-up exams, this type of structure remained in 7% of patients. Testes with an initial ratio <0.25 and inhomogeneous structure did not show any significant growth.Scrotal US can be used for an accurate comparative assessment of the structure and growth of the testes before and after orchidopexy.Abnormalities in the structure of the testes may identify testes requiring more advanced methods of evaluation.
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Affiliation(s)
| | | | - Pawel Osemlak
- Department of Pediatric Surgery, Medical University of Lublin, Lublin, Poland
| | - Pawel Nachulewicz
- Department of Pediatric Surgery, Medical University of Lublin, Lublin, Poland
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Jawdat JR, Kocherov S, Chertin B. One-Stage Laparoscopic Orchiopexy for the Treatment of Intraabdominal Testis. Isr Med Assoc J 2016; 18:669-672. [PMID: 28466616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Laparoscopy has gradually become the gold standard for the treatment of non-palpable testicles (NPT), with different success and complication rates. OBJECTIVES To evaluate outcomes of the one-stage laparoscopic orchiopexy for NPT in our department. METHODS We retrospectively evaluated the medical files of patients who underwent laparoscopic orchidopexy with the identical technique. Only patients with at least one year follow-up were included. At follow-up we assessed the age (at surgery), follow-up time, laterality of testes, postoperative complications, testicular size and testicular localization. RESULTS Thirty-six consecutive patients, median age 16 months, underwent one-stage laparoscopic orchiopexy. Sixteen patients (44.4%) had peeping testis type, in 13 patients (36.1%) the testicle was located within 2 cm from the internal ring and in the remaining 7 patients (19.4%) it was detected > 2 cm from the internal ring. In six children (16.7%) dividing the spermatic vessels was performed in one stage with laparoscopic orchiopexy. In the remaining 30 patients (83.7%) a laparoscopic one-stage procedure was performed with preservation of the spermatic vessels. Testicular atrophy was observed in 2 cases (5.6%), and 6 patients (16%) had a relatively small testicle compared to the contralateral normal testicle at follow-up. Two patients (5.6%) presented with testicle positioning at the entrance area into the scrotum. None of the patients demonstrated hernia recurrence at follow-up. There was no difference in surgical outcome in children who had surgery with preservation of the spermatic vessels versus those who underwent orchiopexy with division of the spermatic vessels in one stage. CONCLUSIONS Laparoscopic transection of the testicular vessels appeared to be safe in boys with high abdominal testes that did not reach the scrotum after laparoscopic high retroperitoneal dissection.
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Affiliation(s)
- Jaber R Jawdat
- Department of Pediatric Urology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Stanislav Kocherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Hidas G, Ben Chaim J, Udassin R, Graeb M, Gofrit ON, Zisk-Rony RY, Pode D, Duvdevani M, Yutkin V, Neheman A, Fruman A, Arbel D, Kopuler V, Armon Y, Landau EH. Timing of Orchidopexy for Undescended Testis in Israel: A Quality of Care Study. Isr Med Assoc J 2016; 18:697-700. [PMID: 28466623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Strong evidence suggests that in order to prevent irreversible testicular damage surgical correction (orchidopexy) for undescended testis (UDT) should be performed before the age of 1 year. OBJECTIVES To evaluate whether orchidopexy is delayed in our medical system, and if so, to explore the pattern of referral for orchidopexy as a possible contributing factor in such delays. METHODS We conducted a retrospective chart review of all children who underwent orchidopexy for UDT between 2003 and 2013 in our institution. We collected data on the age at surgery and the child's health insurance plan. We also surveyed pediatricians from around the country regarding their pattern of UDT patient referral to a pediatric urologist or surgeon for surgical correction. RESULTS A total of 813 children underwent orchidopexy in our institute during the study period. The median age at surgery was 1.49 years (range 0.5-13). Only 11% of the children underwent surgery under the age of 1 year, and 53% between the ages of 1 and 2 years. These findings were consistent throughout the years, with no difference between the four health insurance plans. Sixty-three pediatricians who participated in the survey reported that they referred children to surgery at a median age of 1 year (range 0.5-3 years). CONCLUSIONS Our results demonstrate delayed orchidopexy in our medical system. There is a need to improve awareness for early specialist consultation in order to facilitate earlier surgery and better care.
