Evaluation of staged fowler-stephens orchiopexy for the high abdominal testis

Objective: To evaluate staged Fowler - Stephens orchiopexy for the high intra-abdominal testis. Patients and Methods: The study included 78 patients with laparoscopically diagnosed high intra-abdominal testes. Their age ranged from 2 -16 years. All cases underwent staged Fowler - Stephens orchiopexy. The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open (67 cases) or laparoscopic orchiopexy (11 cases) was performed. Only 65 patients were available for follow up at 6 and 18 months following the second stage. At each follow-up visit; the testicular position; size and viability were assessed by Technetium 99 (Tc99m) testicular scintigraphy. Results: Out of 78 cases; 10 had bilateral high intra-abdominal testes. Second stage open orchiopexy was done in 67 cases while the remaining 11 cases were subjected to laporoscopic orchiopexy. No operative or postoperative complications were detected apart from a prolonged ileus after the second stage in 6 patients. On follow up; 49 testes were scrotal and of good size while 6 testes were scrotal and atrophic. In the remaining 10 cases the testes were at the neck of the scrotum and of good size. Tc99m testicular scintigraphy was done in 65 cases. A good perfusion was detected in the majority of them (59 cases) while no radiotracer accumulation was detected in the remaining 6 cases. Conclusion: Laparoscopic clipping of the gonadal vessels is safe in patients with high abdominal testes. The staged approach with preservation of the testicular collateral vascular supply provides an adequate viability of the high abdominal testis with a high success rate. Tc99m testicular scintigraphy allows a proper assessment of the testicular viability as compared to measurement of the testicular size only

Bladder neck resection with preservation an antegrate ejaculation

Objective: To evaluate a new method of bladder neck resection and to determine; whether or not antegrade ejaculation can be preserved. Patients and Methods Twenty patients with bladder neck obstruction were treated by bladder neck resection with preservation of more than 1 cm proximal to the verumontanum. The patients were evaluated before and after resection by semen volume; sperm count symptom improvement and urodynamic evaluation. Results With this technique preserving 1 cm of the supramontanal part; we could preserve antegrade ejaculation in 17 out of 20 patients (85); while in two patients only a small amount of semen was ejaculated and in one patient; complete retrograde ejaculation was reported. Conclusion The complication of retrograde ejaculation in young patients who are in need of fertililty may be avoided by preservation of 1 cm of the supramontanal part during bladder neck resection