Microvascular orchidopexy

Abstract

Purpose In the management of the impalpable testis the one or two stage Fowler-Stephens procedure or orchidopexy by high testicular vessel transection with microvascular reanastomosis of the testicular vessels to the inferior epigastric vessels have been suggested. The Fowler-Stephens procedure has a success rate of no greater than 80%. However, there are reports that more than 90% success rate of autotransplantation. In this study two patients with nonpalpable testis treated with microvascular orchidopexy was presented. Material and methods Two patients 2 and 8 years old presented with bilateral nonpalpable testes. No testis was found at physical examination. On laparoscopy, both testes were found at intraabdominal position in each patient and microvascular orchidepexy was planned. Both intraabdominal testis of each patient was brought to the scrotum by microvascular technique. At microvascular orchidopexy, the testis and vessels are exposed and divided near their origin and anastomosed to the inferior epigastric artery and vein by microsurgical technique using 10-zero nylon suture and 24 times magnification. Testicular biopsies were also taken. Results At the follow-up exam after one year both testes of one patient and one testis of the other patient maintaining normal size were palpated at scrotum. Doppler ultrasound examination showed sufficient blood supply of these three testes. Conclusions Autotransplantation of an intraabdominal testis is a safe and reliable procedure even in small children and should be considered as a treatment option for nonpalpable testis. In the management of the impalpable testis the one or two stage Fowler-Stephens procedure or orchidopexy by high testicular vessel transection with microvascular reanastomosis of the testicular vessels to the inferior epigastric vessels have been suggested. The Fowler-Stephens procedure has a success rate of no greater than 80%. However, there are reports that more than 90% success rate of autotransplantation. In this study two patients with nonpalpable testis treated with microvascular orchidopexy was presented. Two patients 2 and 8 years old presented with bilateral nonpalpable testes. No testis was found at physical examination. On laparoscopy, both testes were found at intraabdominal position in each patient and microvascular orchidepexy was planned. Both intraabdominal testis of each patient was brought to the scrotum by microvascular technique. At microvascular orchidopexy, the testis and vessels are exposed and divided near their origin and anastomosed to the inferior epigastric artery and vein by microsurgical technique using 10-zero nylon suture and 24 times magnification. Testicular biopsies were also taken. At the follow-up exam after one year both testes of one patient and one testis of the other patient maintaining normal size were palpated at scrotum. Doppler ultrasound examination showed sufficient blood supply of these three testes. Autotransplantation of an intraabdominal testis is a safe and reliable procedure even in small children and should be considered as a treatment option for nonpalpable testis.