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Affiliation(s)
- Guy Hidas
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Ben Chaim
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Refael Udassin
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mary Graeb
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer N Gofrit
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Dov Pode
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mordechai Duvdevani
- Departments of Urology and Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amos Neheman
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amos Fruman
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Arbel
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vadim Kopuler
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yaron Armon
- Department of Pediatric Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ezekiel H Landau
- Pediatric Urology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Pederiva F, Guida E, Codrich D, Scarpa MG, Olenik D, Schleef J. Laparoscopic orchiopexy: short-term outcomes. Experience of a single centre. Minerva Pediatr 2016; 68:278-281. [PMID: 26505958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Increased infertility and smaller volume accompany undescended testis. Timing of orchiopexy is still a matter of debate. We evaluated the growth of non-palpable testes after laparoscopic orchiopexy according to age at surgery, intraoperative findings and type of procedure. METHODS Forty-one boys undergoing laparoscopy for nonpalpable testes were retrospectively reviewed and divided into two groups, ≤18 months and >18 months, according to their age at surgery. RESULTS At follow-up, 14 testes in the younger group had normal size, while 3 atrophied either after single (2) or two stage procedure (1). Similarly, in older boys 11 testes grew normally, while 5 atrophied after both procedures. CONCLUSIONS Most of the non-palpable testes grew normally after laparoscopic orchiopexy and the postoperative volume seemed independent from the surgical strategy. Both techniques led to a few cases of testicular hypotrophy. In our experience, the age at surgery did not affect the outcome in terms of testicular growth.
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Affiliation(s)
- Federica Pederiva
- Pediatric Surgery, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy -
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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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Zani A, Ade-Ajayi N, Cancelliere LA, Kemal KI, Patel S, Desai AP. Is single incision pediatric endoscopic surgery more painful than standard laparoscopy in children? Personal experience and review of the literature. Minerva Pediatr 2015; 67:457-463. [PMID: 25034218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM It has been speculated that single incision pediatric endoscopic surgery (SIPES) in children could result in more postoperative pain given the device size for a child umbilicus. Herein, we compare the postoperative pain in children who underwent SIPES or standard laparoscopy (SL). METHODS Patients who underwent SIPES via Olympus TriPort™ Access system between 2010 and 2011 were prospectively compared with SL controls (similar age, sex and type of operation). Primary endpoint was analgesic requirement (number of doses and dose/kg). A systematic review of the literature included all articles (2008-2012) comparing postoperative pain following transumbilical SIPES and SL in children. Data were analyzed using non-parametric tests. RESULTS Ten patients (8 males, median age 9 years, range 4-15) underwent 11 SIPES procedures: appendicectomy (N.=6), orchidopexy (N.=2), cholecystectomy (N.=2), and total colectomy (N.=1). There was no difference in paracetamol requirement between SIPES (median 74 mg/kg, range 14-149) and SL (median 59 mg/kg, range 13-108, P=0.76) patients. Morphine was required by only two patients per group (no difference in dosage or frequency). Eight studies (2010-2012) comparing 334 SIPES vs. 343 SL patients were analysed. Three studies showed advantage of SIPES, and four no difference between SIPES and SL. One randomized trial reported greater pain in SIPES appendicectomy, but no difference with SL once patients were discharged home. CONCLUSION SIPES does not seem to be associated with more postoperative pain than SL in children. In appropriate cases, SIPES is a valid alternative to SL for a good range of pediatric procedures.
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Affiliation(s)
- A Zani
- Department of Pediatric Surgery, King's College Hospital, London, UK -
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Abeş M, Bakal Ü, Petik B. Ascending testis following inguinal hernia repair in children. Eur Rev Med Pharmacol Sci 2015; 19:2949-2951. [PMID: 26367711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Failure to replace the testes in the scrotum during hernia repair leads to iatrogenic undescended testes. At other times, the testes may spontaneously move back to the inguinal area after being placed in the scrotum, thus resulting in ascending testes. The cases in this study were assessed. PATIENTS AND METHODS Records of 910 boys operated due to inguinal hernia were assessed retrospectively. Following hernia repair, the testes were placed in the scrotum. After the operation, all the testes were checked for being in the scrotum. They were called for follow-up after the operation. Their testes were checked for remaining in the scrotum. RESULTS Ascending testes were detected in 4 (0.43%) of the patients. These patients had scrotal hypoplasia and/or retractile testes. Their age ranged between 1-3 years. Ascending testes were bilateral in 2 patients, and on the right side in 2. Human chorionic gonodotropin (hCG) was initiated in 3 patients. Two of them improved. Two underwent scrotal orchiopexy. CONCLUSIONS These patients may benefit from hCG in the early postoperative period. Later, scrotal orchiopexy may be needed. Patients who have retractile testes or scrotal hypoplasia in addition to inguinal hernia need orchiopexy together with herniorrhaphy.
