Subdartos Pouch Research Articles

ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes

Abstract Aim SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015). We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique. Methods Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023). The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above. A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure. Results The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.

(403) Artificial Urinary Sphincter Implantation for Severe Post-Prostatectomy Incontinence in Setting of Salvage Radiotherapy and Prior Inflatable Penile Prosthesis

Abstract Introduction Artificial urinary sphincter (AUS) implantation is one of the most common treatment options for individuals with severe stress urinary incontinence (SUI), which is a common complication after radical prostatectomy (RP). The modern AUS consists of a urethral cuff, pump, and reservoir, which serves as a replacement for the native incompetent sphincter. There are various surgical approaches for AUS insertion, including transperineal, transscrotal, and abdominal approaches. Objective This video covers the surgical technique for the implantation of an AUS for management of SUI. Notably, this patient underwent RP followed by salvage radiotherapy (XRT) for biochemical recurrence of prostate cancer and had prior inflatable penile prosthesis (IPP) placement. Methods A standard step-by-step surgical technique for placement of an AUS through a perineal incision and additional counter incision to allow for high submuscular placement of the pressure-regulating balloon is demonstrated in this unique case of a patient with prior IPP placement and salvage XRT. Results We highlight a meticulous dissection around the urethra in a case that had a challenging urethral dissection secondary to prior radiotherapy and a prior IPP in the proximal corpora. The AUS pump was successfully placed in the subdartos pouch of the scrotum on the contralateral side to avoid the patient’s prior IPP pump. At the conclusion, a flexible cystourethroscopy showed adequate AUS cuff coaptation and cycling. Conclusions This video covers the step-by-step technique for insertion of an AUS with a transperineal approach in the unique context of a patient with prior IPP placement and XRT. Preoperative counseling, evaluation, and careful intraoperative dissection of key parts of the procedure are critical for successful placement of the AUS, especially in patients who are at high-risk for complications, such as in this case. Disclosure No

Abdominal vs Sub-Inguinal Placement of Pressure Regulating Balloon for Artificial Urinary Sphincter

ObjectivesTo compare peri- and postoperative outcomes following artificial urinary sphincter (AUS) insertion using an abdominal versus a sub-inguinal counterincision for pressure regulating balloon (PRB) placement. MethodsThis was a retrospective review of all AUS placements by a single surgeon from 2010-2020. Demographic, clinical, and surgical details were obtained from chart review. The cohorts were divided by PRB placement technique (sub-inguinal, abdominal, and attempted sub-inguinal converted intra-operatively to abdominal [“conversion group”]). ResultsThere were 182 AUS devices placed. The sub-inguinal approach was successfully completed in 132/144 (92%) and converted to abdominal PRB placement in 12/144 (8.3%). The risk of conversion was not increased by prior laparoscopically-assisted robotic prostatectomy (LRP) or radiotherapy (RT). Median operative time was 62, 75, and 77 minutes for sub-inguinal, abdominal, and conversion groups, respectively ( P = 0.30). Time to device activation was 25.0, 32.0, and 37.5 days for abdominal, sub-inguinal, and conversion groups, respectively (P<0.01). There were no bowel or bladder injuries and no PRB herniation in any group; however, there were five instances of pump migration superiorly, all in the sub-inguinal or conversion groups (P = 0.05). ConclusionsThe sub-inguinal approach to PRB placement during AUS is safe and can be successfully completed over 90% of the time. However, it is not faster than the abdominal approach to PRB placement and it is associated with an increased risk of pump migration, though the latter may be confounded by the sub-dartos pouch for pump placement that was used in all sub-inguinal cases.

