Case Of Testicular Atrophy Research Articles

750 LAPAROSCOPIC VERSUS OPEN ORCHIOPEXY IN THE MANAGEMENT OF ABDOMINAL TESTIS: A DESCRIPTIVE STUDY

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013750 LAPAROSCOPIC VERSUS OPEN ORCHIOPEXY IN THE MANAGEMENT OF ABDOMINAL TESTIS: A DESCRIPTIVE STUDY Ahmad Abolyosr Ahmad AbolyosrAhmad Abolyosr Qena, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.313AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment of patients with abdominal non-palpable testis (NPT) is still controversial among pediatric urologists. This is a prospective randomized comparative study between open and laparoscopic orchiopexy for management of abdominal testis. The aim of this study was to evaluate the success rate and morbidity of both approaches. METHODS Eighty-two patients with a mean age of 5.3 years were evaluated by laparoscopy for 87 NPT. Patients with viable abdominal testes were randomly treated with either open or laparoscopic orchiopexy procedures. RESULTS On laparoscopy, 75 viable abdominal testes were found. According to location: 41 (47.1%) testes were high abdominal, 27 (31%) testes were low abdominal and 7 (8%) testes were peeping from the internal ring. Laparoscopic first stage Fowler–Stephens orchiopexy was done initially for those with high abdominal testes. For further management, all patients were divided randomly into open (36 cases) and laparoscopic (39 cases) groups where primary (with spermatic vessel preservation) or second stage Fowler-Stephens orchiopexy was done. Statistical analysis was done using Student's t-test. Laparoscopic procedures showed significant less morbidity than the open counterparts. Follow up ranged from 9 to 31 months and included evaluation of testicular site and size. All testes were located satisfactorily inside the scrotum. Five cases of testicular atrophy were encountered (three and two testes with open and laparoscopic second stage Fowler-Stephens orchiopexy respectively) after 1 year follow up. CONCLUSIONS Results of open versus laparoscopic orchiopexy procedures (primary or staged) are fairly comparable. However, laparoscopy provides significantly less morbidity. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e308-e309 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmad Abolyosr Qena, Egypt More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Syndrome de Prune Belly : aspects épidémiologiques, cliniques et thérapeutiques

Prune Belly syndrome (PBS) is a rare complex malformation with male predominance. His pathogeny is not yet completely elucidated. The goal of this work is to analyze the epidemiological, anatomoclinical and treatment aspects of a retrospective trial in Aristide-Le-Dantec Hospital. We carried out a retrospective study about 22 cases collected in the departments of urology-andrology and pediatric surgery in Aristide-Le-Dantec Hospital between April 1995 and November 2004. The mean age of the patients was 15 months with extremes of one day and 10 years. The somatic examination revealed 20 cases of complete abdominal muscle aplasia, one right partial form and the last case had a left partial form. Nineteen patients were managed with conservative treatment and three patients benefited a surgical act for urinary abnormalities. The Montfort intervention was performed in two patients respectively aged eight and 10 years. The orchidopexy, stage 1, by Fowler-Stephens technique was performed in 13 cases. Five cases of death and nine cases of testicular atrophy after orchidopexy occurred. The followings were satisfactory in the three operated patients for urinary abnormalities. The renal failure is the main cause of death. The management of the urinary tract abnormalities must be performed individually. The testis descending should be performed in newborn period to enhance the fertility chances. The abdominoplasty also should be done early for aesthetic reason and to improve pulmonary, defecation, and voiding functions.

Trauma to male genital organs: a 10‐year review of 156 patients, including 118 treated by surgery

To assess testicular rupture, scrotal haematoma, penile fracture and penile injury, comparing the prognoses of surgery and conservative management, as trauma to male external genital organs can cause devastating effects on patients and their partners. We reviewed the medical records of 156 male patients who presented to our emergency centre with trauma to the external genital organs between January 1996 and March 2006. In all, 74 patients had testicular rupture, 32 penile fracture, 26 a penile injury and 24 a scrotal haematoma (mean age 27.8 years). The main cause of trauma was assault (52, 33%). Four of 14 patients with penile trauma who were managed conservatively had complications. Of 20 patients, 17 had a partial orchidectomy and were followed for a month after surgery; scrotal ultrasonography showed three cases of testicular atrophy. The mean hospital stay was less for patients with surgical intervention, at 6.4 days, than for those managed conservatively, at 8.7 days (P < 0.05). A visual analogue pain scale showed less pain in patients who were surgically treated (P < 0.05). Prompt surgical intervention is crucial; it should be considered by urologists, and is strongly recommended. Ultrasonography was highly sensitive and specific, and should be used in all patients with trauma to the external genital organs, to aid diagnosis and evaluation before surgery.