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Affiliation(s)
- M Abeş
- Department of Pediatric Surgery, Firat University Medical Faculty, Elazig, Turkey.
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Canning DA. Re: Outcome of Bilateral Laparoscopic Fowler-Stephens Orchidopexy for Bilateral Intra-Abdominal Testes. J Urol 2015; 194:201. [PMID: 26088250 DOI: 10.1016/j.juro.2015.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bansal D, Cost NG, Bean CM, Minevich EA, Noh PH. Pediatric urological laparoendoscopic single site surgery: single surgeon experience. J Pediatr Urol 2014; 10:1170-5. [PMID: 24993421 DOI: 10.1016/j.jpurol.2014.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/29/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single site (LESS) surgery. MATERIALS AND METHODS A retrospective review was performed of all children who underwent LESS surgery at a single pediatric institution from September 2010 to July 2013. Patient demographics, intraoperative details, narcotic usage, and complications were reviewed. The umbilicus was used as the surgical site in all cases. All procedures were performed with a flexible tip laparoscope, a multichannel port, standard 3- or 5-mm laparoscopic instrumentation, and articulating instruments. RESULTS Sixty-one patients (50 male, 11 female) were identified. Procedures included 18 orchidopexies, 15 nephrectomies, 11 varicocelectomies, nine nephroureterectomies, four partial nephrectomies, one ureterectomy, one ureterolithotomy, one orchiectomy, and one utricle excision. The ureterolithotomy was converted to open surgery for failure to progress. The utricle excision was converted to conventional laparoscopy by adding one accessory port and one skin puncture because of the close proximity of the vas deferens to the utricle. Intraoperative complications included one vas deferens injury during orchidopexy in a postpubertal male. Postoperative complications occurred in six patients: five grade II and one grade IIIb. CONCLUSIONS Pediatric urological LESS procedures are technically feasible, safe, and effective. Further evaluation is warranted to better define its role in pediatric urological surgery.
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Affiliation(s)
- Danesh Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Nicholas G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Christopher M Bean
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Eugene A Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA.
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Lu RG, Ma G, Zhu HB, Chen CJ. [Transumbilical single-site laparoscopic orchiopexy for inguinal cryptorchidism in children: report of 33 cases]. Zhonghua Nan Ke Xue 2014; 20:1025-1028. [PMID: 25577840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the feasibility and effect of transumbilical single-site laparoscopic surgery in the treatment of inguinal cryptorchidism in children. METHODS From August to November 2013, 33 children with inguinal cryptorchidism (41 testes) underwent transumbilical single-site laparoscopic orchiopexy. The undescended testes were palpable in the inguen intra-operatively in all the cases, 14 on the right, 11 on the left, and 8 bilaterally. RESULTS All the operations were performed successfully with neither intraoperative complications nor conversion to operi surgery. Adequate length of spermatic cord was pulled down to allow the testis to descend through the inguinal canal into the scrotum in all the cases. Totally, 39 testes in 31 cases were fixed at the bottom and 2 testes in 2 cases in the middle of the scrotum. Follow-up ranged from 6 to 9 months, which showed normal development of the testes, but no such postoperative complications as testicular retraction and atrophy, indirect hernia, and hydrocele. CONCLUSION Transumbilical single-site laparoscopic orchiopexy is a feasible and effective technique for the treatment of inguinal palpable undescended testis in children, and its cosmetic results were desirable.
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Affiliation(s)
- Ru-gang Lu
- Department of Urology, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Jiangsu, China.
