Testicular Fixation Research Articles

Diagnoses and Treatment of Acquired Undescended Testes: A Review.

Acquired undescended testes were once considered a sporadic disease. In recent years, reports suggest that they are not uncommon, with an incidence rate about 3 times that of congenital undescended testes. The etiology of acquired undescended testes remains inconclusive, clinical diagnostic standards are unclear, and treatment approaches are still controversial. There is ongoing debate about the mechanism of testicular ascent. The prevailing view is that acquired undescended testes occur due to the partial absorption of the gubernaculum, which forms part of the parietal peritoneum. The residual gubernacular fibers continuously pull on the spermatic cord, preventing the spermatic cord from elongating proportionately to somatic growth, leading to a re-ascent of the testis. Acquired undescended testes may increase the risk of testicular cancer, but this is still debated. The preferred treatment method is also controversial. However, surgical fixation has an immediate effect; no studies have proven that early surgery improves fertility in patients. The etiology of acquired undescended testes is closely related to the continuous pull of the residual gubernacular fibers on the spermatic cord, which prevents the cord from extending proportionately to body growth. There are no clear diagnostic standards for acquired undescended testes yet, and spontaneous descent is possible, so testicular fixation surgery may not be the preferred treatment method.

P-079 Bilateral versus unilateral orchidopexy: IVF/ICSI-ET outcomes

Abstract Study question Does unilateral and bilateral cryptorchidism infertility have an impact on IVF/ICSI-ET results? Summary answer Unilateral and bilateral orchidopexy do not affect the final live birth rate in IVF. What is known already A study was compared ICSI-ET outcomes between bilateral and unilateral cryptorchidism in NOA patients. Although 90.36% of their study population have undergone orchidopexy to improve their conditions at around 9 to 10 years old, the fertilization rates of bilateral and unilateral cryptorchidism group were only at 46.8% and 46.5% respectively, which were slightly below the average ICSI fertilization rate. The other study showed that patients of bilateral cryptorchidism had lower implantation rate. Apart from the mentioned study, no other study has attempted to evaluate the IVF/ICSI-ET outcomes in infertile men who had undergone orchidopexy. Study design, size, duration A retrospective cohort study at a tertiary hospital, including a total of 99 infertile men who underwent orchidopexy to treat cryptorchidism and subsequently underwent their first IVF/ICSI-ET cycle from January 2014 to January 2022. Participants/materials, setting, methods Men are divided into unilateral fixation group and bilateral fixation group based on the laterality of the cryptorchidism and testicular fixation surgery they have received. Choose fertilization rate and live birth rate as parameters for evaluating the results. Main results and the role of chance The sperm concentration and viability were significantly higher in unilateral orchidopexy group than in bilateral orchidopexy group (28.09 ± 27.99 vs 7.99 ± 14.68, P=0.001; 33.34 ± 22.52 vs 11.95 ± 17.85, P=0.001). Unilateral orchidopexy group showed lower demand for ICSI (66.07% vs 95.35%, P<0.001). Interestingly, both groups exhibited similar rates of fertilization, clinical pregnancy, live birth and birth defect. Boy birth ratio was lower in bilateral orchidopexy group as compared to unilateral orchidopexy group (27.27% vs 58.62%, P=0.026). Limitations, reasons for caution This study was limited in that the data source captured only patients from a single medical center, which could lead to selection bias, small sample size and limited external validity to the findings. Wider implications of the findings Our study suggested that blastocyst-stage ET is a good strategy for patients with history of orchidopexy. Trial registration number not applicable

Recidiverende testiculaire torsie 27 jaar na eerdere orchidopexie: casusbespreking

Recurrent testicular torsion 27 years after previous orchidopexy: a case report A recurrent testicular torsion after a previous orchidopexy is a rare phenomenon that requires a high index of suspicion to avoid misdiagnosis and delayed treatment. This case intends to emphasize the importance of considering a recurrent testicular torsion in the differential diagnosis of acute scrotal pain, regardless of the patient’s age. The case involves a 45-year-old man with a history of a bilateral testicular fixation for a testicular torsion at the age of 18. The patient presented with recurrent testicular pain, despite the fact that both testes previously had been fixed to the scrotal wall. This case illustrates that a recurrent testicular torsion can manifest even when the testis is fixed to the scrotal wall. This emphasizes the importance of including a recurrent testicular torsion in the differential diagnosis of acute scrotal pain. Furthermore, during the surgical intervention particular attention should be given to ensuring a proper fixation of both testes using non-absorbable sutures at a minimum of 2 points to reduce the risk of a recurrent torsion. A recurrent testicular torsion following a previous orchidopexy is a rare condition that requires vigilance in case of acute scrotal pain. This case report reinforces the need for a thorough examination and emphasizes the importance of safe testicular fixation during surgery to minimize the risk of recurrence. The threshold for surgical exploration should always be kept low, even after a previous orchidopexy.