Transverse Testicular Ectopia: A Rare Case Report

Transverse testicular ectopia (TTE) is a rare but well-known congenital anomaly that occurs 1 in 4 million in which both testes migrate toward the same hemiscrotum. In most of the cases it is an intra-operative finding, but preoperative diagnosis can be made by careful history taking, physical examination and imaging studies. Further evaluation is very important because it can be associated with other congenital anomalies. We report a case of TTE in a 32 years old male who presented with sudden painful swelling in right inguinoscrotal region. Physical examination revealed right sided obstructed inguinal hernia and left sided non palpable testis with underdevelopment of left hemiscrotum. On exploration, one testis is found within the hernial sac and the other testis within scrotum of same side. The testis which was already in right side of scrotum was kept in same place and the other testis which was found within hernial sac was kept in subdartos pouch at the root of right side of scrotum. Faridpur Med. Coll. J. 2021;16(1):52-54

Abnormal histology in testis from prepubertal boys with monorchidism

BackgroundLittle is known about the histology of contralateral descended testes in boys with unilaterally absent testis. We investigated whether absence of one testis is associated with abnormal tissue architecture of the solitary contralaterally descended testis.Design, setting, and patientsFor this retrospective study, we examined the results of biopsies of the contralateral descended testis in 43 boys with monorchidism. Data from 26 control testes from boys of matching ages were selected from results published in 1977 and 2009. During surgery, any nubbins were removed. In each case, the scrotal testis was biopsied, and the testis fixed by subdartos pouch or suture.ResultsOf the 43 affected boys, 23 had normal testicular histology in the contralateral descended testis, whereas 20 (46%) had abnormal histology. Eight of the abnormal biopsies matched the criteria for high infertility risk. Samples from three boys in this latter group revealed a Sertoli-cell-only phenotype. Immunohistochemical assays were positive for steroidogenic acute regulatory (STAR) protein in Leydig cells and spermatogonia. STAR expression was stronger in the monorchid group with normal testicular histology.ConclusionsAlmost half of the patients with unilateral absent testis were at risk for subfertility or infertility. Our results emphasize the need for testicular biopsy of the solitary testis in boys with monorchidism to appropriately assess infertility risk.

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

Laparoscopy is the gold standard to assess for presence of an intra-abdominal testis. However, techniques for the subsequent orchidopexy vary, and include the recently described staged laparoscopic traction orchidopexy (SLTO) (Shehata in Pediatr Surg 51(2):211–215, 2016). SLTO enables elongation of the testicular vessels without division, with initial success rates reportedly superior to Fowler–Stephens. We present the first UK data following a preliminary study using SLTO. 19 boys prospectively presenting with 22 intra-abdominal testes (IAT) underwent STLO in a single centre, with a median age of 2.5 years (IQR 1.4–5.2) at first stage. 3/19 (16%) boys had bilateral IAT and nine (41%) were left-sided. Pneumoperitoneum was established using 5 mm umbilical and 3 mm accessory ports in bilateral iliac fossae. The gubernaculum and lateral peritoneal attachments were divided prior to securing the intra-abdominal testis to the contralateral anterior abdominal wall with 2/0 Ti-cron™. Second-stage procedures were planned for 3–6 months later. The securing stitch was cut; an 11 mm STEP port was placed trans-scrotally to retrieve the testis and secured in a sub-dartos pouch. Outcome measures included palpable testes in the scrotum and surgical complications. 13/22 IAT have undergone follow-up. Twelve (92%) IAT were palpable in the scrotum following SLTO. There was one diathermy-related bladder injury necessitating laparoscopic repair, and 3/22 (13.6%) slipped sutures, requiring repeat first-stage procedures. Staged laparoscopic traction orchidopexy is a feasible technique, which can be performed as an alternative to Fowler–Stephens procedure, with potentially better outcomes for the testis. The complications described should be preventable as the technique evolves.

Early Clinical Outcome of Staged Laparoscopic Traction Orchidopexy for Abdominal Testes.

