100 research outputs found
Laparoscopic Evaluation and the Management of the Nonpalpable Testis
From June 1992 to December 1996, we performed laparoscopic evaluation for 28 nonpalpable
testes in 22 patients (1–21, median 3 years old)
The Role Of Videolaparoscopy In The Diagnostic And Therapeutic Approach Of Nonpalpable Testis.
Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes. Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47%) patients presented nonpalpable testes bilaterally, 7 (14%) only at the right side and 20 (39%) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume. Nine (12%) testes were not localized, but their vessels and deferent duct were atrophic. Two (3%) testes were intra-abdominal and atrophic, and 2 (3%) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25%) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29%) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10%) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17%) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54%) cases, reaching a surgical success of 89%. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12%) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89%. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17%) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77% of good results. Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.29345-51; discussion 351-
Laparoscopic classification of the impalpable testis: an update
Purpose We present a classification for the nonpalpable testis (NPT) based on laparoscopic findings and suggest guidelines for the interpretation of these findings.Patients and methods From October 2002 to December 2010, 121 patients with NPT underwent laparoscopy at two tertiary centers of Pediatric surgery in Egypt. The lower abdomen and pelvis were inspected to identify the following structures and their inter-relationships: the internal inguinal ring (and its patency), spermatic vessels, vas deferens, and testis. The laparoscopic findings were documented by one of the authors who attended all procedures, and video recordings were available in some cases. Further management was dependent on laparoscopic findings, classification, and plan of treatment.Results The study included 117 patients with 142 nonpalpable testes. Their mean age was 4.9 years. Among patients with unilateral NPT, a contralateral palpable undescended testicle was always associated with a viable NPT (100%), whereas a contralateral scrotal testis had an equal chance (50%) of finding a viable NPT, without a significant difference whether it was right or left sided.Conclusion Failure of normal testicular descent leads to a spectrum of anatomical variations that can be precisely and safely defined by laparoscopy in about two-thirds of patients with nonpalpable testes. In the remaining one-third of patients, including inguinal exploration after laparoscopy can help us to exclude a missed viable inguinal testis.Keywords: cryptorchidism, laparoscopy, testi
In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?
Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients’ mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler–Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient
عنوان به فارسی: ارزیابی نتایج اورکیوپکسی لاپاراسکوپیک در درمان بیضههای نزول نیافته غیر قابل لمس در بیمارستان اکباتان همدان، از تیر ماه 1385 تا آذر ماه 1387
زمینه و هدف: کریپتورکیدیسم شایعترین ناهنجاری تولد در پسران است که شیوع آن در شیرخواران ترم 2-5 % میباشد. این ناهنجاری با افزایش شیوع سرطان بیضه و نازایی و نیز فتق، پیچش بیضه و تنش روانی همراه است. جراحی روش اصلی درمان برای این ناهنجاری است. این مطالعه با هدف ارزیابی اثربخشی درمانی اورکیوپکسی لاپاراسکوپیک در درمان بیضههای نزول نیافته غیرقابل لمس صورت گرفت. مواد و روشها: در این مطالعه توصیفی مقطعی 40 بیمار با بیضه غیرقابل لمس که تحت اورکیوپکسی لاپاراسکوپیک در بیمارستان اکباتان همدان، از تیر ماه 1385 تا آذر ماه 1387 قرار گرفتند، ارزیابی شدند. بیماران بعد از جراحی و 3 ماه بعد از آن بر اساس پاسخدهی به درمان و آتروفی بیضه مورد پیگیری قرار گرفتند. یافتهها: میانگین سن بیمـاران 16/12±19سال بود. 13 بیمار در ارزیابی لاپاراسکـوپیک فاقـد یک بیضه بودند و در 6 بیمار بیضهها در کانال اینگـوینال قـرار داشت که این افـراد از مطالعه کنار گذاشته شدند. 17 بیمـار با اورکیوپکسی لاپاراسکوپیک در 1 مرحله درمان شدند، درحالیکـه 4 بیمار تحت اورکیـوپکسی فاولـر-استفانس در 2 مـرحله قـرار گرفتند. شانس موفقیت برای درمان 100% محاسبه شد. نتیجهگیـری: اورکیوپکسی لاپاراسکوپیک یک روش مطمئن و ایمن در درمان بیضههای نزول نیافته غیرقابل لمس میباشد
Laparoscopy for the management of impalpable testis