Follow‐up results regarding fixation of contralateral testis after testicular torsion in children

AbstractThe aim is to investigate the possible advantages and disadvantages of contralateral testicular fixation (CTF) for boys with testicular torsion (TT) by long‐term clinical follow‐up results. A retrospective cohort study was conducted on TT boys at Children’s Hospital of Chongqing Medical University from September 2005 to December 2020. The baseline characteristics, intraoperative findings, and clinical follow‐up results were compared between TT patients underwent orchiopexy with or without CTF, and orchiectomy with or without CTF, respectively. The χ2 test and the Fisher’s Exact test were used to compare dichotomous outcomes, and the Mann‐Whitney U test was used to compare continuous outcomes without normal distribution. A total of 140 cases were included in this study. The bell clapper deformity was found in 30.4% of all torsed testes underwent orchiopexy, 16.4% during contralateral testicular exploration, and only 10.9% in bilateral sides. Contralateral testicular volume, adverse events, and paternity rates were comparable between patients underwent orchiopexy with or without CTF, and no subsequent contralateral TT observed during follow‐up. However, those patients underwent orchiectomy without CTF had more incidence of scrotal discomfort than those had orchiectomy with CTF (P = 0.027). In addition, one boy suffered subsequent contralateral TT after orchiectomy without CTF. The incidence of bell clapper deformity was lower in this research than that of literature reports. CTF would not induce testicular volume loss, atrophy or scrotal pain. Contralateral testicular discomfort and even subsequent TT could be more easily observed during follow‐up in patients without CTF. We still recommend routine surgical fixation of contralateral testicle during surgery.

Современные подходы к фиксации яичка после устранения внутриоболочечной тестикулярной торсии.

Introduction. Testicular torsion is the most common emergency urological pathology of boys. If it is impossible to exclude TT, a testicular revision is necessary. In every third case, the torsed testicle is not viable and an orchidectomy is performed. If the testicle is recognized as viable during the operation, then questions arise about the choice of fixation technique, suture material, as well as the need and timing of fixation of the contralateral testicle. The presence of a large number of possible complications after testicular fixation shows the relevance of studying actual experience on this problem. The purpose of the study: to evaluate the experience of using various methods of testicular fixation. Materials and methods. We searched for relevant publications in the PubMed and e-Library databases using the keywords «testicular torsion», «testicular fixation», «emergency urology», «testicular detorsion», «orchidectomy», «orchidopexy». As a result of the search, 43 sources were selected and included in the literature review. Results. We analyzed articles that published the results of using testicular fixation methods. The described methods were divided into four groups: 1. Various options for fixation with interrupted sutures without modeling the tunica vaginalis. 2. Fixation options with fenestration, eversion or excision of the tunica vaginalis. 3. Techniques using the «dartos pouch» method with or without fixation. 4. Exotic fixation techniques. Conclusion. There are very few publications devoted to the analysis of experience in using various methods of testicular fixation during torsion. An anatomical anomaly of the «bell clapper» type is detected in most cases with TT and with contralateral fixation. Currently, fixation techniques with eversion of the tunica vaginalis are not widely used. Leading guidelines on pediatric urology recommend the use of 3-point non-absorbable sutures and fixation using the «dartos pouch» method for testicular fixation after detorsion; however, there is an understanding that the used fixation methods are not universal, not effective and secure enough, which determines the relevance of new research on the «method of choice» for testicular fixation in case of TT.

A national survey of practice for the emergency fixation of testis.

