Intra-abdominal Testicles Research Articles

A Comparison of Outcomes of Staged Laparoscopic traction Orchiopexy and Two Stage Fowler-Stephens Orchiopexy in the management of Intra-abdominal Testicle; Prospective controlled clinical trial study.

A Comparison of Outcomes of Staged Laparoscopic traction Orchiopexy and Two Stage Fowler-Stephens Orchiopexy in the management of Intra-abdominal Testicle; Prospective controlled clinical trial study.

A giant intra-abdominal right testicular seminoma in a bilateral undescended testicle: a case report

Cryptorchidism is the most common congenital malformation of the male genitourinary tract. An undescended testicle has a 10% chance of developing cancer, with an intra-abdominal testicle having the highest risk. We present a 24-year-old man with a history of bilateral cryptorchidism, complaining of lower abdominal mass for two months. An abdominal computed tomography scan showed an intra-abdominal mass lesion measuring 13 x 9 cm and displacing the bladder caudally. Exploratory laparotomy revealed a right intra-abdominal testicular tumor. A right orchiectomy and left orchidopexy was performed. Histopathological examination revealed a testicular seminoma. The patient was discharged without complications and was referred to the oncology department for chemotherapy and further management. Our findings support the early treatment and close monitoring of cases of cryptorchidism due to the risk of malignancy as well as the necessity of routine scrotal examinations in all males presenting with an abdominal mass.

Persistent Müllerian Ducts Syndrome: A Case Report

We report the case of a 6 years old child, admitted for management of testicular ectopia, the clinical examination found an empty scrotum, a normal looking penis and a urethral meatus in place. The scrotal ultrasound showed an intra-abdominal testicle (left illiac fossa) of homogeneous echostructure on the left side, while the right testicle was not visualized. The gonadotropins LH and FSH levels were low, as well as the level of testosterone, the secretion of which is stimulated after administration of Pregnyl. Laparoscopy revealed 2 gonadal formations on the same side, 2 tubes and a median formation reminiscent of the uterus. The karyotype of the patient was male 46XY, the dosage of anti Müllerian hormone (AMH) was high, confirming an abnormality of its receptors, which explains the persistence of the Müllerian ducts in this child. The child underwent a left gonadectomy with bilateral hysterectomy and adnexectomy, associated with a lowering of the right testicle. At 9 years, pubertal development was classified as T3P4 according to Tanner's classification, scrotal ultrasound showed a free left testicular compartment with testicular calcifications classified as grade 3, and tumor marker levels were normal.

Testicular, Epididymal and Vasal Anomalies in Pediatric Patients with Cryptorchid Testes and Testes with Communicating Hydrocele.

