Postoperative Testicular Volume Research Articles

A prospective comparative study of open versus laparoscopic stage II Fowler-Stephens orchidopexy in pediatric patients.

Laparoscopic Fowler Stephens orchidopexy, single stage or two-stage, is now routinely performed in non-palpable testis. We performed second stage orchidopexy as open inguinal approach and compared the outcome of this approach to two-staged laparoscopic orchidopexy. We performed a prospective randomized interventional study of two different approaches for intra-abdominal testis. In group A, Laparoscopic stage I (SFO) followed by open inguinal orchidopexy was compared for final outcome in group B cases, who underwent laparoscopic staged SF orchidopexy. The average duration between stage I SF and stage II SF was 6 months. All the procedures were done under GA and caudal analgesia. The pre-operative and post-operative USG dimensions were compared in cm and cm3/ml. The procedure outcome was considered successful if testis remained inside scrotum below mid-scrotal point. Any testis above the mid-scrotal point was considered as unacceptable or failure of procedure. This study was performed on 74 children with 84 testis (group 'A' 38 patients (48 testis) and group 'B' 36 patients (46 testes)), with average age was 3.3 ± 0.46 and 3.9 ± 0.58 years, respectively. In group 'A', 38 patients (48 testes) underwent lap SFO I followed by inguinal orchidopexy and in group 'B', 36 patients (46 testes) underwent laparoscopic staged SF O. The mean testicular volume pre-operative in group 'A' & 'B' was 0.28 ± 0.04 and 0.23 ± 0.06 cm2, respectively. The mean post-operative testicular volume was 0.34 ± 0.07 and 0.28 ± 0.05 cm2, respectively. The average follow-up of the patients in group 'A' & 'B' was 24 ± 3.67 and 20 ± 2.90 months, respectively. Testis was having good volume in 87.5% and 76.60% of these successful cases, respectively. There were (3/48) 6.25% (4/46) 8.69% testicular atrophy cases in group 'A' & 'B', respectively. The differences were not statistically significant (p < 0.05). The mean operative time in group A was 20 ± 8.07 min and group B 30 ± 7.19 min in stage II procedure. The success rate in group A was more than the group B which was statistically significant (p > 0.05). Our study connotes that open stage II orchidopexy is still feasible and practicable with better final outcome of management of non-palpable cases.

Degrees of Testicular Atrophy Following Orchidopexy for Testicular Torsion.

Introduction Testicular torsion is an urological emergency. It is a time-sensitive condition in which twisting of the spermatic cord and testicular blood supply occurs, causing acute onset severe scrotal pain. The incidence of testicular torsion is highest amongst prepubertal males; however, it can occur at any age. Every hour that passes from the onset of symptoms has been shown to decrease the salvageability rate of the torted testis. Another significant factor that impacts testicular salvage is the degree of torsion. Prompt surgical exploration of the scrotum and orchidopexy, if the testis is salvageable, is the mainstay of treatment. A major sequela following orchidopexy for torsion is the decrease in testicular volume. The aim of this study is to assess testicular volume loss post orchidopexy in patients who presented with testicular torsion, as well as to identify the significance of the degree of rotation and duration of torsion in post-fixation volume loss. Methods This is a retrospective study in which all patients who underwent scrotal exploration for a primary diagnosis of testicular torsion between June 1, 2016, to January 15, 2023, were reviewed. The information obtained included the patients' demographics such as age, duration of symptoms, and laterality. Ultrasound images were reviewed for pre- and postoperative findings which included confirmation of testicular torsion as well as testicular volume measurements. Patients were excluded if they underwent an orchidectomy, had a diagnosis other than testicular torsion once scrotal exploration was done, or did not perform a follow-up scrotal ultrasound. Additionally, patients who underwent an orchidopexy for undescended testis earlier in life were also excluded. For statistical analysis purposes, degrees of testicular torsion and time to surgery were classified into mild, moderate, and severe. Results A total of 109 patient records were reviewed within the specific time frame. Of these, 47 patients were excluded as per the exclusion criteria mentioned previously, which gave us a sample size of 62 patients. Our findings showed that increasing severity of the degree of torsion as well as the time for surgery have statistically significant (p-value <0.05) effects on postoperative testicular volume loss. However, it was noted that time to surgery has a more pronounced effect on the mean volume loss than the degree of torsion. Moreover, the analysis also showed that, on average, with every additional hour from the onset of symptoms to surgery, the approximate volume loss is 0.15 ml. However, once time exceeds the 4.5-hour mark, the mean volume loss is 0.4 ml for each additional hour. Conclusion The current study indicates that earlier surgical intervention and correction of torsion are associated with enhanced preservation of postoperative testicular volume. Both the degree of torsion and time to surgery influence mean volume loss; however, time to surgery has a greater impact on the mean volume loss. These results highlight the importance of early diagnosis and intervention in cases of testicular torsion to minimize the risk of long-term testicular volume loss.