Scrotal exploration for suspected testicular torsion is a common emergency procedure in the United Kingdom (UK). There is no universally agreed practice for how the testis should be fixed, or whether a nontorted testis should receive fixation. This survey aims to describe the methods used for emergency scrotal exploration and testicular fixation in the UK. An online survey was distributed to urologists, general surgeons and specialist paediatric surgeons in approved NHS trusts, and via the email lists of collaborating organisations. The survey questioned surgeons on their operative management of a variety of common diagnoses encountered during scrotal exploration using multiple choice and free-text answers. A total of 340 responses were received from 83 institutions. Respondents included urologists (consultants, 33%; trainees, 24%), paediatric surgeons (consultants, 12%; trainees, 16%) and general surgeons. In cases of torsion, respondents predominantly perform sutured fixation (74%); however, sutureless dartos pouch fixation was used frequently (37%) by paediatric surgeons. The finding of 'bell-clapper' anatomy without torsion prompts 69% of respondents to undertake sutured fixation, but alternative nontorsion diagnoses frequently prompt use of sutureless methods (53-66%). This study is the largest survey of methods for emergency scrotal exploration and describes current UK practice. The majority of surgeons prefer sutured fixation in cases of torsion and/or bell-clapper anomalies, and sutureless methods in the absence of it.

Is testicular fixation to the scrotum necessary in patients with undescended testis? A comparative study.

This study aimed to compare the outcome of undescended testicle patients with and without transparenchymal sutures. Patients were divided into two distinct groups for evaluation: Group 1 (Testicular Fixation +): this group comprised 41 patients who underwent a procedure that involved testicular fixation. Group 2 (Testicular Fixation -): this group included 47 patients who had not undergone any testicular fixation. The age difference between these groups was not statistically meaningful (p>0.05). As for the presence of hypospadias, 2 patients (4.8%) in Group 1 and 3 patients (6.4%) in Group 2 were affected, showing no significant difference (p>0.05). Post-surgical local infection was evident in 9.8% of Group 1 and 8.5% of Group 2 patients, showcasing no significant difference (p>0.05). When assessing recurrence, both groups bore almost identical rates, 7.3% for Group 1 and 6.4% for Group 2 (p>0.05). Atrophy was observed in 2.4% of Group 1 and 2.1% of Group 2, with no marked distinction (p>0.05). Both groups exhibited similar outcomes, suggesting that no fixation method was also a good option.

Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility

Introduction: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. Methods: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. Results: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). Conclusion: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study

ObjectiveIn this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. MethodsPostpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. ResultsA total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. ConclusionThere is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

¿Cuándo se debe realizar la fijación testicular contralateral en pacientes pospuberales con torsión testicular? Estudio comparativo

ObjectiveIn this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. MethodsPostpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into two groups according to the «patient-based approach» criteria we adopted in our clinic. Group1 in whom the contralateral teste was fixed in the same surgical act and group2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. ResultsA total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% group1 vs. 5.3% group2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. ConclusionThere is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

Testicular ischemia secondary to acute epididymitis: A case report.

Rare side effects of acute epididymitis include testicular infarction and ischemia. Distinguishing them from testicular torsion is challenging, both clinically and radiologically. However, only a few such cases have been reported to date. A 12-year-old child presented with persistent right testicular pain for 3 days. It developed after trauma and was accompanied by gradual swelling and enlargement of the right scrotum, with nausea and vomiting. Scrotal color Doppler ultrasonography demonstrated right epididymitis, right scrotal wall swelling, and right testicular torsion. Routine blood tests revealed leukocyte and neutrophil counts were both above normal. Scrotal exploration revealed edema and adhesions in all layers of the scrotal wall. The right testicle was pale. The patient was diagnosed with testicular ischemia secondary to acute epididymitis. The patient underwent simultaneous lower spermatic cord sheath dissection and decompression, testicular sheath reversal, and right testicular fixation. Blood flow to the testicles gradually recovered after decompression, as did the color. Postoperatively, the patient's scrotal swelling and pain improved significantly. Despite the rarity of this condition, it is a potentially serious consequence of epididymitis and should be considered when patients experience sudden scrotal pain.

The Role of Manual Detorsion in Pediatric Testicular Torsion During the Global COVID-19 Pandemic: Experience From 2 Centres