The goal of this study was to determine the prevalence of the testicular, epididymal, and vasal anomalies (TEVA) in cryptorchid and communicating hydrocele pediatric patients. Six hundred and ninety-one prepubertal boys underwent inguinal exploration for 741 undescended (UDT) or hydrocele testes. Two hundred and fifty-five TEVA were detected in 154 UDT boys, compared to 32 defects in 24 hydrocele patients (p < 0.001). The TEVA were more frequent in bilateral UDT (p = 0.009). Multiple defects were observed more frequently in the intra-abdominal testicles (p = 0.028). A correlation was found between the testicular atrophy index (TAI) and the incidence and number of TEVA in the UDT boys (p < 0.001). The smaller the testis (higher TAI), the more the defects that appeared in it and the higher the frequency of their appearance. Another correlation was established between testis position and the incidence and number of TEVA (p < 0.001). The higher the testis position, the more the defects that appeared in it and the higher the frequency of their appearance. A correlation was established between the position and the volume of the affected testis (p < 0.001). The higher the gonad position, the more severe the atrophy observed in it. The TEVA were more frequent in the UDT boys than in the hydrocele patients. We revealed that the risk of abnormal fusion between the testis, epididymis, and vas deferens is connected with the testis position (intra-abdominal testes) and bilateral non-descent.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Mar 2022This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Malignancy Yield of Testis Pathology in Older Boys and Adolescents with Cryptorchidism Patients with undescended testicles are typically operated on early in life. This is done to help maximize future fertility. Intervention also brings the testicles into a position where self-examination can be done. Cryptorchid males are known to have a markedly increased risk of malignancy. This risk appears to be related to age at intervention. Postpubertal intervention appears to double the risk as compared to prepubertal treatment. These concerns can lead to orchiectomy being chosen over orchiopexy for older males presenting with cryptorchidism. Xu et al (page 694) from Boston, Massachusetts look at this question in a single-institution retrospective review of pathology reports.1 Excluding patients with differences of sexual development, they compared the malignancy rates and types between intra-abdominal testicles and all other undescended testicles. With a median age of intervention of 15 years, 12.5% of the intra-abdominal testicles had a malignancy, whereas none of the other undescended testicles had a malignancy. The results suggest that for adolescents and peripubertal boys, late presentation of an inguinal testicle may not necessarily lead to orchiectomy. There are limitations that should be considered by the reader. The design of the study introduces sampling bias because pathology specimens are only available in those patients who underwent orchiectomy or had sampling, an action that is itself uncommon. The study also does not distinguish between patients who present with an undescended testicle from birth and those with ascended testicles. An ascended testicle would probably not have the same malignancy risk. Low Serum Inhibin B/FSH and AMH/FSH Ratios of Markers of Decreased Germ Cells in Infants with Bilateral Cryptorchidism As noted above, intervention for cryptorchidism occurs usually early on with the hopes of improving future fertility outcomes after puberty. While early intervention can help, are there other markers that can assist in predicting the risk of infertility in individual patients, particularly boys with bilateral cryptorchidism? Kato et al (page 701) from Japan look at the pre-treatment testicular position, serum hormone levels and the mean number of germ cells per tubule on transverse section in a retrospective study drawing data from over 300 boys who underwent orchiopexy from 2014 to 2019.2 All boys aged 9 years or older were excluded. Testicular biopsies were obtained from each cryptorchid patient at the time of orchiopexy. They found that patients with bilateral undescended testicles had significantly lower serum inhibin B and germ cell per tubule values. The ratios of inhibin B to FSH (follicle-stimulating hormone) levels and AMH (anti-Müllerian hormone) to FSH levels were found to be positively correlated with germ cell per tubule count in boys with bilateral cryptorchidism. For boys with unilateral cryptorchidism, these ratios did not offer any prognostic help. The key limitation of this study is that actual sperm counts and paternity rates are not available. While it may not immediately affect how we manage patients with undescended testicles, the paper suggests directions for further investigations on how to predict the long-term fertility benefits in individual patients.

P123 TAPP - THE BEST APPROACH FOR INGUINAL HERNIA ASSOCIATED WITH ADULT CRYPTORCHIDISM: CASE REPORT AND LITERATURE REVIEW

Abstract Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up. Results Cryptorchidism in adult is rare. The association with hernia is even more rare. The open management is not easy, often in pelvic/abdominal localization, the inguinal approach can be cumbersome. There is no standard of care for these cases, but we found the minimally invasive approach to be a good choice. Laparoscopic surgery has the advantage of enhanced exploration and orhidectomy can be easily performed. Associated with the orchidectomy, hernia cure can be facilitated by laparoscopic TAPP procedure. Conclusions In cases of concomitant hernia and cryptorchidism, we emphasize the idea of simultaneously cure hernia via laparoscopic TAPP procedure associated with orchidectomy as feasible and safe.

Surgical approach to prune-belly syndrome: A review of our series and novel surgical technique

Surgical management of children with Prune-belly syndrome (PBS) can be divided into three categories: urinary tract reconstruction, abdominal wall reconstruction, and orchidopexy. Adequate repair of the abdominal wall by abdominoplasty at an early age, allows an adequate aesthetic appearance, but also allows a correct development of walking, breathing, defecation and urination. To present a novel surgical technique for abdominal wall reconstruction, which combines plication with complete overlap of the fascia and neoumbilicoplasty with an island flap rotated on itself. A retrospective review of the patients with PBS who underwent surgery in our center between 2009 and 2020. A new abdominoplasty technique was performed, which consists of plication with complete overlap of the fascia, as well as a neoumbilicoplasty with an island flap rotated on itself. The skin is then well freed from the rest of planes, and the plication is performed with complete overlapping of the muscle-aponeurotic plane from one side to the other. At this time, the interposition of some type of reinforcement material (mesh) may be required in the event of complete absence or insufficient presence of the fascia and muscle. Abdominoplasty was performed in four patients. In all patients, bilateral orchidopexy was performed in the same surgical procedure for intra-abdominal testicles. The mean age of the patients at the time of surgery was 10,5 years and the average admission time was 4 days. There were no short-term or long-term complications. Average follow-up time was 7 years. All patients and their families are satisfied with the aesthetic result obtained. Abdominoplasty in patients with PBS in addition to aesthetic reconstruction, brings significant improvements to wandering, breathing, urination and defecation, improving the quality of life of the patient. Compared to the techniques described, the abdominoplasty we propose makes it possible to easily improve the abdominal wall support by means of meshes or synthetic devices if necessary and allows the evaluation and correction of cryptorchidism or other associated renal abnormalities in the same surgical act, as it allows full abdominal exposure. Likewise our modified abdominoplasty allows the creation of the new umbilicus in a more anatomical way, rectifying its natural position. In our experience, this modified surgical technique for abdominal wall repair is a novel procedure in the PBS approach, easily reproducible, which provides good aesthetic results in our series of cases.

Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results

Amaç: Nonpalpabl testis tanı ve tedavisinde laparoskopi altın standart yöntemdir. Bu çalışmamızda nonpalpabl testis olgularında laparoskopinin tanı ve tedavideki yerini, etkinliğini ve sonuçlarını tartışmayı amaçladık.Materyal ve Metod: Nonpalpabl testis tanısı ile laparoskopi planlanan 56 hasta çalışmaya dahil edildi. Hastaların yaşı, özgeçmişi, fizik muayene bulguları, laboratuar bulguları, ultrasonografi ve manyetik rezorans görüntüleme bulguları incelendi. Tüm hastalara genel anestezi altında tekrar muayene yapıldı. Nonpalpabl testis tanısı teyit edilen hastalara tanısal laparoskopi uygulandı. Laparoskopi bulguları, cerrahi prosedür ve komplikasyonlar değerlendirildi.Bulgular: Çalışmaya dahil edilen 56 hastanın yaş ortalaması 15,3±2,1 yıl idi. Hastaların 28’inde sağ, 22’sinde sol, 6’sında ise her iki testis palpe edilemedi. Sekiz hastada genel anestezi sonrası yapılan muayenede testislerin palpe edilmesi üzerine laparoskopi uygulanmadan orşiopeksi yapıldı. Testisleri palpe edilemeyen 48 hastaya ise tanısal laparoskopi uygulandı. 24 hastada spermatik kordun inguinal kanala girdiği, 15 hastada testislerin intra-abdominal yerleşimli olduğu, 7 hastada kör sonlanan spermatik kord ve 2 hastada ise testis bulunmamakla birlikte müllerien yapılar görüldü. İntra-abdominal testis bulunan hastalardan 9’una laparoskopik orşiopeksi, 6’sına ise laparoskopik orşiektomi uygulandı. Spermatik kordun inguinal kanala girdiği görülen 24 hastaya inguinal eksplorasyon yapıldı. Komplikasyon oranı %4,2 olarak bulundu. Sonuç: Nonpalpabl testis olgularında hem tanı hem de tedavi amacıyla kullanılabilen laparoskopi, düşük komplikasyon oranları ile standart olarak önerilen ve yaygın kabul gören bir yöntemdir.

PD25-12 FERTILITY POTENTIAL OF MEN TREATED FOR UNCORRECTED BILATERAL CRYPTORCHIDISM AS ADULTS: A SYSTEMATIC LITERATURE REVIEW