Scrotal Incision Orchiopexy for Undescended Testes With or Without a Patent Processus Vaginalis

Bianchi and Squire first described scrotal incision orchiopexy as an alternative to the traditional inguinal approach in the 1980s. The goal of this study was to review our series of scrotal orchiopexies to evaluate operative times, success rates and complications in patients with and without a patent processus vaginalis. A total of 121 scrotal incision orchiopexies were performed in 103 patients with palpable undescended testes between November 2002 and January 2006. This technique involves manipulation of the testis down to the scrotum so that it is secured between the thumb and index finger as fixation is performed. Charts were retrospectively reviewed to assess operative times as well as position and size of the testes at followup. Patient age ranged from 6 months to 13 years (mean 4.5 years). The processus vaginalis was patent in 75 testes (62%). A total of 121 testes (100%) were successfully placed within the scrotum using a single incision. Operative times ranged from 7 to 36 minutes (mean 18.9). There were no cases of testicular atrophy or ascent, hernia or hydrocele formation with followup that ranged from 6 months to 1 year. The only complications were 4 wound infections (3.3%), which were successfully treated with antibiotics. The scrotal incision technique is an underused method of orchiopexy regardless of patency of the processus vaginalis. Shorter operative times, comparable success and complication rates, and a more cosmetically appealing result compared to the traditional inguinal approach make scrotal orchiopexy an attractive alternative.

Laparoscopic versus open orchiopexy in the management of abdominal testis: A descriptive study

Treatment of patients with abdominal non-palpable testis (NPT) is still controversial among pediatric urologists. This is a prospective randomized comparative study between open and laparoscopic orchiopexy for management of abdominal testis. The aim of this study was to evaluate the success rate and morbidity of both approaches. Eighty-two patients with a mean age of 5.3 years were evaluated by laparoscopy for 87 NPT. Patients with viable abdominal testes were randomly treated with either open or laparoscopic orchiopexy procedures. On laparoscopy, 75 viable abdominal testes were found. According to location: 41 (47.1%) testes were high abdominal, 27 (31%) testes were low abdominal and 7 (8%) testes were peeping from the internal ring. Laparoscopic first stage Fowler-Stephens orchiopexy was done initially for those with high abdominal testes. For further management, all patients were divided randomly into open (36 cases) and laparoscopic (39 cases) groups where primary (with spermatic vessel preservation) or second stage Fowler-Stephens orchiopexy was done. Statistical analysis was done using Student's t-test. Laparoscopic procedures showed significant less morbidity than the open counterparts. Follow up ranged from 9 to 31 months and included evaluation of testicular site and size. All testes were located satisfactorily inside the scrotum. Five cases of testicular atrophy were encountered (three and two testes with open and laparoscopic second stage Fowler-Stephens orchiopexy respectively) after 1 year follow up. Results of open versus laparoscopic orchiopexy procedures (primary or staged) are fairly comparable. However, laparoscopy provides significantly less morbidity.

Laparoscopic orchiopexy: report of 203 cases with review of diagnosis, operative technique, and lessons learned.

Proper management of the nonpalpable testicle requires an accurate diagnosis. Laparoscopic orchiopexy (LO) has become the standard for diagnosis and treatment. We classified the location of nonpalpable testicles, reviewed the technique of LO in detail, and report the results of our series, the largest described to date. We compiled the records of all cryptorchid patients seen between 1994 and 2002. Those with testicles located near the internal inguinal ring and those with nonpalpable testicles underwent laparoscopy and LO in the same session. The 173 patients underwent 203 procedures, all performed by the senior authors. The undescended testicles were right-sided in 33% of patients, left-sided in 53%, and bilateral in 14%. Six testicles were excluded because of hypotrophy (N=4) or agenesis of the vas deferens (N=2). At laparoscopy, 58% of the testicles were at the iliac vessels or higher (high intra-abdominal), 22% were between the iliac vessels and the internal ring (low intra-abdominal), 16% were peeping, 3% were intracanicular, and 1% were retrovesical. Standard LO was performed in 70.5% of the patients, with the remainder being treated by laparoscopic Fowler-Stephens orchiopexy. There have been four cases of testicular atrophy, all after Fowler-Stephens procedures. Two were virgin gonads, and the other two had previously been subjected to extensive orchiolysis. Only 3% of the patients required repeat surgery because of an unsatisfactory testicular location. The reported success rate for LO of intra-abdominal testicles has far exceeded that of open repair (95% v 76%). It is our belief that minimal manipulation of the testicle during dissection, a wider peritoneal window, and sparse use of electrocautery will result in adequate testicular position even for high intra-abdominal gonads with minimal risk of atrophy.

The incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral germ cell testicular cancer in Hungary.

To examine the incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral testicular cancer in the referral center in Hungary, to determine which parameters might predict a second testicular tumor. . Clinical parameters-such as time of original surgery, histology of primary tumor, extent of the disease, serum marker concentrations, history of testicular abnormalities, treatment, response to treatment, follow-up period, data on second carcinoma-of bilateral testicular tumors among the 2,386 patients with testicular cancer treated between November 1988 and November 1998 were analyzed. The incidence of patients with synchronous testicular tumor was 0.8% (19 of 2,386 patients). The clinical stages were 8 I/A, 5 I/B, 1 II/A, 2 II/B, 1 III/A, and 2 III/B. Median follow-up time was 93 months and the 5-year overall survival was 84%. The incidence of patients with metachronous testicular cancer (median age 28 years and 35 years at first and second tumor diagnosis) was 2.2% (53 of 2,386 patients) and the median time to second tumor was 76 months (range 18-203 months). The clinical stages at the first and second tumor diagnosis were: 14 I/A, 21 I/B, 15 II/A, 2 II/B, and 1 III/B, and 26 I/A, 16 I/B, 3 II/A, 1 II/B, 7 III/B, respectively. The median follow-up time was 42 months and the 5-year overall survival was 93%. In thirteen patients with metachronous cancers, two family histories of testicular cancer, five cases of undescended testicles, seven cases of testicular atrophy, and one case of azoospermia were detected. There was a non-significant trend to a longer cancer interval after chemotherapy and radiotherapy and a tendency to a greater incidence of asynchronous seminoma after chemotherapy. Clinical stage I tumors were more frequent in the surveyed group than among patients not followed up according to the institutional protocol ( P = 0.01), but the survival rate was good in both groups. Seminoma as a second tumor was diagnosed in an older age group (median 38 years, range 25-49 years) than nonseminoma (median 32 years, range 21-51 years, P < 0.045). The interval till the appearance of a metachronous testicular cancer depended on tumor histology: in seminoma cases it was longer than in nonseminoma cases (median time: 121 months versus 50 months, P = 0.002). The overall incidence of bilateral testicular cancer in the referral center in Hungary was 3%. We could not identify clinical factors which predicted a higher risk for metachronous testicular cancer. With regular follow-up the early diagnosis of second testicular tumors is probable; therefore education, self-examination of the remaining testicle, and long-term follow-up are important in early detection.

Management of chronic testalgia by microsurgical testicular denervation.

Chronic testicular pain (CTP) is defined as uni- or bilateral, intermittent or continuous testicular discomfort of at least 3 months duration that interferes with the patient's daily activities and prompts him to seek medical advice is a rather common urological manifestation of chronic pain syndrome. Diagnosis and treatment of CTP has been a difficult and often unrewarding clinical situation. Success rates of conservative and surgical measures including epididymectomy and orchiectomy rarely exceed 55-73% and 10-40%, respectively. We report our experience on microsurgical testicular denervation as therapeutic option in CTP. Following an extensive preoperative work-up (urine/semen cultures, transrectal ultrasound, testicular sonography, pain and orthopedic consultation) not revealing any pathologic abnormalities and a positive response to spermatic cord block, 35 patients underwent microsurgical testicular denervation. In brief, spermatic cord was dissected, vas deferens, cremasteric muscle and testicular vessels were separated. After identification of the testicular artery by application of vasodilatating agents using magnifying loops or the operating microscope, all structures besides the testicular artery, vas deferens and 1-2 lymphatic vessels were coagulated and transsected using bipolar diathermy. After a mean follow-up of 31.5 months 34/35 (96%) patients are completely pain-free; no intra- or postoperative complications were encountered. No case of testicular atrophy or hydrocele formation was observed during postoperative follow-up. Microsurgical testicular denervation results in reliable and reproducible excellent therapeutic success rates of 96% and should be integrated in the management of CTP at an early stage. High success rates require adequate and meticulous diagnostic work-up of the patients by spermatic cord block using saline as placebo and different local anaesthetics as an initial therapeutic armentarium predicting postoperative outcome.

