Open Orchiopexy Research Articles

Laparoscopic vs Open Orchiopexy for Palpable Undescended Testis in Children

Abstract Background Cryptorchidism is the absence of one or both testes in the scrotum and is generally synonymous with undescended testis. Undescended testis is the most common genital disorder identified at birth. Undescended testes occur in 1–3% of full-term and up to 45% of preterm male neonates. Approximately 80% of undescended testes are clinically palpable and 20% are non-palpable. Aim of the Work To compare between laparoscopic and open orchiopexy evaluating final testicular position, success rate, and complications. Patients and Methods A prospective comparative study was made in Urology department, Ain Shams University Hospital for Twelve months starting from 1st of June 2021 to 1st of May 2022 on 50 children (aged from 1-18 years) with UDT and were included in the study and divided in to 2 groups 25 for each study group. Results In the present study the mean age in group I was 8.1± 0.99 y and in group II was 9.28± 0.91 y with no significant difference. The mean operative time in group I was 63.6 ± 5.56 min, and in group II was 58.44. ± 5.28 min with no statistically significant difference. There was in group I all the studied cases had no testicular atrophy, no testicular ascent, no need for redo-orchiopexy and a hernial sac was detected in all cases. In group II all the studied cases had no testicular atrophy, 92% had negative testicular ascent and 96% had a hernial sac. As regard to complications, only 2 patients presented with wound infection in group I and in group II there were a case with wound infection, a case with hydrocele and 2 cases with scrotal haematoma with no significant difference. Conclusion For the treatment of inguinal cryptorchidism, laparoscopic orchiopexy is a safer and less invasive option than open groin surgery. In children with palpable undescended testis, laparoscopic orchiopexy is linked with improved testicular position and a better success rate as open orchiopexy.

Is YouTube a source of misinformation for pediatric surgeons? Post pandemic cross-sectional study

BackgroundOnline learning resources are a powerful tool in the modern post pandemic world. YouTube being regarded as the most go-to platform for everyone including the medical personnel, the question of how misleading it can be being a social platform with no scientific control on its content. Additionally, the website algorithm measures and promotes the video success based on viewers subjective opinion and interaction This study assesses the quality of laparoscopic orchiopexy YouTube videos using the LAP-VEGaS criteria and whether video popularity correlates with higher LAP-VEGaS scores. MethodsOn 15th of January 2023, a YouTube search was performed using the term “laparoscopic orchiopexy”. The search results were sorted by views and the top 60 videos were included. Exclusion criteria included being duplicated, animated, showing open orchiopexy, and a non-English language. YouTube video criteria were recorded (view count, time since upload (days), video length, number of comments, number of likes/dislikes, and country of origin and were subdivided into individually produced or academic. Videos were scored according to the LAP-VEGaS criteria. For comparison, a freely available peer-reviewed video on WebSurg, and an institutionally produced video by StayCurrent were scored and compared. ResultsForty-three videos met the inclusion criteria being uploaded from July 2006 to September 2020. India and Egypt contributed the most videos (67 % and 7 %, respectively), while European countries and the United States combined contributed about 10 %. YouTube videos scored 6.5/17 on average, much lower than their non-YouTube counterparts (WebSurg: 10/17, and StayCurrent: 11/17). However, the best YouTube video outscored them both with a total of 13/17. Video introduction was given the most attention by authors (mean score: 1.5/2), while educational content was rather neglected (mean score: 0.5/4). Nonetheless, there were significant positive correlations between most LAP-VEGaS subscales, and the videos’ popularity (measured by the Video Power Index). ConclusionSurgical education videos are important, especially in the context of Laparoscopic Orchiopexy. The use of YouTube as a source of education is promising but should be consumed with great caution and skepticism. There is a need for a platform for those working in surgical education that can empower the publishing of educational videos while providing adequate peer-review and production guidance. Level of EvidenceLevel III CompetenciesMedical knowledge, Practice-based learning, and improvement.

Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆

BackgroundDue to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. MethodsASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg−1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. ResultsA total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). ConclusionLateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. Clinical Trials RegistryNCT03969316.

Comparison of clinical outcomes between laparoscopic orchiopexy and open orchiopexy in the treatment of palpable undescended testes.