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD25)1 Apr 2020PD25-12 FERTILITY POTENTIAL OF MEN TREATED FOR UNCORRECTED BILATERAL CRYPTORCHIDISM AS ADULTS: A SYSTEMATIC LITERATURE REVIEW Wade Muncey*, Rahul Dutta, Ryan P. Terlecki, Lynn L. Woo, and Kyle Scarberry Wade Muncey*Wade Muncey* More articles by this author , Rahul DuttaRahul Dutta More articles by this author , Ryan P. TerleckiRyan P. Terlecki More articles by this author , Lynn L. WooLynn L. Woo More articles by this author , and Kyle ScarberryKyle Scarberry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000882.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bilateral undescended testicles (bUDT) is typically recognized early in life, but may go unaddressed into adulthood. Guidelines on post-pubertal management are lacking, and the hormonal and fertility benefits of adult orchidopexy (OP) are not well established. We aim to conduct a literature review to determine an evidence-based approach to management. METHODS: A systematic literature review, conforming to the PRISMA statement, was conducted using the PubMed/Medline databases through October 2019 using the search terms “adult cryptorchidism” and “adult orchidopexy.” Any report or series including an adult (age>17) with untreated, bilateral undescended testicles was included. RESULTS: 51 reports were identified with 209 adults with uncorrected bUDT included for analysis. Semen analysis (SA) identified azoospermia in 100% (139/139). Unilateral (23%) or bilateral (77%) OP was performed in 132 men. Intraabdominal testicles were identified in 40 patients (30%), one or both inguinal testicles in 38 (29%), or unspecified location in 54 (41%). SA after OP was reported in 43 men (age 18-38) in 14 series with 11 cases (25.6%) identifying return of sperm to ejaculate. Five reports described delayed testicular sperm extraction (TESE) in 18 men with persistent azoospermia at a median of 8 (6-168) months after OP with success in 8 (44%). Only 1 report exists of sperm obtained after OP for intraabdominal testicles. The remainder had OP for inguinal testicles (13) or unspecified location (5). Successful paternity was reported in six men: natural conception (2), intrauterine insemination (1), intracytoplasmic sperm injection (ICSI) with ejaculated sperm (1), and TESE + ICSI (2). TESE was performed in 12 men at time of OP with 0% sperm retrieval. One man had successful TESE 84 months after failed TESE during OP. Pathology of 55 UDTs in 40 men following pre-OP biopsy (64%) or contralateral orchiectomy (36%) revealed no cases (0%) of mature spermatozoa identification and complete lack of germ cells in 51%. Median testosterone in 67 men was 360 ng/dl (90-700), with hypogonadism identified in 9 (13%), but normal puberty reported in all. One report noted de novo hypogonadism post-OP. CONCLUSIONS: Azoospermia is the rule in adults with uncorrected bUDT, but testosterone is sufficient for pubertal development. Adult orchidopexy can restore spermatogenesis, with retrieval noted from ejaculate or TESE. TESE of the uncorrected UDT is of limited benefit and should be abandoned and reserved for after OP. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e543-e543 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wade Muncey* More articles by this author Rahul Dutta More articles by this author Ryan P. Terlecki More articles by this author Lynn L. Woo More articles by this author Kyle Scarberry More articles by this author Expand All Advertisement PDF downloadLoading ...

Sutureless Laparoscopic Inguinal Hernia Repair in Children − Don’t Risk Injury with Sutures

Introduction: There have been multiple descriptions for the laparoscopic repair of inguinal hernia in children. Except for one, they all involve a suture ligation of the internal ring. Our concern is that suture ligation of the internal ring can injure the vas deferens, gonadal vessels, or cause unnecessary bleeding. We report the results of our laparoscopic inguinal hernia repairs, where we incise the peritoneum of the internal ring, and dissect the tunica vaginalis for 1 cm. We do not suture ligate the internal ring. This includes patients who underwent laparoscopic evaluation and treatment for intraabdominal testicles, and thus have 6 month laparoscopic follow-up of those patients having a staged orchiopexy. Study design: We reviewed the charts from 2005 to 2016 of all patients with CPT codes 54692 (laparoscopic orchiopexy) and 49650 (laparoscopic inguinal hernia). During laparoscopy for the nonpalpable testicle, we proceeded to either a one stage or 2 stage orchiopexy. When we observed inguinal hernia opening on the contralateral side of the undescended testicle, we repaired it by incising around the internal ring, and carefully excising the tunica vaginalis from the internal ring for a distance of 1 cm, leaving the internal oblique muscle to heal together, and peritoneum to resurface the area, without using sutures. (This is the same as is done for the laparoscopic orchiopexy side). In those patients with a staged orchiopexy, and we reevaluated the hernia sight for closure. Results: We reviewed charts of 87 patients with ages ranging from 3 months to 10 years. Eighteen of these had bilateral laparoscopic orchiopexy, 38 had left, and 24 had right. We performed 21 bilateral laparoscopic hernia repairs, 27 had left only, and 18 had right only. Of those patients with hernias, 11 hernias were found on the side opposite an undescended testis. In 4 patients we had the opportunity to perform a second stage orchiopexy six months later and observed the inguinal ring had closed. Follow up was at least 6 months for all patients, and no clinical hernias resulted. Conclusion: Laparoscopic inguinal hernia repair in children can be successfully and safely performed by excising the hernia sac (patent processus vaginalis) from the inguinal canal, and does not require suture ligation of the internal ring.

