Ligation Of Spermatic Vessels Research Articles

Comparison of High Spermatic Vessel Ligation and Low Spermatic Vessel Ligation in an Undescended Model of Rat Testis.

The aim of this study was to compare the immediate and long-term outcomes after high spermatic vessel ligation (HSVL) and low spermatic vessel ligation (LSVL) in a high undescended testis (UDT) model in rats. A prospective randomized controlled study was conducted on 24 male Wistar rats. The rats were randomly divided into three groups. Group A underwent a sham laparotomy and acted as the control. Group B underwent HSVL of both testicular vessels. Group C underwent LSVL of both testicular vessels. Each group was again subdivided into two subgroups. One sub-group underwent blood collection and testicular biopsy of both testes 24 h after the procedure to demonstrate immediate changes. Other subgroups underwent blood sample collection and testicular biopsy of both testes on day 50 following the procedure for hormonal changes and long-term changes. All the testes in HSVL showed atrophy (100%) in the long term, whereas LSVL showed atrophy in 12.5% of testes, even though both groups showed adequate neovascularization. Testes in HSVL showed poor bleeding on incision at both 24 h and day 50. On histology, 75% of testes in HSVL showed complete necrosis, and 50% in LSVL showed partial necrosis at 24 h. On day 50, all the testes in HSVL (100%) showed complete necrosis with dystrophic calcification, whereas all the testes in LSVL showed normal histology with good maturation of seminiferous tubules. There was no significant difference in testosterone levels between both groups. Both immediate and long-term changes following LSVL showed an increase in blood flow to the testis after ligation through collaterals and reverses early ischemic changes to the testis. Given the higher testicular atrophic rate after HSVL, LSVL or at least low ligation can be preferred for the management of high intra-abdominal UDT.

Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience.

Fowler-Stephens Laparoscopic Orchiopexy (FSLO) permits the mobilization of Intra-Abdominal Testis (IAT) to the scrotal position after spermatic vessel ligation. We reported our experience of FSLO for IAT. The charts of all boys who underwent a FSLO were retrospectively reviewed. Data were analysed for demographic data, procedure, complications and follow-up results. From January 2008 to June 2016, 160 laparoscopies for Non Palpable Testis (NPT) were performed at a mean age of 3,2 years. 61% of patients had a right NPT, while 6% were bilateral. In 64 cases, an IAT was found: 20 were managed by FSLO with a two-stage procedure in 11 patients. There were no differences in hospitalisations; one patient had a prolonged ileus. Follow-up ranged from 1 to 8 years. Of the 20 patients who underwent FSLO, testicular atrophy developed in three; the remaining testes were in the scrotal position, with normal consistency. FSLO was applied in 31% of IAT. The overall success rate of the technique was 85 %. The percentage of atrophy associated after spermatic vessels interruption appears to provide a good chance of testicular survival.

812 - Is the Koff procedure with low spermatic vessel ligation the optimal choice for testes at the inner inguinal ring with long-looping vas?

812 - Is the Koff procedure with low spermatic vessel ligation the optimal choice for testes at the inner inguinal ring with long-looping vas?

Laparoscopic versus open inguinal spermatic vessel ligation in infertile men with varicocele

Objective: Varicocele in infertile men is effectively treated by either Laparoscopic or Open Inguinal Spermatic Vessel Ligation (L-SVL and OI-SVL, respectively), but comparative information is limited. This retrospective study compared the outcomes and complications of L-SVL and OI-SVL. Methods: Infertile men with varicocele were treated with L-SVL (n=140; 2001-2006) or OI-SVL (n=120; 2007-2012). Each patient had infertility>1 y; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the partner; and basal eco-color Doppler ultrasound showed continuous reflux in the spermatic vessel. Evaluations were conducted regarding rates of recurrence, intraoperative and postoperative complications, operative time, hospitalization, cost, and semen parameters 6 months after surgery. Results: The demographics and preoperative (baseline) clinical features of the 2 groups were similar. Fewer men in the L-SVL group (0.83%) had recurrence of the varicocele after surgery compared with the OI-SVL group (2.86%, P<0.01), and men given L-SVL experienced significantly less time in surgery, recovery, and hospital stay. The groups were similar regarding rates of wound complications, damage to the genitofemoral nerve, testicular atrophy, epididymo-orchitis, and hydrocele, and procedural cost. Compared with the baseline, both groups showed significant postoperative improvements in sperm count, motility, and morphology (P<0.01), while the postoperative findings of the 2 groups were similar. Conclusion: Both L-SVL and OI-SVL were effective in correcting varicocele in men, but L-SVL was associated with a lower varicocele recurrence rate, shorter hospitalization, better security, and healing rate.

