Orchiopexy Group Research Articles

Effects of Orchiopexy on Congenitally Cryptorchid Insulin-3 Knockout Mice

Insulin-3 (Insl3) knockout mice exhibit isolated, bilateral, high intra-abdominal cryptorchidism. If left in this position until adulthood, these testes will deteriorate to the Sertoli-cell-only state, leading to infertility in 100%. We examined the effect of orchiopexy in this genetically engineered animal model.A total of 160 testes from 80 male offspring of Insl3 F crosses underwent either no orchiopexy (29 testes), sham surgery (25 testes), 1-stage Fowler-Stephens scrotal orchiopexy (57 testes) or primary orchiopexy into a low abdominal, subcutaneous pouch (49 testes). A group of postoperative mice underwent fertility testing 3 months postoperatively. At 6 to 9 months postoperatively the testes were harvested and histologically analyzed.Testes were atrophic in 100% (25 of 25) of the sham group, 91% (52 of 57) of the Fowler-Stephens orchiopexy group and 33% (16 of 49) of the subcutaneous pouch group (testis weight less than 50 mg.). Fertility testing was done in 30 mice (sham 5, Fowler-Stephens orchiopexy 17 and subcutaneous pouch 8). Infertility was secondary to bilateral testicular atrophy (sham 5 of 5, Fowler-Stephens orchiopexy 13 of 17), spermatogenic maturation arrest (subcutaneous pouch 8 of 8) and ductal obstruction [normal spermatogenesis with epididymis devoid of sperm] (Fowler-Stephens orchiopexy 2 of 17). Fertility with normal spermatogenesis was observed in 2 of 17 Fowler-Stephens orchiopexy mice, both of which were Insl3 knockout mice.Intrascrotal orchiopexy can rescue these congenitally cryptorchid Insl3 knockout testes from their intra-abdominal fate of Sertoli-cell-only and lead to fertility. The results suggest that orchiopexy has a crucial and central role in preservation of spermatogenesis.

The effects of one- and two-stage orchiopexy on postoperative serum testosterone levels and testicular volume in adult patients with bilateral nonpalpable testes.

In this study, we investigated the effects of one- and two-staged orchiopexy on testicular volume and serum testosterone levels in cases with high, abdominally localized, bilateral nonpalpable testes. Between March 1996 and April 2001, orchiopexy was performed on 46 testes in 23 patients with bilateral nonpalpable testes. In 15 of the 23 patients, a two-stage Fowler-Stephens orchiopexy was performed, and in 8 of the 23 patients, a one-stage laparoscopic orchiopexy was performed. For one patient who lacked both testes, bilateral prosthetic testes were inserted. The patients' ages were between 20 and 23 years (average, 21 years). In the first stage of the two-stage orchiopexy, the spermatic artery was ligated laparoscopically. Six months later, open surgery orchiopexy was performed. Patients were followed for 2 to 16 months (average, 10 months) and were evaluated for testicular atrophy, serum testosterone levels, and complications. In all the patients, the preoperative secondary sexual characteristics and serum testosterone levels were normal. Among the postoperative controls, evaluated at months 3 and 6, one patient's testes were found at the pubic area. Testicular atrophy was not observed in any of the patients, and the serum testosterone levels were in the normal range. In the two-stage orchiopexy group, 5 (33%) of the 15 patients had an average 30% volume decrease, and in the one-stage group, 2 (25%) of the 8 patients had an average 40% volume decrease. In this study, it was shown that either two-stage Fowler-Stephens orchiopexy or laparoscopic orchiopexy can be successfully performed in patients with bilateral abdominal testes, and that the testes can be fixed to their palpable original positions without interfering with the secretion of testosterone. Although the results are similar, our experience suggests that single-stage laparoscopic orchiopexy is the preferable method.

Postoperative pain control in paediatric ambulatory herniorrhaphy and orchiopexy using atraumatic intraoperative instillation of bupivacaine in comparison with rectal application of acetaminophen: a double-blind study

Herniorrhaphy and orchiopexy are increasingly performed on an outpatient basis in paediatric surgery. In such cases, postoperative analgesia should receive special attention so that the hospital stay need not be unnecessarily prolonged due to side effects of the analgesic agents, such as sedation, respiratory depression or vomiting. Therefore, the present study is a randomized double-blind investigation to assess the effectiveness of atraumatic intra-operative instillation of bupivacaine in the surgical site and the rectal application of acetaminophen as a postoperative analgesic following herniorrhaphy and orchiopexy. Male patients between the ages of 3 and 6 yr who were scheduled to receive ambulatory herniorrhaphy or orchiopexy were included in the study. One hundred children in each of the herniorrhaphy and orchiopexy groups were treated respectively with acetaminophen or with bupivacaine as the postoperative analgesic. Atraumatic intraoperative instillation of bupivacaine into the surgical site proved to be significantly superior as a postoperative analgesic in both the herniorrhaphy and orchiopexy groups as compared to rectal application of acetaminophen (χ 2 test: herniorrhaphy group P < 0.05; orchiopexy group P < 0.001). For herniorrhaphy and orchiopexy in childhood, local atraumatic instillation of bupivacaine during surgery into the wound bed is a simple, easy to use and reliable method for post-operative pain control with no side effects.