A systematic review and meta-analysis on the efficacy of internal spermatic artery ligation during laparoscopic varicocelectomy in children and adolescents: Is it safe?

Challenges in identifying small testicular arteries and lack of microscopic experience have led to a rising trend in the use of laparoscopic technique for pediatric and adolescent varicocele. The controversy over artery ligation (AL) and artery preservation (AP) during laparoscopic varicocelectomy (LV) is still debatable. This study investigates the effectiveness of AL and AP during LV in pediatric and adolescent varicocele cases. The systematic searches based on PRISMA guideline were conducted in PubMed, Scopus, ScienceDirect, Web of Science and ProQuest databases with pre-defined keywords. Both quantitative and qualitative analyses were performed to assess catch-up growth, persistence, recurrence, hydrocele, operative time, post-operative testicular volume, and sperm analysis. A total of 1512 patients from 9 eligible studies were included. There were no significant differences in catch up growth (OR 0.89; 95%CI 0.53, 1.51; p = 0.68) or hydrocele incidence (OR 0.59; 95%CI 0.28, 1.24; p = 0.16). The recurrence rate and persistence rate in AP group is significantly higher compared to AL group (OR 2.95; 95%CI 1.53, 5.68; p = 0.001 and OR 5.13; 95% CI 2.04, 12.88; p = 0.0005, respectively). The mean operative time during laparoscopic varicocelectomy is significantly longer when arteries are preserved as opposed to when they are ligated (OR 5.33; 95%CI 2.05, 8.60; p = 0.001). AL and AP both improved testicular volume and post-operative sperm analysis. AL showed higher efficacy and comparable safety to AP. We recommend using AL with lymphatic sparing to minimize hydrocele complications.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring.

ObjectiveTo compare the clinical efficacy and safety of laparoscopic orchiopexy with the modified Prentiss maneuver (LOMPM) and laparoscopic trans-inguinal orchiopexy (LTIO) for the treatment of non-palpable testis (NPT) <1 cm from the internal ring.MethodsChildren with unilateral NPT who underwent laparoscopic orchiopexy at our center between February 2018 and January 2021 were retrospectively analyzed. According to the surgical method, they were divided into LOMPM and LTIO groups. The operation time, postoperative pain degree, postoperative complications and follow-up results were compared between the two groups.ResultsA total of 98 patients were included in this study, including 41 cases in the LOMPM group and 57 cases in the LTIO group. All patients underwent successful surgery. The LOMPM group was superior to the LTIO group in terms of postoperative testicular position (lower scrotm: 90.2 vs. 71.9%, P = 0.026). There were no significant differences in operation time, postoperative pain score, and complications between the two groups. Preoperative testicular volume, postoperative testicular volume, and testicular growth rate in the LOMPM group were comparable to those in the LTIO group. There were no testicular atrophy, inguinal hernia and hydrocele in both groups after operation.ConclusionsLOMPM was comparable in safety to LTIO, but LOMPM had a good post-operative testicular position, and was suitable for the treatment of NPT near the internal ring.