Subcutaneous endoscopically assisted ligation of spermatic vessels (SEAL-SV) using an epidural-&-spinal needle: a novel technique to repair adolescent varicocele.

We describe a novel technique of subcutaneous endoscopically assisted ligation of spermatic vessels (SEAL-SV) using a modified epidural-&-spinal needle. This technique achieves very cosmetic and minimally invasive outcomes. We have successfully performed SEAL-SV for five consecutive boys and considered it a simple, safe, and effective procedure for adolescent varicoceles.

Influence of hCG on inducible nitric oxide synthase gene expression in ram testicular arteries.

Background. Experimental evidence suggests a relationship between the vasodilatory effect of hCG and the NOS system in the testis. The influence of hCG administration on testicular vascular NOS gene expression has not been fully investigated. This study aimed to evaluate the presence of the nitric oxide syntheses gene in ram testicular arteries and the influence of hCG administration on its expression. Both testicular arteries of sixteen rams were extracted before and after i.v. administration of 5000 IU of hCG or placebo. The expression of the iNOS gene was investigated by real time PCR. Data were analyzed by means of Wilcoxon and Mann-Whitney tests. A p value of &lt; 0.05 was considered statistically significant. PCR revealed the presence of iNOS mRNA in all basal samples but the expression of the iNOS gene was significantly reduced in all arteries obtained 24 h after the administration of either hCG or placebo. A significant reduction in the expression of iNOS gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups. On the other hand hCG stimulation did not significantly influence iNOS expression following its administration compared to a placebo. Ram testicular arteries express the iNOS gene but hCG stimulation did not significantly influence iNOS expression. A significant reduction in the expression of this gene was observed in the testicular arteries extracted after 24 h in both treated and placebo groups, suggesting that iNOS expression on the testicular artery could be influenced by the spermatic vessel ligation of the controlateral testis.

High Undescended Testis Treatment with Distal Espermatic Vessel Ligation (Koff-Sethi Technique)

Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni- or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