The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes.

IntroductionThe aim of our study was to evaluate testicular growth and risk of atrophy at different lengths of time from the 2SLF-SO in boys with intra-abdominal cryptorchidism.Material and methodsTwenty-seven boys aged one to 24 months were treated for 35 non-palpable testes. Twenty-one boys with 29 IAT underwent a two-stage laparoscopic Fowler-Stephens operation. The patients underwent ultrasound examination of the TV at six time points: before treatment (TP1), 3 months (TP2) and 9–12 months after laparoscopic F-S operation (TP3), 3 months after inguinal orchidopexy (TP4), 3–6 years of age (TP5) and 7–9 years of age (TP6). The testicular atrophy index (TAI) of the affected testicle was calculated.ResultsThe overall success rate of treatment was 93.1% (27/29). The median volume of the affected testicles before treatment was less than the median TV of the healthy gonad, but increased systematically at the successive time points, showing significant growth between the second and sixth time points (p < 0.02, R = 2.75). The median TAI value decreased at the subsequent time points from the level of 26% at TP1 to 5.4% at TP6, with no significant difference.ConclusionsTwo-stage laparoscopic Fowler-Stevens operation proved to be an effective procedure for the treatment of intra-abdominal testicles. The undescended testis had a chance to grow and to equalize with the healthy testis after this procedure. The incidence of testicular atrophy was low.

Microdissection TESE (mTESE) following adult orchidopexy for undescended intra‐abdominal and inguinal testicles – surgical techniques and outcomes from a single‐centre cohort

Adult undescended testicles (UDTs) often present to fertility specialists with subfertility or azoospermia and with either an intra-abdominal or inguinal testicle(s). Performing an orchidopexy followed by a surgical sperm retrieval (SSR) is a potential option to retrieve spermatozoa. A microdissection TESE (mTESE) procedure is performed to retrieve mature spermatozoa for use in ICSI. This paper reviews the outcomes of mTESE in adults following an orchidopexy. A cohort of azoospermic patients underwent adult orchidopexy over a 10-year period at a single specialist centre. Data were collected retrospectively from the patient records retrieved from an institutional database. All patients underwent pre-operative imaging to localize the testicles, serum testosterone levels and a semen analysis. Separate intraoperative testicular biopsies were performed to exclude intratubular germ cell neoplasia (ITGCN) and to analyse the Johnsen score. Twelve patients (age range 18-36years) underwent orchidopexy procedures for either intra-abdominal or inguinal testicles. Mean follow-up was 34months (range 13-58). Ninety per cent of patients had bilateral UDT with azoospermia. Pre-operative testosterone levels were within the normal range (mean 13.9nmol/L; range 9.1-24.2). Five pelvic testicles (from four patients) were brought down and underwent a delayed mTESE. A total of nine inguinal orchidopexy procedures were carried out in eight men, and spermatozoa were found and preserved in three patients. None of the men with intra-abdominal testicles had mature spermatozoa present following a delayed mTESE. Overall, SSR was successful in 37.5% of the patients. Histological analysis showed no cases of ITGCN and the Johnsen scores ranged from 1 to 3.3. Microdissection TESE following orchidopexy for inguinal testicles can result in a successful SSR in over 1/3rd of patients. Intra-abdominal testicles appear to lack spermatogonia although the testicles can still be preserved for endogenous hormone production. Adult orchidopexy allows preservation of endogenous testosterone, easier self-examination and an immediate or delayed mTESEin azoospermic patients.

Inferior vena cava thrombosis as a complication of Crohn’s disease

Twenty-nine years old male, a case of Crohn's disease diagnosed by histopathology 5 years back, when he developed a perforative peritonitis. Resection and anastomosis was done, and he was started on Mesalamine therapy. Patient stopped the drug 8 months back and presented with cough for 1-month duration. HRCT chest showed IVC thrombosis. CECT abdomen showed intrahepatic extension of thrombus with active colitis and absent left testicle in scrotum with no intra-abdominal testicle. Coagulation parameters were normal. Colonoscopy and biopsy was done showing features of active Crohn's disease. Patient was restarted on Mesalamine and anticoagulation. Follow up imaging showed features of resolution of thrombus.

