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Wahyudi I, Raharja PAR, Situmorang GR, Rodjani A. Comparison of scrotal and inguinal orchiopexy for palpable undescended testis: a meta-analysis of randomized controlled trials. Pediatr Surg Int 2024; 40:74. [PMID: 38451346 DOI: 10.1007/s00383-024-05655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 02/11/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Scrotal and inguinal orchiopexy are two commonly used surgical approaches for palpable undescended testis (UDT), each with distinct advantages. However, the optimal approach remains a matter of debate, warranting a comprehensive meta-analysis of randomized controlled trials (RCTs) to guide clinical decision-making. MATERIALS AND METHODS A comprehensive literature search was conducted, adhering to PRISMA guidelines, to select RCTs comparing scrotal and inguinal orchiopexy for palpable UDT. Eight RCTs were selected for meta-analysis. Outcome measures included operative time, hospitalization duration, total complications, wound infection or dehiscence, testicular atrophy or hypotrophy, and testicular re-ascent rate. The evaluation of the study's quality was conducted by utilizing the revised Cochrane risk-of-bias tool. RESULTS Scrotal orchiopexy showed significantly shorter operative time compared to the inguinal approach (WMD: - 15.06 min; 95% CI: - 21.04 to - 9.08). However, there was no significant difference in hospitalization duration (WMD: - 0.72 days; 95% CI: - 1.89-0.45), total complications (OR: 1.08; 95% CI: 0.70-1.66), wound infection or dehiscence (OR: 0.73; 95% CI: 0.27-1.99), testicular atrophy or hypotrophy (OR: 1.03; 95% CI: 0.38-2.78), and testicular re-ascent (OR: 1.43; 95% CI: 0.67-3.06) between the two approaches. A small proportion of cases (7.3%) required conversion from scrotal to inguinal orchiopexy due to specific anatomical challenges. CONCLUSION Both scrotal and inguinal orchiopexy are safe and effective for palpable UDT, with comparable outcomes in terms of hospitalization and complications. Scrotal orchiopexy offers the advantage of shorter operative time. Clinicians can use this evidence to make informed decisions on the surgical approach for palpable UDT.
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Affiliation(s)
- Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia.
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
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Siegal AR, Mbaye F, Chin CP, Ferrer FA, Malhotra NR, Makari JH. Contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database. J Pediatr Urol 2024:S1477-5131(24)00088-3. [PMID: 38431462 DOI: 10.1016/j.jpurol.2024.02.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION When evaluating the timeliness of orchiopexy for cryptorchidism, health disparities are apparent among Hispanic and African American males and those with public insurance. Since the publication of these data, the COVID-19 pandemic has stressed our healthcare system and significantly affected the provision of pediatric urology care. OBJECTIVE We sought to assess if certain groups were disproportionately affected in progression to orchiopexy after the diagnosis of cryptorchidism during and after the pandemic in US freestanding children's hospitals. STUDY DESIGN Using the PHIS database, pediatric patients ≤5 years who underwent orchiopexy between January 2018 and December 2022 were retrospectively analyzed. Exclusion criteria included prematurity, retractile testes, and testicular torsion. Primary outcomes were age at orchiopexy and the proportion of individuals undergoing timely orchiopexy for cryptorchidism. RESULTS Over the study period 3140 patients ≤5 years old underwent orchiopexy for cryptorchidism. Non-Hispanic Blacks and Hispanics were significantly less likely to have timely orchiopexy and underwent orchiopexy 2.13 and 3.60 months later compared to whites (p < 0.01). As compared to pre-COVID-19, during the pandemic the proportion of patients who had timely surgery was higher and the median age was significantly lower (p = 0.01 and p < 0.01, respectively) in white patients only. Over the study period, patients with public insurance were less likely to have timely orchiopexy and underwent orchiopexy 2.94 months later (p < 0.01) than patients with private insurance. Compared to during the pandemic, post-pandemic a significantly lower proportion of publicly insured patients have since undergone timely orchiopexy (p = 0.04). Patients in the West were less likely to have timely orchiopexy and had a higher age at time of orchiopexy (p < 0.01) than other regions. However, in the West during the pandemic, the proportion of children who had timely surgery was higher compared to pre-and post-COVID-19 (p < 0.01). DISCUSSION Overall, regardless of insurance status, race, or location, a significant proportion of patients did not undergo timely orchiopexy. During the pandemic white patients had a lower median age and an increased proportion underwent timely orchiopexy, despite the number of orchiopexies remaining constant. Disparities in the post-COVID-19 era have been further exacerbated for publicly insured patients, who a significantly lower proportion of have since undergone timely orchiopexy. Specific efforts are required across the United States to increase timely orchiopexy for all boys. CONCLUSIONS Progression to timely orchiopexy remains low for all boys in the era surrounding COVID-19; certain groups appear to be more adversely affected.
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Affiliation(s)
- Alexandra R Siegal
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Farimata Mbaye
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fernando A Ferrer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - Neha R Malhotra
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Pediatric Urology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - John H Makari
- Department of Pediatric Urology, Children's Hospital and Medical Center, Omaha, NE, USA; Division of Urology, University of Nebraska Medical Center, Omaha, NE, USA
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Press BH, Olawoyin O, Arlen AM, Silva CT, Weiss RM. Heresy - Is there a role for ultrasound in management of the non-palpable testicle? J Pediatr Urol 2024; 20:106-111. [PMID: 37749009 DOI: 10.1016/j.jpurol.2023.08.032] [Citation(s) in RCA: 1] [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: 05/30/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION AUA Guidelines do not support the routine use of ultrasound (US) in evaluation of boys with an undescended testicle (UDT) prior to urology referral. Multiple studies have demonstrated that real time US is inferior to a physical examination by a pediatric urologist in detecting an UDT. However, improved US technology, which now permits detection of the non-palpable testis located just proximal to the internal ring, may aid in guiding the surgical approach to the non-palpable testis. We evaluated US findings of boys deemed to have a non-palpable UDT and compared them to surgical findings. OBJECTIVE To assess the role of pre-operative ultrasonography in guiding surgical management in boys deemed to have a non-palpable testis by a pediatric urologist. STUDY DESIGN US of boys with a non-palpable UDT, as reported by a pediatric urologist on physical exam, during a 3-year period, were reviewed. All US were performed jointly by a technician and pediatric radiologist. Patient demographics, laterality, and intra-operative findings were assessed. RESULTS Thirty-one boys with a non-palpable testicle on physical exam underwent scrotal/inguinal/pelvis US at a median age of 7.5 months (IQR 2.5-12.3 months). Two patients had bilateral non-palpable testicles, 21 had a non-palpable left sided testicle and 8 had a non-palpable right sided testicle. Of the 33 non-palpable testes, 5 (15.2%) were identified in the inguinal canal. Sixteen (48.5%) were visualized in the lower pelvis just proximal to the internal ring and graded as intra-abdominal. Four (12.1%) nubbins or very atrophic testes were identified in the inguinal region or scrotum and 5 (15.2%) testes were not identified on US. Three (9.1%) testes were observed to be mobile between the lower pelvis just proximal to the internal ring and the inguinal canal. Of the 8 patients with testes that were identified in the inguinal canal, or mobile between the lower pelvis and inguinal canal, 7 avoided a diagnostic laparoscopy and underwent an inguinal orchiopexy. Of the 16 testicles located in the lower pelvis proximal to the internal ring, only 2 underwent laparoscopy/laparoscopic orchiopexy. DISCUSSION In cases of a non-palpable testicle following a physical examination by a urologist, an ultrasound can impact the operative plan, and allow for patients to avoid laparoscopy. In our cohort, 87.5% of non-palpable testes avoided laparoscopic surgery after ultrasound identification of a viable testis. CONCLUSIONS US in the evaluation of cryptorchidism can guide surgical management in select cases in which a testis is non-palpable following careful examination by a urologist.
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Affiliation(s)
- Benjamin H Press
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Olamide Olawoyin
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Angela M Arlen
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cicero T Silva
- Department of Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Robert M Weiss
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT, USA.
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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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Seizilles de Mazancourt E, Khene Z, Sbizerra M, Kaulanjan K, Plassais C, Bardet F, Pinar U, Duquesne I, Margue G, Ali Benali N, Berchiche W, Gaillard C, Wandoren W, Manuguerra A, Dang VT, Mauger de Varennes A, Hulin M, Gaillard V, Dominique I, Michiels C, Grevez T, Felber M, Vallee M, Gondran-Tellier B, Freton L, Lannes F, Pradère B, Matillon X. Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years. World J Urol 2023; 41:3789-3794. [PMID: 37897515 DOI: 10.1007/s00345-023-04671-x] [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: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.
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Affiliation(s)
- Emilien Seizilles de Mazancourt
- Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| | - Zinnedine Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Marc Sbizerra
- Department of Urology, Lyon Sud Hospital, Lyon, France
| | - Kevin Kaulanjan
- Department of Urology, Pointe A Pitre University Hospital, Guadeloupe, France
| | - Caroline Plassais
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Florian Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - Ugo Pinar
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Igor Duquesne
- Department of Urology, APHP, Hôpital Cochin, Université de Paris, Paris, France
| | - Gaelle Margue
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Nadia Ali Benali
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - William Berchiche
- Department of Urology, La Conception University Hospital, Marseille, France
| | | | - William Wandoren
- Department of Urology, Pointe A Pitre University Hospital, Guadeloupe, France
| | | | - Van Thi Dang
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | | | - Maud Hulin
- Department of Urology, Reims University Hospital, Reims, France
| | - Victor Gaillard
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | | | - Clement Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Tristan Grevez
- Department of Urology, Tours University Hospital, Tours, France
| | - Margaux Felber
- Department of Urology, APHP, Hôpitaux Universitaires Pitie-Salpetriere-Charles Foix, Sorbonne Université, Paris, France
| | - Maxime Vallee
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | | | - Lucas Freton
- Department of Urology, Rennes University Hospital, Rennes, France
| | - François Lannes
- Department of Urology, La Conception University Hospital, Marseille, France
| | - Benjamin Pradère
- Department of Urology, Toulouse University Hospital, Toulouse, France
| | - Xavier Matillon
- Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France
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Zanbak Mutlu ÖP, Tütüncü AÇ, Kendigelen P, Kara Esen B. Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆. Braz J Anesthesiol 2023:S0104-0014(23)00068-4. [PMID: 37429376 DOI: 10.1016/j.bjane.2023.06.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. METHODS ASA I-III, aged 6 months - 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 mL.kg-1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. RESULTS A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). CONCLUSION Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. CLINICAL TRIALS REGISTRY NCT03969316.