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Abstract
An undescended testis may be associated with abnormal testicular development and function. A number of testes that are undescended at birth have been observed to descend spontaneously. The goal of orchidopexy remains to place those testes in the scrotum that would not have descended spontaneously. How long should the surgeon wait for spontaneous descent? By what age should the testis be positioned in the scrotum to avert further damage? Does earlier intervention result in a better functioning testis? Do different surgical techniques differ in their success in retaining the testis in the scrotum when dealing with the palpable undescended testis? This article reviews the current information on the timing and types of surgical intervention of the palpable undescended testes and their outcomes.
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Affiliation(s)
- Reju J Thomas
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia
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Adesanya OA, Ademuyiwa AO, Evbuomwan O, Adeyomoye AAO, Bode CO. Preoperative localization of undescended testes in children: comparison of clinical examination and ultrasonography. J Pediatr Urol 2014; 10:237-40. [PMID: 24184321 DOI: 10.1016/j.jpurol.2013.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 09/28/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative localization of the testis aids effective management of undescended testes. Various diagnostic techniques have been applied in the localization of undescended testes with varying results. The aim of this study was to compare clinical assessment and ultrasound evaluation in the preoperative localization of undescended testes in children. METHODS A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi Araba, from July 2010 to June 2011 was carried out. The findings on preoperative clinical and ultrasound examinations were compared with intraoperative findings. RESULTS Forty boys with 52 undescended testes were studied. The median age of the boys at the time of surgery was 4 years (range 1-11 years). Forty-five testes (86.5%) were accurately localized preoperatively by ultrasound while 25 testes (48.1%) were accurately localized on clinical examination. Ultrasound evaluation had an accuracy of 86.5% in preoperative localization of undescended testes. Clinical examination had an accuracy of 48.1% in preoperative localization of undescended testes. Ultrasound was more accurate than physical examination (p < 0.001). CONCLUSIONS Ultrasonography is more accurate than clinical examination in the preoperative localization of undescended testes in children and could play a role in preoperative evaluation of patients with undescended testes.
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Affiliation(s)
- O A Adesanya
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria.
| | - A O Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - O Evbuomwan
- Department of Radiodiagnosis, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - A A O Adeyomoye
- Department of Radiodiagnosis, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
| | - C O Bode
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Idi Araba, Lagos, Nigeria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mahomed A, Dunckley MG. Spontaneous peritoneal closure after orchidopexy in children : comment to: orchidopexy without ligation of the processus vaginalis is not associated with an increased risk of inguinal hernia. Ceccanti S, Zani A, Mele E and Cozzi DA (2013). Hernia 2013; 18:343-4. [PMID: 24100928 DOI: 10.1007/s10029-013-1160-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Affiliation(s)
- A Mahomed
- Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Eastern Road, Brighton, BN2 5BE, UK,
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Abstract
The intra-abdominal testis (IAT) has been always an enigma for both diagnosis and treatment. Imaging techniques are known for low sensitivity for localizing the IAT. It has been universally accepted that the gold standard for localizing the IAT is diagnostic laparoscopy. Orchiopexy techniques for IAT are complicated and attended with a higher rate of failure and complication than those for the palpable testis. For the low-lying abdominal testis, a one-stage procedure without interruption of the vessels has a high success rate. The Prentiss maneuver bridges the borders of normal pathway to gain a straighter course to the scrotum. The interruption of the main vascular supply of the testis, depending on collateral circulation, has been used for many years but with questionable effects on the microscopic delicate structure of the testis. Microvascular autotransplantation was intended to avoid this effect, but it is technically demanding and requires special expertise. The principle of traction has been used in the past but was abandoned due to high rate of atrophy. Recently, traction has been revisited with a new approach with very encouraging results. The key to success in any technique for orchiopexy is the complete absence of tension.