To compare the clinical effects of laparoscopic orchiopexy (LO) and open orchiopexy (OO) in the treatment of palpable undescended testes. Seventy-six children with palpable undescended testes treated in Zaozhuang Municipal Hospital from June 2019 to January 2021 were selected in this observational retrospective study. Patients were grouped according to their different surgical methods, 33 patients received OO (Open-group) and 43 patients received LO (Laparoscopic-group). The clinical outcomes of the two groups were compared, including surgical-related indicators, near and long-term surgical complications and postoperative testicular growth. Operation time, intraoperative bleeding, first ambulation time and hospitalization time in the Laparoscopic-group were lower than those in the Open-group (p<0.05). The short-term complication rate in the Laparoscopic-group was lower than that in the Open-group (2.27% vs 15.15%; p<0.05), but the long-term complication rate in the Laparoscopic-group was not significantly different from the Open-group (4.65% vs 3.03%; p>0.05). Follow-up was up to 18 months post-operation, with the rate of testicular growth (97.67% vs 96.97%; p>0.05) and testicular volume (0.59 ± 0.14ml vs 0.58 ± 0.12ml p>0.05) not significantly different between the Laparoscopic-group or Open-group respectively. LO is as clinically effective as OO in the treatment of palpable undescended testes, however, shorter operation time, less intraoperative bleeding and rapid recovery time have been noted with LO.

Comparative Study between Laparoscopic versus Open Orchiopexy in Peeping and High Inguinal Undescended Testis: Review article

Comparative Study between Laparoscopic versus Open Orchiopexy in Peeping and High Inguinal Undescended Testis: Review article

Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis.

Background: Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism. Methods: Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery. Results: The final meta-analysis included five studies involving 705 children; LO, n = 369 (52.3%) and CO, n = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03–1.88, p = 0.17), early complications (RR = 0.66, 95% CI 0.21–2.08, p = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03–3.88, p = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies. Conclusion: LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.

Nonligation and ligation of hernial sac technique during orchiopexy for palpable undescended testis in children: A comparative study

Purpose: We prospectively evaluated the surgical outcomes of non ligation of hernial sac technique in children with a palpable undescended testis compared with the traditional hernial sac ligation technique during orchiopexy.&#x0D; Material and Methods: A total of 34 orchiopexies (30 children with age ranged from 6 months to 5 years) were included and randomly assigned to the non ligation of hernial sac technique orchiopexy group (Group-A, 15 children, 16 testes) and the traditional hernial sac ligation orchiopexy group (Group-B, 15 children, 18 testes). Operation time and surgical complications were compared between the two groups. Complications, testicular location and development of inguinal hernia were assessed at the follow-up evaluation for 6 months postoperatively.&#x0D; Results: The operation time was significantly shorter in Group-A (34.13±10.3 minutes) than Group-B (73.73±28.97 minutes) (&lt;p001). Postoperative complications were found in two cases (wound infection and testicular re-ascent) in Group-B. Wound infection was managed by conservative care and redo surgery was done for testicular re-ascent after 6 months of operation. None of the patients developed post operative inguinal hernia.&#x0D; Conclusion: We conclude that non ligation of hernial sac technique is a simple procedure that is associated with a shorter operation time than the conventional hernial sac ligation technique during open orchiopexy for palpable undescended testis.&#x0D; Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (2): 35-40

Incidence of wound infection in common paediatric day care surgeries following a no-antibiotic protocol: a viable recommendation for a public hospital in India