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Affiliation(s)
- Özgecan P Zanbak Mutlu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Ayşe Ç Tütüncü
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Pınar Kendigelen
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Beril Kara Esen
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Public Health, Istanbul, Turkey
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Tian Q, Zhao X, Zhang C, Yu K, Fang E, Zhou X, Yuan J, Li N. Compared outcomes of high-level cryptorchidism managed by Fowler-Stephens orchiopexy versus the Shehata technique: A systematic review and meta-analysis. J Pediatr Urol 2023:S1477-5131(23)00075-X. [PMID: 36966014 DOI: 10.1016/j.jpurol.2023.02.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The surgical approach for high-level intra-abdominal testis (IAT) is variable. While most pediatric urologists prefer staged Fowler-Stephens orchiopexy (FSO), Shehata publicized a novel approach-known as staged laparoscopic traction orchiopexy (SLTO) or the Shehata technique-to better manage IATs. OBJECTIVE This study compares the overall success rates, atrophy rates, retraction rates, and operation times of the two procedures to assist surgeons with developing procedure strategies. METHODS Databases were searched for relevant literature involving these two approaches, and studies meeting the eligibility criteria were involved; RevMan 5.4 was used to conduct this meta-analysis. The relative risk (RR), weighted mean difference, 95% confidence interval (CI), p-value, publication bias, and heterogeneity were calculated. RESULTS The Shehata technique demonstrated better performance than staged FSO regarding the overall success and atrophy rate, while the retraction rate and operation time had no statistical difference. CONCLUSIONS This study revealed that the Shehata technique may be an alternative to staged FSO for managing high-level IATs. Additional high-quality studies regarding the Shehata technique, as well as a long-term follow-up, are required for further and more credible analysis.
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Affiliation(s)
- Qingqing Tian
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Zhao
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chu Zhang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kechi Yu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Erhu Fang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Zhou
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiyan Yuan
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Li
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ok F, Durmus E, Ayaz M. The role of the resistive index in predicting testicular atrophy after orchiopexy in unilateral undescended testis. Pediatr Surg Int 2022; 39:38. [PMID: 36480074 DOI: 10.1007/s00383-022-05336-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT. METHODS The data of 215 patients aged < 15 years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded. RESULTS TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy. CONCLUSION Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.
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Affiliation(s)
- Fesih Ok
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey.
| | - Emrullah Durmus
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey
| | - Muzaffer Ayaz
- Department of Radiology, Siirt Training and Research Hospital, 56100, Siirt, Turkey
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Williamson SH, Davis-Dao CA, Huen KH, Ehwerhemuepha L, Chuang KW, Stephany HA, Wehbi EJ, Kain ZN. Timely orchiopexy by 18 months of age: Are we meeting the standards defined by the 2014 AUA guidelines? J Pediatr Urol 2022; 18:683.e1-683.e7. [PMID: 35981940 DOI: 10.1016/j.jpurol.2022.07.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cryptorchidism is one of the most common reasons for pediatric urology referral and one of the few pediatric urologic conditions in which there are established AUA guidelines that recommend orchiopexy be performed before 18 months of age. While access to timely orchiopexy has been studied previously, there is no current study with data from a national clinical database evaluating timely orchiopexy after the AUA guidelines were published. Additionally, prior studies on delayed orchiopexy may have included patients with an ascended testis, which is a distinct population from those with true undescended testicles. OBJECTIVES To evaluate in a national, clinical database if timely orchiopexy improved after the AUA guidelines were published in 2014. In particular, we aim to evaluate a younger group of patients, 0-5 years of age, in an effort to account for potential ascending testes. STUDY DESIGN Using Cerner Real-World Data™, a national, de-identified database of 153 million individuals, we analyzed pediatric patients undergoing orchiopexy in the United States from 2000 to 2021. We included males 0-18 years old and further focused on the subset 0-5 years. Primary outcome was timely orchiopexy, defined as age at orchiopexy less than 18 months. Predictor variables included race, ethnicity and insurance status. Statistical analyses were performed using logistic regression. RESULTS Of the total 17,012 individuals identified as undergoing orchiopexy, 9274 were ages 0-5 at the time of surgery. Comparing time periods pre and post AUA guidelines (2000-2014 versus 2015-2021), we found a significant difference in the proportion of timely orchiopexy (51% versus 56%, respectively; p < 0.0001) (Figure). In multivariable analyses, Hispanic (OR = 0.65, p < 0.0001), African American (OR = 0.74, p < 0.0001), and Native American males (OR = 0.66, p = 0.008) were less likely to have timely orchiopexy compared to non-Hispanic White males. Individuals without insurance (OR = 0.81, p = 0.03) or with public insurance (OR = 0.88, p = 0.02) were less likely to have timely orchiopexy as compared to those with private insurance. CONCLUSIONS Nearly a decade after publication of the AUA cryptorchidism guidelines, a large proportion of patients are still not undergoing orchiopexy by 18 months of age. This is the first study to show that timely orchiopexy has improved among patients 0-5 years, but the majority of patients are still not undergoing timely orchiopexy. Health disparities were apparent among Hispanic, African American, Native American, and uninsured males, highlighting the need for further progress in access to pediatric surgical care.
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Affiliation(s)
- Sarah H Williamson
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Carol A Davis-Dao
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA.
| | - Kathy H Huen
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | | | - Kai-Wen Chuang
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Elias J Wehbi
- Division of Pediatric Urology, Children's Hospital of Orange County, Orange CA, USA; Department of Urology, University of California-Irvine School of Medicine, Orange CA, USA
| | - Zeev N Kain
- Center on Stress and Health, University of California-Irvine School of Medicine, Orange CA, USA; Department of Anesthesiology & Perioperative Medicine, University of California-Irvine School of Medicine, Orange CA, USA; Child Study Center, Yale University School of Medicine
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Erlich T, Ghazzaoui AE, Pokarowski M, O'Kelly F, Lorenzo AJ, Bagli DJ, Koyle MA. Perinatal testicular torsion: The clear cut, the controversial, and the "quiet" scenarios. J Pediatr Surg 2022; 57:288-297. [PMID: 34753560 DOI: 10.1016/j.jpedsurg.2021.10.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal testicular torsion (PTT) is a catastrophic event that occurs in utero or up to 30 days postnatally, with testicular loss being the most common outcome. OBJECTIVE To assess clinical evaluation, surgical management and clinical outcomes in patients with PTT in a quaternary referral pediatric center, to determine testicular salvageability and propose future management options. METHODS We retrospectively reviewed a cohort of males born outside the quaternary center with a diagnosis of PTT, from May 2000 to July 2020. Data collection included mode of delivery, gestational age, birth weight, testicular examination at birth, clinical presentation, ultrasound results at diagnosis, surgical management and findings, perioperative complications, and follow-up. RESULTS 62 patients, including 2 patients with bilateral asynchronous PTT, were identified. Median (IQR) gestational age and birth weight were 39 (38-39.4) weeks and 3.4 (3.1-3.72) kg, respectively. Abnormal testicular examination at birth was found in 69% (Table 1). Doppler ultrasound was performed in all but 1 patient. 59 patients underwent surgery, 21 within 4 h, with bilateral exploration in 44 cases. Affected and non-affected testicles were explored in 76% and 98% of cases, respectively. 3 "nubbins" were found, of which 2 were excised. 3 nonsurgical complications were identified. During a median (IQR) follow-up of 3 (3-3) months, 63 testicles were removed or found to be non-functional, with compensatory hypertrophy in 38% of patients. CONCLUSION Given that 3% of our patients presented with asynchronous bilateral PTT, as well as the safety of general anesthesia in a referral pediatric hospital, early bilateral scrotal exploration of PTT is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tomer Erlich
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
| | - Ali El Ghazzaoui
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martha Pokarowski
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Darius J Bagli
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
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11
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Ahn JJ, Garrison MM, Merguerian PA, Shnorhavorian M. Racial and ethnic disparities in the timing of orchiopexy for cryptorchidism. J Pediatr Urol 2022; 18:696.e1-696.e6. [PMID: 36175288 PMCID: PMC9771941 DOI: 10.1016/j.jpurol.2022.09.004] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many children do not undergo surgery for cryptorchidism in a timely fashion, increasing risk of infertility and malignancy. Racial and ethnic disparities in surgery timing has been suggested in other specialties, but has not been well-explored in Pediatric Urology. OBJECTIVES Our aim was to investigate the association of race and ethnicity with age at orchiopexy. MATERIALS AND METHODS We performed a retrospective cohort study of individuals <18 years of age as captured in the NSQIPP PUF from 2012 to 2016. Those with cancer were excluded. The primary outcome of interest was age at time of surgery. Secondary outcome was the proportion of individuals undergoing surgery by recommended age. Generalized linear models and logistic regression models were created for the outcomes of interest. RESULTS The median age at orchiopexy was 17.4 months (10.7, 43.0) and overall, 51% of subjects underwent orchiopexy by 18 months of age. Non-Hispanic white individuals were most likely to have undergone orchiopexy by 18 months of age, at 56%, compared with only 44% of non-Hispanic black individuals (p < 0.001). When adjusting for co-morbidities and developmental delay, Hispanic patients underwent orchiopexy 5 months later than white patients, on average, and black patients had a delay of 7 months compared to white patients. DISCUSSION These data suggest that orchiopexy is happening at younger ages compared to prior large-scale studies. However, minority patients are on average older at time of orchiopexy, potentially increasing future risk of infertility or malignancy. While an estimated average delay of 5-7 months may not seem high, studies suggest there is an appreciable change in risk with a 6-month delay. Patient, provider, and system-level factors likely all contribute, and these need to be further elucidated. CONCLUSIONS Many racial and ethnic minorities with cryptorchidism have later orchiopexies, and are more likely to have surgery outside the recommended timeframe. Further investigation is warranted to determine the factors contributing to these disparities.
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Affiliation(s)
- Jennifer J Ahn
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA.
| | - Michelle M Garrison
- University of Washington School of Public Health, Department of Health Services, USA
| | - Paul A Merguerian
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA
| | - Margarett Shnorhavorian
- University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA
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12
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Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
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13
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Ceccanti S, Migliara G, De Vito C, Cozzi DA. Prevalence, management, and outcome of cryptorchidism associated with gastroschisis: A systematic review and meta-analysis. J Pediatr Surg 2022; 57:1414-1422. [PMID: 34344532 DOI: 10.1016/j.jpedsurg.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Cryptorchidism associated with gastroschisis has been poorly investigated. We aimed to assess the prevalence of this association, and to address the management and outcome of cryptorchidism in this context. MATERIALS AND METHODS In this systematic review, we searched electronic databases (PubMed, Web of Science, and Google Scholar), without language restrictions from inception to March 31, 2021, for studies on cryptorchidism and gastroschisis co-occurrence. Random effects meta-analysis was used to calculate pooled prevalence estimates of cryptorchidism in gastroschisis and spontaneous testicular descent in this population. RESULTS Twenty-five studies were included for the systematic review. All were retrospective case reports or series for a total of 175 patients. Pooled prevalence estimate for cryptorchidism in gastroschisis was 19% (95% CI 13-26). Complete data sets for management and outcome analysis were available in 94 patients, involving 120 undescended testes [63 (52.5%) nonpalpable, 34 (28.3%) prolapsed outside the abdominal wall defect, and 23 (19.2%) palpable]. Fifty-five descended spontaneously, with a pooled prevalence estimate of 50% (95% CI 31-69). Twelve testes/remnants were primarily removed or absent, while 49 testes underwent orchiopexy (success rate, 63%). Excluding 4 testes still awaiting orchiopexy, 30 of the remaining 116 (25.8%) testes had a dismal outcome, including testicular loss (19), hypoplasia (8) or recurrent cryptorchidism (3). CONCLUSION Cryptorchidism in gastroschisis appears to occur more frequently than in the normal population. The overall mediocre testicular outcome seems to reflect the most unfavorable presentation of cryptorchidism in gastroschisis, which is represented by originally intrabdominal or prolapsed testis in the majority of cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Silvia Ceccanti
- Pediatric Surgery Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Azienda Ospedaliero Universitaria Policlinico Umberto I, Viale Regina Elena, 324, Rome 00161, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Denis A Cozzi
- Pediatric Surgery Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Azienda Ospedaliero Universitaria Policlinico Umberto I, Viale Regina Elena, 324, Rome 00161, Italy.