To assess the short-term clinical outcome of the novel Shehata technique of laparoscopic traction-lengthening for abdominal testes in a single center over a 12-month period (January-December 2014). An ethics approval of the study and appropriate consents were obtained for all patients before inclusion in our study. A total of 47 consecutive boys presented with impalpable testes in the ipsilateral hemiscrota, 3 of them were bilateral summing up to a total of 50 U of impalpable testes to a single center over 12 months (January-December 2014). Those boys underwent a preoperative ultrasound (US) Doppler scan for the ipsilateral and contralateral testes. They then proceeded to a first-stage laparoscopic exploration for the testes in which the cranial testicular artery and the caudal vas deferens were traced to their meeting point to locate the abdominal testes that were either found (peeping at the internal inguinal ring [IIR] or more cranially) or otherwise vanishing (intraabdominally blind-ending vas and vessels or extra-abdominally passing through the IIR). All 50 testes failed to stay at the contralateral IIR when brought there mandating a preliminary lengthening of the testicular vessels by lateral dissection, traction, and fixation to a point 1-2 cm superolateral to the contralateral anterior superior iliac spine (ASIS), essentially a mobile traction point. After 12 weeks, all underwent a second-stage laparoscopic-assisted ipsilateral subdartos orchidopexy for the testes under traction. Occasional slippage of the testis under traction mandated an otherwise second-stage retraction and a third-stage orchidopexy. All underwent US Doppler scan 3 and 6 months after orchidopexy. The 47 cryptorchid boys presented at a mean age of 3 years 2 months (range: 6 months-8 years). Out of the 50 impalpable testes, 9 were nonvisualized on preoperative US Doppler scan and 16 were vanishing on laparoscopic exploration: 5 abdominally (in utero vascular accident) and 11 scrotally (perinatal torsion). The remaining 34 testes were fixed loosely near the contralateral ASIS in the first-stage laparoscopic exploration. Out of which, 3 had slipped traction at the second stage. The 12-week traction interval went uneventfully and a predefinitive US Doppler scan confirmed viability of all testes under traction. All 34 elongated testes were mobilized and fixed in the ipsilateral hemiscrota inside a created subdartos pouch (of de Netto). All 34 fixed testes were confirmed viable on US Doppler scan 1, 3, and 6 months after orchidopexy. The novel Shehata technique of staged laparoscopic traction-lengthening for abdominal testes is safe, easy, and convenient as evidenced by our limited early experience. Neither internal herniation complicated the traction period nor testicular atrophy (by undue tension) complicated the traction or follow-up periods. We believe it is a good alternative to the Fowler-Stephens staged orchidopexy that entails risky division of the testicular vessels.

Crossed testicular ectopia

Crossed testicular ectopia (CTE) is one of the rare incidental findings during surgical intervention for an inguinal hernia or cryptorchidism, more than 100 cases have been reported in published studies. We collected 7 cases of CTE operated during the period from September 2016 to January 2018 at 4 different university hospitals in Egypt, with the age range from (25 days–3 years); mean age at presentation was 1.6 year. Clinical presentation, intraoperative findings, operative technique and follow-up duration of 3 months up to 2 years were assessed. Six cases were born full term, and one case was preterm. Four cases born as 1st offspring while 3 cases born as a 2nd offspring. Three cases associated with Persistent Müllerian duct syndrome (PMDS) (type 2), one case associated with penoscrotal hypospadias (type 3), one case associated with both (PMDS) and penoscrotal hypospadias (type 3), one case associated with congenital inguinal hernia only (type 1), and one case was not associated with a hernia or any associated anomalies. Three cases discovered accidentally during laparoscopic exploration for undescended testes, two of them had a common vas deferens or union cord. Surgery was offered to all patients, five cases were operated by Ombredanne's technique; one case was operated by laparoscopic intraperitoneal transposition approach and the last case had one testis atrophied which may be attributed to the ischemic effect of obstructed hernia but the other associated testis was normally vascularized. All testes except one atrophied fixed at ipsilateral subdartos pouch. CTE may be present in cases of cryptorchidism with or without an associated congenital hernia and may be discovered incidentally during diagnostic laparoscopy for cryptorchidism. It should be suspected in any case of abscent testis with congenital hernia in the same side. Karyotyping is recommended for cases of CTE with PMDS. We cannot find an evidence for relationship between prematurity and CTE as most of our cases were full term.