Background: Cryptorchidism is encountered in 21% of preterm infants, 2-4% of all full term boys and 1% of one year old boys.Objectives:To present our experience in the utilization of diagnostic laparoscopy for the management of children with impalpable testes.Method:This is a retrospective study conducted between March 2010 and December 2011. The medical records of boys with impalpable testis were reviewed. Diagnostic laparoscopic findings regarding presence, morphological state, and location of testis were analyzed. Special attention to how initial laparoscopy influenced subsequent surgical procedures and management.Results:Fifty four boys underwent laparoscopy with 76 impalpable testes. Forty testes were unilateral impalpable testes, two third of them were left sided. Thirty seven testes were intraabdominal, eight of them were atrophied and excised laparoscopically. Twenty nine of them were viable, 90% of them underwent first stage Fowler-Stephens procedure, while the rest underwent primary laparoscopic orchidopexy. Vas and spermatic vessels were seen entering inguinal canal in 25 testes. This group had immediate inguinal exploration, 22 of testes underwent orchidopexy and three orchidectomy. Fourteen boys found to blind end vas and vessels with no further treatment needed.Conclusions: Laparoscopic exploration should be performed because it accurately identifies and localizes the missing testis. In addition, it facilitates the planning of definitive surgical management of orchidopexy, staged orchidopexy or orchidectomy. So we recommend that initial laparoscopic exploration should be performed for patient with impalpable testis.Keywords:Impalpable testis, Laparoscopy, Orchidopexy, Jordan
Bipolar diathermy as another method for testicular vascular division in laparoscopic two-stage Fowler–Stephens orchidopexy: A retrospective study
Objective The current study assessed the outcome of the two-stage laparoscopic Fowler–Stephens orchidopexy (LFSO) for intra-abdominal testis (IAT). Testicular blood vessels were divided by two different methods, bipolar diathermy or the conventional clipping method.Summary background data The shortness of testicular vessels may play a role in making the surgical approach in IAT a technical challenge and can hinder the dragging of the testicles to the scrotum.Patients and methods We reviewed 31 records of pediatric patients who underwent operations for IAT between July 2010 and July 2017, using the two-stage LFSO. We evaluated methods used for dividing the testicular vessels in the first stage. We evaluated the intrascrotal position and testicular size. Success was defined as a nonatrophic, intrascrotal testis.Results Two-stage LFSO was performed in 31 boys with 39 IAT. The mean age at the first stage was 32.18 months and at the second stage was 42.25 months. Two methods were used to divide the testicular vessels in the first stage of the LFSO, which were clipping by metallic clips (5 mm) in 25 testes and bipolar diathermy (3 mm) in 14 testes. With an average follow-up of 16 months, the preoperative volume was maintained in 97.43% of the testes, whereas 94.87% of the testes were intrascrotal. One testicular atrophy was reported in the clipping group. Two testicles were outside the scrotum within the bipolar coagulation group.Conclusion Two-stage LFSO is safe and feasible. Bipolar diathermy could be used as an alternate method for dividing testicular vessels. Keywords: Fowler–Stephens, intra-abdominal testis, laparoscopic, laparoscopic Fowler–Stephens orchidopexy, nonpalpable testes, orchidopexy, pediatric
Role of color Doppler ultrasound in the diagnosis of nonpalpable testes
Purpose Color Doppler ultrasound has been used for the diagnosis of torsion of testes. The purpose of this study was to evaluate the sensitivity of this noninvasive tool in detecting impalpable testes.Patients and methods Twenty-five children with nonpalpable testes were treated at the Department of Pediatric Surgery, Institute of Medical Science, Banaras, between 2007 and 2009. Color Doppler ultrasound was used for detecting the position, size, and vascularity of nonpalpable testes. These patients were subsequently revaluated by laparoscopy.Results Out of 25 cases, 15 cases were unilateral and 10 cases were bilateral (a total of 35 nonpalpable testes). The color Doppler ultrasound study successfully localized 30 of the 35 nonpalpable testes, which were confirmed by subsequent laparoscopic examination. The sensitivity of color Doppler in locating testes was 85.71% (95% confidence interval = 0.64–0.97).Conclusion Color Doppler ultrasound is an effective noninvasive method for the initial diagnosis of impalpable testes and for planning its subsequent management.Keywords: color Doppler ultrasound, laparoscopy, nonpalpable teste
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