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14
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Choi JB, Han KH, Lee Y, Ha US, Cho KJ, Kim JC, Koh JS. The incidence of testicular torsion and testicular salvage rate in Korea over 10 years: A nationwide population-based study. Investig Clin Urol 2022; 63:448-454. [PMID: 35670008 PMCID: PMC9262487 DOI: 10.4111/icu.20220122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We performed a nationwide epidemiological study of testicular torsion using the National Health Insurance System database for the entire male population of Korea. MATERIALS AND METHODS Age, sex, socioeconomic status, regional information, and diagnostic codes were retrieved from January 2009 to December 2019. To clearly identify the diagnosis of testicular torsion, patients who had not undergone orchiectomy or orchiopexy were excluded from the study. Multivariable logistic regression models were used to analyze the association between demographic characteristics and testicular loss. RESULTS The overall incidence of testicular torsion in males was 2.02 cases per 100,000 person-years and 6.99 cases per 100,000 person-years in males under 19 years of age. Testicular torsion most commonly occurred either in infancy or adolescence. The total testicular salvage rate was 75.22% and highest in children at 79.91%. The rate of orchiectomy was high in infancy and in the oldest patients. We determined that age distribution was related to the risk of testicular loss. CONCLUSIONS This study is the first nationwide epidemiological study of testicular torsion, which contains the entire Korean population. Although the testicular salvage rate in Korea was higher compared to other countries, it is necessary to educate males under 19 years of age on the seriousness of acute testicular pain to minimize the possibility of testicular loss.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hun Han
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yunhee Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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15
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Fernández Atuan R, González Ruiz Y, Salcedo Arroyo P, Vargova P, Bragagnini Rodríguez P, Ruiz de Temiño M. Testicular volume in adult patients undergoing cryptorchidism surgery in childhood, and impact on paternity. Cir Pediatr 2022; 35:25-30. [PMID: 35037437 DOI: 10.54847/cp.2022.01.15] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the impact of orchiopexy on testicular volume. To determine whether age at surgery impacts testicular volume. To determine whether paternity is associated with testicular volume. METHODS Patients born between 1961 and 1985 who had undergone cryptorchidism surgery at the Pediatric Surgery Department of Miguel Servet University Hospital were included. Testis location and macroscopic appearance data were collected. Control testicular ultrasonographies and paternity surveys were carried out. Initially, the study was descriptive, and subsequently, inferential. RESULTS Ultrasonography was performed in 216 testicular units a mean of 14.9 years following surgery, whereas the paternity survey was conducted among 157 respondents a mean of 41.9 years following surgery. There were significant differences (p = 0.0038) in testicular volume distribution according to epididymal dissociation. There was a linear correlation between older age at surgery and lower testicular volume, but without statistical significance. Significant differences (p < 0.0001) in testicular volume according to groups - operated and non-operated -, as well as between unilateral and bilateral cases, were found. No differences in paternity rates according to testicular volume were noted. CONCLUSION Operated testes have lower volumes than normally descended testes. Older age at surgery may contribute to lower final volumes. Testes with full epididymal-testicular dissociation have lower total volumes. No relation between testicular volume and paternity rates was found. Further long-term studies are required.
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Affiliation(s)
- R Fernández Atuan
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain). Healthcare Research Institute of Aragon (IIS Aragón). (Spain)
| | - Y González Ruiz
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain). Healthcare Research Institute of Aragon (IIS Aragón). (Spain)
| | - P Salcedo Arroyo
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain)
| | - P Vargova
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain)
| | - P Bragagnini Rodríguez
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain). Healthcare Research Institute of Aragon (IIS Aragón). (Spain)
| | - M Ruiz de Temiño
- Pediatric Surgery Department. Miguel Servet University Hospital. Zaragoza (Spain). Healthcare Research Institute of Aragon (IIS Aragón). (Spain)
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Dawood W, Youssif M, Badawy H, Ghozlan A, Orabi S, Fahmy A. Laparoscopic staged management of high intrabdominal testis: A prospective randomized study. J Pediatr Surg 2021; 56:2385-2391. [PMID: 33814186 DOI: 10.1016/j.jpedsurg.2021.02.066] [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] [Received: 12/15/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT). MATERIALS AND METHODS Forty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO). Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage. Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up. RESULTS Staged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery. At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048). CONCLUSIONS Both staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.
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Affiliation(s)
- Waleed Dawood
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Mohamed Youssif
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Haytham Badawy
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Assem Ghozlan
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Samir Orabi
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt
| | - Ahmed Fahmy
- Urology Department, Alexandria University of Medicine, Alexandria, Egypt.
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17
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Dinkelbach L, Lehnick D, Shavit S, Szavay P, Zundel S. Acquired undescended testis: When does the ascent occur? J Pediatr Surg 2021; 56:2027-2031. [PMID: 33248683 DOI: 10.1016/j.jpedsurg.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the timeframe in which acquired undescended testes occur. To guide recommendations for screening examinations, we aimed to (1) specify the ratio of acquired undescended testes in orchiopexy cases and to (2) identify a predisposing age for the development of acquired undescended testis. METHODS Three-hundred-forty cases of orchiopexy were retrospectively analyzed and classified as congenital or acquired cases of undescended testis. In acquired cases, the time of the last documented physiological testicular position was obtained. The time of testicular ascent was approximated by calculating the mean between the last physiological finding and orchiopexy. RESULTS In 151 cases (44.4%) prior physiological position of testes was documented and acquired undescended testis was assumed. In 115 of these cases (76.2%) details on the age at last physiological position were available. Ascent occurred between the age of one and fourteen. The 50th, 75th, 85th, 90th and 95th percentile for the estimated age at ascent was 5.8, 7.3, 8.4, 8.7 and 11.1 years, respectively. CONCLUSIONS Acquired undescended testes are a common cause of cryptorchidism. Ascent occurs throughout all prepubertal ages, emphasizing the need to regular follow-up of testicular position until puberty. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Lars Dinkelbach
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225 Duesseldorf, Germany; Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland.
| | - Dirk Lehnick
- Clinical Trial Unit Central Switzerland / Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Sandra Shavit
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
| | - Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, Switzerland
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Al Hindi S, Khalaf Z. The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience. J Pediatr Urol 2021; 17:536.e1-536.e7. [PMID: 33827777 DOI: 10.1016/j.jpurol.2021.03.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Early orchidopexy has been linked to improved long term outcomes of fertility and reduced malignancy rates. However, the optimal age of intervention has been subject to change over the years. OBJECTIVE This study aims to study males aged 6 months or less who undergo laparoscopic assisted orchidopexy for intraabdominal testes to establish the safety, efficacy, and benefit in the defined age group. STUDY DESIGN We prospectively assessed 19 boys at or below 6 months of age, who had laparoscopic assisted orchidopexy for intraabdominal undescended testes at Salmaniya Medical Complex in Bahrain between January 2014 and December 2018. We examined: demographics, laterality, testicular locations, testicular volumes, operative time, complications, and durations of hospitalization and follow-up. Ultrasound-derived testicular volumes were assessed before and after orchidopexy. They were calculated using the Hansen formula (Testicular volume = 0.52 × length [L] × width [W]2 [1]. They were then compared with reference ranges from a Dutch cohort study of 769 healthy boys. Successful outcomes were correct intrascrotal position with minimal complications and normal testicular volumes. RESULTS A total of 19 males were operated at a mean age of 5.6 months and followed for a mean of 2.35 years. Of these, 7 had left-sided and 12 had right-sided cryptorchidism. Testicular locations were noted intra-operatively; 10 were above the internal ring, 5 near the iliac vessels, and 4 close to the kidney. The mean operative time was 59.58 minutes. Only 2 minor complications occurred and no cases of testicular atrophy. None of the patients required hospital-stay beyond 24 hours. The success rate was 89.46% in achieving correct scrotal position. Testicular volumes were normal before and after orchidopexy. They significantly increased after orchidopexy (P ≤ 0.05). The testicular growth rate after 24 months was slightly higher than normal. DISCUSSION In line with previous studies we were 89.46% successful in re-positioning testes [2]. In contrast to studies intervening at older ages which associated intra-abdominal testes with greater risks of complications, we found few minor complications and no testicular atrophy [3,4]. Testicular volumes in the affected testes were normal, contrary to decreased volumes found by other researchers [5]. Limitations of this study are the small number of patients and short follow-up which limits assessment of long-term outcomes. CONCLUSION Early orchiopexy is safe and effective. Laparoscopic assisted orchidopexy at an early age was beneficial and resulted in normal testicular volumes before and after surgery.
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Affiliation(s)
- Saeed Al Hindi
- Department of Pediatric Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain.
| | - Zahra Khalaf
- Rotating Doctor, Department of Pediatric Surgery, Salmaniya Medical Complex, P.O. Box 12, Manama, Bahrain.
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Hayes M, Patel A, Seideman C. Staged Fowler Stephens, Who Requires a Third Procedure? Curr Urol Rep 2021; 22:32. [PMID: 34009488 DOI: 10.1007/s11934-021-01049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The two-stage Fowler-Stephens orchiopexy is a well-described surgical approach for most pediatric urologists tackling the high intra-abdominal testis. Testicular ascent is a well-reported outcome of the surgery and a problem that could be fixed with a repeat procedure. The purpose of this review is to determine the rate of subsequent testicular ascent and repeat surgery after a two-stage Fowler-Stephens using best available evidence. RECENT FINDINGS/RESULT We selected 16 studies that pertained to our topic. 0-13% of testicles were deemed to be in an inappropriate position on follow-up (6-37 months). The definition of appropriate postoperative position varied between studies and rates of repeat procedures were sparsely available. Available data reports a repeat orchiopexy rate of 2.6-7.5% after two-stage Fowler-Stephens. Two-stage Fowler-Stephens orchiopexy is a highly successful surgical technique to manage high intra-abdominal testes. Rates of testicular ascent are difficult to ascertain due to varying definitions and small sample sizes. While repeat procedures are typically indicated, the actual rate of repeat orchiopexy is rarely reported and long-term outcomes following a third procedure is sparse.