V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION

You have accessJournal of UrologyED, Infertility & Male Incontinence1 Apr 2018V11-07 ROBOT-ASSISTED AMS 800®- SPHINCTER IMPLANTATION AROUND THE MEMBRANOUS URETHRA IN SPINA BIFIDA – A NEW CUFF POSITION Nadim Abo Youssef, Jürgen Pannek, Kevin Horton, Marco Randazzo, and Hubert John Nadim Abo YoussefNadim Abo Youssef More articles by this author , Jürgen PannekJürgen Pannek More articles by this author , Kevin HortonKevin Horton More articles by this author , Marco RandazzoMarco Randazzo More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2855AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic lower urinary tract dysfunctions have an important impact on the quality of life in patients due to spina bifida. The artificial urinary sphincter AMS 800® has been used for years as standardized long-term therapy in patients with severe stress incontinence. A robot-assisted subprostatic cuff positioning around the membranous urethra has not yet been described in the literature. METHODS This video shows the robot-assisted AMS 800®-sphincter implantation in a 43-year-old patient with neurogenic voiding dysfunction as a result of impaired detrusor contractility due to spina bifida. In this context he underwent previous surgical interventions, namely a bulbar AMS 800®-sphincter implantation in April 2002 and a bulbar double-cuff implantation in January 2003. About 14 years later the patient now complains about progressive stress incontinence. After initiating a transperitoneal approach we performed the extraperitonealisation of the bladder and the incision of the endopelvic fascia in a first step. This was followed by the enlacement and measurement of the membranous urethral circumference. The cuff was positioned at the implant site with mesh towards the outside and «pillow» side towards the urethra. The pressure-regulating balloon was implanted through the 12 mm trocar and the connecting-tubing through another suprapubic trocar. After tunnelling through the trocar position and creating a dependent subdartos pouch in the scrotum, the control pump was placed into the scrotal pouch. The balloon was filled with 22 ml dilute Iopamiro 300 / Aqua Dest. (57 ml/60 ml) solution and the procedure was completed with the «Quick Connection» of the tubing. RESULTS The blood loss was irrelevant and there were no intra- or postoperative complications. The newly implanted membranous AMS 800®-sphincter has been activated at about 6 weeks postoperative. 6 months after surgery the patient showed a satisfying continence with a use of 1-2 pads per day (preoperative 5-6 pads/day). CONCLUSIONS The subprostatic, robot-assisted implantation of an AMS 800® around the membranous urethra is a new minimal-invasive therapeutic option. To our knowledge, this approach is described so far for the first time in the literature. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1163-e1164 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nadim Abo Youssef More articles by this author Jürgen Pannek More articles by this author Kevin Horton More articles by this author Marco Randazzo More articles by this author Hubert John More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Single perineal incision placement of artificial urinary sphincter with cadaveric correlation of sub-dartos pump placement.

ABSTRACTPurposeWe present a novel AUS implantation technique using a single perineal incision for single device placement or in combination with an inflatable penile prosthesis (IPP). Urinary and sexual dysfunction following the management of prostate cancer has a significant impact on the quality of life of our patients. While there are marginal changes in the prosthetic devices, we strive to reduce post-operative morbidity while maximizing efficacy.Materials and MethodsWe retrospectively reviewed the outcomes of 6 patients who underwent single perineal incision placement of a virgin AUS in 2014, 3 with simultaneous IPP placement. In all cases, the pressure regulating balloons (PRB) were placed in a high sub-muscular ectopic position and the pumps were placed into a sub-dartos pouch through the perineal incision, which was also validated using a cadaveric model.ResultsThe mean patient age was 61 (SD, 7.5 years) with mean body mass index of 31 (SD, 5.9). The average pre-operative pad usage was 7.7 (SD 1.63) pads per day. The mean follow-up was 13.9 months (SD 9.45). Four out of the six patients reported utilizing ≤1 pad daily at follow-up. The one patient who was not initially dry required downsizing of his cuff to 3.5cm; the remaining patient was lost to follow-up. There were no identifiable perioperative or post-operative complications.ConclusionsWe present our initial report of using a single perineal incision for AUS implantation with a validated sub-dartos pump location, which is safe and effective for implantation of an AUS as a single or double implantation in well-selected patients.