1374 SPERMATOGENESIS AFTER ONE-STAGE FOWLER-STEPHENS ORCHIOPEXY WITH AN EXPERIMENTAL CRYPTORCHID RAT MODEL

You have accessJournal of UrologyPediatrics: Andrology - Cryptorchidism & Varicoceles1 Apr 20121374 SPERMATOGENESIS AFTER ONE-STAGE FOWLER-STEPHENS ORCHIOPEXY WITH AN EXPERIMENTAL CRYPTORCHID RAT MODEL Hideyuki Kamisawa, Kentaro Mizuno, Yoshiyuki Kojima, Satoshi Kurokawa, Yoshinobu Moritoki, Yasue Kubota, Noriyasu Kawai, Keiichi Tozawa, Yutaro Hayashi, and Kenjiro Kohri Hideyuki KamisawaHideyuki Kamisawa Nagoya, Japan More articles by this author , Kentaro MizunoKentaro Mizuno Nagoya, Japan More articles by this author , Yoshiyuki KojimaYoshiyuki Kojima Nagoya, Japan More articles by this author , Satoshi KurokawaSatoshi Kurokawa Nagoya, Japan More articles by this author , Yoshinobu MoritokiYoshinobu Moritoki Nagoya, Japan More articles by this author , Yasue KubotaYasue Kubota Nagoya, Japan More articles by this author , Noriyasu KawaiNoriyasu Kawai Nagoya, Japan More articles by this author , Keiichi TozawaKeiichi Tozawa Nagoya, Japan More articles by this author , Yutaro HayashiYutaro Hayashi Nagoya, Japan More articles by this author , and Kenjiro KohriKenjiro Kohri Nagoya, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With intra-abdominal testes, failure to mobilize the gonad to the scrotum is usually the result of inadequate length of the testicular vessels rather than of the vas deferens, so Fowler-Stephens orchiopexy is often selected. In most reports, the success of this maneuver was assessed based on whether the testis was transferred to the scrotum or testicular atrophy was not present after operation. However, these reports did not evaluate spermatogenesis by long-term observation, and it has not been proven whether these patients who underwent Fowler-Stephens orchiopexy were able to achieve spermatogenesis in the future. In order to evaluate the validity of one-stage Fowler-Stephens orchiopexy, we performed this procedure for intra-abdominal testes with an experimental cryptorchid rat model, and assessed spermatogenesis after this operation. METHODS Experimental cryptorchid rats were induced by injecting flutamide into the abdomen of pregnant Sprague-Dawley rats for 7 days from days 14 to 20 of gestation. Four-week-old cryptorchid rats were divided into 4 groups; sham operation (group 1, n=7), only orchiopexy (group 2, n=7), only spermatic vessel ligation (group 3, n=7) and both spermatic vessel ligation and orchiopexy (one-stage Fowler-Stephens orchiopexy; group 4, n=7). The testes were removed 12 weeks after birth in all groups, and testicular weight, testicular histopathological findings and presence of sperm in the epididymis were examined. RESULTS All operated testes had reticulated vessels on tunica albuginea. There were no statistically significant differences in the testicular weight between groups 1 (0.47+/−0.04 g) and 4 (0.30+/−0.19 g), suggesting that Fowler-Stephens orchiopexy did not induce significant testicular atrophy. However, the seminiferous tubule diameters (STD) of group 4 were significantly smaller than those of group 1 (p<0.001), and no sperm was observed in the epididymis of group 4, suggesting that Fowler-Stephens orchiopexy reduced STD and did not improve spermatogenesis. CONCLUSIONS Although Fowler-Stephens orchiopexy is a good procedure to maintain testicular size and to dissolve cosmetic deformity of an absent scrotum, it may offer a poor contribution to improvement of spermatogenesis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e558 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideyuki Kamisawa Nagoya, Japan More articles by this author Kentaro Mizuno Nagoya, Japan More articles by this author Yoshiyuki Kojima Nagoya, Japan More articles by this author Satoshi Kurokawa Nagoya, Japan More articles by this author Yoshinobu Moritoki Nagoya, Japan More articles by this author Yasue Kubota Nagoya, Japan More articles by this author Noriyasu Kawai Nagoya, Japan More articles by this author Keiichi Tozawa Nagoya, Japan More articles by this author Yutaro Hayashi Nagoya, Japan More articles by this author Kenjiro Kohri Nagoya, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Spermatogenesis After 1-Stage Fowler-Stephens Orchiopexy in Experimental Cryptorchid Rat Model

To evaluate the validity of 1-stage Fowler-Stephens orchiopexy, we performed this procedure for intra-abdominal testes in an experimental cryptorchid rat model and assessed postoperative spermatogenesis. Cryptorchidism in rats was induced by injecting flutamide into the abdomen of pregnant Sprague Dawley rats for 7 days (days 14 to 20 of gestation). Four-week-old cryptorchid rats were divided into the 4 groups of sham operation (group 1, 7 rats), orchiopexy only (group 2, 7), spermatic vessel ligation only (group 3, 7), and spermatic vessel ligation and orchiopexy (1-stage Fowler-Stephens orchiopexy, group 4, 7). The testes were removed 12 weeks after birth in all groups, and testicular weight, testicular histopathological findings and presence of sperm in the epididymis were examined. All operated testes had reticulated vessels on the tunica albuginea. There were no statistically significant differences in the testicular weight between groups 1 (mean +/- SD 0.47 +/- 0.04 gm) and 4 (0.30 +/- 0.19), suggesting that Fowler-Stephens orchiopexy did not induce significant testicular atrophy. However, seminiferous tubule diameters in group 4 were significantly smaller than in group 1 (p <0.001), and no sperm was observed in the epididymis of group 4 rats, suggesting that Fowler-Stephens orchiopexy reduced seminiferous tubule diameters and did not improve spermatogenesis. Although Fowler-Stephens orchiopexy is a good procedure to maintain testicular size and correct cosmetic deformity of an absent scrotum, it may not significantly contribute to the improvement of spermatogenesis.