Comparison of Testicular Volume and Blood Flow in Children Before and After Surgery for Inguinoscrotal Diseases- A Prospective Cohort Study

Introduction: Testicular diseases in children include hernia, hydrocele, undescended testis, epididymal cyst or torsion testis. Some of these like hernia and undescended testis will have affect on the testicular volume and blood flow. These are predictors for the future function of the testis. Manipulations during surgery can also affect blood flow to the testis. Aim: To compare testicular volume and blood flow in children undergoing surgery for inguinoscrotal diseases in both normal and diseased sides, before and after surgery. Materials and Methods: A prospective cohort study was conducted from March 2019 to December 2019 in which 30 children were selected from Surgery Outpatient Department (OPD), Department of Paediatrics, Gian Sagar Medical College, Rajpura, Punjab, India. For patients having inguinoscrotal disease, ultrasonography (US) and colour doppler was done preoperatively on all cases by an experienced radiologist, using the same machine settings on the seventh day and three months postsurgery. Preoperative and postoperative testicular volume and blood flow was recorded in all the patients. The Statistical Package for Social Sciences (SPSS) software was used to statistically analyse the data arising, p&lt;0.05 was accepted as statistically significant. Results: Total of 30 children (10 months to 10 years of age) formed the total sample of the study. Pathology was found in 18 patients on the right side and 12 patients on the left side. When the right and left side pathology were compared, it was found that right testicular volume was less as compared to left side. This difference was statistically significant with the p-value 0.006. There was a significant difference in blood flow between the right and left testis, both before (p-value 0.007) and after surgery (p-value=0.004). Testicular volume increased three months postsurgery in all the patients. This difference was more evident in left side pathology (p&lt;0.05) as compared to right side (p&gt;0.05). The increase in mean blood flow of diseased testis was significant after seven days of surgery (p-value &lt;0.05). But change in mean testicular volume and blood flow after three months of follow-up was found to be non-significant. Conclusion: Inguinal surgery does not affect the testicular volume and blood flow. But long term follow-up for children of inguinal surgery for its effect on fertility should be evaluated.

Testicular Volume Changes in Laparoscopic Staged Fowler-Stephens Orchiopexy: Studying the Impact of Testicular Vessel Division

To study the effect of testicular vessel division on testicular volume during laparoscopic staged Fowler Stephens orchiopexy (LSFSO). Testicular dimensions were prospectively measured intraoperatively at both first (S1) and second stages (S2) of LSFSO, and with scrotal ultrasound 3-12 months postoperatively. Testicular volumes were compared to reference ranges. Volume changes were tracked with a change of >20% considered clinically significant. A total of 52 nonpalpable testes treated with LSFSO between 2008 and 2018 were included in the study. After a median follow-up of 6.8 (3-91.3) months, 46 (88.5%) testes were palpable in a scrotal location without adjunctive procedures and 39 (75%) maintained vascular flow on duplex ultrasound. One testis retracted to an inguinal position and was successfully treated with inguinal orchiopexy for an overall success of 90.4% (47/52). Of 36 testes with intra- and postoperative testicular volume documentation, only 2 (5.6%) had significant volume loss after S1. Both testes had catch-up growth after S2. Eight (22.2%) testes had significant volume loss after S2. At follow-up, 24 (66.7%) testes were smaller than the mean for age, of which 20 (83.3%) were small at baseline. Only 41.7% of testes larger than mean for age at follow-up, were small at baseline (P = .02). Significant testicular volume loss does not occur after testicular vessel division at S1, but expected in approximately 1 quarter of testes after S2. We propose that testicular atrophy after LSFSO is primarily due to defective testicular development and rarely due to vascular compromise during S2.