V5-07 PERINEAL ARTIFICIAL URINARY SPHINCTER (AUS) WITH HIGH SUBMUSCULAR (HSM) PLACEMENT OF PRESSURE REGULATING BALLOON (PRB)

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-07 PERINEAL ARTIFICIAL URINARY SPHINCTER (AUS) WITH HIGH SUBMUSCULAR (HSM) PLACEMENT OF PRESSURE REGULATING BALLOON (PRB) Billy Cordon and Allen Morey Billy CordonBilly Cordon More articles by this author and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1412AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients undergoing Artificial Urinary Sphincter (AUS) placement, with a history of major pelvic surgery, avoidance of the Space of Retzius with traditional placement of the Pressure Regulating Balloon (PRB) may be beneficial. This video presents perineal AUS placement with high submuscular placement (HSM) of the PRB. METHODS A perineal incision provides excellent exposure of the bulbar urethra for proximal bulbar urethral cuff placement. Via a separate 2cm high scrotal incision the external inguinal ring is identified. A pediatric Deaver is placed within the superficial ring and blunt finger dissection used above the transversalis fascia develops a space below the rectus that accommodates the PRB. Using one's index finger the PRB is then easily placed in the HSM space without any additional instrumentation. Finally through this same incision a subdartos pouch is created for pump placement. The AUS is cycled and deactivated and the wound is closed in multiple layers. RESULTS There is no difference in revision rates between HSM PRB placement versus Space of Retzius placement. CONCLUSIONS HSM placement of the PRB at the time of AUS implantation avoids the Space of Retzius with associated potential bladder, bowel, or vascular injury and/or complications. HSM placement avoids peritoneal placement post-robotic prostatectomy. HSM placement is safe, effective, can easily be learned and implemented, and may be used with concomitant IPP placement. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e601 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Billy Cordon More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Extracorporeal Testicular Ectopia through Inguinal Canal: A Case Report

A preterm (36 week) neonate, presented with his left testicle hanging outside through the inguinal canal. The testicle was pexed in a sub-dartos pouch.

A modified technique for scrotal fixation during orchiopexy

Undescended testes are a common problem, affecting up to 3% of newborn males. The goals of orchiopexy in humans are to provide adequate scrotal fixation, to prevent recurrent torsion of the testis and spermatic cord or ascent of the testis, and to achieve these goals with minimal trauma to the testis. The best method of achieving fixation remains controversial. The aim of our study is to evaluate our modified extra Dartos pouch technique in retaining testis in the scrotum. A prospective randomized study included 159 patients with 185 orchiopexies age ranging from 5 months to 14 years with the mean age of 49.5 ± 33.3 months (4.08 years). They were divided into two groups: Group I for whom the extra Dartos pouch technique was applied were compared to Group II for whom classic sub-Dartos pouch technique was done. Testis was located in the superficial inguinal pouch in 102 cases (64.1%) and intra-canalicular in 57 cases (35.6%). Hernial sac was found in 153 cases (96.2%), postoperative wound infection occurred in 3 cases (1.9%) and hematoma formation in three cases (1.9%); one case reported ascent of the testis and another one had testicular atrophy in the follow-up period which extends now up to 3 years and we are still in follow-up with those cases. Our modified technique for extra Dartos pouch fixation seems to be a fast reliable method for orchiopexy; however, comparative studies and long-term assessment is still needed to establish this method.