Effect of Naloxone on Oxidative Stress and Testicular Injury due to Spermatic Vessel Ligation of Rat Testis

Aims: Two-stage Fowler-Stephens orchiopexy has been accompanied by testicular atrophy in some cases but neither of the mechanisms responsible for testicular injury are clear, nor is there an effective agent that might prevent this injury. In this study we aimed to investigate the long-term effects of naloxone, a morphine antagonist, on testicular histopathology and oxidative stress after spermatic vessel ligation (SVL) in rats. Methods: 32 prepubertal rats were randomly divided into four equal groups: group 1: control (only bilateral orchiectomies were performed); group 2: sham-operated group; group 3: SVL, and group 4: SVL+naloxone (1 mg/kg twice daily for 1 month). One month postoperatively, bilateral orchiectomies were performed to evaluate histopathologic findings and measurement of malondialdehyde (MDA) and nitric oxide (NO) levels. Results: Considering group 3, left SVL resulted in significant tissue damage in both testes, more severe in the ipsilateral testis. The SVL resulted in a significant increase in testicular MDA levels of both testes in this group (p < 0.05). While the ipsilateral testicular NO levels of groups 2 and 3 were significantly lower than of group 1 (p < 0.05), the contralateral testicular NO levels of all these groups were similar. After naloxone therapy, while there was no significant improvement in ipsilateral testicular histopathology (p > 0.05), the contralateral testicular histopathology improved significantly (p < 0.05). However, naloxone did not change either testicular MDA or NO levels. Conclusions: The SVL led to bilateral testicular injury, and oxidative stress may be a reason for this injury. Naloxone significantly improved contralateral testicular injury without showing any antioxidative effect.

First Clinical Use of an Omental Pedicle Flap for the Surgical Correction of a High Intra-Abdominal Testicle

Sir: Intra-abdominal testes are five times as likely to undergo malignant degeneration as testicles within the inguinal canal.1 High intra-abdominal testes are the most difficult to correct, with the results of testicular viability and function frequently being disappointing. The high failure rate (26 percent)2 is likely due to the fact that testicular blood flow is reduced up to 80 percent with spermatic vessel ligation, leading to insufficient germ cell perfusion.3 Another procedure used in this situation is microvascular autotransplantation, but this operation requires vessels of adequate size and expertise in microsurgical technique. Therefore, especially when the contralateral testicle is normal, an orchiectomy is preferred due to the high risk of testicular atrophy associated with most of the salvage procedures. However, if the chances of postoperative viability of the testicle could be increased, perhaps more salvage orchiopexies would be performed. In situations where the testicular vessels are not adequate for microvascular autotransplantation and the collateral circulation from the vas deferens is not sufficient to maintain testicular viability, a different technique is needed. Our solution was to perform an orchiopexy in two stages with the use of an omental pedicle flap. Our patient had a single left intra-abdominal hypoplastic testicle superior to the left common iliac artery. There was no vas deferens attached to the gonad due to previous operations. His vascular pedicle was too small (0.5 mm in diameter) to permit safe microvascular transfer. Therefore, the testicle was marsupialized in an omental flap to allow external neovascularization of the testicle (Fig. 1, above). The patient returned to the operating room 6 months later. The testicular pedicle was divided and the omental flap was lengthened (Fig. 1, below). It was transferred down through the midline between the rectus muscles, just above the pubic bone, into the left hemiscrotum. The testicle remains viable and the patient continues to demonstrate normal testosterone levels, maintaining his secondary male sexual characteristics.Fig. 1.: (Above) Left high intra-abdominal hypoplastic testicle and omental flap. (Below) Neovascularized testicle within the omental flap, demonstrating adequate length for scrotal placement.There are several indications for use of the omentum in reconstructive surgery,4 thanks to its plasticity, volume, and ability to neovascularize adjacent tissue through the induction of angiogenesis.5 Clinical use of the omentum to perform a two-stage orchiopexy has not previously been described. In summary, a two-stage transposition to the scrotum of a high intra-abdominal testicle was performed successfully via an omental pedicle flap. The omental pedicle flap for orchiopexy has several advantages, including the ease of lengthening the flap, so that the testicle can be transferred into the scrotum, and neovascularization of the testicle, decreasing its probability of atrophy. This procedure should be performed in two stages, to allow angiogenesis and neovascularization of the testicle to occur. Due to the high rate of atrophy associated with the standard orchiopexy of intra-abdominal testes, we propose that our procedure be added as a surgical option to increase the likelihood of preserving testicular viability and function. This is especially important in patients who have only a single functional testicle, to prevent their need for life-long treatment with exogenous testosterone. Steven A. Earle, M.D. University of Miami School of Medicine Jackson Memorial Hospital Deirdre M. Marshall, M.D. Division of Plastic and Reconstructive Surgery Andrew S. Labbie, M.D. Division of Urology Miami Children’s Hospital Miami, Fla.