To evaluate the role of emergency manual detorsion as first line management for testicular torsion in the context of the COVID-19 pandemic. This retrospective observational study includes 90 pediatric patients ≤14 years old with diagnosis of testicular torsion made at 2 tertiary centers between October 2020 and June 2022. Variables examined included age, presentation delay, surgical wait time, number of attempts at manual testicular detorsion, and manual testicular detorsion success. All patients finally underwent surgery, including contralateral testicular fixation. Outcomes included predictors of successful manual detorsion, testicular findings at surgery, and operation time. Mean (SD) age at diagnosis was 11.51 (2.64) years. Mean presentation delay was 11.76 (13.79) hours. Detorsion was attempted in 72 (80%) patients, resulting successful in 58 (80.5%). Surgical wait time after successful manual detorsion was 22.85 (16.94) hours. On multivariable analysis, successful manual detorsion was associated with a presentation delay<6 hours (odds ratios [OR] 0.154, 95% confidence intervals (CI) 0.036-0.655, P = 0.01) and absence of scrotal edema (OR 0.171, 95% CI 0.038-0.769, P = 0.02). Vice versa, a heterogeneous echo-texture (OR 0.57, 95% CI 0.007-0.461, P = 0.007) and absent blood flow on Doppler ultrasound scan (OR 0.256, 95% CI 0.067-0.971, P = 0.045) were significantly associated with the likelihood of manual detorsion failure. In our experience, manual detorsion provided safe and effective emergency treatment for pediatric testicular torsion, especially in absence of edema and when presentation delay is <6 hours. This maneuver should be more widely attempted immediately after diagnosis as temporizing rescue.

Testicular blood supply and growth in children with high cryptorchidism treated with gubernaculum preserving vs. cutting laparoscopic orchiopexy: A pilot trial

It is still controversial whether the frenum of testis should be retained in laparoscopic testicular fixation. It is a prospective experiment to study testicular preservation on testicular growth in children with high cryptorchidism. From January 2018 to June 2020, 120 children with high cryptorchidism in Inner Mongolia Maternal and Child Health Care Hospital and The Fourth Hospital of Baotou were randomly divided into retention group (60 cases in group P, aged 1-3 years, average 1.85±0.58) and cutting group (60 cases in group C, aged 1-3 years, average 1.75±0.66) (P=0.52). PSV, EDV, RI and testicular volume were measured by color Doppler ultrasound before operation and 1,3,6,12 months after operation. No, there was significant difference between the two groups (P>0.05). There is no significant difference in testicular blood supply and growth between laparoscopic testicular fixation and frenulum amputation in children with high cryptorchidism.

MP04-02 CONTRALATERAL ORCHIOPEXY AT THE TIME OF URGENT SCROTAL EXPLORATION: IS IT SAFE? A PROPENSITY SCORE MATCHED ANALYSIS FROM THE TORSAFUF COHORT

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP04)1 Sep 2021MP04-02 CONTRALATERAL ORCHIOPEXY AT THE TIME OF URGENT SCROTAL EXPLORATION: IS IT SAFE? A PROPENSITY SCORE MATCHED ANALYSIS FROM THE TORSAFUF COHORT Igor Duquesne, Ugo Pinar, François Lannes, Florian Bardet, Kevin Kaulanjan, Clément Michielis, Emilien Seizilles de Mazancourt, Ines Dominique, Maxime Vallée, Bastien Gondran-Tellier, Xavier Matillon, Lucas Freton, Zine Eddine Khene, and Benjamin Pradere Igor DuquesneIgor Duquesne More articles by this author , Ugo PinarUgo Pinar More articles by this author , François LannesFrançois Lannes More articles by this author , Florian BardetFlorian Bardet More articles by this author , Kevin KaulanjanKevin Kaulanjan More articles by this author , Clément MichielisClément Michielis More articles by this author , Emilien Seizilles de MazancourtEmilien Seizilles de Mazancourt More articles by this author , Ines DominiqueInes Dominique More articles by this author , Maxime ValléeMaxime Vallée More articles by this author , Bastien Gondran-TellierBastien Gondran-Tellier More articles by this author , Xavier MatillonXavier Matillon More articles by this author , Lucas FretonLucas Freton More articles by this author , Zine Eddine KheneZine Eddine Khene More articles by this author , and Benjamin PradereBenjamin Pradere More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001971.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The safety of immediate contralateral orchiopexy (ICLO) at the time of a scrotal exploration for testicular torsion (TT) remains questionable and lacks high-quality evidence. The objective of our study was to evaluate the safety of ICLO at the time of scrotal exploration for TT suspicion. METHODS: We performed a multicentric retrospective study conducted between 2005 and 2019 at 14 academic French hospitals. Patient data were retrieved from the TORSAFUF cohort project. Each patient who underwent surgical exploration for TT suspicion was included. Patients with a history of surgical testis exploration were excluded. We assessed the impact of immediate contralateral orchiopexy during scrotal exploration. The primary study outcome was the safety of ICLO compared to homolateral scrotal exploration alone. The primary outcome of interest was the complication rate within 90 days after surgery. To account for potential selection biases arising from non-random allocation of patients to different groups, we performed a propensity score matched analysis. The two groups were then paired 1:1 on these propensity scores using nearest-neighbour matching within a propensity-score-based calliper. Uni- and multivariable logistic regression analyses were performed to evaluate predictors of complications. RESULTS: Overall, 2775 patients were included of whom 1554 (56%) underwent ICLO. After propensity score matching and multivariable analysis, ICLO was associated with a higher complication rate (odds ratio [OR], 1.51; 95% CI 1.1 to 2.1; P=.01), especially a higher rate of hematoma (OR, 2.9; 95% CI 1.3 Table 2: Univariable and multivariable logistic regression analysis for predictors of overall complications. CONCLUSIONS: Prophylactic contralateral testicular fixation was significantly associated with an increase in the postoperative complication rate, especially an increase in hematoma and delayed wound healing. Therefore, an immediate contralateral orchiopexy should not be performed systematically and can be safely omitted. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e67-e68 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Duquesne More articles by this author Ugo Pinar More articles by this author François Lannes More articles by this author Florian Bardet More articles by this author Kevin Kaulanjan More articles by this author Clément Michielis More articles by this author Emilien Seizilles de Mazancourt More articles by this author Ines Dominique More articles by this author Maxime Vallée More articles by this author Bastien Gondran-Tellier More articles by this author Xavier Matillon More articles by this author Lucas Freton More articles by this author Zine Eddine Khene More articles by this author Benjamin Pradere More articles by this author Expand All Advertisement Loading ...