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Affiliation(s)
- Sameh M Shehata
- Pediatric Surgery, Alexandria University, Alexandria, Egypt,
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Palmer LS. Laparoscopic orchidopexy for bilateral intra-abdominal testes. Can J Urol 2013; 20:6956. [PMID: 24128838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Lane S Palmer
- Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York, USA
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Safwat AS, Hammouda HM, Kurkar AA, Bissada NK. Outcome of bilateral laparoscopic Fowler-Stephens orchidopexy for bilateral intra-abdominal testes. Can J Urol 2013; 20:6951-6955. [PMID: 24128837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION To evaluate the outcome of bilateral laparoscopic Fowler-Stephens orchidopexy (BLFSO) for bilateral intra-abdominal testes. MATERIALS AND METHODS Prospectively, all patients with bilateral intra-abdominal testes between 2006 and 2010 were included in this study. Patients' data were analyzed for age, procedure whether single stage or staged Fowler-Stephens, intraoperative and postoperative complications, and follow up results. RESULTS BLFSO was performed in a total of 48 testes in 24 boys with a median age of 31.6 months (range 12 to 150). All procedures were performed on an outpatient basis. Of the 24 boys, six were managed with a single stage BLFSO. The remaining 18 patients were managed with staged Fowler-Stephens orchidopexy. Testicular position after laparoscopy was the mid lower scrotum in 43 testes, the remaining five testes retracted to the inguinal canal in three (required inguinal approach for orchidopexy) and to the neck of scrotum in two. Testicular atrophy was encountered in two testes with a follow up of 18 months postoperatively. CONCLUSIONS Outpatient single stage or staged bilateral laparoscopic Fowler-Stephens orchidopexy were successful in managing boys with bilateral intra-abdominal testes.
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Jansen R, Fooks H, Zaslau S. An atypical presentation of testicular torsion: a case report. W V Med J 2013; 109:30-31. [PMID: 24294708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Testicular torsion is an emergent condition requiring prompt surgical intervention to avoid permanent testicular compromise and death. As its symptoms overlap with other disease processes, diagnosis is sometimes difficult. When considering the presenting symptoms, one must be careful not to ignore unusual causes of torsion and misdiagnose the patient. In this case report we describe an unusual etiology of testicular torsion (traumatic) with an atypical patient presentation (mildly painful) which presented many obstacles before proper diagnosis and treatment.
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Wang T, Xiang Q, Liu F, Wang G, Liu Y, Zhong L. Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy. J Anesth 2013; 27:650-6. [PMID: 23608774 DOI: 10.1007/s00540-013-1613-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/07/2013] [Indexed: 11/26/2022]
Abstract
PURPOSES Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy. METHODS Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25% 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25% 1 ml/kg only. HR or MAP fluctuation >20% or entropy increase >15% during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded. RESULTS There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45%) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71%) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001). CONCLUSION In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.
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Affiliation(s)
- Tingting Wang
- Department of Anesthesia, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gupta A, Panda N, Saha ML, Ganguly S, Bandyopadhyay SK, Das R. Persistent Mullerian duct syndrome with transverse testicular ectopia: rare presentation of inguinal hernia. Urol J 2013; 10:909-911. [PMID: 23801478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
MESH Headings
- Biopsy
- Cryptorchidism/complications
- Cryptorchidism/diagnosis
- Cryptorchidism/surgery
- Diagnosis, Differential
- Disorder of Sex Development, 46,XY/complications
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/surgery
- Follow-Up Studies
- Hernia, Inguinal/complications
- Hernia, Inguinal/diagnosis
- Hernia, Inguinal/surgery
- Herniorrhaphy/methods
- Humans
- Laparoscopy
- Male
- Orchiopexy/methods
- Young Adult
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Affiliation(s)
- Ashish Gupta
- Department of Surgery, R.G KAR Medical College, Kolkata, India
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Kollin C, Stukenborg JB, Nurmio M, Sundqvist E, Gustafsson T, Söder O, Toppari J, Nordenskjöld A, Ritzén EM. Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol Metab 2012; 97:4588-95. [PMID: 23015652 DOI: 10.1210/jc.2012-2325] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT A randomized controlled study was conducted comparing the outcome of surgery for congenital cryptorchidism at 9 months or 3 yr of age. OBJECTIVE The aim of the study was to investigate whether surgery at 9 months is more beneficial than at 3 yr and to identify early endocrine markers of importance for testicular development. PATIENTS AND METHODS A total of 213 biopsies were taken at orchidopexy, and the number of germ and Sertoli cells per 100 seminiferous cord cross-sections and the surface area of seminiferous tubules and interstitial tissue were analyzed. Inhibin B, FSH, LH, and testosterone were determined. Testicular volume was assessed by ultrasonography and by a ruler. RESULTS The number of germ and Sertoli cells and testicular volume at 9 months were significantly larger than at 3 yr. The intraabdominal testes showed the largest germ cell depletion at 3 yr. At both ages, testicular volume correlated to the number of germ and Sertoli cells. None of the hormones measured during the first 6 months of life (LH, FSH, testosterone, and inhibin B) could predict the number of germ or Sertoli cells at either 9 or 36 months of age, nor could hormone levels predict whether spontaneous descent would occur or not. CONCLUSION Morphometric and volumetric data show that orchidopexy at 9 months is more beneficial for testicular development than an operation at 3 yr of age. Testicular volume was furthermore shown to reflect germ cell numbers in early childhood, whereas endocrine parameters could not predict cellular structure of the testis or its spontaneous descent.