Collateral Circulation after Spermatic Vessel Ligation for Abdominal Testis And Its Impact on Staged Laparoscopically Assisted Orchiopexy

Staged laparoscopically assisted orchiopexy for abdominal testis entails initial spermatic vessels ligation followed by mobilization of the testis, preserving the vas and its vessels as a sole source of testicular blood supply. This mobilization includes all peritoneal attachments of the testis, including the gubernaculum, which may carry collateral circulation to the testis. This study considers the anatomy of the gubernaculum and the collateral circulation after spermatic vessels ligation and its possible effects on the viability of the testis. The anatomy of the gubernaculum and the effect of spermatic vessels ligation on the collateral circulation were studied in 90 boys with 100 abdominal testes with a short pedicle. Patients with vanishing testis or those not needing ligation of the spermatic vessels were excluded from the study. The anatomy and the vascularity of the testis, gubernaculum, and vas were studied at initial laparoscopy and 6 weeks later after spermatic vessel ligation. Based on these findings, the technique for laparoscopically assisted orchiopexy were modified, preserving the gubernaculum whenever possible in cases having prominent collaterals. Based on the attachment and blood vessel configuration of the gubernaculum, the patients were divided into two groups: in group 1 (open internal ring), there were 46 testes in which the gubernaculum passed through an open internal ring having an inguinal attachment. In group 2 (closed internal ring), there were 54 testes with a soft gubernaculum attached to a closed internal ring without inguinal attachment. In group 1 the gubernaculum was short and tough in 32 of 46 testes, with no visible blood vessels in all cases. In group 2 the gubernaculum was long and soft in 43 of 54 testes and showing evident blood supply before clipping of the spermatic vessels in 30 testes. Subsequent laparoscopy done after 6 weeks showed prominent collateral circulation around the gubernaculum in 26 testes and around the vas in 20 testes in the group 1 patients, and around the vas in 20 and the gubernaculum in 34 testes in group 2. Preservation of the gubernaculum was possible in 43/54 (80%) of group 2 patients and in 14/46 (30%) of group 1 patients. Routine cutting of the gubernaculum is not necessary for proper mobilization of the abdominal testis: collateral circulation varies from patient to patient, and once the gubernaculum shows prominent blood supply, its preservation is mandatory. The decision to cut the gubernaculum should be taken while the performing initial spermatic vessel ligation and not during the second stage to avoid compromise of the settled collateral circulation.

Twelve Years of Minimally Invasive Surgery in Children and Adolescents: A Single Center Experience

Minimally invasive surgery plays an important role in the daily practice of pediatric surgeons. However, there have been few reports of large series of patients. The aim of this paper is to report our experience over the past 12 years with a broad range of pediatric laparoscopic procedures. We performed a retrospective analysis of 1084 minimally invasive procedures conducted in the department of pediatric surgery from June 1992 to March 2004. The mean age of the patients was 14 years (range, 1-19). Seven hundred forty-six operations (69%) were thoracoscopic sympathectomy for hyperhydrosis. Other common operations were high ligation of spermatic vessels (n=98), cholecystectomy (n=65), exploration of nonpalpable testes (n=53), appendectomy (n=55), female adnexal surgery (n=24), and splenectomy (n=13). Thirty miscellaneous procedures included Nissen fundoplication, liver biopsies, diagnostic laparoscopy, Morgani and Bochdalek hernia repair, Swenson procedures, V-P shunt placement, splenic and hepatic cyst removal, thorcoscopy for pleural empyema, treatment of gastric ulcer perforation, and nephrectomy. We reviewed the indications for surgery, the surgical technique, and the outcome for each procedure. All patients in this series were well at follow-up and there was no long-term morbidity. Although laparoscopic procedures have gained an integral place in pediatric surgery and are relatively safe, advanced laparoscopic procedures should be developed, practiced and evaluated in dedicated surgical units to ensure a broad base of experience on which to base future decisions and guidelines.