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Affiliation(s)
- Mitchell Hayes
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
| | - Amir Patel
- Department of Urology, Oregon Health & Science University, Portland, OR, USA. .,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA.
| | - Casey Seideman
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.,Department of Pediatric Urology, Doernbecher Children's Hospital, Portland, OR, USA
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Shumaker A, Neheman A. Robot-assisted Modified One-Stage Orchiopexy: Description of a Surgical Technique. Urology 2021; 153:355-357. [PMID: 33864858 DOI: 10.1016/j.urology.2021.03.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years, robot-assisted laparoscopic procedures have gradually replaced standard laparoscopic procedures in the realm of pediatric urology. The potential advantages of the robot-assisted technique include a higher degree of dexterity, three-dimensional visualization, and reproducibility. Although laparoscopic orchiopexy is considered to be the gold standard approach in cases of intra-abdominal testes, it can be technically challenging. A crucial point in decision-making is choosing between preservation of testicular blood vessels or sacrificing the vessels in order to achieve sufficient length, as with the one and two-stage Fowler-Stephens orchiopexy (FSO). It is perceived that the one-stage FSO has lower success rates than the two-stage procedure. We present a modification of the one-stage FSO procedure for intra-abdominal testes, utilizing a robot-assisted laparoscopic orchiopexy (RAL-O) method. METHODS The key surgical maneuvers for the modified one-stage RAL-O include mobilization of the blood vessels and ligation of the artery as cranial as possible, maintenance of a wide flap of peritoneum between the vessels and vas deferens and employing the Prentiss maneuver. RESULTS The cohort included 5 boys, all of which underwent RAL-O between April 2018 and May 2020. Median age at the time of surgery was 11 months (interquartile range [IQR] 8-16) and median weight was 9.6 kilograms (IQR 9.3-11.3). Median operating time and follow-up time were 97 minutes (IQR 77.5-109.5) and 8 months (IQR 4-14.5), respectively. All cases were completed as RAL-O and there was no conversion to a two-stage procedure. There were no cases of testicular atrophy. CONCLUSION Modified one-stage Fowler Stephens RAL-O is safe and effective. It can be employed in all cases of intra-abdominal testis regardless of testis location, and eliminates the need for intra-operative decision-making, thus allowing for a standardized, one-stage approach.
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Affiliation(s)
- Andrew Shumaker
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel. Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel..
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel. Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Anand S, Singh A, Bajpai M. Transparenchymal testicular suture: A systematic review and meta-analysis highlighting the impact of additional fixation suture during routine orchiopexy. J Pediatr Urol 2021; 17:183-9. [PMID: 33478901 DOI: 10.1016/j.jpurol.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Orchiopexy for cryptorchidism is one of the common day-care surgeries performed by pediatric surgeons across the globe. Although majority of the surgeons reposition the testis into a sub-dartos pouch, the practice of taking an additional transparenchymal anchoring suture is often debated. The potential risks include impaired spermatogenesis and sub-fertility. Also, a consensus statement regarding the superiority of suture fixation over no suture fixation, in terms of prevention of recurrence of cryptorchidism, is lacking. This systematic review and meta-analysis aims to compare the outcomes of orchiopexy between the two groups i.e. without (Group A) and with the transparenchymal suture fixation (Group B). METHOD The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through October, 2020 for comparative studies. Statistical analysis was performed using a fixed-effects model; and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale. RESULT Five comparative studies, comprising a total of 734 and 1002 children within the groups A and B respectively, were recruited in this study. As compared to the children belonging to group A, a significantly higher incidence of recurrence of cryptorchidism (RR 1.75; 95% CI 1.10-2.80, p = 0.02) was observed among the children of group B. However, the difference in the incidence of testicular atrophy could not reach statistical significance (RR 1.56; 95% CI 0.23-10.50, p = 0.65). The average Downs and Black scale scores ranged from 15 to 21.5, with all the studies having moderate to high-risk of bias. CONCLUSION The present meta-analysis revealed superiority of orchiopexy performed without transparenchymal suture fixation in terms of recurrence of cryptorchidism. Although, the incidence of testicular atrophy was higher among the children belonging to the suture group, no statistically significant difference was observed among the two groups. However, the level of evidence of the published comparative studies is limited. Therefore, it is recommended to focus on adequate mobilization of the testis and its positioning in the sub-dartos with minimal tension rather than over-reliance on futile adjuncts like taking transparenchymal testicular suture.
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Dupond-Athénor A, Peycelon M, Abbo O, Rod J, Haraux E, Scalabre A, Arnaud A, Guérin F, Irtan S. A multicenter review of undescended testis torsion: A plea for early management. J Pediatr Urol 2021; 17:191.e1-191.e6. [PMID: 33388261 DOI: 10.1016/j.jpurol.2020.12.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Torsion of an undescended testis (UT) is a surgical emergency, difficult to diagnose, whose prognosis depends on a quick management. AIM OF THE STUDY To evaluate the management and outcome of these patients. STUDY DESIGN We retrospectively analyzed all cases of UT torsion operated in nine French hospitals between 1997 and 2017. We divided patients in two groups: patients referred less than 6 h after the onset of symptoms (group A) or more than 6 h (group B). MAIN RESULTS We collected 60 cases (17 in group A and 43 in group B). Median age was 2.2 years [IQR = 0.7-7.8] (2.3 y in group A and 2 y in group B, p = 0.76). Eleven patients (10 in group B) had neurological disorders (p = 0.15). The main reason for absence of UT treatment was the absence of surgical consultation in a normal delay (n = 44, 73%). Symptoms were pain (n = 58, 97%), inguinal mass (n = 55, 92%) and vomiting (n = 16, 27%). An inguinal mass with no palpable testis in the ipsilateral hemiscrotum was seen in 55 patients (92%). An ultrasound scan performed in 27 patients led to the diagnosis in 16 patients (59%). At surgery, an orchiectomy was performed in 4 patients (23%) of group A and 24 patients (56%) of group B (p = 0.04). After a median follow-up of 11 months [IQR = 4-23], 11 patients of group A (65%) and 7 patients of group B (16%) had a clinically normal testis (p = 0.03). The salvage rate among patients with conservative treatment was 85% for group A and 37% for group B (p = 0.01). DISCUSSION Our study reveals that although UT torsion is an emergency, 72% of patients are referred more than 6 h after the onset of symptoms. We mostly found classic clinical presentation of UT torsion: a painful inguinal mass with an empty ipsilateral scrotum. Ultrasound was performed in half cases, and even if the result was not significant, it still seemed to be associated with a higher rate of orchiectomy especially in group B because of the delay in care. However, when ultrasound was realized early, it led to diagnosis in all cases. This dilemma poses the problem of the role of imaging in diagnostic management. CONCLUSIONS Early clinical diagnosis in front of a painful inguinal mass with an empty scrotum is essential to improve the salvage rate of testis in UT torsion. Early management of UT should have avoided 68% of testis loss.
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Affiliation(s)
- Adrien Dupond-Athénor
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, APHP Hôpital Universitaire Robert-Debré, Centres de Référence Maladies Rares, Maladies Endocriniennes Rares de la Croissance (CRMERC), Université de Paris, 48 Bd Sérurier, 75019, Paris, France; Sorbonne Université, INSERM UMR_S933, Maladies Génétiques d'expression Pédiatrique, APHP, Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
| | - Olivier Abbo
- Department of Pediatric Surgery, Hôpital des Enfants de Toulouse, CHU Toulouse, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Julien Rod
- Department of Pediatric Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Elodie Haraux
- Department of Pediatric Surgery, University Hospital, 1 Rue Du Professeur Christian Cabrol, 80054, Amiens, France.
| | - Aurélien Scalabre
- Department of Pediatric Surgery, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Alexis Arnaud
- Department of Pediatric Surgery, Hôpital Sud, University Hospital, 16 Boulevard de Bulgarie, 35200 Rennes, France.
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpital Bicêtre, AP-HP Paris Saclay, 78 Rue Du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | - Sabine Irtan
- Sorbonne Université, Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, 26 Avenue du Dr Arnold Netter, 75012, Paris, France.
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23
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Yang Z, Li S, Yin J, Bao J, Zeng H, Xu W, Zhang X, Xing Z, Zhao W, Liu C. A prediction model for risk factors of testicular atrophy after orchiopexy in children with undescended testis. Transl Pediatr 2021; 10:882-892. [PMID: 34012837 PMCID: PMC8107851 DOI: 10.21037/tp-20-473] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There have been limited studies with small sample sizes about risk factors of testicular atrophy. Thus, we aimed to investigate the risk factors for testicular atrophy after orchiopexy in male children with undescended testes and develop a prediction model based on clinical variables. METHODS We performed a retrospective review of data on children who underwent orchiopexy for undescended testes from 2013 to 2017. The variables assessed included age, laterality, testicular location, preoperative testicular volume ratio, deferens and epididymis anomaly, hormonal treatment, comorbidities, type of surgical procedure, operating time, and complications as the outcome of testicular atrophy. A nomogram was constructed to predict the probability of testicular atrophy. We also validated our model based on a prospective cohort of patients who underwent orchiopexy from January 2018 to December 2018. RESULTS A total of 1,608 patients undergoing orchiopexy were included in the training cohort. The median age was 2.8 years (range, 0.5-11.3 years). After follow-up for 12 to 18 months (median, 14 months), 228 (14.2%) cases of atrophic testes were recorded. The independent predictors of testicular atrophy were preoperative testicular volume ratio [odds ratio (OR) 0.001, P=0.001], testicular location (OR 1.903, P=0.001), deferens and epididymis anomaly (OR 6.470, P=0.001), and two-stage Fowler-Stephens orchiopexy (OR 2.613, P=0.04). Successful validation was achieved, and a receiver operating characteristic (ROC) curve was constructed. The sensitivity and specificity of the prediction model were 78.1% and 77.5%, respectively. The area under the ROC curve was 0.851. CONCLUSIONS In patients with undescended testes, excluding those with chromosomal abnormalities and testicular nubbin, the incidence of testicular atrophy after orchiopexy is higher in patients with a lower testicular volume ratio, higher testicular location, deferens and epididymis anomaly, and in two-stage Fowler-Stephens orchiopexy. Therefore, this prediction model provides useful evidence for surgeons to choose an appropriate surgical procedure for undescended testes and predict the probability of testicular atrophy.
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Affiliation(s)
- Zhilin Yang
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.,Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianchun Yin
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiming Bao
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Wanhua Xu
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Xuan Zhang
- Department of Pediatric Surgery, Shenzhen Pingshan District Woman's and Children's Hospital, Southern Medical University, Shenzhen, China
| | - Zhihao Xing
- Clinical laboratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Weiguang Zhao
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Shenzhen, China
| | - Cundong Liu
- Department of Urology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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Al-Omar K, Bakkar S, Spinelli C. Introducing a new scrotal orchiopexy technique: The fat anchor orchiopexy. J Pediatr Surg 2021; 56:632-634. [PMID: 33189298 DOI: 10.1016/j.jpedsurg.2020.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
Cryptorchidism is the most common congenital anomaly of the male genital tract. Cryptorchidism is associated with potentially serious consequences including reduced fertility, increases risk of cancer, susceptibility to torsion and traumatic injury, as well as future psychological problems related to an abnormal scrotal appearance. The mainstay of orchiopexy is to achieve an adequate tension-free and permanent scrotal fixation of the testis; one that prevents recurrent ascent. A number of suggestions have been made regarding keeping the testis in the scrotal position once it was brought down in the scrotum without tension. Several techniques for testicular fixation have been described to date; however, the optimal method remains controversial. We herein introduce a novel scrotal orchidopexy technique. This innovative fixation technique utilizes the sub-scrotal fat as a permanent anchor for fixing the low-lying cryptorchid testicle in the scrotum through a trans-scrotal incision. Therefore, the procedure was named "the fat anchor orchiopexy". We believe our method will give better options for scrotal fixation especially in cases of low-lying cryptorchid testes. This article provides a detailed description of this new fixation technique.