LAPAROSCOPIC EVALUATION OF CONTRALATERAL PATENT PROCESSUS VAGINALIS IN GIRLS WITH INGUINAL HERNIAS

INTRODUCTION AND OBJECTIVE: Abdominoscrotal hydroceles (ASH) can present a formidable surgical challenge even to an experienced surgeon. They are extremely difficult to correct due to the complex nature of the hydrocele looping back through the internal ring back into the abdomen. This makes identification of the hernia opening difficult at times. We have utilized the Jones preperitoneal approach to handle these hydroceles with improved success. METHODS: We operated on 11 hernias in 7 patients ranging in age from 6 months to 1.5 years. All patients were males, 6 were on the left side and 5 were right sided. Surgical exploration was performed via an inguinal incision and the external inguinal ring was exposed. An incision was made superior to the hydrocele at the level of the internal ring. The muscle layers were split and the hydrocele was identified as it entered the internal ring. The Vas and vessels are then isolated extraperiotneally and tagged. The hydrocele is then dissected from the retro peritoneum and drained. The sac can be followed into the internal ring. The hernia defect can be closed from the inside. The excess hydrocele sac is excised and the testis inspected. If there is a need the testis can be fixed in the scrotum in a subdartos pouch. RESULTS: All patients had and excellent result with a marked reduction in operative time and a decrease in the manipulation of the cord structures. There was no evidence of testicular atrophy noted in any of the patients. CONCLUSIONS: This appears to be an improved approach to the abdominoscrotal hydrocele minimizing the risk of injury to the vas and vessels during the dissection of the large, redundant sac which is commonly encountered in these cases. Intraoperative times is significantly reduced compared to standard inguinal techniques.

Balloon inflation-created subdartos pouch during orchiopexy: a new simplified technique

Creation of subdartos pouch is an integral part of orchidopexy. The objective of this study was to describe and evaluate the results that can be achieved by using a new simplified technique (creation of subdartos pouch by balloon inflation of small sized Foley's or Fogarty catheter during orchiopexy). Seventy-five boys with undescended testicle had been operated upon at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia in the period from April 2007 to April 2008. The technique will be described in detail. All patients were followed up for 12 months on average, range (2-12) months. They were 75 boys with undescended testicle, 53(71%) palpable cases [48(64%) unilateral, 5(7%) bilateral] and 22(29%) impalpable cases [20(26%) unilateral, 2(3%) bilateral]. Mean age of 13 +/- 1.47 months (range, 9-36 months). The mean operative time was 11.5 +/- 1.12 min. (range, 10-15 min) for each orchiopexy; whereas, the mean operative time for creation of subdartos pouch was 23.7 +/- 1.12 s (range, 20-30 s). There were no intraoperative or early postoperative complications (hematoma or infection). There was no evidence of testicular atrophy by testicular ultrasound among cases of palpable testes. Only two testes among the cases of impalpable testes became smaller in size but viable after 12 months. However, almost all families were happy with good esthetic appearance of the scrotum. The new technique of balloon inflation-created subdartos pouch during orchiopexy is an easy, safe bloodless and quick technique with good cosmetic outcome.

A history of cryptorchidism: Lessons from the eighteenth century

Purpose John Hunter in 1786 opened the door to more than 200 years of study and discussion of the cryptorchid testis. We review the history that has brought us to our current surgical treatment of this condition. Materials and methods We performed a review of the medical and historical surgical literature pertaining to cryptorchidism. Results The study of cryptorchidism began with the anatomical descriptions of Baron Albrecht von Haller and John Hunter. Attempts at surgical correction of the undescended testis began in the early 1800s, culminating in the first successful orchidopexy by Thomas Annandale in 1877. Further contributions to the surgical technique include: (1) Arthur Dean Bevan's division of the processus vaginalis to prevent reascent and his stress on the importance of adequate mobilization of the spermatic cord, (2) the description by Robert Prentiss of surgical triangles which allowed for mobilization of the spermatic cord and placement of the testis into the scrotum without tension, and (3) Lattimer's subdartos pouch. Conclusion Our understanding and the surgical treatment of cryptorchidism have continued to evolve over the last 200 years. A study of the history of surgical management of the undescended testis sheds light on the rationale behind current management.