Impact of concomitant hernia repair at the time of complete primary repair of bladder exstrophy

Inguinal hernias are common in the bladder exstrophy population. As these hernias may present with incarceration following bladder closure, several groups recommend inguinal exploration and hernia repair at the time of initial bladder closure. However, the benefits of such an approach are not well defined. In 2006, we modified our approach to this condition by routinely performing concomitant inguinal herniorraphy (CIH) repair at the time of initial exstrophy repair. The aim of this study was to test the hypothesis that simultaneous inguinal hernia repair will be safe and effective in reducing subsequent unplanned inguinal procedures in this high-risk group. We conducted a retrospective chart review of patients with classic bladder exstrophy managed with complete primary repair (CPRE) from 1990 to 2014, with focus on inguinal hernia repair at the time of bladder closure and subsequent need for inguinal surgery. We excluded patients with follow-up less than 6 months, missing data with regards to the initial inguinal approach at the time of bladder closure, and patients with intra-abdominal testicles. A total of 43 patients were included for analysis with 27 (61%) having inguinal hernias identified either at birth or in subsequent follow-up, including 20 of 27 boys and 7 of 16 girls. A summary of comparison groups with and without CIH at the time of CPRE, as well as follow-up and need for subsequent hernia repair, is given in the summary Table. Of 25 patients without concomitant inguinal herniorraphy at CPRE, 10 patients required subsequent inguinal surgeries for inguinal herniorraphy (seven), orchiopexy (one), or inguinal herniorraphy plus orchiopexy (two). CIH at the time of CPRE is safe, with no significant inguinal complications noted. Subsequent inguinal operations were more often required in the cohort of patients not receiving CIH at the time of CPRE, including one patient presenting with incarceration. Thus, CIH appears to reduce need for subsequent inguinal operations when performed at the time of bladder closure. Our study adds to other authors' claims that CIH should be attempted at the time of bladder closure. This study is limited by the retrospective nature of the review and differences in follow-up times between groups. Simultaneous inguinal hernia repair at the time of initial exstrophy repair is safe and associated with decreased incidence of subsequent inguinal surgery. Such an approach should be undertaken during initial bladder closure.

Laparoscopic treatment of nonpalpable testicle. Factors predictive for diminished size

PurposeThe purposes of this study were to demonstrate the usefulness of laparoscopy in intraabdominal testicle (IAT) and to determine factors associated with diminished size during the final outcome after laparoscopic orchidopexy. MethodsThis is a retrospective analysis of consecutive patients from 1999 to 2013 with a minimum follow-up of 1year. Patient and testicular factors were related to diminished size. ResultsSixty one patients, and 92 testicles were included. Median age at operation was 42months. Initially we found 66 normal sized testes (71.7%), 22 hypotrophic (23.9%) and four atrophic (4.3%). Eighty seven testes were brought down laparoscopically, 50 in one surgical stage and 37 in two stages. Mean follow-up was 40.2months and the final outcome was success: 73.5% and diminished size: 26.5%. Variables associated with diminished size were hypotrophy during initial evaluation, short spermatic vessels, section of spermatic vessels, two-stage surgery and tension to reach contralateral inguinal ring. Multivariate analysis showed that initial hypotrophy (odds ratio [OR] 4.96, confidence interval 95% [CI] 1.36–18.10) and tension to reach contralateral ring (OR 4.11, 95% CI 1.18–14.34) were associated with diminished size. ConclusionsLaparoscopy is useful in treating IAT. Initial size and tension to reach contralateral ring are factors associated with diminished size.

La laparoscopie chez le cheval

Laparoscopy in the horse. Equine laparoscopy was described for the first time in the seventies. Thanks to the work of Wilson in the eighties, it has developped and is currently widely used by veterinary surgeons. Several types of procedures have been reported : (1) explorative laparoscopy is used for diagnosis and biopsy ; (2) organs such as ovary, intraabdominal testicle and kidney can be removed ; (3) gastro-intestinal diseases can be prevented like strangulated inguinal hernia by hernioraphy of the internal inguinal ring ; (4) repair of organs can be performed such as ruptured bladder in the foal ; and (5) pain of the ovary ligaments can be treated. This article describes the caracteristics of laparoscopy in the horse

Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler-Stephens procedure.

