Early experience with laparoscopic management of nonpalpable undescended testes

Background: Nonpalpable undescended testes (NPT) constitute 20%­30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care. Aim: This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center. Methodology: Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016. Results: A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.Conclusion: Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity

Undescended testes in a developing country: a study of the management of 71 patients

BACKGROUND: A testis located outside the scrotum is prone to a lot of complications but early detection and correction give good result. The purpose of this study was to determine the pattern of presentation, complications recorded, the surgical treatment offered and outcome in a developing country. PATIENTS AND METHODS: A retrospective study of patients that presented with undescended testes at the University of Benin Teaching Hospital between January, 1997 and December, 2006. RESULTS: A total of 76 orchidopexies and 10 orchidectomies were done on 71 patients with undescended testes during the period. They were aged 9 months and 47 years (mean 8.3 +/- 7.9 years) at surgery. Only 31 (43.7%) patients presented at age 5 years and below while 40 (56.3%) presented after 5 years. Seventy-two (83.7%) testes were palpable, ultrasound scan was used to locate 10 (11.6%), while 4 (4.7%) could only be located during groin exploration. Intraoperative assessment of the testes were 54 (62.8%) normal testicular volume, 22 (25.6%) reduced volume and 10 (11.6%) atretic. All those aged 5 years and below had normal/reduced testicular volume and all had orchidopexy whereas those above 5 years with normal/reduced testicular volume had orchidopexy and those with atretic testis had orchidectomy. Post operatively, testicular growth was recorded only among the pre/pubertile boys, the testes retracted in two patients, scrotal skin infection in one, and intra scrotal haematoma in two. CONCLUSION: Delayed presentation resulted in morphological changes, increased complications, number of orchidectomy and reduced chance of testicular growth post orchidopexy

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

Interet du traitement chirurgical de la cryptorchidie a Yaounde

Une etude retrospective visant a evaluer l'interet du traitement chirurgical de la cryptorchidie a porte sur 123 patients operes a Yaounde pendant une periode de 10 ans allant de 1984 a 1994. L'analyse a revele que 93 patients (75;6 pour cent) avaient ete operes apres l'age de trois ans; au moment ou des alterations histologiques avaient deja compris le pronostic fonctionnel du testicule et augmente le risque de cancerisation. Des resultats comparables dans la litterature montrent l'insuffisance de l'information medicale sur l'age optimal de l'abaissement des testicules cryptorchides. L'etude fait des propositions pour un changement de comportement

Les problemes poses par les testicules non descendus

L'auteur; qui donne d'abord le sens de testicule non descendu; expose ensuite les raisons de cette malformation. A 5 ans d'age; avec une cryptorichidie unilaterale droite non palpable; l'auteur pense qu'il n'y a pas de la place pour un traitement hormonal; seul un traitement chirurgical se justifie et devra etre realise sans delai