Pre-Ischemic Administration of Nitric Oxide Synthase Inhibitors Reduced Germ Cell Apoptosis after Spermatic Vessel Ligation in the Rat Testis

Introduction: The Fowler-Stephens maneuver,a modeofspermatic vessel ligation, is a method of choice in the management of high testes. The aim of the present study is to investigate the effects of pre-ischemic administration of N^G-nitro-L-arginine methyl ester (L-NAME), a nitric oxide (NO) synthase (NOS) inhibitor, in preventing testicular ischemic damage and germ cell-specific apoptosis in rats. Materials and Methods: 30 min before ligation of the spermatic vessels, L-NAME was administered intraperitoneally to a group of rats and saline was given to another group of rats (controls). Biochemical assessments of NO and germ cell-specific apoptosis were performed. Results: Testicular NO levels in the L-NAME group showed significant decreases in the ipsilateral (p = 0.004) and contralateral (p = 0.015) testes in relation to those of the control group. The apoptotic indices were found in 2.3% of the L-NAME group and 3.1% of the control group. Conclusion: Pre-ischemic administrations of the NOS inhibitor, L-NAME, effectively decreased NO production and to some degree caused a reduction in germ cell apoptosis in the rat testes after spermatic vessel ligation. Further studies are mandatory to confirm our preliminary results and to address the potential introduction of NOS inhibitors into clinical practice.

Prepubertal unilateral spermatic vessel ligation decreases haploid cell population of ipsilateral testis postpubertally in rats

DNA flow cytometry is a sensitive and rapid technique to evaluate the germ cell maturation of testis. The haploid cell population of testis specifically denotes testicular maturation. High ligation of spermatic vessels (HLSV) and low ligation of spermatic vessels (LLSV) have been described in the surgical treatment of high undescended testis. Estimation of germ cell population of testis after these maneuvers has not been performed so far by DNA flow cytometry; hence this study was designed. Thirty male rats, aged 30 days, were randomized into three groups. Group I underwent sham surgery; group II underwent unilateral HLSV-ligation and division of main spermatic vessels, similar to the Fowler-Stephens technique; and group III underwent unilateral LLSV-ligation and division of main spermatic vessels close to the testis, similar to the Koff and Sethi technique. Thirty days later, the ipsilateral testes were harvested, and haploid, diploid, and tetraploid cells were counted by DNA flow cytometry. The mean (+/-SD) percentage of the haploid cell population was 68.7+/-4.8, 49.3+/-6.5, and 50.8+/-6.4 in groups I, II, and III, respectively. There was a significant (p<0.05) decrease in haploid cell population between groups I and II and between groups I and III. However, there was no significant difference between groups II and III. In conclusion, prepubertal HLSV as well as LLSV decreases the haploid cell population of ipsilateral testis in rats. LLSV has no advantage over HLSV.

The effect of spermatic vessel ligation on testicular nitric oxide levels and germ cell-specific apoptosis in rat testis

Management of high testis may vary but the most popular method in surgical treatment is the Fowler-Stephens maneuver. The aim of the present study was to investigate the effects of spermatic vessel ligation on testicular nitric oxide (NO) levels, expression of inducible nitric oxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) and germ cell-specific apoptosis in both ipsilateral and contralateral testes in rats. Twenty-eight animals were randomly allocated into four groups (n=7 each). The spermatic vessels were ligated as a simulation of the Fowler-Stephens maneuver. The groups of animals were sacrificed at 2 h (group 1), 4 h (group 2) and 24 h (group 3) after ligation, respectively. Sham-operated animals served as controls (group 4). Biochemical assessment of testicular NO levels was performed by the Griess method. iNOS and eNOS expression and apoptosis were studied in ipsilateral and contralateral testes. Testicular NO levels at 24 h after the simulated Fowler-Stephens maneuver were found to be significantly increased in both ipsilateral and contralateral testes when compared with the sham-operated group. eNOS expression was clearly increased in ipsilateral testes, whereas moderate expression was detected in the contralateral seminiferous tubules at 24 h after ligation. Mild focal iNOS immunostaining was also observed in seminiferous tubules of the ipsilateral testis at 24 h after the simulated Fowler-Stephens maneuver. Apoptosis was dramatically increased in ipsilateral testes; however, it was only detected in single cells in the contralateral side at 24 h after ligation. In conclusion, the simulated Fowler-Stephens maneuver induces testicular nitric oxide synthesis and germ cell-specific apoptosis in the ipsilateral testis. These results suggest that high levels of NO induce apoptosis and may impair spermatogenesis thus explaining the unsuccessful outcome of the Fowler-Stephens maneuver.