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Affiliation(s)
- Khaled Al-Omar
- Department of Surgery, Faculty of Medicine, the Hashemite University, Zarqa 13133, Jordan.
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, the Hashemite University, Zarqa 13133, Jordan
| | - Claudio Spinelli
- Department of Pediatric Surgery, the University of Pisa, Pisa 56124, Italy
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Abstract
Background Splenogondal fusion (SGF) is a rare congenital anomaly characterized by abnormal association between the splenic tissue and the gonads or mesonephric remnants. SGF that requires separate two-stage laparoscopic staged Fowler-Stephen orchiopexy on both the left and right sides is extremely rare. SGF could be misdiagnosed as testicular malignancy and leads to unnecessary orchiectomy. Case presentation This is a case of an 8-month old male infant presented with bilateral cryptorchidism, B-mode ultrasound visualized the left and right testes in the lower abdominal cavity and the upper margin of the left testicle as a hypoechoic mass extending to the spleen, indicating an undescended right testis and possible SGF on the left side. Single-site laparoscopic examination confirmed the diagnosis of SGF on the left side and an undescended right testis. As both testes were high and the right spermatic vessel was poorly developed and short, a routine single stage orchiopexy would be difficult and risky, therefore, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides were implemented. Stage 1 of the staged Fowler-Stephen orchiopexy for the right side was performed first without treating the left side, Stage 2 for the right side, separation of the left testis from the spleen as well as Stage 1 for the left side were performed 7 months later, and Stage 2 for the left side was performed 7 months after that. Follow-up ultrasound 1 year after the surgery revealed no obvious abnormalities in the shapes of the testes or their blood supply. This treatment strategy prevented unnecessary orchiectomy. Conclusions We reported a rare case of SGF that needed separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides, and a review of the recent literature. SGF is a rare congenital anomaly often diagnosed incidentally during exploration/surgery for scrotal swelling/mass, cryptorchidism or inguinal hernia in young patients. Surgeons, especially pediatric surgeons should be aware of this rare condition to avoid unnecessary, life-altering radical orchiectomy. When routine single stage orchiopexy is not feasible or risky for either side, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies could be performed on both the left and right sides to avoid unnecessary orchiectomy.
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Affiliation(s)
- Guangjie Chen
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Xiaohao Wang
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Yijun Zhao
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Linfeng Zhu
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China
| | - Daxing Tang
- Department of Urology, The Children's Hospital, Zhejiang University, School of Medicine, National Clinical Research Center for Child Health, 57 Zhugan Xiang, Hangzhou, 310053, China.
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26
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Wang Y, Chen L, Cui X, Zhou C, Zhou Q, Zhang Z. Clinical effect of minimally invasive surgery for inguinal cryptorchidism. BMC Surg 2021; 21:21. [PMID: 33407324 PMCID: PMC7788907 DOI: 10.1186/s12893-020-01010-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism. Methods The patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery. Results There was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group. Conclusions Minimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.
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Affiliation(s)
- Yunjin Wang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liu Chen
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Xu Cui
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Chaoming Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qing Zhou
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zhengmian Zhang
- Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Abstract
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as "perinatal TT" (PTT) or "neonatal TT" (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described.
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Affiliation(s)
- R I Kylat
- Department of Pediatrics, University of Arizona, College of Medicine, PO BOX 245073, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
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de Vasconcelos RAL, Ximenes RAA, Calado AA, Martelli CMT, Gonçalves AV, Brickley EB, de Araújo TVB, Rocha MAW, Miranda-Filho DDB. Surgical findings in cryptorchidism in children with Zika-related microcephaly: a case series. BMC Urol 2020; 20:186. [PMID: 33225931 PMCID: PMC7681962 DOI: 10.1186/s12894-020-00721-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Background Complications in the urinary tract related to congenital Zika syndrome have recently been reported. One complication, cryptorchidism, has been reported by the Microcephaly Epidemic Research Group/MERG, in Pernambuco/Brazil. The present article describes for the first time the surgical findings in a case series of boys with Zika-related microcephaly and cryptorchidism, who underwent surgical testicular exploration as a contribution to better understand the possible mechanisms involved in gonads formation and descent. Methods A total of 7 children (11 testicular units), aged 3 to 4 years, were submitted to inguinal or scrotal orchidopexy for the treatment of palpable cryptorchidism between August 2019 and January 2020. Characteristics of the gonads and its annexes related to appendixes, testis-epididymis dissociation, gubernacular insertion, and associated hydroceles and/or hernias were described. Measures in centimetres were taken for volume calculate. Results We found a low prevalence of testicular and epididymal appendix (66.7%), a high prevalence of testis-epididymis dissociation (55.6%), low mean testicular volume for their ages (lower for older boys) and ectopic gubernacular insertion in all cases. There was no evidence of associated hydroceles and/or hernias in any case. No surgical complication was registered or reported, and all explored gonads were properly placed in the scrotal sac. Conclusions We herein describe the surgical findings of these children's orchidopexies and discuss the possible mechanisms of viral action in embryogenesis and postnatal growth and development of the testes and annexes. These children need to be followed over time due to the higher risk of testicular atrophy and malignancy. Surgical timing seems to be relevant to avoid loss of testicular volume.
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Affiliation(s)
| | - Ricardo A A Ximenes
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.,Universidade Federal de Pernambuco, Recife, Brazil
| | - Adriano A Calado
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
| | | | - Andreia V Gonçalves
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil.,Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Maria A W Rocha
- Universidade de Pernambuco, Rua Arnóbio Marques, 310 - Santo Amaro, Recife, PE, 50100-130, Brazil
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Abstract
Cryptorchidism or undescended testis is the single most common genitourinary disease in male neonates. In most cases, the testes will descend spontaneously by 3 months of age. If the testes do not descend by 6 months of age, the probability of spontaneous descent thereafter is low. About 1%-2% of boys older than 6 months have undescended testes after their early postnatal descent. In some cases, a testis vanishes in the abdomen or reascends after birth which was present in the scrotum at birth. An inguinal undescended testis is sometimes mistaken for an inguinal hernia. A surgical specialist referral is recommended if descent does not occur by 6 months, undescended testis is newly diagnosed after 6 months of age, or testicular torsion is suspected. International guidelines do not recommend ultrasonography or other diagnostic imaging because they cannot add diagnostic accuracy or change treatment. Routine hormonal therapy is not recommended for undescended testis due to a lack of evidence. Orchiopexy is recommended between 6 and 18 months at the latest to protect the fertility potential and decrease the risk of malignant changes. Patients with unilateral undescended testis have an infertility rate of up to 10%. This rate is even higher in patients with bilateral undescended testes, with intra-abdominal undescended testis, or who underwent delayed orchiopexy. Patients with undescended testis have a threefold increased risk of testicular cancer later in life compared to the general population. Self-examination after puberty is recommended to facilitate early cancer detection. A timely referral to a surgical specialist and timely surgical correction are the most important factors for decreasing infertility and testicular cancer rates.
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Affiliation(s)
- Jaeho Shin
- Division of Pediatric Surgery, Department of Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Jabali SS, Mohammed AA. Crossed testicular ectopia: Case report with review of literature. Int J Surg Case Rep 2020; 75:189-192. [PMID: 32966926 PMCID: PMC7509342 DOI: 10.1016/j.ijscr.2020.09.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Crossed testicular ectopia is a rare form of urogenital anomalies in which both testes are migrated and descend through a single inguinal canal, one or both testes may be ectopic in the abdomen, the inguinal region or descent to the hemi-scrotum with empty contralateral hemi-scrotum. CASE PRESENTATION A 1.5-year-old male patient had an empty left scrotum with no palpable testis in the inguinal region with a palpable testis in the right scrotum with palpable other testis in the right inguinal region. Ultrasound examination showed the right testis in the right scrotum and another testis measuring in the right inguinal region giving suggestion of both testes in the right side. During operation two testes was found in the right inguinal region with two small indirect inguinal sacs. Herniotomy was performed for both sacs. The right testis was placed and fixed in the right hemi-scrotum and the left testis was fixed in the left hemi-scrotum through trans-septal window. CONCLUSION During surgery, the surgeon should adopt a conservative approach to preserve the fertility. Trans-septal orchiopexy or extra-peritoneal transposition orchiopexy is advised. In case of persistent Müllerian duct syndrome, preservation of the Müllerian remnants is recommended to preserve blood supply to the vas deferens and testis. Karyotyping may be required in some cases specially if associated with other congenital anomalies of the genitalia. Patients usually need long term follow up because such patients may have future fertility problems and there is an increased risk of the development of testicular cancer.
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Affiliation(s)
- Shakir Saleem Jabali
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq.
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Young CD, Walker AM, Weber BA, Spencer AO. Quality improvement assessment of a bianchi-technique pediatric orchiopexy perioperative pain management pathway. J Pediatr Urol 2020; 16:461.e1-461.e9. [PMID: 32698984 DOI: 10.1016/j.jpurol.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/30/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical correction of undescended testes is a common surgical procedure which can be performed via a two-incision technique or a single high scrotal incision (Bianchi technique). The Bianchi technique requires less surgical time and may be associated with less pain in the initial postoperative period, however it has been adopted slowly due to a lack of familiarity and perceived technical challenges of the technique. Traditionally postoperative orchiopexy pain is managed with a caudal or ilioinguinal/iliohypogastric nerve block. As urologists at our site adopted the Bianchi technique, the anesthesiologists stopped performing caudals or ilioinguinal/iliohypogastric nerve blocks as local infiltration appeared sufficient. Therefore, this quality improvement (QI) project endeavoured to assess Alberta Children's Hospital's care pathway in its effectiveness to control pain in the first 24 h following pediatric orchiopexy using the Bianchi technique. METHODS We completed a prospective QI project examining a care pathway for patients undergoing orchiopexy using the Bianchi technique. Eligible patients were healthy and aged 6 months to 12 years. A multimodal analgesic approach including local anesthetic surgical infiltration was used. Pain scores (FLACC) were recorded for up to 2 h postoperatively and a PPPM was completed at 24 h postoperatively. RESULTS Sixty-four patients were included in the final analysis. The median discharge FLACC score was 0 (range 0-2) (Table 2). Median intraoperative morphine administered was 0.09 mg/kg with no significant correlations between the amount of morphine administered and postoperative pain measures. Median PPPM scores were 4 and 3.5 for unilateral and bilateral procedures, respectively. CONCLUSIONS We have demonstrated that orchiopexies repaired using the Bianchi technique following the care pathway established at Alberta Children's Hospital are associated with minimal pain scores. Our QI project suggests that combining a Bianchi technique with a simple multimodal analgesic approach including local infiltration, negates the need for regional anesthesia techniques, yet still provides adequate analgesia.