Testicular fixation and its effect on ipsilateral and contralateral testis in prepubertal rat model

BackgroundWhile performing orchidopexy, various suture materials or fibrin glues are used to achieve testicular fixation. This study was designed to assess the histological changes in testis after orchidopexy using fibrin glue and suture material.MethodsMale Wistar rats (n = 80) were divided randomly into four groups. Group I, (n = 20): sham operation, Group II (n = 20): Dartos Pouch (DP), Group III (n = 20): Transtunical fixation (TF), Group IV (n = 20): Tissue Adhesive (TA). Ipsilateral and contralateral testicular histology was assessed at 70 and 120 days of life after sacrificing animals by using thiopental sodium intraperitoneally at a dose of 100 mg/kg.ResultsMorphologically, at day 70, contralateral testis in Group III had a significant (p value 0.046) decrease testicular width (0.92 ± 0.01 vs 1.24 ± 0.39 cm). At 120 of life, Group I, II, III, and IV had a significant (p value < 0.001 each) decrease testicular width and weight in ipsilateral and decrease testicular length (p value 0.002) in contralateral testis. Histologically, mean seminiferous tubular diameter and DNA flow cytometry had a significant (p value < 0.001) decrease in size in Group I, II, III, and IV both ipsilateral as well as contralateral testis. Intergroup comparison at 70 and 120 days of life showed a significant decrease in seminiferous tubular diameter in Group II, III and IV and in Johnsen maturation score, seminiferous tubular diameter, DNA flow cytometry in Group I, II, III, and IV.ConclusionsDartos Pouch is most suitable procedure for treatment of orchidopexy. Suture fixation must be avoided and if the need arises then instead of suture materials, fibrin glue should be used for testicular fixation.

Comment on ‘Outcomes Following Emergency Fixation of Torted and Non-Torted Testes’

Scrotal exploration due to scrotal pain is a common urological emergency operation. In the present study, a large series of scrotal explorations and their outcomes, dependent also on whether a fixation was performed or not and how have been reviewed [ [1] Boam T. Kiely D. Peeraully R. Jancauskaite M. Fraser N. Outcomes following emergency fixation of torted and non-torted testes. J Pediatr Urol. 2021; 17: 538.e1-538.e8 Abstract Full Text Full Text PDF Scopus (1) Google Scholar ]. While there are inherent limitations due to the retrospective design, the detailed reporting and the large number of patients allows for a unique insight. Outcomes following emergency fixation of torted and non-torted testesJournal of Pediatric UrologyVol. 17Issue 4PreviewScrotal exploration is a frequently performed emergency procedure in children. It is a subject of debate as to whether and how a non-torted testis should be fixed, with a wide variation in practice across the UK. This study aims to ascertain whether the method of testicular fixation (if any) impacts on patient outcomes. Full-Text PDF

