Repeated surgical interventions for relapses of cryptorchidism in children

Abstract

The aim of the study is to demonstrate a differentiated approach to recurrent cryptorchidism treatment. Materials and methods. Over the past five years (since 2015), the staff of the Department of Pediatric Surgery of A.I. Evdokimov Moscow State University of Medicine and Dentistry, performed surgical treatment of 20 children aged 2-17 years with recurrent cryptorchidism (22 testicles). Relapse of cryptorchidism on one side was diagnosed in 18 patients. Two patients had a bilateral cryptorchidism recurrence, these children had a combined pathology in the form of Prader-Willi syndrome. In 3 children, surgical treatment at their place of residence was performed two or more times. As a preoperative preparation to increase the elasticity of blood vessels and to lengthen them, a course of human chorionic gonadotropin (hCG) hormone therapy was carried out according to the scheme. The exception was children over the age of 6-7 as administration of hCG at this age can provoke an earlier onset of puberty. Intraoperatively, in 15 children, the testicle was fixed in the scrotum according to the method of Shemaker, Herzen, and others. In 5 children with abdominal cryptorchidism, the testicle was not descended into the scrotum and was fixed in the inguinal canal due to a deficiency in the length of the spermatic cord (SC). On examination, a testicle in the middle or lower third of the inguinal canal was found in 10 patients, at the root of the scrotum - in 7. In 5 patients, the testicle was not detected. The average period between the first and repeated surgery was 3 years (from 4 months to 8 years). Upon admission, all patients underwent a clinical examination, ultrasound examination of the inguinal canals, and a study of the hormonal profile if indicated. Results. After revision of the inguinal canal, 17 testicles were successfully re-descended using the Shemaker technique. Of these, 16 testicles were fixed in the scrotum, 1 testicle - at the root of the scrotum. During the second operation, the vaginal process of the peritoneum was found in 7 children. Laparoscopically-assisted orchipexy was performed in 3 patients. Orchiectomy was performed in 5 cases due to testicular atrophy. The duration of the surgery was 55-120 minutes. There was no intraoperative blood loss. In the long-term postoperative period (after a year or more), postoperative testicular atrophy was not detected.