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Affiliation(s)
- Christopher D Young
- Department of Anaesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, Foothills Medical Centre, Calgary, Canada.
| | - Andrew M Walker
- Department of Anaesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, Foothills Medical Centre, Calgary, Canada
| | - Bryce A Weber
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adam O Spencer
- Department of Paediatric Anaesthesia, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Elzeneini WM, Mostafa MS, Dahab MM, Youssef AA, AbouZeid AA. How far can one-stage laparoscopic Fowler-Stephens orchiopexy be implemented in intra-abdominal testes with short spermatic vessels? J Pediatr Urol 2020; 16:197.e1-197.e7. [PMID: 32085874 DOI: 10.1016/j.jpurol.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the study was to compare the outcome of the prospective cohort who had one-stage laparoscopic Fowler-Stephens orchiopexy (LFSO) with an earlier, similar cohort who had a two-stage LFSO. Both cohorts included only intra-abdominal testes (IATs) with short spermatic vessels. STUDY DESIGN The present study initially included all patients between the age of six months and preschool age, presenting with an IAT to the authors' tertiary clinic from January 2012 to December 2014. Only intra-abdominal testes with short testicular vessels, correlating to type 3A, 3B and 4A as per the updated Ain Shams classification, were included in this study. One-stage LFSO was performed on all patients. Patients with bilateral intra-abdominal testes had the procedure performed on the contralateral side 6-8 weeks later. Follow-up was performed at 6, 12 and 36 months postoperatively by means of Doppler ultrasound in the first two visits. A similar subgroup of the historical cohort from years 2002 to 2010 had a two-stage LFSO, with the second stage being performed 12-16 weeks later. In bilateral cases, a three-interval surgery based on two-stage LFSO was performed, with a follow-up at 6 months postoperatively. RESULTS The recent cohort included 16 IATs (10 unilateral and 3 bilateral). The median age of the patients was 1.41 years. At 6-month follow-up, 4 testes were found atrophic (25%), whereas the remaining 12 testes (75%) were viable. In those viable, only half of them had a low scrotal position. No difference was found at 12- or 36-month follow-up. Doppler ultrasound confirmed adequate intratesticular blood flow at 6 and 12 months postoperatively. In the similar subgroup of the historical cohort, 3 of 25 (12%) testes were found atrophied at six months postoperatively, with only one testis (4%) having a high scrotal position. In a comparison of both cohorts, the two-stage LFSO was found to be associated with a halving of the testicular atrophy rate (p value = 0.401) and a higher incidence of low scrotal position (p value = 0.004). A comparison of both cohorts is shown in the summary table. CONCLUSION Although one-stage LFSO may seem tempting, it still holds a higher rate of testicular atrophy, which is not justified. LEVEL OF EVIDENCE Level III (Case-control study).
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Affiliation(s)
- Wael M Elzeneini
- Pediatric Surgery Department, Ain-Shams University Chidren's Hospital, Egypt.
| | - Mohamed S Mostafa
- Pediatric Surgery Department, Ain-Shams University Chidren's Hospital, Egypt
| | - Mohamed M Dahab
- Pediatric Surgery Department, Ain-Shams University Chidren's Hospital, Egypt
| | - Ahmed A Youssef
- Pediatric Surgery Department, Ain-Shams University Chidren's Hospital, Egypt
| | - Amr A AbouZeid
- Pediatric Surgery Department, Ain-Shams University Chidren's Hospital, Egypt
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You J, Li G, Chen H, Wang J, Li S. Laparoscopic orchiopexy of palpable undescended testes_ experience of a single tertiary institution with over 773 cases. BMC Pediatr 2020; 20:124. [PMID: 32178653 PMCID: PMC7075009 DOI: 10.1186/s12887-020-2021-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Discuss the superiority of laparoscopic orchiopexy in the treatment of inguinal palpable undescended testes. Methods Inclusion criteria: Preoperative examination and color Doppler ultrasound examination confirmed that the testes were located in the inguinal canal and could not be pulled into the scrotum, except for retractive and ectopic testes. The surgical steps were depicted as follow. The retroperitoneal wall was carved by ultrasonic scalpels, separates the spermatic vessels closed to the inferior pole of the kidney if necessary, dissects the peritoneum of vas deferens, cuts the testicular gubernaculum, and pulls back the testicle into the abdominal cavity. Besides, protect the vas deferens, and descend the testes to the scrotum and fix them without tension. Results There were 773 patients with 869 inguinal undescended palpable testes, 218 cases on the left side, 459 cases on the right side and 96 cases with bilateral undescended testes, whose age ranged from 6 months to 8 years, with an average of 20 months. All testes were successfully operated, no converted to open surgery. The average operation time was (34.8 ± 5.4) min. There were 692 testes have an ipsilateral patent processus vaginalis (89.5%); In 677 cases of unilateral cryptorchidism, 233 cases (34.4%) have a contralateral patent processus vaginalis, and laparoscopic percutaneous extraperitoneal closure the hernia sac carry out during the surgery. There was no subcutaneous emphysema during the operation, no vomiting, no abdominal distension, no wound bleeding and obvious pain after surgery, especially wound infection is rarely. Doppler ultrasound was evaluated regularly after surgery. The patients were followed up for 6 to 18 months. All the testes were located in the scrotum without testicular retraction and atrophy. No inguinal hernia or hydrocele was found in follow-up examination. Conclusion Laparoscopic orchiopexy manage inguinal palpable cryptorchidism is safe and effective, and there are obvious minimally invasive advantages. Furthermore, It could discover a contralateral patent processus vaginalis, and treat at the same time, which avoid the occurrence of metachronous inguinal hernia.
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Affiliation(s)
- Jia You
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Gang Li
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Haitao Chen
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Jun Wang
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China
| | - Shuang Li
- Department of Pediatric Urology Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No.100, Hong Kong Road, Jiang'an District, Wuhan, 430016, China.
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Abstract
INTRODUCTION Diagnostic laparoscopy is recommended for boys with non-palpable testis (NPT) by American and European guidelines with the decision to pursue inguinal exploration based upon testicular vessel appearance. We hypothesized that management decisions are not consistent with the guidelines, and that assessment of vessels is subjective. MATERIALS AND METHODS Pediatric urologist management decisions were evaluated via an electronic survey to determine impact of contralateral testicle size, sonographic findings, surgeon region, and years in practice. In a digital image survey, surgeons were asked to interpret gonadal vessel status of 32 consecutive cases of NPT with absent abdominal testis as normal, atretic, or blind-ending to determine intra- and inter-rater reliability. RESULTS Of the 339 participants, more Europeans (49%) chose sonography as the first management step for NPT compared to US surgeons (12%). Regardless of sonographic findings, over 80% chose laparoscopy as the first step. In the presence of normal, atretic, and blind-ending vessels, the decisions to proceed with inguinal/scrotal exploration were 88%, 68%, and 17%, respectively. Contralateral hypertrophy and sonography findings had no significant impact on the decision to proceed with inguinal/scrotal exploration. The visual gonadal vessel survey showed surgeon interpretation of normal or blind-ending vessels had moderate inter-rater reliability. Surgeons did not agree on normal status 37% of the time and did not agree on atretic status 66% of the time. There was no statistical difference between European and US respondents (P = 0.23). Intra-rater reliability was fair for blind-ending vessels. When the first interpretation was blind-ending, the same surgeon changed interpretation of the same image 39% of the time. There was no statistical difference by years of practice. CONCLUSIONS Non-visualization of NPT on sonography and contralateral testis size had no significant impact upon management decisions. Surgeons chose to pursue inguinal/scrotal exploration based upon laparoscopic gonadal vessel status. However, these interpretations were subjective with low inter- and intra-rater reliability.
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Affiliation(s)
- Leanna W Mah
- Department of Urologic Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA
| | | | - Eric A Kurzrock
- Department of Urologic Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA.
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Abstract
Congenital testicular anomalies affect about 5% of newborn boys. Testicular torsion is a rare anomaly that occurs in 1 in 4000 men under the age of 25. Perineal ectopia is an even more rare anomaly. It occurs in less than 1% of all cases of cryptorchidism. In this study, we present a rare case of testicular torsion with perineal ectopia in a boy of 18 months. To establish the anomaly, we used Doppler ultrasound and MRI. We performed inguinal exploration with subsequent detorsion testis and orchiopexy using the dartos pouch technique.
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Affiliation(s)
- Boyan Stoykov
- Department of Urology, Medical University Pleven, Bulgaria
| | - Nikolay Kolev
- Department of Urology, Medical University Pleven, Bulgaria
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Goetz J, Roewe R, Doolittle J, Roth E, Groth T, Mesrobian HG, Rein LE, Szabo A, Kryger J. A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males. J Pediatr Urol 2019; 15:610-616. [PMID: 31690483 DOI: 10.1016/j.jpurol.2019.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
SHORT INTRODUCTION/BACKGROUND Surgical intervention for acute testicular torsion can require either orchiopexy or orchiectomy. The decision of which surgery to perform is dependant on the amount of time that the testicle experienced ischemia and the viability of the testicle after reperfusion. OBJECTIVE It is hypothesized that (1) there is a difference in orchiectomy and orchiopexy rates between prepubertal and postpubertal males with acute testicular torsion and (2) presenting symptoms may vary between the two age groups as prepubertal males may present with atypical symptoms, which could result in delayed presentation and diagnosis. STUDY DESIGN A retrospective chart review was conducted on pediatric patients who were diagnosed with acute testicular torsion between June 2010 and August 2017. Demographic and clinical characteristics were extracted: age, ethnicity, referral pattern, primary insurance status, symptoms at presentation, prior history of ipsilateral testicular pain or intermittent torsion, recent trauma to genitalia, duration of symptoms (hours), gradual vs. acute onset of symptoms, time/weekday/season at presentation, and time interval from arrival at the study institution to surgical intervention (minutes). Patients were categorized into two groups: prepubertal group (age 1-12 years) and postpubertal group (age 13-18 years). Statistical analyses were performed using R, version 3.3.1. RESULTS Ninety-one patients were included in the study. The overall orchiectomy rate was 30.8%. More prepubertal males underwent orchiectomy than postpubertal males (42.4% vs. 24.1%, respectively). Prepubertal males were more likely to present with abdominal pain than postpubertal males (27.3% vs. 10.3%, respectively). Those who underwent orchiectomy were more likely to present with longer duration of symptoms, testicular swelling, and abdominal pain than those who underwent orchiopexy. The risk of orchiectomy decreased by 14% per 1-year increase in age (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.94-1.00, p = .009). A steady decline in the proportion of patients undergoing orchiectomy was seen from 1 to 12 years of age. DISCUSSION This study found that prepubertal males are at higher risk for orchiectomy than postpubertal males. The risk of orchiectomy decreases by 14-16% per 1-year increase in age. Prepubertal males are more likely to present with atypical symptoms and delayed presentation and diagnosis, leading to delayed surgical intervention. It is important for providers to perform a genital examination in prepubertal males who present with abdominal pain to rule out acute testicular torsion. Patients presenting with longer duration of symptoms, testicular swelling, and abdominal pain are at higher risk for orchiectomy. No correlation was found between orchiectomy rate and ethnicity, referral status, primary insurance status, and time/weekday/season at presentation. CONCLUSION Among patients presenting to a tertiary pediatric hospital with acute testicular torsion, prepubertal males (younger than 12 years) are at higher risk for orchiectomy than postpubertal males. Prepubertal males are more likely to present with atypical symptoms which results in delayed presentation and diagnosis, leading to delayed in surgical intervention.