Background: The use of broad spectrum antibiotic administered intravenously 1 hour before incision has a well-established role in preventing surgical site infection following major surgeries. However, the benefit of this practice in clean, day care surgeries is less clear. The aim of the our study is to determine the incidence of wound infection in paediatric day care surgeries where antibiotics were not used. The objective of the present study was to observe the rate of Surgical Site Infection in paediatric day care surgery at a tertiary care public hospital where prophylactic antibiotics are not used empirically.Methods: We reviewed all paediatric patients undergoing day care common procedures namely herniotomy, open orchiopexy, circumcision and other minor procedures such as lymph node biopsy, lipoma excision, mucous retention cyst excision and dermoid cyst excision at our institute in a public hospital between January 2015 and December 2016. Those with heart diseases requiring infective endocarditis prophylaxis, those with immunosuppression and those who had received antibiotics perioperatively for any reason other than treatment of surgical site infection were excluded. Surgical site infection (SSI) was classified as superficial or deep as defined by the Centre For Disease Control (CDC). Results: A total of 576 paediatric patients underwent clean day- care procedures at our institute between January 2015 and December 2016, of which 478 patients met the inclusion criteria and were included in the study. 2 (0.41%) of these 478 patients developed surgical site infection. 1 patient had serous discharge at one point along the suture line while the other developed pus and required debridement.Conclusions: Clean day- care surgeries in children can be carried out safely without the empiric use of perioperative antibiotics even in the setting of a public hospital in a developing country.

Management of the patients with persistent Müllerian duct syndrome: Is the ultimate goal testicular descent?

Persistent Müllerian duct syndrome (PMDS) is a rare congenital disease characterized by the presence of rudimentary Müllerian structures within an intra-abdominal or hernial sac in a virilized male, often presenting as undescended testes. In this study, we aim to present a series of the PMDS patients who were managed by orchiopexy without removal of Müllerian remnants (MR). Between May 2010 and June 2017, we treated six cases diagnosed as PMDS in our department. Laparoscopy and gonadal biopsy were performed in all patients, and vessel ligation was done in four patients for the first session of Stephen-Fowler orchiopexy. After initial diagnosis, genetic analyses and endocrine investigations were performed. Demographic and clinical features of the patients, operative methods and follow-up data were analyzed retrospectively. Mean age of the patients was 5.5 years. Three boys had undergone inguinal surgery due to hernia or undescended testis, while others were diagnosed during laparoscopic investigation of nonpalpable testis. As a definitive operation, testes and MR were completely removed in an adult patient, and the remaining patients were treated with laparoscopic or open orchiopexy with or without utero-cervical splitting and the MRs were left in situ. Two testes atrophied during follow-up period. The goal of the approach in PMDS patients is to preserve testes, as well as carry them to their natural location. Leaving the MR in place is a suitable option for blood circulation of the testes but the long-term results are still unknown.

Early Experience with Laparoscopic Management of Nonpalpable Undescended Testes.

Background:Nonpalpable undescended testes (NPT) constitute 20%–30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care.Aim:This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center.Methodology:Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016.Results:A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.Conclusion:Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity.

Surgical Management of the Undescended Testis: Recent Advances and Controversies.

Undescended testis (UDT) is the most common disorder of sexual development in boys and affects 3.5% of male newborns. Although approximately half of newborn UDTs descend spontaneously, some boys develop an ascending testis later in childhood. Recent guideline recommendations advocate orchiopexy by 18 months of age to maximize potential for fertility and perhaps reduce the risk for testicular carcinoma in the future. For palpable testes, a standard inguinal approach is appropriate. However, the prescrotal approach is often effective for low inguinal testes and reduces surgical time and patient discomfort with an equivalent success rate in boys with an ascending testis. Some advocate monitoring until adolescence to determine whether the testis will spontaneously descend into the scrotum, but data do not support this approach. Instead, prompt orchiopexy is recommended. In boys with a nonpalpable testis, approximately 50% are abdominal or high in the inguinal canal and 50% are atrophic, typically in the scrotum. Routine inguinal/scrotal ultrasound is not recommended, although in an older boy who is overweight, it is appropriate. If the patient has contralateral testicular hypertrophy, scrotal exploration is appropriate, and removal of the testicular remnant and contralateral scrotal orchiopexy to prevent future contralateral testicular torsion is recommended. In most cases, diagnostic laparoscopy is advised to determine whether the testis is abdominal. For the abdominal testis, there are numerous treatment options. If the testis is mobile or a peeping testis just distal to the internal inguinal ring, standard one-stage laparoscopic or open orchiopexy should be attempted using the Prentiss maneuver. If the testicular vessels are short or the testis is not mobile, a two-stage Fowler-Stephens orchiopexy is appropriate. The second stage can be performed laparoscopically or open. Another option is microvascular testicular autotransplantation, which is a technically demanding procedure. Surgical results of abdominal orchiopexy are highly variable, short term, and highly subjective. Prospective clinical trials with follow-up into adolescence and adulthood are necessary to assess the success of various surgical approaches.