AB093. The effect of different strategies of vessel management on vasovasostomy

BackgroundTo study the effect of different strategies of vessel management on vasovasostomy.MethodsFifty 8-week-old male Sprague-Dawley rats were randomly divided into groups A, B, C, D and E. In group A all the vessels were preserved. In group B all vessels were ligated and cut. In group C only arteries were preserved. In all the groups above end to end anastomosis were performed and contralateral testis was removed. In group D only veins were preserved. Group E is the control group with vas deferens intact. All rats’ testicles were measured the size before operations. After 4 weeks, the rats were raised with female rats with 1:1 in the same cage for 2 weeks and the number of pregnant rats were recorded. Then rats were sacrificed, dissected and testicles and vas deferens were collected and detect the patency.ResultsThe patency rate was 90%, 80%, 90%, 80%, 100% and conception rate was 30%, 30%, 20%, 30%, 80% in groups A, B, C, D and E respectively. Preoperative testicular volume was 1.88667±0.11912, 1.176293±0.06971, 1.91651±0.1163, 1.82947±0.12312, 1.80818±0.149 cm3 in groups A, B, C, D and E respectively and 6 weeks postoperative testicular volume was 1.21519±0.19, 1.20181±0.17, 1.27018±0.29, 1.23696±0.21, 1.78842±0.12 cm3. Rate of testicular atrophy was 70%, 50%, 50%, 70%, 0% and rate of postoperative adhesion was 60%, 50%, 50%, 60%, 0% in groups A, B, C, D and E respectively. There was no significant difference in patency rate, conception rate, testicular atrophy and adhesion among the groups (P>0.05) while statistically significant to the control group (P<0.05). Logistic regression analysis showed postoperative adhesion increased the risk testicular atrophy. (OR =60.000000, P<0.05), while testicular atrophy was negatively correlated with pregnancy rate (OR =0.048128, P<0.05).ConclusionsDevascularization does not affect the surgical outcomes of vasovasostomy (VV). Postoperative adhesion can increase the risk of testicular atrophy after vasovasostomy, then consequently affects the rate of pregnancy. Reduction in postoperative adhesion may play a role in vasovasostomy outcomes.

Efficacy of microsurgical versus laparoscopic techniques on adolescent varicocele: a meta-analysis

Objective To analyze the efficacy of microsurgical versus laparoscopic varicocelectomy in treatment of adolescent varicocele. Methods All literature about treatment of adolescent varicocele, which met the inclusion criteria, were retrieved by two reviewers and data were extracted to perform a meta-analysis in the use of RevMan 5.3 downloaded from Cochrane library. Results A total of four controlled trials consist of 310 patients were included in the analysis, which displayed that: there was no significant difference in patients with postoperative testicular volume increase or in postoperative recurrence rate between the microsurgical group and the laparoscopic group(P=0.66 and P=0.19). Operative time of the microscopic group was longer than the laparoscopic group(P<0.01) and incidence of postoperative complications of microsurgery was lower(P=0.003). Conclusions Compared with adolescent varicocele, microsurgical varicocelectomy is relatively safer. More high-quality randomized controlled trials in this study are needed for further verification. Key words: Varicocele; Laparoscopes; Microscopy; Meta-Analysis

Instructions to Authors

To compare the curative effect of single-stage and two-stage Fowler–Stephens (F–S) laparoscopic orchidopexy for intraabdominal high testis and explore the appropriate surgical approach.We performed a prospective analysis of the clinical data of 28 patients who underwent F-S laparoscopic orchidopexy for intraabdominal high testis in our department from May 2012 to April 2015, including 15 cases of the single-stage F-S operation and 13 cases of the two-stage F-S operation. By comparing the two groups preoperative and postoperative (6 months) clinical data of testicular position, testicular volume, and sex hormone levels [testosterone (T), follicle stimulating hormone (FSH), and estradiol (E2)], we analyzed the difference in efficacy between the two procedures.Twenty-eight patients completed laparoscopic surgery, no case was converted, and no testis was excised. All patients were followed up for 9–25 months after the operation, with an average follow-up of 16.2 months. The postoperative testicular volume of the single-stage and two-stage F-S groups was not significantly reduced (p > 0.05). In both groups, the postoperative T levels were significantly increased compared to the preoperative levels (p < 0.05), while the FSH and E2 levels were significantly decreased (p < 0.05). The differences in testicular volume and T, FSH, and E2 levels between the two surgical procedures were not significant (p > 0.05). In the single-stage F-S group, the testes were located in the scrotum in 13 cases and retracted to the lower groin in two cases. In the two-stage F-S group, the testes were located in the scrotum in 12 cases and retracted to the lower groin in one case. The difference in postoperative testicular position between the two groups was not significant (p > 0.05).In the case of testis with good collateral circulation, single-stage F-S laparoscopic orchidopexy had the same safety and efficacy as the two-stage F-S procedure. Surgical options should be based on comprehensive consideration of intraoperative testicular location, testicular ischemia test, and collateral circumstances surrounding the testes. Under the appropriate conditions, we propose single-stage F-S laparoscopic orchidopexy be preferred. It may be appropriate to avoid unnecessary application of the two-stage procedure that has a higher cost and causes more pain for patients.