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Affiliation(s)
- J Goetz
- Division of Pediatric Urology, Children's Hospital of Wisconsin, Children's Hospital of Wisconsin, 999 N, 92nd Street, Suite 330, Milwaukee, WI, 53226, USA
| | - R Roewe
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - J Doolittle
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - E Roth
- Division of Pediatric Urology, Children's Hospital of Wisconsin, Children's Hospital of Wisconsin, 999 N, 92nd Street, Suite 330, Milwaukee, WI, 53226, USA
| | - T Groth
- Division of Pediatric Urology, Children's Hospital of Wisconsin, Children's Hospital of Wisconsin, 999 N, 92nd Street, Suite 330, Milwaukee, WI, 53226, USA
| | - H-G Mesrobian
- Division of Pediatric Urology, Children's Hospital of Wisconsin, Children's Hospital of Wisconsin, 999 N, 92nd Street, Suite 330, Milwaukee, WI, 53226, USA
| | - L E Rein
- Division of Biostatistics in the Institute for Health and Society, Medical College of Wisconsin, Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Medical Education Building. (MEB): M2460, Milwaukee, WI, 53226, USA
| | - A Szabo
- Division of Biostatistics in the Institute for Health and Society, Medical College of Wisconsin, Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Medical Education Building. (MEB): M2460, Milwaukee, WI, 53226, USA
| | - J Kryger
- Division of Pediatric Urology, Children's Hospital of Wisconsin, Children's Hospital of Wisconsin, 999 N, 92nd Street, Suite 330, Milwaukee, WI, 53226, USA.
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Berrondo C, Ahn JJ, Shnorhavorian M. Pre-operative skin antisepsis with chlorhexidine gluconate baths and wipes does not prevent postoperative surgical site infection in outpatient pediatric urologic inguinal and scrotal surgery. J Pediatr Urol 2019; 15:652.e1-652.e7. [PMID: 31564588 DOI: 10.1016/j.jpurol.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To reduce surgical site infections (SSI), many institutions utilize pre-operative antisepsis with chlorhexidine gluconate (CHG) baths and/or wipes. CHG reduces bacterial colonization of the skin, but it is unclear whether this reduces SSI, and current guidelines from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization do not support this practice. There are several factors that increase the risk of SSI in adults, but there is limited understanding of these factors in pediatric patients. OBJECTIVES The primary objectives were to describe the proportion of pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy who develop a postoperative (postop) SSI and to determine whether pre-operative CHG baths/wipes were associated with SSI. The secondary objectives were to identify other factors associated with SSI and to estimate the cost of CHG baths/wipes in this population. STUDY DESIGN Pre-operative antisepsis with CHG baths/wipes was implemented at the authors institution in 2006. The authors performed a retrospective cohort study of patients aged 0-18 years undergoing hernia/hydrocele repair and/or orchiopexy by a pediatric urologist at their institution before (2004) and after (2008) the introduction of CHG. The authors compared the proportion of patients with SSI in the no CHG and CHG groups and evaluated for factors associated with SSI. Statistical analysis included Wilcoxon rank-sum test, Chi-squared test, and Fisher's exact test. The cost of CHG baths and wipes was estimated using institutional fees in 2018 US dollars. RESULTS A total of 543 patients met inclusion criteria, 203 in the no CHG group and 340 in the CHG group. The overall rate of SSI was 0.92%. There was no association between use of CHG and SSI. No patient or peri-operative factors were associated with development of SSI. There were no CHG-associated adverse events. The cost of materials was estimated at $3.29/patient ($1118.60 for 340 cases in 2008) in 2018 US dollars. DISCUSSION SSI is not common in pediatric patients undergoing hernia/hydrocele repair or orchiopexy. In the present study, pre-operative antisepsis with CHG baths/wipes is not associated with a reduction in SSI and carries additional cost. CONCLUSIONS To the authors knowledge, this is the first study to evaluate the use of pre-operative antisepsis with CHG baths/wipes in an exclusively pediatric population. In the study, CHG baths/wipes add cost with no clear benefit for reducing SSI in pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy.
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Affiliation(s)
- Claudia Berrondo
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
| | - Jennifer J Ahn
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
| | - Margarett Shnorhavorian
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
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Higgins M, Smith DE, Gao D, Wilcox D, Cost NG, Saltzman AF. The impact of age at orchiopexy on testicular cancer outcomes. World J Urol 2019; 38:2531-2536. [PMID: 31781896 DOI: 10.1007/s00345-019-03034-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age. METHODS This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0-6 years, 7-9 years, 10-12 years, 13-15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes. RESULTS For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age. CONCLUSION While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities.
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Affiliation(s)
- Margaret Higgins
- Department of Urology, University of Kentucky, 800 Rose Street, MS 237, Lexington, KY, 40536, USA
| | - Derek E Smith
- Department of Pediatrics, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, USA
| | - Dexiang Gao
- Department of Pediatrics, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, USA
| | - Duncan Wilcox
- Division of Urology, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Amanda F Saltzman
- Department of Urology, University of Kentucky, 800 Rose Street, MS 237, Lexington, KY, 40536, USA. .,Division of Urology, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
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Abstract
Perineal ectopic testis is a rare condition seen in less than 1% of all cases of undescended testis. In this study, we diagnosed a perineal ectopic testis in a 7-month-old physical examination. A solitary, oval mass on the lower and lateral side of the palpation right hemiscrotum was identified and this mass was defined as the correct testicle at the ultrasound of scrotal. Orchiopexy was performed following herniography, and the scrotum was attached to the scrotum using the dartos pouch technique. We believe that orchidopexy is the preferred treatment of choice.
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Affiliation(s)
- Mahmut Ulubay
- Department of Urology, Samsun Training and Research Hospital, Faculty of Medicine, Sağlık Bilimleri University, Samsun, Turkey
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Chen CJ, Kavoussi N, Jacobs MA. Splenogonadal fusion: A rare finding during routine orchiopexy. Urol Case Rep 2019; 27:100904. [PMID: 31687344 PMCID: PMC6819776 DOI: 10.1016/j.eucr.2019.100904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022] Open
Abstract
Splenogonadal fusion remains a rare congenital anomaly, with limited reports in the literature. It is important to be aware of this benign condition as orchiectomy can result from confusion with malignant processes. We present a case of splenogonadal fusion in a 12-month-old healthy male with history of cryptorchidism found at the time of surgery.
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Affiliation(s)
- Catherine J Chen
- University of Texas Southwestern, Department of Urology, United States
| | | | - Micah A Jacobs
- University of Texas Southwestern, Department of Urology, United States
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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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Jang JB, Ko YH, Choi JY, Song PH, Moon KH, Jung HC. Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay. World J Mens Health 2019; 37:99-104. [PMID: 30584993 PMCID: PMC6305858 DOI: 10.5534/wjmh.180049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival. Materials and Methods Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. Results Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p<0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p<0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p<0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p<0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14). Conclusions This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.
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Affiliation(s)
- Jun Bo Jang
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Young Hwii Ko
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
| | - Jae Young Choi
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Ki Hak Moon
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Hee Chang Jung
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
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Maizels M, Liu D, Yerkes E, Meade P, Biondi M, Sutherland R. Improving surgical training by identifying the most common feedback trainees receive for index cases. J Pediatr Urol 2018; 14:577-583. [PMID: 30270102 DOI: 10.1016/j.jpurol.2018.07.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND To make surgical training more effective, a proven method is needed to provide feedback to residents on their surgeries. Residency programs may make up for limited training time in the operating room by improving feedback that trainees receive about cases. OBJECTIVE The goals of this study were (1) to determine if an online tool to communicate feedback for attendings and trainees shows face validity and (2) to use an online tool to identify the most common feedback trainees receive after performing orchiopexy and hypospadias repair by survey. METHODS In 2016, determining whether an online tool to provide pediatric urology trainees feedback after surgery shows face validity begun. The tool was launched at the authors' institutions. Then, attendings, fellows, and postgraduate year 4-5 trainees of 65 resident training programs were surveyed for their observations on preparing for and performing orchiopexy and hypospadias repair using the study tool to identify common feedback. RESULTS The results of using the tool to provide feedback shows face validity are as follows: feedback was exchanged between attendings and trainees on orchiopexy (n = 28) and hypospadias (n = 22). Anecdotally, the tool was easy to use. The results of using the tool to identify the most common feedback trainees receive by survey are as follows: from a pool of 65 institutions, 37 attendings and 28 trainees were enrolled who made 219 observations. Most trainees prepare using undocumented online resources (17/28, 67%) instead of speaking with their attendings or cotrainees (11/28, 33%). For orchiopexy, most respondents reported that trainees need to improve skills for hernia ligation (observations: attending = 28/45, 62%; and trainee = 17/26, 65%) and strategies for hernia exposure (observations: attending = 17/27, 62%; and trainee = 7/12, 58%). For hypospadias, most respondents reported that trainees need to improve skills for neourethroplasty (observations: attending = 31/53, 58%; and trainee = 10/16, 62%) and strategies for repair choice (observations: attending = 15/22, 68%; and trainee = 12/18, 67%) (chi-squared, all P = NS). DISCUSSION It was shown that both trainees and attendings agree on the areas of surgical strategy and execution which require improvement. With this study, it is also shown that the online feedback tool developed shows face validity in allowing attendings and trainees to communicate before and after surgery. CONCLUSIONS The most common feedback pediatric urology trainees receive for routine pediatric urology surgery is identified. Online tools that emphasize remediations to address a trainee's specific feedback needs are to be built, so that they will be able to improve their skills at their next case.
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Affiliation(s)
- M Maizels
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - D Liu
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - E Yerkes
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - P Meade
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - M Biondi
- UNC School of Medicine, Chapel Hill, NC, USA
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Anwar AZM, Fathelbab TK, Abdelhamid AM, Galal EM, Ali MM, Tawfiek ER. Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience. Int Urol Nephrol 2018; 50:2139-2144. [PMID: 30311046 DOI: 10.1007/s11255-018-2006-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/11/2018] [Accepted: 10/05/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE We evaluated the role of initial laparoscopy and optimized approach in cases of unilateral nonpalpable testis. METHODS Seventy-four patients with nonpalpable testes were presented. We excluded 9 patients, with palpable testes under anesthesia. Laparoscopy was offered to 65 patients. Contralateral testis hypertrophy with length ≥ 1.8 cm was confirmed in 47 patients. Ultrasound results were available for 35 patients. RESULTS Age ranged from 1 to 10 years. Of 65 nonpalpable testes, right side comprised 23 (35.4%) and the left 42 (64.6%). Laparoscopy revealed intra-abdominal testis in 18 patients (27.7%), blind-ending vessels and vas in 8 (12.3%), and vas and vessels traversing the internal ring in 39 (60%). Treatment of intra-abdominal testes included Fowler-Stephens orchiopexy in 7 patients, laparoscopic orchiopexy in 9, and laparoscopic orchiectomy in 2. In 8 patients with blind-ending vas and vessels, laparoscopy was terminated. In 39 patients with vas and vessels traversing the internal ring, scrotal exploration was performed in 36 patients with closed internal ring and inguinal exploration in 3 with open internal ring. Vanished testes were present in 43/47(91.5%) of patients with contralateral testis hypertrophy ≥ 1.8 cm. Ultrasound detected the presence of a testis in only 4/11 (36.3%) of patients, although it could not identify vanished testis. CONCLUSIONS Initial laparoscopy should be retained as one of the standard treatment for nonpalpable testis. It was the only required modality in 26 patients (40%) and optimized further treatment in 39 patients (60%) by evaluation of the condition of the internal ring.