Outcomes following emergency fixation of torted and non-torted testes

Scrotal exploration is a frequently performed emergency procedure in children. It is a subject of debate as to whether and how a non-torted testis should be fixed, with a wide variation in practice across the UK. This study aims to ascertain whether the method of testicular fixation (if any) impacts on patient outcomes. A review of all emergency scrotal explorations performed in children under the age of 18 between 2008 and 2018 in a tertiary Paediatric Surgery unit was undertaken. Patients were categorised by initial fixation method, chi squared analysis was used to compare complication and reoperation rates. 522 boys were taken to theatre, 424 had a unilateral procedure and 98 had bilateral; after 35 orchidectomies, 585 testes were left in situ. The most frequent diagnosis at operation was torted testicular appendage (n=278, 53%), followed by testicular torsion (n=79, 15%). The number of testes by category of fixation were: 72 no documented fixation, 130 dartos pouch only, 34 absorbable sutures, 346 non-absorbable sutures and 3 unspecified sutures. There was no difference in the reattendance rate between groups after outliers were removed (p=0.72). Thirty-seven patients experienced complications, most commonly ongoing pain. Nine patients required an ipsilateral reoperation, 25 underwent a contralateral operation at a later date. The complication rate appeared to be higher in the no fixation group compared to the dartos (p=0.02) and sutured groups (p=0.048). Testes in the no fixation group had a higher reoperation rate compared to the sutured group (p=0.002). The present study is a detailed analysis of a wide variety of emergency testicular fixation methods in a large cohort, including the routine fixation of non-torted testes. Whilst there appears to be a benefit to using sutured or dartos fixation, this merits cautious interpretation. It is likely that influences on complications and reoperations are multifactorial and cannot be attributed solely to the method of testicular fixation. Adoption of a standardised approach to emergency fixation of testes within or across institutions may be a potential avenue for future studies.

The fat anchor orchiopexy technique: results and outcomes from 150 cases surgical experience

PurposeThe purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as “fat anchor orchidopexy” (FAO), for the treatment of palpable low inguinal undescended testis.Materials and methodsWe retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli’s technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient’s age, operative times and complications.ResultsA total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient’s age was 21 months (range: 14–28 months). All the procedures were planned in a day-surgery setting. Trans-scrotal orchiopexy was successful in all cases and no patients required an additional groin incision. No intraoperatively and postoperatively major complications were observed. Patients’ post-operative pain was mild (mean pediatric visual analog scale = 2). In all cases, the healing process was rapid and no surgical wounds infections were reported during the post-operative period, referring excellent cosmesis results. During a mean 48-month follow-up period, no testicular retraction, recurrence or testis atrophy was reported.ConclusionThe original Spinelli’s technique (FAO) proves to be a safe and effective method for the treatment of palpable or distal-to-external-inguinal-ring testes. No immediate and delayed post-surgery complications were reported. In all cases, the anchored testicle remained in the scrotal position with normal vascularization. This novel surgical technique could give better options for scrotal fixation in case of low-lying cryptorchid testes.

Результаты использования оригинальной техники фиксации яичка при трансскротальном доступе в хирургии крипторхизма у детей

Introduction. Transscrotal orchiopexy is gradually gaining more and more adherents and expanding the boundaries of its use. At the stage of funiculolysis, the use of the transscrotal approach is accompanied by extensive dissection of the tunica dartos, which makes it almost impossible to use the Shoemaker technique for testicular fixation. The described situation determines the need to develop a testicular fixation technique with transscrotal approach (TA). Material and methods. The study included 186 patients operated on for unilateral inguinal cryptorchidism in the period from 2009 to 2019 using TA Left-sided cryptorchidism was in 76 (41%), right-sided in 110 (59%) boys. Group I – 89 (47.8%) patients operated on TA according to the Bianchi technique, the average age of patients was 45.9 ± 39.6 months. Group II – 97 (52.2%) patients, mean age 47.8 ± 41.6 months, operated on TA using an original method of testicular fixation, consisting in the formation of a cuff from subcutaneous adipose tissue around the spermatic cord by suturing it from superficial inguinal ring, above and below the spermatic cord in the caudal direction to the entrance to the scrotum. In the postoperative period, the volume and position of the gonads in the scrotum were assessed at 3, 6 and 12 months after surgery. To determine the significance of differences between the groups, Student's t-test and chi-square test were used. Results. Unsatisfactory position of the gonads in the postoperative period in group I was noted in 6 (9.5 %), in group II in 1 (1.16%) cases (p &lt; 0.05). Testicular atrophy was detected in group I in 1 (1.59%) patient, in group II also in 1 (1.16%) patient (p&gt; 0.05). The testicular hypotrophy index decreased after 12 months. In group I from 60.7 ± 21.2% to 44.3 ± 23.9%, in group II from 63.1 ± 19.4% to 43.8 ± 19.1%, (p &lt; 0.05). Conclusions. The author's testicular fixation technique for transscrotal orchiopexy provides the safety of surgery comparable to the standard Bianchi and Squire technique, but higher efficiency in preventing testicular malposition after surgery.