Efficacy of single-stage and two-stage Fowler–Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis

To compare the curative effect of single-stage and two-stage Fowler-Stephens (F-S) laparoscopic orchidopexy for intraabdominal high testis and explore the appropriate surgical approach. We performed a prospective analysis of the clinical data of 28 patients who underwent F-S laparoscopic orchidopexy for intraabdominal high testis in our department from May 2012 to April 2015, including 15 cases of the single-stage F-S operation and 13 cases of the two-stage F-S operation. By comparing the two groups preoperative and postoperative (6 months) clinical data of testicular position, testicular volume, and sex hormone levels [testosterone (T), follicle stimulating hormone (FSH), and estradiol (E2)], we analyzed the difference in efficacy between the two procedures. Twenty-eight patients completed laparoscopic surgery, no case was converted, and no testis was excised. All patients were followed up for 9-25 months after the operation, with an average follow-up of 16.2 months. The postoperative testicular volume of the single-stage and two-stage F-S groups was not significantly reduced (p>0.05). In both groups, the postoperative T levels were significantly increased compared to the preoperative levels (p<0.05), while the FSH and E2 levels were significantly decreased (p<0.05). The differences in testicular volume and T, FSH, and E2 levels between the two surgical procedures were not significant (p>0.05). In the single-stage F-S group, the testes were located in the scrotum in 13 cases and retracted to the lower groin in two cases. In the two-stage F-S group, the testes were located in the scrotum in 12 cases and retracted to the lower groin in one case. The difference in postoperative testicular position between the two groups was not significant (p>0.05). In the case of testis with good collateral circulation, single-stage F-S laparoscopic orchidopexy had the same safety and efficacy as the two-stage F-S procedure. Surgical options should be based on comprehensive consideration of intraoperative testicular location, testicular ischemia test, and collateral circumstances surrounding the testes. Under the appropriate conditions, we propose single-stage F-S laparoscopic orchidopexy be preferred. It may be appropriate to avoid unnecessary application of the two-stage procedure that has a higher cost and causes more pain for patients.

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study.

Objective:To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow.Methods:This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant.Results:Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery.Conclusions:The modified Ferguson technique do not change the testes volume and blood flow.

Retroperitoneoscopic Varicocelectomy in Adolescents: Long-term Follow-up in Two Italian Centres.

Background:The varicocele is the most commonly diagnosed pre-pubertal andrological condition with an incidence of 10%–15% between adolescents. The aim of this study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in two Italian centres with particular attention to post-operative testicular volume and semen analysis after 18 years of life.Materials and Methods:From 1999 to 2010, 286 adolescents underwent retroperitoneoscopic left varicocelectomy. Of these patients, 67 were evaluated by clinical examination, ultrasound and semen analysis, allowing an adequate long-term follow-up.Results:Surgery was performed at a mean age of 13 years (range 10–17) without intraoperative complications. There were two recurrences (3%), two left testis hypotrophy (3%) and four hydroceles (6%), not yet undergone surgery because asymptomatic or without tension. Currently, 44 patients accepted to perform semen analysis which showed a reduction in sperm motility in 12 cases, with associated morphological alterations in 3 and reducing number of spermatozoa in one case.Conclusions:In consideration of morphological and biomolecular spermatic alterations reported in adolescent varicocele that could interfere with cellular migration, differentiation and nutrition, it is fundamental to consider the correction of varicocele, not only for the classical indications, but also as a choice for arresting the progressive damage that inevitably acts for several years on the adolescent testis. The RV in adolescents is a safe and feasible procedure for experienced paediatric laparoscopic surgeons with early good clinical outcomes, but more studies occur to understand the real impact of adolescent varicocelectomy on testicular function.