Laparoscopically Assisted Correction Of Transverse Testicular Ectopia

Transverse testicular ectopia or crossed testicular ectopia is a well described congenital anomaly in which the 2 testes descend through a single inguinal canal. The usual clinical presentation is an impalpable testis on 1 side and a normally descended testis with symptomatic inguinal hernia on the contralateral side. The patient often undergoes unsuccessful inguinal exploration and the ectopic testis is usually discovered operatively during herniotomy. CASE REPORT A 2-year-old boy was referred in May 1998 for evaluation of an impalpable right testis after negative inguinal exploration was performed elsewhere. Physical examination demonstrated a right inguinal incision with a nonpalpable testis. The left hemiscrotum was remarkable for a communicating hydrocele. Left communicating hydrocele repair was planned with diagnostic laparoscopy through the patent processus vaginalis. When the tunica vaginalis was opened, a tubular structure was noted running from the testis more proximal into the peritoneal cavity. Careful traction on this structure revealed a contralateral intra-abdominal testis, which was present in crossed, fused fashion (see figure). With this entity identified laparoscopic entry was achieved via a 5 mm. umbilical port. The gubernaculum connecting the 2 testes was divided. A right inguinal incision was made and a Kelly clamp was passed through it under laparoscopic guidance. The crossed testis was then grasped at the site of the gubernaculum and passed to the contralateral inguinal ring. Standard right orchiopexy was performed using a subdartos pouch. Notably generous cord length on this side obviated the need for a Fowler-Stephens procedure. Long-term followup confirmed 2 healthy testes in their respective orthotopic locations. DISCUSSION

Testicular histology after transparenchymal fixation using polytetrefluoroethylene suture: An animal model

Background/Purpose: The optimal surgical technique for orchiopexy is controversial. Studies have shown that adequate fixation can be obtained using a subdartos pouch alone; however, transparenchymal suture fixation with a permanent suture frequently is used to provide additional security and for the treatment and prevention of testicular torsion. In previous studies, the suture has been placed through the tunica albuginea. This could have a detrimental effect on future spermatogenesis. Polypropylene has been shown to have the least histological change and is considered to be the suture of choice. However, polypropylene is a stiff suture and can be disconcerting for the patient when left in place. Polytetrafluoroethylene (PTFE) is a soft, permanent suture used widely in vascular surgery because of its handling characteristics. In this study, the authors compare the histological changes caused by PTFE and polypropylene. Methods: Bilateral orchiopexies were performed in 36 Sprague-Dawley rats. All rats were 27 to 31 days old and weighed 75 to 100 g at the time of orchiopexy. The animals were divided into 3 groups receiving polypropylene and PTFE, silk and PTFE, or polypropylene and silk. After 30 days, all rats were killed, and the testes were harvested. The testes were step sectioned and examined for histological changes. These changes were graded by a pathologist in a blinded fashion. Results: The data obtained were statistically analyzed. The superficial histological changes associated with transparenchymal fixation by polypropylene, PTFE, and silk were significantly different, but the parenchymal changes were not. Conclusions: PTFE causes no greater histological change than polypropylene. In light of the PTFE's softness and superior handling characteristics, the authors recommend the use of PTFE when a permanent suture is used in orchiopexy.

UNDESCENDED TESTIS: A STUDY OF 50 CASES

Fifty consecutive cases of undescended testis treated at a service hospital over a period of 3 years from January 1993 to December 1995 were studied. Only 2 patients (4%) were below the age of 2 years and 25 (50%) were past the age of 15 years. Two cases presented with seminoma in intraobdominal testis. Ultrasonography was found unreliable in localizing the impalpable testis. Subdartos pouch orchiopexy (Winsburry-White) was the definitive procedure adopted in 21 out of the 25 orchiopexies performed and the results were good. Orchidectomy seems the best option of treatment in post-pubertal patients with unilateral symptomatic maldescent.

Transverse testicular ectopia: report of three cases

Two patients who presented with a history of right inguinal hernia and a third with an impalpable left testis were found to have transverse testicular ectopia. Both testes were fixed in their own scrotum, through a modified Ombredanne operation in two patients and a subdartos pouch in one.