Clinical efficacy of two-staged Fowler-Stephens laparoscopic orchidopexy in the treatment of children with high cryptorchidism

Objective: To Evaluate the clinic effect of two-staged laparoscopic Fowler-Stephens orchiopexy in the treatment of high cryptorchidism, and compare it with laparoscopic orchiopexy treatment without disconnecting spermatic vessels. Methods: A retrospective analysis was conducted on 20 cases of children with high cryptorchidism who were treated with two-staged Fowler-Stephens orchiopexy from January 2015 to April 2019 (F-S group). All the children in this group had unilateral cryptorchidism, age 6 to 18 months. The average age was 13.5 months. Seven cases were on the left side, and 13 cases were on the right side. There were 20 control children in the same age group who were treated with testicular fixation without disconnecting spermatic vessels, age 6 to 18 months. The average age was 12.5 months. Six cases were on the left side, and 14 cases were on the right side. Testicular ultrasonography and sex hormone examination were conducted before operation. F-S group met the indications for Fowler-Stephens surgical. In the first stage, the testicular vessels were doubly clipped at a site away from the testis in laparoscopic, and the second stage was scheduled about 6 months after the first stage. The children in the control group were treated with laparoscopic orchiopexy without disconnect spermatic vessels. The two groups were followed up to 6 months after the operation, and the testicular volume and sex hormone indexes of the two groups were measured. The testicular volume and sex hormones before and after the operation of the F-S group and the control group were respectively subjected to a self-control study, and a hormone comparison study was carried out between the two groups of children. Results: Both the F-S group and the control group successfully fixed the testes in the scrotum without tension during the operation. In both groups, 20 cases of testicular positions were reexamined 6 months after the operation without retraction. All the patients had a viable testis in scrotum after operation. Two of F-S group had an atrophic testis in the scrotum, and the others had a good vascularization detected on echo color doppler ultrasound. The average testicular volume of F-S group was (0.34±0.16) ml before operation and the postoperative one was (0.38±0.13) ml, P=0.089, P>0.05. In control group, the preoperative average testicular volume was (0.40±0.14) ml, and postoperative one was (0.40±0.15) ml, P=0.933, P>0.05. The testicular volume of two group had no significant difference. Sex hormone reexamination: Testosterone (T), estradiol (E2) and luteinizing hormone (LH) did not change after operation. Prolactin (PRL) in F-S group was 13.44 μg/L before operation and 12.3 μg/L after operation, PRL in control group was from 15.45 μg/L to 10.34 μg/L, P=0.732, the change of prolactin (PRL) has no significant difference. The median preoperative follicle stimulating hormone (FSH) in the F-S group was 1.18 U/L preoperatively and 1.61 U/L postoperatively; the median FSH of the control group was 1.21 U/L preoperatively and 1.1 U/L postoperatively. Compared between the two groups, the postoperative increase in the FS group was higher than that before the operation, P=0.032, P<0.05, the difference was statistically significant. The median of progesterone (PROG) in the F-S group was 0.25 nmol/L before operation and 0.17 nmol/L after operation; the median PROG of the control group was 0.56 nmol/L before operation and 0.24 nmol/L after operation. It was lower after the operation than before the operation, P=0.034, P<0.05, the difference was statistically significant. Conclusions: (1) Laparoscopic Fowler-stephens staging operation is an effective method for the treatment of patients with high cryptorchidism, and it is worthy of further promotion. (2) Disruption of spermatic cord vessels does have an impact on hormones changes. The choice of this surgical procedure should be carefully and fully evaluated.