Testicular atrophy following paediatric primary orchidopexy: A prospective study

With the Nordic consensus statement advocating orchidopexy at an earlier age, the present study sought to investigate the outcomes of primary paediatric orchidopexy at a tertiary UK centre. To prospectively assess testicular atrophy following primary orchidopexy for undescended testes in a paediatric population. Secondary outcomes were complication rates and whether outcomes were dependent on grade of operating surgeon. Prospective data regarding age at operation, classification of the undescended testis, length of follow-up, and subjective comparison of intraoperative and postoperative testicular volumes compared with the contralateral testis were collected. Testicular atrophy was defined as >50% loss of testicular volume or a postoperative testicular volume <25% of the volume of the contralateral testis. Patients were excluded for incomplete data and follow-up <6 months. Data for 234 patients were analysed. Testicular atrophy occurred in 2.6% of cases. There was no reported testicular re-ascent. All secondary acquired cases underwent a previous ipsilateral hernia repair. There was no significant difference in outcomes comparing the grade of surgeon (consultant n=8, trainee/staff-grade surgeon n=7-8). There was a trend towards postoperative catch-up growth in approximately one fifth of cases. Previous studies have reported a testicular atrophy rate of 5%. The present study reported a similar rate of 2.6%. In agreement with a previous publication, it was also found that testicular atrophy was not dependent on the grade of operating surgeon. The mechanism for testicular catch-up growth is not well understood. Animal studies have supported the hypothesis that increased temperature has a detrimental effect on testicular volume. However, follow-up in the present cohort was short (median 6.9 months), making interpretation of this finding difficult. It is acknowledged that clinical palpation alone to determine testicular volume potentially introduces intra-observer and inter-observer error. However, prospective studies using ultrasound to determine testicular volumes following orchidopexy have reported catch-up growth. This study represented one of the larger collections of prospective assessments of outcomes following primary orchidopexy. It was acknowledged that subjectively assessing testicular volume is not ideal; however, the data correlated with similar studies.

Adolescent Varicocelectomy—Is the Potential for Catch-Up Growth Related to Age and/or Tanner Stage?

Adolescent varicocelectomy is associated with a 70% incidence of postoperative catch-up growth in boys with ipsilateral testicular hypotrophy. We determined whether preoperative patient age and Tanner stage were related to subsequent catch-up growth. In other words if patients are followed with a period of observation, will a window of opportunity be lost for achieving catch-up growth? We studied a total of 163 boys (mean age 15.1 years, range 10 to 24) with left or bilateral varicoceles who demonstrated 10% asymmetry or greater preoperatively, and had preoperative and postoperative testicular volume measurements available (using either ring orchidometer or ultrasound). Of these patients 59 also had preoperative Tanner stage recorded. Of the patients with preoperative left hypotrophy 69% had achieved catch-up growth at last followup (mean followup 28 months). When treated as a continuous variable, or when divided into general prepubertal vs postpubertal groupings, age at surgery was not significantly associated with catch-up growth. Similarly, there was no significant difference in catch-up growth associated with grade of varicocele, duration of postoperative followup or presence of unilateral left vs bilateral varicocele. No association with Tanner stage was found, although the patient numbers were too small to draw any statistically significant conclusions. The prevalence of testicular catch-up growth after varicocelectomy is high, even for patients in their early 20s. Among males 10 to 24 years old there is no specific age or Tanner stage that offers the best opportunity for catch-up growth.

Five Year Follow-up Testicular Growth Results after Orchiopexy in Palpable Cryptorchid Testis

Purpose: Postoperative long-term follow-up studies after orchiopexy are rare as compared for other studies such as for histological changes and proper operative age. We analyzed the five-year long-term follow-up results after orchiopexy, expecting a proper prognosis of testicular growth. Materials and Methods: A total of 57 patients were selected from a follow-up study in 211 boys who underwent orchiopexy between January 1999 and July 2001. Patients were divided in several categories (operation age, testis consistency, pre-operational position of the testis) and were analyzed by examination of the previous medical records, preoperative and postoperative testicular volume (measured by ultrasonography), followup history taking, and from a physical examination. Results: For the 57 patients, 14 patients had bilateral and 43 patients had unilateral cryptorchidism. All of the cryptorchid testes were smaller than a normal testis in the unilateral group of patients as determined by testis ultrasonography. Sorting by operation age, only patients that received orchiopexy within two years from birth showed a significant recovery of testicular volume percentage (operated testis/normal testis x100%: in the unilateral group) at follow-up. Sorting by consistency, the patients with normal testicular consistency showed a significant recovery of testicular volume percentage (operated testis/normal testis x100%: in the unilateral group) at follow-up. Sorting by the preoperative position of the testis, the proximity of the testis to the scrotum was a significant factor for recovery of delayed cryptorchid testicular growth. Conclusions: Orchiopexy performed at less than two years from birth and the proximity of the testis to the scrotum were significant factors for recovery of delayed cryptorchid testicular growth. Consistency of a cryptorchid testis can be a meaningful factor for expectation of testicular growth by the establishment of an objective measurement for testicular consistency and studies for histological correlation. (Korean J Urol 2008; 49:271-276) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Improvement of sexual activity, pregnancy rate, and low plasma testosterone after bilateral varicocelectomy in impotence and male infertility patients.