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Affiliation(s)
| | | | | | - Ehab Mohmed Galal
- Urology Department, School of Medicine, University Hospital, 61111, Minia, Egypt
| | - Mostafa Magdi Ali
- Urology Department, School of Medicine, University Hospital, 61111, Minia, Egypt
| | - Ehab Rifat Tawfiek
- Urology Department, School of Medicine, University Hospital, 61111, Minia, Egypt
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Osumah TS, Jimbo M, Granberg CF, Gargollo PC. Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol 2018; 14:394-401. [PMID: 30087037 DOI: 10.1016/j.jpurol.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Testicular torsion remains the most frequent cause of testicular ischemia, especially in adolescents and young adults. Timely diagnosis and intervention are keys to saving the affected testicle. This review presents current trends in the diagnosis and treatment of torsion, potential pitfalls and consequent outcomes. Additionally, other salient issues surrounding testicular torsion are also discussed, including: pathogenesis of injury, legal ramifications, fertility outcomes, novel management techniques, and recent advances in diagnostic technology.
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Affiliation(s)
- T S Osumah
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - M Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - C F Granberg
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - P C Gargollo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
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Elsherbeny M, Abdallah A, Abouzeid A, Ghanem W, Zaki A. Staged laparoscopic traction orchiopexy for intra-abdominal testis: Is it always feasible? J Pediatr Urol 2018; 14:267.e1-267.e4. [PMID: 29567012 DOI: 10.1016/j.jpurol.2018.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic orchiopexy for intra-abdominal testis is a well-known and commonly practiced technique. The traction technique is based on elongation of the testicular vessels without cutting them, in contrast with the two-stage Fowler-Stephens technique in which the testicular vessels are divided. The current study evaluated the feasibility of the traction technique according to the type of intra-abdominal testis. PATIENTS AND METHODS The study included 20 boys with 22 intra-abdominal testes and who underwent staged laparoscopic traction orchiopexy between October 2013 and October 2015. Eighteen testes were proximal to the internal ring by <2 cm (type III), while the remaining four were high and away from the internal ring by >2 cm (type IVa). The patients' ages ranged between 6 months and 5 years (mean 2.2 years; median 2 years). Patients were followed up for 1 year for testicular atrophy and satisfactory scrotal site relocation. RESULTS This study did not detect any cases of testicular atrophy among the participants (0/22), while failure to achieve satisfactory scrotal site was found in two out of the four cases with type IVa intra-abdominal testes. DISCUSSION Traction techniques for elongating the testicular vessels were employed years ago, but this was revisited by Shehata in 2008. It has the advantage of preserving the main testicular blood supply, which can be reflected by the decreasing rate of testicular atrophy when compared with the Fowler-Stephens orchiopexy. The results of the traction technique may be less satisfactory regarding the testicular location for higher types of intra-abdominal testes (type IVa). CONCLUSION Staged laparoscopic traction orchiopexy was a feasible technique for intra-abdominal testes (within 2 cm of the internal ring), but the results were less satisfactory when applied for higher intra-abdominal testes (type IVa).
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Affiliation(s)
| | | | - Amr Abouzeid
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wael Ghanem
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Zaki
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Rensing AJ, Whittam BM, Chan KH, Cain MP, Carroll AE, Bennett WE Jr. Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy? J Pediatr Urol 2018; 14:261.e1-7. [PMID: 29501378 DOI: 10.1016/j.jpurol.2018.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surgeons frequently use surgical antibiotic prophylaxis (SAP), despite limited evidence to support its efficacy. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), Clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean pediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the pediatric population. OBJECTIVE It was hypothesized that children who received SAP prior to orchiopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. METHODS A retrospective cohort study was conducted of all males aged between 30 days and 18 years who underwent an orchiopexy (ICD-9 CM 62.5) in an ambulatory or observation setting from 2004 to 2015 using the Pediatric Health Information System database. Inpatients and those with concomitant procedures were excluded. Chi-squared or Fisher's exact tests were used to determine the association between SAP and allergic reaction (defined as a charge for epinephrine or ICD-9 diagnosis code for allergic reaction on the date of surgery) and any of the following within 30 days: SSI, hospital readmission or any repeat hospital encounter. Mixed effects logistic regression was performed, controlling for age, race, and insurance, and clustering of similar practice patterns by hospital. RESULTS A total of 71,767 patients were included: median age was 4.6 years, 61.4% were white, and 49.3% had public insurance; 33.5% received SAP. Of these participants, 996/71,767 (1.4%) had a perioperative allergic reaction and <0.1% were diagnosed with an SSI. On mixed effects logistic regression, those who received SAP had 1.2 times the odds of a perioperative allergic reaction compared with those who did not receive SAP (P = 0.005). Surgical antibiotic prophylaxis was not associated with decreased rates of SSI, lower hospital readmission, nor a lower chance of a repeat encounter within 30 days. CONCLUSIONS In patients undergoing orchiopexy, it was found that SAP did not reduce the risk of postoperative SSI, readmissions, or hospital visits. Patients who received SAP had significantly increased odds of perioperative allergic reaction. This demonstrated that the risks of SAP outweigh the benefits in children undergoing orchiopexy.
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Williams K, Baumann L, Shah A, Abdullah F, Johnson EK, Oyetunji TA. Age at orchiopexy for undescended testis in the United States. J Pediatr Surg 2017; 53:S0022-3468(17)30642-5. [PMID: 29102151 DOI: 10.1016/j.jpedsurg.2017.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level. METHODS We retrospectively reviewed both the State Ambulatory Surgery Database (SASD) in 2012 and the Pediatric Health Information System (PHIS) for 2015. All patients aged 18years or less with a diagnosis of UDT who underwent orchiopexy were included. Demographic data including age at repair as well as surgical subspecialty and payer status were extracted. RESULTS Analysis of the 2012 SASD for New Jersey, Florida, and Maryland yielded 1654 patients. The majority were white, 791 (48.3%), with a median age at repair of 4years (IQR 1-8). Most patients, 1048 (64%), had orchiopexy later than age 2. A total of 844 males were identified from the PHIS database. Of these, 63% were white. The median age at repair was 5years (IQR 1-9). There were 577 (68%) patients older than 2years at orchiopexy. CONCLUSION Almost 70% of boys with undescended testes in the United States are undergoing orchiopexy at least 6months later than the recommended age. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kibileri Williams
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Lauren Baumann
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Adil Shah
- Howard University Hospital, 2041 Georgia Avenue NW, Washington DC, 20060
| | - Fizan Abdullah
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
| | - Emilie K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 63, Chicago, IL, 60611; Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611
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Castañeda-Sánchez I, Tully B, Shipman M, Hoeft A, Hamby T, Palmer BW. Testicular torsion: A retrospective investigation of predictors of surgical outcomes and of remaining controversies. J Pediatr Urol 2017; 13:516.e1-4. [PMID: 28476481 DOI: 10.1016/j.jpurol.2017.03.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/25/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Testicular torsion (TT), a common surgical emergency worldwide, is typically treated with orchiectomy or orchiopexy. It is widely accepted that the chance of salvaging the testicle declines with time and degree of torsion. The impact of ethnicity on outcome is less well understood, and the association between weather and onset of TT remains a controversy. OBJECTIVES It is important to know the signs of TT so that appropriate treatment can be given quickly. The purpose of this study was to provide a detailed analysis of registered cases of TT in adolescent patients diagnosed at a single institution to better understand the association between clinical indicators and surgical outcomes and to examine some remaining controversies in the literature on TT. STUDY DESIGN A retrospective chart review was conducted, using medical records from the present institution. Data were collected for 165 patients who met the following inclusion criteria: 1) adolescent males between 10 and 18 years of age at the time of diagnosis, and 2) TT between January 2001 and June 2013. RESULTS Of the 165 patients, 38% had orchiectomies. Patients with orchiectomies had longer wait times for surgery (p < 0.0001)-but not greater driving times, driving distances, or degrees of torsion-than those with orchiopexies (Table). Yet, among patients who waited less than the median wait time to surgery (197 min), patients with orchiectomies had greater degrees of torsion than did those with orchiopexies (p = 0.02). Assuming that patients without reference to presence of bell clapper deformity in their medical notes did not have the deformity, those with orchiectomies were less likely to have bell clapper deformity than were those with orchiopexies (p < 0.01). Although mean atmospheric temperature was unassociated with onset of TT and with surgical outcome in general, patients without bell clapper deformity had TT on relatively colder days (p = 0.02). DISCUSSION AND CONCLUSION Wait time to surgery positively correlates with orchiectomy. Early identification and intervention is vital to testicular salvage. As the degree of torsion increases, the blood supply to the affected testis decreases and the time required to inflict testicular vascular damage decreases. Our results showed the presence of the bell clapper deformity moderated the relationship between temperature and TT: Those without the deformity had torsions on colder days than did those with the deformity. A comprehensive multi-centered study could help draw further conclusions regarding temperature correlation and the bell clapper deformity.
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Demirbas A, Demir DO, Ersoy E, Kabar M, Ozcan S, Karagoz MA, Demirbas O, Doluoglu OG. Should manual detorsion be a routine part of treatment in testicular torsion? BMC Urol 2017; 17:84. [PMID: 28915866 PMCID: PMC5602835 DOI: 10.1186/s12894-017-0276-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background It was aimed to investigate the efficiency and reliability of the manual detorsion (MD) procedure in patients diagnosed with testicular torsion (TT). Methods A retrospective analysis was made of the data of 57 patients diagnosed with TT, comprising 20 patients with successful MD (Group I), 28 patients who underwent emergency orchiopexy (Group II), and 9 patients applied with orchiectomy (Group III). The groups were compared in respect of age, and duration of pain. The success rate of MD, the time of testicular fixation (TF), any problems encountered in follow-up, and follow-up times were analyzed in Group I. Data were analyzed with P-P pilot, Mann-Whitney U, Kruskal Wallis and Chi-square tests. A value of p < 0.05 was considered statistically significant. Results MD was successful and detorsion could be achieved in 20 of 26 patients. The groups were similar in respect of age (p = 0.217). The median duration of pain was 3 (1–8), 4 (1–72), and 48 (12–144) hours in Groups I, II, and III, respectively, and determined as similar in Groups I and II (p = 0.257), although a statistically significant difference was determined between the 3 groups (p < 0.001). TF was applied to Group I after median 10 (0–45) days, and no parenchymal disorder was determined in the median follow-up period of 21.5 (2–40) months. Conclusion MD that can be easily and immediately performed after the diagnosis of TT decreases ischemia time. This seems to be an efficient and reliable procedure when applied together with elective orchiopexy, as a part of the treatment. Electronic supplementary material The online version of this article (10.1186/s12894-017-0276-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arif Demirbas
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey.
| | - Demirhan Orsan Demir
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Erim Ersoy
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Mucahit Kabar
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Serkan Ozcan
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
| | - Ozgecan Demirbas
- Department of Pediatrics, Ankara Dr. Sami Ulus Women Health, Children's Training and Research Hospital, 06340, Ankara, Turkey
| | - Omer Gokhan Doluoglu
- Department of Urology, Ankara Training and Research Hospital, 06340, Sukriye, Altındağ Ankara, Turkey
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