Morbidity after neonatal inguinal herniotomy

Neonatal inguinal herniotomy is recognised by paediatric surgeons to be a potentially difficult procedure. This study reviewed the clinical, operative, and outcome details of 74 infants undergoing herniotomy at less than 44 weeks' gestation with particular reference to the incidence of complications such as recurrent hernia and testicular atrophy. Follow-up information was obtained in 69 patients (93%, mean follow-up, 8.1 months). There were 8 recurrent hernias in 5 patients (2 bilateral recurrences, 1 second recurrence) giving an overall hernia recurrence rate of 8.6%. There was only 1 case of testicular atrophy (secondary to a wound infection and scrotal abscess). Despite the provision of a consultant-led service, the recurrence rate in neonates is much higher than that seen in the paediatric population as a whole. In light of commissioners' current demands for quality standards and managed healthcare, it is important that outcomes in this high-risk group are defined separately from those of other patients undergoing inguinal herniotomy.

Color Doppler Imaging in the Diagnosis of the Acute Scrotum

To determine the value of color Doppler imaging (CDI) in the diagnosis of acute scrotum. We evaluated 102 consecutive patients referred to our institution with scrotal pain. All patients were evaluated by physical examination, ultrasound with stethoscopic Doppler followed by CDI. Radionuclide scanning was performed only in 14 patients. Patients with a diagnosis of testicular torsion by CDI underwent surgical exploration. Patients with CDI diagnosis of epididymorchitis were treated with intravenous antibodies and underwent repeat CDI evaluation after treatment. Of the 102 patients evaluated ages 11-44, CDI diagnosed 18 patients with testicular torsion and 78 patients with epididymorchitis. Cases of testicular torsion were found to have absent flow on CDI. CDI findings of normal or increased flow were present in all patients with epididymorchitis. All cases of torsion were confirmed on surgical exploration, 11 patients underwent orchidopexy and 7 patients underwent orchiectomy. No cases of testicular atrophy were encountered on long-term follow-up in patients with epididymorchitis. Diagnoses in the remaining patients were testicular tumor 1, testicular abscess 2, scrotal hematoma 2 and incarcerated hernia 1. CDI was found to be 100% sensitive and 100% specific in the diagnosis of the acute scrotum. We found CDI to be more accurate and reliable than physical examination in conjunction with gray-scale ultrasound and Doppler stethoscopic examination in the differential diagnosis of the acute scrotum. CDI is practical and can be performed in a rapid manner. CDI should become an integral part of the urologist's armamentarium in the differential diagnosis of the acute scrotum.

Inguinal herniotomy in young infants, with emphasis on premature neonates

Over a period of 6 years, 251 infants under 6 months of age underwent repair of inguinal hernias (IH; n = 311). There were 241 males and 10 females. Incarceration occurred in 59 infants (24%), one of whom had bilateral incarceration. As a result of the authors' policy to operate on infantile IH within 7 days of diagnosis, only 6% of the incarcerations occurred in already diagnosed cases. Sedation and taxis did not reduce the hernia in 22 cases (38%); transpertioneal closure of the internal ring was performed in 14 of these. Eighty-nine infants (36%) were born premature; thirty-nine (41%) of these had been ventilated before, a possible cause of the hernia. Bilateral presentation was more common in the premature infants (35% v 17%); surprisingly, incarceration was less common (13% v 24%). Hence, the policy of delaying herniotomy until discharge from the neonatal unit was justified. During follow-up, six recurrences were noted and two cases of testicular atrophy.

A study of testicular tumor on magnetic resonance imaging

Magnetic resonance imaging (MRI) was performed on 13 testes of 12 patients with testicular abnormalities. In all cases, scrotal palpation and initial clinical course had suggested malignant testicular tumors. The normal testes showed homogeneous intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images such as the appearance of the corpus cavernosum penis. Ten patients proved to have testicular tumors. In eight of them, the tumors showed homogeneous intermediate signal intensity on T1-weighted images, while in the other two, these images showed heterogeneous signal intensity. In four patients, tumors were of homogeneous low signal intensity on T2-weighted images, while in the other six, these images showed heterogeneous signal intensity. The rate of correspondence about local staging of testicular tumor between MRI and pathological diagnosis was 70 percent. In three patients whose testes were undoubtedly malignant according to clinical findings and examination data, MRI enabled us to diagnose one case of testicular atrophy. However, MRI suggested benign disease in the other two patients; nevertheless, surgery was performed as indicated by the other findings.