593 Laparoscopic versus open orchiopexy in the management of peeping testis: A multi-institutional prospective randomized study

Objective: Peeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchio- pexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. Patients and methods: Between September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy pro- cedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. Results: Themedianageofthechildrenwas2.5years(range0.5e12.0).Thefollow-upperiodran- ged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic

Sanligation technique of orchidopexy-Our experience

Introduction: A debate still exists in literature whether to ligate the indirect hernia sac during herniotomy in orchiopexy and hernia surgery. The study is designed with the aim to evaluate whether the ligation of hernial sac during orchiopexy is necessary to prevent the development of postoperative hernia. Material and Methods: This prospective study was conducted in 25 children with an age range of 6 months to 15 years with a diagnosis of palpable undescended testis. Of the 25 cases, 19 were unilateral and 6 were bilateral cases. Of the 19 unilateral undescended testis, 8 were right-sided and 11were left-sided. All children underwent open orchiopexy without the ligation of the hernia sac. Results: Clinically and radiologically all the patients were followed up to a period of two years. No evidence of inguinal hernia was detected during the follow-up in any patient. Conclusion: According to this study ligation of hernial sac is not necessary during orchiopexy and leaving the remnant stump open is safe with no recurrence.

Palpable Undescended Testes: 15 Years of Experience and Outcome in Laparoscopic Orchiopexy.

Most of the current literature concerning laparoscopy in patients with cryptorchidism reports on those with nonpalpable testes. The purpose of this study is to share our experience and outcome in laparoscopic orchiopexy on patients with palpable undescended testes. From January 1999 to July 2014, 240 cryptorchid testes were treated of which 192 (155 patients) were palpable and were operated on by laparoscopy. Before starting, the bladder is emptied with a Foley catheter. Four trocars are used: One 5 mm for the lens (45 degree), one 10 mm (transscrotal), and two 3 mm placed at the subcostal midclavicular line for the instruments. We localize the deep inguinal ring and open the peritoneum. The spermatic vessels and vas deferens are dissected in a cephalic direction. The epigastric vessels are dissected and sectioned to facilitate the localization of the testicle inside the canal. Once found, the testis is dissected and taken into the abdominal cavity where the gubernaculum testis is cut. A 10-mm trocar is introduced through the scrotal sac into the peritoneal cavity. The testicle is grabbed and pulled down to the scrotum where it will be fixed with a 5-0 polypropylene suture in the usual manner. Of 192 cryptorchid palpable testes treated with laparoscopy, only one procedure was converted to conventional open orchiopexy because of an ectopic testicle (above the aponeurosis of the oblique muscle). The rest of the testicles could be moved down to the scrotal sac. Our follow-up ranges from 6 months to 15 years, and we have not found atrophy in any of the testicles. To date, only two (0.4%) testicles have reascended. Laparoscopy is a great and safe option for patients with palpable undescended testes, regardless of its position in the inguinal canal.

English

INTRODUCTION: The goal of management of a non-palpable testis is to identify whether a viable testis is present and, if so, either perform an orchiopexy or, in selected cases, an orchiectomy. Management of palpable undescended testis is quite straightforward and diagnostic studies are usually not necessary. However, management of non-palpable testes is more complex. MATERIAL AND METHODS: It was a prospective hospital based study conducted in the department of surgery, Chirayu Medical College, Bhopal during the period of January 2012 to June 2014. 30 patients were selected in the study. Surgical management was not done before 6 months of age. Open orchiopexy was performed in palpable group. For impalpable group, diagnostic laparoscopy was done and managed accordingly. RESULTS: Forty undescended testes were operated upon, of which twelve (40%) were situated in the inguinal canal, twelve (40%) external ring and three (10%) each at the level of internal ring and intra-abdominal respectively. 6 patients (aged five to nine years) with canalicular testes had macroscopically atrophic testes, as did three (aged four to twelve years) with abdominal testes and one (two years) with the testes at the level of the internal ring. CONCLUSION: Laparoscopy is a safe and effective method for the diagnosis of non-palpable and undescended testis. Microvascular orchiopexy is a feasible technique even in small children with good results.

Laparoscopic versus open orchiopexy in the management of peeping testis: A multi-institutional prospective randomized study

ObjectivePeeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. Patients and methodsBetween September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. ResultsThe median age of the children was 2.5 years (range 0.5–12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered. ConclusionOpen and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group.

The value of laparoscopic classifications in decision on definitive surgery in patients with nonpalpable testes

Background / purpose The aim of the study was to present our clinical experience with the laparoscopic approach in patients with nonpalpable testes (NPTs) and review the literature on laparoscopic classifications. Materials and methods Between May 2010 and August 2012, 30 boys with NPT (mean age 3.9 years) underwent laparoscopy as a part of diagnosis and treatment in our clinic. The laparoscopic findings were classified into four types according to Castilho. The patients were managed according to the presence or position of the testes and testicular vessels. Results Six patients were excluded from the study. Twenty-six testicular units (19 left, three right, and four bilateral units) in 24 patients were managed laparoscopically. Laparoscopy was terminated in eight patients in whom blind-ending cord structures were detected intra-abdominally. An inguinal canal exploration was performed in 10 cases in whom cord structures were seen entering the internal inguinal ring. No viable testis was found, and testicular remnants were excised for histopathologic examination. Four canalicular testes (peeping) were treated with open orchiopexy. Laparoscopy-assisted orchiopexy without vascular ligation was performed in two testes. Fowler-Stephens orchiopexy in single stage was performed in one testicular unit and in two stages in another unit. All patients were discharged on the same day. The testes were normal in size and found in the scrotum after a mean follow-up period of 14 months. Conclusion The laparoscopic findings in NPT had an important influence on treatment decisions. To be able to interpret the definitive surgery relative to the laparoscopic classification, collaborative studies are required. Keywords : laparoscopy, nonpalpable testis, nubbin, orchiopexy, vas deferens

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

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

Laparoscopic management of impalpable undescended testes: 20 years′ experience

BACKGROUND:Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years.MATERIALS AND METHODS:From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler — Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite.RESULTS:None of the testis atrophied after two-stage Fowler — Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy.CONCLUSIONS:Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler — Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler — Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.

Laparoscopy-assisted orchiopexy versus laparoscopic two-stage fowler stephens orchiopexy for nonpalpable testes: Comparative study

Background/Purpose:To assess the outcome of the primary laparoscopy-assisted orchiopexy (LAO) and the laparoscopic two-stage Fowler Stephens orchiopexy (FSO) for managing patients with nonpalpable testis in terms of safety, feasibility and efficacy.Materials and Methods:This study included 94 patients (110 nonpalpable testes) who underwent laparoscopy at King Khalid University Hospital, Riyadh between July 1998 and June 2012. Patients were evaluated postoperatively to check the location and size of testes and to exclude any other complications.Results:Mean age at presentation was 24+/−19 months (9-96 months). Orchiectomy was done for 5 atrophic testes. 36 open orchiopexy was done for 29 canalicular testes and 7 peeping testes. 35 LAO were done for 1 canalicular testis, 5 peeping testes, 16 low intraabdominal testes and 13 high intraabdominal testes. 34 FSO were done for 23 high intraabdominal testes, 9 low intraabdominal testes and 2 peeping testes. Median follow up was 12 months (1-84 months) and 6 patients were lost to follow up. The overall success rates for LAO and FSO were 88% and 63%, respectively. Overall testicular atrophy rates were 3% and 30% for LAO and FSO, respectively (OR 0.08 [95% CI, 0.01-0.69], P = 0.006). For high intraabdominal testes, the atrophy rates were 3% and 20% for LAO and FSO, respectively (OR 0.14 [95% CI, 0.02-1.21, P = 0.049).Testicular displacement rates were 9% and 7% for LAO and FSO, respectively (OR 1.5, 95% CI, 0.24-9.59, P = 0.514).Conclusions:Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with nonpalpable testes. LAO appears to be feasible and effective in management of high intraabdominal testes. Further well-conducted comparative studies are needed.