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Affiliation(s)
- C Kollin
- Department of Women's and Children's Health, Pediatric Surgery Unit, Karolinska Institutet and University Hospital, Q2:08, SE-17176 Stockholm, Sweden.
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Komarowska MD, Hermanowicz A, Matuszczak E, Oksiuta M, Dzienis-Koronkiewicz E, Zelazowska-Rutkowska B, Debek W. Anti-Müllerian hormone levels in serum 1 year after unilateral orchiopexy. J Pediatr Endocrinol Metab 2012; 25:1073-6. [PMID: 23329751 DOI: 10.1515/jpem-2012-0210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 08/17/2012] [Indexed: 11/15/2022]
Abstract
The aim of this study was to determine the serum anti-Müllerian hormone (AMH levels) in a group of boys with cryptorchidism before and 1 year after surgery. Additionally, the effect of orchiopexy, based on the testicular position and morphology, was evaluated. Fifty boys who were 1-4 years old (median, 2.4 years) with unilateral cryptorchidism were evaluated before and 1 year after they underwent orchiopexy. Prior to the procedure, all of the patients had undergone karyotyping to exclude chromosomal abnormalities. Blood samples were collected while obtaining blood for standard laboratory tests routinely performed just before and 12 months after surgery. Twelve months after the orchiopexy, in most cases surgically treated testes were in the middle or lower pole of the scrotum. The descended glands were of comparable size and density in comparison with the testes on the opposite side. In the treated children, serum AMH levels measured at 12 months after orchiopexy were similar to preoperative basal levels. The authors found that AMH levels in children with unilateral undescended testes do not change significantly 1 year after surgical procedure. We still do not have trustworthy factors to predict fertility in children affected with cryptorchidism. We observed an upward trend in AMH concentration 1 year after orchiopexy, but it was statistically insignificant. Therefore, we plan further measurements of AMH in boys after orchiopexy to assess the influence of this procedure on gonadal function.
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Affiliation(s)
- Marta Diana Komarowska
- Medical University of Bialystok, Pediatric Surgery, Waszyngtona 17 Bialystok 15-274, Poland
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Shalaby MM, Shoma AM, Elanany FG, Elganainy EO, El-Akkad MA. Management of the looping vas deferens during laparoscopic orchiopexy. J Urol 2011; 185:2455-7. [PMID: 21555012 DOI: 10.1016/j.juro.2011.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE A number of variables should be assessed during laparoscopic orchiopexy, including vas anatomy. A looping vas deferens enters the inguinal canal and loops back to the abdominal cavity. This anatomical variant is not uncommonly encountered. Some groups considered this condition in their laparoscopic classification of nonpalpable testis. We present our experience with managing the looping vas during laparoscopic orchiopexy. MATERIALS AND METHODS We identified this condition in 18 procedures. In 14 cases it was possible to bring the vas back to the abdominal cavity. In 3 cases the loop could not be brought back laparoscopically and an inguinal incision was used. After the vas was dissected free and dropped into the abdominal cavity pneumoperitoneum was resumed and the procedure was completed laparoscopically. A Web based survey was done to test the value of this method. RESULTS A total of 17 procedures were completed successfully with preservation of the vas deferens while in 1 the vas was inadvertently cut. A looping vas did not significantly affect operative time. All 18 testes were viable and retained the scrotal position on followup scrotal Doppler ultrasound. CONCLUSIONS Verification of vasal anatomy is a crucial step that should be completed before any dissection. Bringing a looping vas back to the abdominal cavity is usually feasible laparoscopically but in a few cases this may require a small incision to dissect the vasal loop from its inguinal attachments.
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Affiliation(s)
- Mahmoud M Shalaby
- Urology Department, Assiut University, Asyut and Mansoura Urology and Nephrology Center (AMS), Mansoura, Egypt.
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