Intra-abdominal Testicles Research Articles

Laparoscopic management of the impalpable abdominal testis

La paroscopy is useful in both diagnosis and management of impalpable testes. Intra-abdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would be desirable prior to subsequent orchidopexy. A second-stage vasal-based orchidopexy then can be performed once adequate testicular reperfusion via the deferential pedicle is believed to have occurred. We have used both diagnostic and therapeutic laparoscopy in the management of 103 non-palpable testes over a period of six years. Open procedures following laparoscopy included 57 orchidopexies, 11 orchiectomies, and 1 microvascular testicular autotransplant. Thirteen laparoscopic interventions were performed: 5 orchiectomies for atrophic testes and 8 testicular vessel clippings followed by 6 second-stage open inguinal orchidopexies. Color Doppler duplex ultrasonography was not found to be reliable for assessment of testicular revascularization following spermatic vessel clipping. There were 3 complications which were all related to puncture with the Veress needle.

Laparoendoscopic Surgical Management of the Abdominal/Transinguinal Undescended Testicle

We report a laparoendoscopic surgical technique to perform a single-stage orchiopexy in a 10-year-old patient with a high intra-abdominal undescended testicle. This approach indicates the technical feasibility of laparoendoscopic orchiopexy and prevents the need for laparotomy. The results are compared with a laparoendoscopic approach in the staged Fowler-Stephens orchiopexy.

Laparoscopic Bilateral Orchiectomy for Testicular Feminization Syndrome

A 13-year-old female patient with complete androgen insensitivity (testicular feminization syndrome) had an excision of bilateral intra-abdominal testicles via the laparoscopic approach. The patient had a very smooth, fast recovery from her surgery. The laparoscopic approach should be considered for most patients in need of surgical removal of undescended or intra-abdominal testes.

Preliminary ligation of the gonadal vessels prior to orchidopexy for the intra-abdominal testicle

A staged technique for orchidopexy for the intra-abdominal testis is described. At a preliminary operation the testicular vessels are ligated in continuity without any mobilization of the testis itself. After an interval to allow enhancement of the blood supply via the vessels accompanying the vas deferens, orchidopexy is performed by the Fowler-Stephens technique.

Male pseudohermaphroditism by persistent mullerian structures

We have studied 2 cases of nonfamilial male pseudohermaphroditism by persistent müllerian ducts. The first case, found in a fourteen-year-old male, can be described as the classic form of cryptorchism which resisted hormonal treatment and in which a rudimentary uterus with fallopian tubes and atrophic testicles were found at exploratory laparotomy. The second case was discovered in a thirty-nine-year-old man who had bilateral crytorchism. He presented with an abdominal mass which was found to be a seminoma in the right intra-abdominal testicle, and a well-defined uterus with fallopian tubes and an atrophic left testicle were seen. Neither case presented phenotype disturbances. Both karyotypes were 46 XY. A total resection of the female sexual organs and testicles was performed in both patients, and the mass was removed in the second case. The tumoral degeneration of the intra-abdominal testicles in this syndrome is found in similar proportion to the simple cryptorchid testicles. Our second case is the tenth one of a testicular tumor in pseudohermaphroditism by persistent mullerian ducts to be reported in the literature.

Transection of the spermatic vessels (Bevan's technique): an experimental study.

Intracanalicular or intra-abdominal undescended testicles often present a difficult surgical problem, due to a vascular pedicle shortening that prohibits scrotal placement with a 1 stage orchiopexy. The division of spermatic vessels to properly place the testis in the scrotum solves the problem of the shortening of the vessels, but raises the question of whether the endocrine function and the potential for fertility are preserved. In the present study transection of spermatic vessels before arterial branch-off was done intra-abdominally in rats. Angiographic, patho-anatomic and hormonal evaluations have been made. Revascularization of the testicular artery through the vasal artery has occurred in all cases. The anastomotic circuit, however, does not always have the same functional value. The spermatogenic alterations suggest that fertility can be impaired in a significant percentage of cases. Spermatogenesis was quantified taking into account the mean tubular diameter and the situation of seminiferous epithelium, expressed as the percentage of tubules containing well-developed spermatogenesis. Plasma testosterone levels are in a low range. However, Leydig cell functional response to human chorionic gonadotropin stimulation is maintained in every case and so are plasma and pituitary luteinizing hormone levels, suggesting that plasma testosterone levels are high enough to maintain an adequate hormonal activity.

Cryptorchidism and abdominal pain

In this case report, abdominal symptoms simulating acute appendicitis were due to recurrent torsion of an intra-abdominal testicle. Cryptorchidism frequently goes unnoted. Most undescended testicles are in the groin and easily palpable. If not, they can be absent, retroperitoneal or intra-abdominal. An intra-abdominal testicle is more likely to occur on the right than the left.

Prune belly syndrome.

Prune belly syndrome was first described in 1895. The syndrome consists of the triad of a thin flaccid, wrinkled, abdominal wall; undescended, intraabdominal testicles; and bladder enlargement with hydroureters. Developmental etiology is unknown with consideration given to both obstructive and mesodermal defects. Evaluation requires assessment of pulmonary and renal function along with other associated system disorders. Treatment should be focused on preservation of renal function through management of stagnant urine and prevention of UTIs. Operative intervention when required is discussed and includes the upper and lower urinary tract, the testicles, and the appearance of the abdominal wall.

Torsion of an intra-abdominal testicle

The literature regarding torsion of an abdominal testicle is reviewed. That the condition is a surgical rarity is attested by the fact that by 1952 only twenty-three cases had been reported in the world literature. Of these cases, there were only eight which occurred with testicles which were non-malignant. Some of the symptoms and clinical findings of the previously reported cases are discussed, illustrating why the condition is usually erroneously diagnosed as acute appendicitis. An additional case of torsion of an intra-abdominal testicle is discussed in this paper, bringing the total to twenty-four known cases. It represents the ninth instance of torsion of a non-malignant intra-abdominal testis, and is probably the first case in which the correct diagnosis was made preoperatively.

Infarction of intraperitoneal undescended testicle

A case is reported herein of a patient in whom an undescended infarcted intra-abdominal testicle caused the symptoms of acute appendicitis. In those patients with undescended testicles who exhibit signs of acute appendicitis the possibility of a strangulated intrapentoneal testicle must be kept in mind. Earlier operation might have resulted in salvage of the testicle.

Undescended intra-abdominal testicle with torsion of the cord and embryonic cell carcinoma: Case report

Undescended intra-abdominal testicle with torsion of the cord and embryonic cell carcinoma: Case report