GERM CELLS MAY SURVIVE CLIPPING AND DIVISION OF THE SPERMATIC VESSELS IN SURGERY FOR INTRA-ABDOMINAL TESTES

Purpose Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis. However, it is uncertain whether the more sensitive germ cells survive this procedure in addition to the Sertoli and interstitial cells of the human testis. Survival of germ cells is a prerequisite of later fertility potential. Materials and Methods We studied 17 nonpalpable testes in 10 patients 1 year and 7 months to 13 1/2 years old. Results of testicular biopsies of 13 intra-abdominal testes taken at stages 1 and 2 of surgery were available for histological comparison. Results Median number of spermatogonia per tubular cross section of the biopsies taken at stage 2 was slightly lower (0.03) compared to the median number at stage 1 (0.06) of the operation but this difference was not significant (p = 0.2031). Conclusions Our study shows that the spermatogonia may survive clipping and division of the spermatic vessels, although the number of spermatogonia per tubular transverse section decreases slightly.

ARTERIAL SUPPLY OF THE HUMAN FETAL TESTIS DURING ITS MIGRATION

Irrespective of the surgical technique chosen to treat high undescended testis, preservation of an adequate arterial supply for the testis is crucial for successful orchiopexy with maintenance of normal testicular size and texture. To provide an anatomical background for such a procedure, we performed a systematic study on the number and origin of arteries supplying the fetal testis during its migration from the abdomen to the scrotum. We studied bilaterally 64 testes from 32 fresh human fetuses 13 to 33 weeks after conception. The fetuses were injected through the thoracic aorta with a microvascular silicone rubber red resin to fill in the arterial tree, thereby enabling identification and dissection of all arteries supplying the testes. Of the 64 testes 3 arteries (testicular, deferential and cremasteric) were found in 46 (71.9%), 2 (testicular and deferential) in 15 (23.4%) and 4 in 3 (4.7%). The fetal testis is always supplied by at least 2 arteries (testicular and deferential arteries) and by 3 or 4 arteries in nearly 80% of the cases.

BENEFITS OF LAPAROSCOPY AND THE JONES TECHNIQUE FOR THE NONPALPABLE TESTIS

Purpose We report on the role of diagnostic laparoscopy combined with the Jones suprainguinal approach to orchiopexy in the treatment of abdominal testes. Materials and Methods A retrospective review was done of 209 boys with 265 cryptorchid testes who underwent orchiopexy between January 1994 and March 1996. A subset of patients with nonpalpable testis underwent diagnostic laparoscopy and according to the laparoscopic findings either standard inguinal or suprainguinal extraperitoneal orchiopexy. Results Of 209 patients 47 had 63 impalpable testes. Laparoscopy was done on 31 patients (42 testes). Findings at laparoscopy revealed 29 (69%) abdominal, 7 (17%) intracanalicular and 6 (14%) vanishing testes. A satisfactory result with scrotal position of the testis and no atrophy was obtained in 18 of 19 patients operated via the Jones approach combined with diagnostic laparoscopy. The only patient with unsatisfactory result underwent ligation of the spermatic vessels at the time of operation. In contrast, satisfactory results were achieved for only 7 of 10 intra-abdominal testes after diagnostic laparoscopy and standard inguinal orchiopexy despite universal spermatic vessel ligation. Of these 10 testes 2 ended in an inguinal location and 1 atrophied. Conclusions Laparoscopy was helpful in determining surgical approach in most cases. The suprainguinal approach allowed most abdominal testes to be placed in the scrotum without vascular ligation.

Two-stage Fowler-Stephens orchiopexy with laparoscopic clipping of the spermatic vessels.

We report the outcome of a staged approach to the intra-abdominal testicle and provide baseline data on operative time, postoperative course and testicular survival. We retrospectively reviewed the records of 441 boys (547 undescended testes). There were 105 boys (24%) with 124 nonpalpable testes (23%). All patients underwent laparoscopy. Ligation of spermatic vessels was performed as stage 1 on 20 abdominal testes (4%) in 18 boys (4%). Stage 2 orchiopexy was done using an open technique. Two-stage orchiopexy in 18 boys included a bilateral procedure in 2, of which 1 was asynchronous and 1 was synchronous. Average operative time was 55 minutes for stage 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were performed on an outpatient basis in 18 and 17 (94%) boys, respectively. There were no complications after stage 1 and 1 wound infection developed after stage 2. One testis with no vas deferens was determined to be nonviable at stage 2. The remaining 19 testes (95%) were considered viable at a followup of 6 months or greater. Viability was based on testicular size and consistency similar to those of the contralateral testis. Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis.