Sonographic evaluation of testicular atrophy after laparoscopic orchidopexy

Abstract

Objective Testicular atrophy is a common complication after Fowler-Stephens (F-S)orchidopexy. So far no objective method for evaluating testicular atrophy is available. Histomorphological changes of the testes secondary to the ischemia can be accurately identified by the ultrasonography, based on previous animal experiment. The aim of this study is to assess testicular atrophy after orchidopexy clinically. Methods Laparoscopic orchidopexy and laparoscopic Fowler-Stephen staged orchidopexy for impalpable cryptorchidism were reviewed. The patients were followed up with sonography on post-operative day 7 and 20 and, 3, 6 and 12 months post-operatively. The atrophy was assessment was based on the testicular volume(no change, slight reduced, marked reduced ≥ 10%),border (clear, blurry, uncertain), echogenicity (homogenous, heterogenous), microlithiasis (none,scattered, massive) and blood flow (apparent, reduced, almost none). A 3 grades sonographic classification was used. Grade O represents no atrophy whereas grade Ⅰ represents partial and grade Ⅱ complete atrophy. Results Forty-three patients with 56 testes were operated. Postoperative sonography could identify the changes within the testes. After 3 to 6 months, ultrasound changes were minimal.Grade O accounted for 75% (42/65), grade Ⅰ21 % (12/56) and Ⅱ 4% (2/56) of all the operations. Of the 35 testes without spermatic cord tension, grade Ⅰ atrophy was found in 14%. Of the 12 testes with tension grade Ⅰ was found in 25% and grade Ⅱ in 8%. Of the 9 testes in F-S group grade Ⅰ and Ⅱ atrophies were detected in 44% and 11 % of testes respectively. The testes with spermatic cord tension orunderwent F-S procedure had a significantly higher atrophic rate when compared with the testes without tension (P＜0.05). Conclusions Sonographic examination is an objective method for evaluating testicular atrophy after laparoscopic orchidopexy. The 3 grades evaluation system for testicular atrophy can be applied clinically. Key words: Cryptorchidism; Testis; Atrophy