Microsurgical Inguinal Varicocelectomy With Delivery of the Testis: An Artery and Lymphatic Sparing Technique

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. We describe a microsurgical technique of varicocelectomy that significantly lowers the incidence of these complications. The testicle is delivered through a 2 to 3cm. inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under the operating microscope. The testicular artery and lymphatics are identified and preserved. All internal spermatic veins are doubly ligated with small hemoclips or 4-zero silk and divided. The vas deferens and its vessels are preserved.Initially, we performed 33 conventional inguinal varicocelectomies in 24 men without delivery of the testis or use of a microscope. Postoperatively, 3 unilateral hydroceles (9%) and 3 unilateral recurrences (9%) were detected. For the next 12 cases 2.5X loupes were used resulting in no hydroceles but another recurrence (8%). We then performed 640 varicocelectomies in 429 men using the microsurgical technique with delivery of the testis. Among 382 men available for followup examination from 6 months to 7 years postoperatively no hydroceles and no cases of testicular atrophy were found. A total of 4 unilateral recurrent varicoceles (0.6%) was identified. The differences between the techniques in the incidence of hydrocele formation and varicocele recurrence are highly significant (p <0.001). No wound infections occurred in any men. Four scrotal hematomas (0.6%), 1 of which required surgical drainage, occurred in the group with microsurgical ligation and delivery of the testis compared to none with the conventional technique. Preoperative and postoperative semen analyses (mean 3.57 analyses per patient) were obtained on 271 men. The changes in sperm count X 106cc (36.9 to 46.8, p <0.001), per cent motility (39.6 to 45.7%, p <0.001) and per cent normal forms (48.4 to 52.10%, p <0.001) were highly significant. The pregnancy rate was 152 of 357 couples (43%) followed for a minimum of 6 months postoperatively.Delivery of the testis through a small inguinal incision provides direct visual access to all possible avenues of testicular venous drainage. The operating microscope allows identification of the testicular artery, lymphatics and small venous channels. This minimally invasive, outpatient technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele recurrence.

Vascular corrosion casts of the dog testis after experimental microvascular surgical orchiopexy. A scanning electron microscope study.

Five mongrel dogs underwent microvascular surgical orchiopexy by anastomosing the testicular artery and vein with the respective caudal epigastric vessels. In order to assess the effect of a 40 to 50-min period of warm ischaemia (the time required to make the anastomosis) on the testicular blood vasculature, plastic corrosion casts were made of the operated testes and compared with non-operated control specimens. The resulting blood vessel casts were inspected in the scanning electron microscope. One case of testicular atrophy developed, caused by a postoperative wound abscess. Comparing operated with non-operated testes, no differences in vascularisation, pattern or density of arterial supply, capillary network and venous drainage were seen. These findings are in agreement with data from the literature concerning histological, hormonal and clinical results.

Course of Testicular Injury Following Accidental Exposure to Nuclear Radiations

Although Cases of testicular atrophy following exposure to ionizing radiations have been known since 1904 (1, 2) and were common in the Hiroshima and Nagasaki bombings (3, 4), little is as yet known of the ultimate fate of this lesion in man. The Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan is investigating this problem, but as yet no reports have been published (5). Experimental investigations of the effects of ionizing radiations on the testes of animals were begun in 1903 (6) and have been reviewed by Heller (7). Regeneration of the atrophic testis following irradiation has been studied in animals but not definitively in man, although many isolated case reports are to be found (8, 9, 10). Regeneration of human “germinal aplasia” from causes other than irradiation has been studied carefully, with the aid of testicular biopsies along with sperm counts (11). One case of irradiation testicular atrophy has been similarly studied (9). Sequential testicular biopsies along ...

Operative cure of inguinal hernia in infancy and childhood

1. 1. A follow-up study of eighty-eight cases of indirect inguinal hernia, in which seventy-eight patients were treated on the Children's Surgical Service of Bellevue Hospital by simple isolation and ligation of the neck of the sac, is presented. 2. 2. The follow-up comprises a period from six months to six years. 3. 3. One recurrence is noted within six months after operation, and is apparently not related to the type of operation performed. 4. 4. No case of testicular atrophy is demonstrated. 5. 5. A new method for the surgical treatment of hydrocele in the young is described.