Management Of Intra-abdominal Testes Research Articles

Comparison of the perspectives of the pediatric surgeons and pediatric urologists in management of cryptorchidism in Saudi Arabia.

Objectives:To evaluate the variability in perspectives between pediatric surgeons and pediatric urologists in managing cryptorchidism.Methods:We conducted this survey among pediatric surgeons and pediatric urologists managing cryptorchidism in Saudi Arabia in October 2020. We distributed a questionnaire to 187 consultants using the Google forms platform. We collected data related to the consultant’s experience, preoperative management, management of nonpalpable testes, management of palpable undescended testes, management of the cryptorchidism in special situations.Results:The response rate was 77% for pediatric surgeons (n=77) and 46% for pediatric urologists (n=40). The number of cases managed by each specialty per year differed significantly (p=0.02); however, there was no significant difference in their experience (p=0.37). The preferred age for orchidopexy was 6-12 months for both specialties. Pediatric surgeons tend to prescribe preoperative ultrasound more frequently for nonpalpable testes (p=0.05). Laparoscopy was the preferred surgical approach by both specialties. Management of intra-abdominal testes not reaching the contralateral internal ring differed between groups (p<0.001), and it was related to the number of procedures performed annually (p=0.03). Both groups responded differently to the management of unsatisfactory testicular position after orchidopexy (p<0.001). Pediatric surgeons managed it with either observation or re-operative inguinal orchidopexy; however, most pediatric urologists preferred re-operative inguinal orchidopexy. This response was affected by the number of procedures performed annually (p=0.04).Conclusion:In Saudi Arabia, practicing pediatric surgeons and pediatric urologists have different perspectives in the management of cryptorchidism. The results of this survey demonstrated the need to establish national guidelines to manage patients with cryptorchidism.

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

Ergebnisse der laparoskopischen Orchidopexie beim nicht palpablen Hoden

Laparoscopy is an established diagnostic procedure but is less frequently used as a therapeutic method for impalpable testes. To compare the results of the classic two-stage orchidopexy described by Fowler-Stephens with a testicular vessel-sparing single-stage approach in the management of intra-abdominal testes we retrospectively analyzed our data.From January 2005 to September 2010, 105 patients (mean age 32 months) underwent laparoscopy for impalpable testes. In cases of intra-abdominal testes, laparoscopic orchidopexy was performed either in a two-stage procedure including initial ligation of the testicular vessels or as a direct single-stage procedure without ligation of the vessels. The results of both approaches were evaluated postoperatively clinically and by ultrasonography. Among the 122 impalpable testes 63 were located intra-abdominally; single-stage orchidopexy was performed in 29 testes whereas a two-stage approach was conducted in 14 testes. Fourteen gonads had to be removed due to atrophy and in six cases no testis was found at all. In the other 59 cases inguinal exploration followed resulting in 22 orchidopexies, 34 removals and 3 blind-ending vessels. During a mean follow-up of 17 months none of the 29 testes treated by single-stage orchidopexy atrophied or reascended. By contrast, two cases of atrophy, one reascent and one subumbilical wound infection occurred after the two-stage procedure. Considering our excellent experiences with single-stage management, we conclude that the single-stage approach is a reliable, safe and efficacious treatment modality of intra-abdominal testes. However, the two-stage procedure including testicular vessel ligation should be restricted to high abdominal testes with very short vessels.

Laparoscopic Versus Open Orchidopexy in Children with Intra-abdominal Testes

The management of intra-abdominal testis has been controversial but has changed significantly since the introduction of the laparoscopic technique. The aim of our study was to evaluate the success rate of laparoscopic orchidopexy (LO) compared with that of open orchidopexy (OO). In Kuopio University Hospital, 35 of 357 children with undescended testes treated between January 1992 and December 2004 had intra-abdominal testes. A retrospective review was performed to compare the outcomes of children having LO with those who had undergone OO. Sixteen children with 19 intra-abdominal testes underwent LO and 18 children with 18 intra-abdominal testes underwent OO. Primary LO was performed in 14 children with 17 testes and staged Fowler-Stephens LO in 2 children. One LO was converted to OO. The mean (+/- standard deviation) operating time was 62 (+/- 30) minutes in the LO group and 43 (+/- 12) minutes in the OO-group (mean difference of 19 minutes, 95% confidence interval of the difference of 2 to 34 minutes; P = 0.025). There were no differences in the length of hospital stay between the two groups. Two major intra-abdominal complications occurred: 1 child in the LO-group had spermatic vessels torn, which led to a one-stage Fowler-Stephens orchidopexy, and the other child, one who had undergone a conversion from LO to OO, had a transection of the vas. One child in both groups was lost to follow-up. The overall success rate (acceptable scrotal position of the testis without testicular atrophy) was 88% in the LO group and 82% in the OO group. Although marginally longer in duration, primary LO appears to be a feasible, safe technique for the management of the low intra-abdominal testes, whereas the staged Fowler-Stephens LO may be more safe than primary LO in cases with high intra-abdominal testes.

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.

Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes : J.S. Elder. J Urol 148:1239–1241, (October), 1992

Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes : J.S. Elder. J Urol 148:1239–1241, (October), 1992

Two-Stage Fowler-Stephens Orchiopexy in the Management of Intra-Abdominal Testes

Of 22 boys with an intra-abdominal testis 8 (12 testes) underwent the 2-stage Fowler-Stephens orchiopexy. During stage 1 the testicular artery and internal spermatic vein were ligated in situ 2 to 3cm. superior to the intra-abdominal testis. The testicular vessels were transected inferior to the ligatures 6 months later and the testis was brought to the scrotum with the standard Fowler-Stephens orchiopexy technique. Patient age ranged from 1 to 6 years (mean 3.2 years). At followup 11 of 12 testes (92%) are in the scrotum and have a normal consistency and size, while 1 (8%) is atrophic. In this preliminary series the 2-stage Fowler-Stephens orchiopexy has a success rate equal or possibly superior to the standard Fowler-Stephens orchiopexy. Whether ultimate testicular function is improved, however, remains to be determined.