To evaluate the effects of bilateral varicocelectomy on sexual activity, testicular volumes, semen quality, and serum hormone levels in impotence and male infertility patients, 48 patients were studied from an outpatient clinic from May 1998 to March 2001. The mean age was 37+/-5.9; 16 patients were complaining of erectile dysfunction and 32 patients were complaining of male infertility. The mean duration of impotence was 3.3+/-2.4 years and for male infertility was 3.8+/-3.2 years. Sexual and reproductive history was taken for erectile dysfunction and male infertility patients. General, local examination, and laboratory investigations were done for all patients. Preoperative and postoperative testicular volumes; semen parameters, including semen volume, sperm count, and motility; and morphology and hormonal parameters, including LH and FSH, and testosterone levels were measured. All patients were followed up for 3-36 months after varicocele repair. Left and right testicular volume was improved in impotence and male infertility patients and fertility groups, but this improvement was not statistically significant (p>.25). The semen volume was significantly increased in male infertility patients and fertility group (p<.05), but there was no statistical significant difference in impotent patients (p>.25). The sperm count was improved in male infertility patients and fertility group, but this improvement was not statistically significant (p>.25), and in impotent patients there was no significant difference (p>.40). The sperm motility was very significantly increased in male infertility patients and the fertility group (p<.0005), and highly significantly increased in impotent patients (p<.005). The abnormal forms were not statistically significant in impotence and male infertility patients (p>.40), but significantly decreased in the fertility group (p<.05). Serum testosterone was very significantly increased in impotence and male infertility patients (p<.0005) and was highly significantly increased in fertility groups (p<.005). Serum FSH was improved in impotence and male infertility patients, but this improvement was not statistically significant (p>.10), and in fertility groups of male infertility patients, the results showed a statistically significant increase (p<.05). Serum LH was not statistically significant in impotence and male infertility patients (p>.10), and was significantly increased in fertility groups (p<.05). The improvement of sexual activity was 50-75%, the pregnancy rate for their partners was 37% and increased plasma testosterone levels over a period of 3 years of follow-up after varicocele repair.

The Effect of Varicocele Repair on Testicular Volume in Children And Adolescents With Varicocele

We investigated the effect of varicocele repair on testicular volume according to age in children and adolescents and review the long-term results of varicocele surgery. The study included 39 boys 11 to 19 years old with clinical palpable varicocele who underwent varicocele surgery with at least 1 year of postoperative followup. Preoperative and postoperative testicular volumes were monitored and measured with an ellipsoid Prader orchidometer. Physical examination findings (testicular volumes and testicular consistency) in all boys, and serum hormone values and semen parameters in 16 adolescents were recorded and compared before and after surgery. Left unilateral varicocelectomy was done in 29 boys (74%) and bilateral varicocelectomy in 10 (26%). While no postoperative hematoma, infection or testicular atrophy was observed, 1 boy (2.5%) had varicocele recurrence and 2 boys (5.1%) had minimal hydroceles that required no intervention. Significant increases were observed in postoperative sperm concentration (p = 0.01), total motile sperm count (p = 0.009), testis volume (p = 0.000) and serum testosterone level (p = 0.014). All 15 boys with preoperative soft testis had normal testicular consistency postoperatively. Of the 19 boys with preoperative testicular atrophy 10 (53%) did regain normal testicular growth, while 9 (47%) retained testicular volume loss after surgery. When comparing preoperative to postoperative increase in testicular volume according to age in all boys, the mean was statistically significantly higher in boys younger than 14 years (left testis p = 0.037, right testis p = 0.000). Testicular consistency achieved normal firmness after varicocelectomy in all boys with preoperative soft testis. While there was catch-up growth in comparison to the contralateral testis, testicular consistency improved but testicular volumes may not increase significantly after varicocele repair at ages older than 14 years. However, in these adolescents postoperative semen parameters and serum hormone values may significantly improve regardless of testicular volume. Therefore, boys with varicocele and their families should be fully informed in light of these findings.

THE EFFECTS OF MESH BIOPROSTHESIS ON THE SPERMATIC CORD STRUCTURES: A PRELIMINARY REPORT IN A CANINE MODEL

Purpose The use of mesh bioprosthesis during inguinal herniorrhaphy is now considered routine. To our knowledge, no studies have examined the effects of mesh induced fibrosis on the structure and function of the adjacent spermatic cord. We present our experience in a canine model. Materials and Methods Unilateral inguinal hernia defects were created in 12 male beagle dogs. Half were repaired using Marlex [TM] mesh and half using a classic Shouldice technique. The inguinal anatomy was then re-examined at 6 and 12 months. Testicular temperature and volume, peripheral and testicular vein testosterone levels, testicular blood flow, vasography, testicular and cord histology, and sperm motility/morphology were recorded. Groups were compared with each other as well as to the non-operated (control) side. Results Although post-operative testicular volumes from both the mesh and Shouldice groups were similar to controls (p >0.05), there was a downward trend after mesh repair (17.8 cc pre versus 12.6 cc post) but this did not reach statistical significance (p = 0.17). Testicular temperatures and blood flow did not differ between experimental groups and controls. While testicular vein testosterone levels were significantly higher than peripheral venous levels after Shouldice repair, this difference was lost after mesh repair. Contralateral (control) testicular vein testosterone levels were higher in animals repaired with mesh than by an anatomic Shouldice repair (p <0.05). There was a significant decrease in cross sectional vasal luminal diameter in both the anatomic and mesh repair groups versus their respective contralateral controls (p <0.05). This was correlated with a marked foreign body reaction to the mesh in the soft tissues surrounding the vas in spermatic cords exposed to Marlex. All vasograms demonstrated patency. Gross pathology was abnormal in 3/6 dogs with mesh repair (2 hydroceles and 1 ischemic testis) and 0/6 animals after Shouldice repair. A traumatic neuroma was identified in the mesh group. Sperm morphology and motility did not differ between the two groups. Conclusions Half of the testicles had gross abnormalities after mesh repair versus none in the control and Shouldice dogs. Although all vasograms were patent, vasal luminal size was significantly decreased with a marked soft tissue foreign body reaction identified after mesh repair. A traumatic neuroma was identified suggesting nerve entrapment in the fibrotic mesh reaction, which may account for post-operative pain seen in some patients. Marlex [TM] mesh may adversely affect spermatic cord structure and function and further work is required to fully elucidate its effects.

The outcome of varicocelectomy in subfertile men with an absent or atrophic right testis.

To determine the effects of varicocelectomy on semen quality, testicular volumes and serum hormone levels in subfertile men with an absent or atrophic right testis. Seventeen patients whose wives were gynaecologically normal were evaluated with at least two semen analyses and measurements of serum hormone levels and antisperm antibodies. Scrotal ultrasonography was used to determine testicular volumes and spermatic vein diameters. Varicocelectomy was performed by high ligation via an inguinal approach. All patients were seen at a follow-up 3 months later, and after 6, 9 and 12 months the scrotal ultrasonography, hormone assessment and semen analyses were repeated. Any pregnancies in their wives were recorded over a median follow-up of 19 months. After surgery, all patients had significant improvements in sperm motility, morphology and concentration (P<0.01) but the differences in pre- and post-operative testicular volumes and plasma hormone levels were not statistically significant (P>0.01). No patients had immunological infertility. Eleven of the wives became pregnant during the follow-up. Higher pregnancy rates can be achieved by left varicocelectomy in subfertile men with an absent or atrophic right testis. Sperm concentration, motility and morphology are significantly improved by varicocelectomy.