Testicular survival following second-stage Fowler-Stephens (FS) procedure depends upon adequate arterial supply. There is evidence that testicular survival rates are greater following gubernaculum-sparing second-stage FS procedure. The importance of collateral vessels in preservation of the testis has been hypothesised, but never shown in the literature. We aim to map the collateral blood supply to the testicle in gubernaculum-sparing, laparoscopic-assisted, second-stage FS procedure for intra-abdominal testicles. Selected patients undergoing a second-stage FS procedure were photographed prior to pexy in the Dartos pouch. Photographs were evaluated for the extent of vascular collateralisation between gubernacular, deferential and the ligated spermatic artery. Twenty-five patients with 28 undescended testicles underwent staged FS procedure over a 7.5-year period between 2005 and April 2013. Mean age at operation was 2.44 years, and all testicles were delivered to the scrotum. Mean follow-up was 3.29 years, and all patients were reviewed by the operating consultant. Testicular survival rate was 100 %. Representative photographs clearly demonstrate substantial cremasteric vessels running along the gubernaculum with robust collateralisation to the deferential vessel and the spermatic arterial stump. These images confirm the presence of robust collateral between the cremasteric and deferential vessels at second-stage FS procedure. Preservation of these collaterals in a gubernaculum-sparing approach may explain the excellent results seen in this series.

Undescended testes: Does age at orchiopexy affect survival of the testis?

PurposeThe optimal age at which to perform orchiopexy for cryptorchidism has long been debated. The aim of this study was to determine if age at orchiopexy affected testicular atrophy. MethodsA retrospective review of patients undergoing orchiopexy from 2000 to 2010 was conducted. An individual testis, rather than patient, was used as the dependent variable. A total of 349 testicles from 1126 charts (ICD-9=752.51) were identified. Primary study outcome was testicular survival without atrophy. ResultsMean follow up for the study was 25months. There was postoperative atrophy in 27 testes (7.7%). Intraabdominal testicle was independently associated with increased postsurgical atrophy (p<0.0001). The odds of postsurgical atrophy were 15.66 times higher for an abdominal vs. inguinal location (95% CI: 5.5–44.6). Testicular atrophy was highest for orchiopexy at ages 13–24months (n=16 of 133, 12%) vs. those less than 13months (n=3 of 64, 5%), and those greater than 24months (n=8 of 152, 5%) (p=0.0024). After adjusting for location, age was not statistically significant with postsurgical atrophy (p=0.055). ConclusionsFrom this study we conclude that there is no increase in testicular atrophy in patients less than 13months.

Magnetic Resonance Imaging for Locating Nonpalpable Undescended Testicles: A Meta-analysis

Preoperative imaging techniques may guide management of nonpalpable, cryptorchid testicles. We evaluated conventional MRI for identifying and locating nonpalpable testicles in prepubescent boys via meta-analysis. Databases including Medline were searched from 1980 to February 2012. Eligible studies included ≥10 boys with cryptorchidism/suspected cryptorchidism and reported data on testicular presence/absence and position (abdominal, inguinal, or scrotal) as determined by imaging and surgery. Two investigators independently reviewed studies against inclusion criteria. We captured the number of testicles that were correctly and incorrectly identified and located, relative to surgically verified status, and estimated sensitivity and specificity by using a random-effects model. Eight unique prospective case series included 171 boys with 193 nonpalpable testicles (22 with bilateral testicles). Surgery identified 158 testicles (81.9%) present and 35 absent. MRI correctly identified testicles with an estimated median sensitivity of 0.62 (95% Bayesian credible interval [BCI]: 0.47-0.77) and a specificity of 1.0 (95% BCI: 0.99-1.0). MRI located intraabdominal testicles with a sensitivity of 0.55 (95% BCI: 0.09-1.0) and inguino-scrotal testicles with a sensitivity of 0.86 (95% BCI: 0.67-1.0). We were not able to obtain estimates for MRI sensitivity or specificity for locating atrophied testicles. The estimated specificity for location-specific testicles reached almost 100%. Conventional MRI has low sensitivity for estimating the population sensitivity for identifying the presence of nonpalpable cryptorchid testicles. When testicles are identified, MRI is poor at locating both atrophied and intraabdominal testicles but performs modestly well in locating those in the inguino-scrotal regions.

Crossed-Fused Testicular Ectopia: A Case for the Use of Laparoscopy to Evaluate Nonpalpable Testicles

A 1-year-old male was referred for evaluation of a nonpalpable right testicle. In children with nonpalpable testicles, it our practice to proceed with diagnostic laparoscopy in an attempt to identify an intra-abdominal testicle or blind-ending spermatic vessels regardless of ultrasound findings. In the operating room, we performed diagnostic laparoscopy through the umbilical stump. We identified a vas deferens passing from the right side to the left side, and what appeared to be a testicle in the area of the left internal inguinal ring (Figures 1 and 2). In the left groin, we found both testicles fused together with a common blood supply, but a separate vas deferens. We placed the right testicle transseptally into the right hemiscrotum.Figure 2Right testicle entering the left inguinal ring.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Crossed testicular ectopia, or transverse testicular ectopia, is an extremely rare finding on exploration for an undescended testicle, with just slightly more than 100 cases reported in the literature to date.1Lam W.W. Le S.D. Chan K.L. Chan F.L. Tam P.K. Transverse testicular ectopia detected by MR imaging and MR venography.Pediatr Radiol. 2002; 32: 126-129Crossref PubMed Scopus (45) Google Scholar, 2Malik M.A. Iqbal Z. Chaudri K.M. Malik N.A. Ahmed A.J. Crossed testicular ectopia.Urology. 2008; 71 (984 e5-6)Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar A classification system has been proposed that accounts for accompanying anomalies, including hernias and mullerian duct structures.3Gauderer M.W. Grisoni E.R. Stellato T.A. Ponsky J.L. Izant Jr., R.J. Transverse testicular ectopia.J Pediatr Surg. 1982; 17: 43-47Abstract Full Text PDF PubMed Scopus (88) Google Scholar The ectopic testicle is usually structurally normal; however, it does carry a risk of malignancy, similar to that associated with other forms of intra-abdominal testicles.4Berkmen F. Persistent mullerian duct syndrome with or without transverse testicular ectopia and testis tumours.Br J Urol. 1997; 79: 122-126Crossref PubMed Google Scholar, 5Naouar S. Maazoun K. Sahnoun L. Jouini R. Ksia A. Elezzi O. et al.Transverse testicular ectopia: a three-case report and review of the literature.Urology. 2008; 71: 1070-1073Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar Although there are reports of successful diagnosis of this anomaly using ultrasonography6Pinto C.W. Toro R.C. Mansilla K.H. Castro T.A. Fuente-Alba C.S. Crossed testicular ectopia.J Ultrasound Med. 2010; 29: 847-849PubMed Google Scholar or magnetic resonance imaging1Lam W.W. Le S.D. Chan K.L. Chan F.L. Tam P.K. Transverse testicular ectopia detected by MR imaging and MR venography.Pediatr Radiol. 2002; 32: 126-129Crossref PubMed Scopus (45) Google Scholar during evaluation of nonpalpable testicles, neither of these studies is sufficiently sensitive to safely rule out an ectopic testicle.7Gokce M.I. Burgu B. Aydogdu O. Fitoz S. Soygur T. Transverse testicular ectopia associated with persistent Mullerian duct syndrome: another entity in which magnetic resonance imaging is unreliable.Urology. 2010; 76: 1475-1477Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 8Tasian G.E. Copp H.L. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis.Pediatrics. 2011; 127: 119-128Crossref PubMed Scopus (93) Google Scholar Laparoscopy has consistently demonstrated superior diagnostic accuracy in nonpalpable testicles9Papparella A. Romano M. Noviello C. Cobellis G. Nino F. Del Monaco C. et al.The value of laparoscopy in the management of non-palpable testis.J Pediatr Urol. 2010; 6: 550-554Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar, 10Cortesi N. Ferrari P. Zambarda E. Manenti A. Baldini A. Morano F.P. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy.Endoscopy. 1976; 8: 33-34Crossref PubMed Scopus (278) Google Scholar, 11Jordan G.H. Winslow B.H. Laparoscopic single-stage and staged orchiopexy.J Urol. 1994; 152: 1249-1252PubMed Google Scholar, 12Siemer S. Humke U. Uder M. Hildebrandt U. Karadiakos N. Ziegler M. Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study.Eur J Pediatr Surg. 2000; 10: 114-118Crossref PubMed Scopus (33) Google Scholar and is instrumental in their evaluation and treatment as underscored by this unusual finding on exploration.