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Objective To explore the safety and feasibility of transumbilical single channel laparoscopic cryp-torchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instru-ments from November 2017 to March 2018 at Department of Pediatric Surgery,the First Affiliated Hospital of Guangxi Medical University. Clinical data were recorded including the general information,operation time,intraoperative blood loss,postoperative testicular position and postoperative complications,etc. Results All 35 patients completed the cryptorchidopexy in one operation. Among those 35 patients,28 patients had unilateral lesions and 7 patients had bilateral lesions,with a total of 42 sides. Twenty - six patients were of groin type( 33 sides),9 patients abdominal type( 9 sides). The average operation time was(40. 4 ± 8. 2)min for unilateral lesion,and(62. 5 ± 15. 3)min for bilateral le-sions;the average intraoperative blood loss was(3. 0 ± 1. 8)mL;and the average postoperative hospital stay was(6. 4 ± 2. 1)h. Testis of 32 patients(40 sides)were fixed in the middle and bottoms of the scrotum,and testis of 2 patients (2 sides)were fixed on the top of the scrotum. One case had poor healing of naval incision,which was recovered in 1 week after dressing change. There were no postoperative complications such as scrotum hematoma,infection of incision, testicular epididymitis,testicular necrosis,testicular retraction or testicular atrophy,etc. No obvious visible scar was found in the abdomen review 2 weeks postoperatively,with the incidence of complications was 2. 9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma,quick recovery,low complication rate and visible scar free result, which is worthy of clinical promotion,but the operation is relatively complex and the correct procedures are required.
ABSTRACT
Objective@#To explore the safety and feasibility of transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism in children.@*Methods@#Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments from November 2017 to March 2018 at Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University.Clinical data were recorded including the general information, operation time, intraoperative blood loss, postoperative testicular position and postoperative complications, etc.@*Results@#All 35 patients completed the cryptorchidopexy in one operation.Among those 35 patients, 28 patients had unilateral lesions and 7 patients had bilateral lesions, with a total of 42 sides.Twenty-six patients were of groin type(33 sides), 9 patients abdominal type(9 sides). The average operation time was (40.4±8.2) min for unilateral lesion, and (62.5±15.3) min for bilateral lesions; the average intraoperative blood loss was (3.0±1.8) mL; and the average postoperative hospital stay was (6.4±2.1) h. Testis of 32 patients (40 sides) were fixed in the middle and bottoms of the scrotum, and testis of 2 patients (2 sides) were fixed on the top of the scrotum.One case had poor healing of naval incision, which was recovered in 1 week after dressing change.There were no postoperative complications such as scrotum hematoma, infection of incision, testicular epididymitis, testicular necrosis, testicular retraction or testicular atrophy, etc.No obvious visible scar was found in the abdomen review 2 weeks postoperatively, with the incidence of complications was 2.9%(1/35 cases).@*Conclusions@#Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma, quick recovery, low complication rate and visible scar free result, which is worthy of clinical promotion, but the operation is relatively complex and the correct procedures are required.
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Objective To explore the application of combined penile and scrotum skin flap in the reoperation process for operation failure cases with hypospadias.Methods A retrospective analysis was performed with the inclu-sion of 1 5 failure cases with hypospadias who received combined penile and scrotal skin flap treatment for reoperation from January 201 3 to December 201 5 in the First Affiliated Hospital of Guangxi Medical University.These cases aged from 7 to 1 5 years old,with a median age of 1 0.2 years old.Among them,a 3 rd operation was performed in 4 cases,4th operation in 5 cases,5 th operation in 4 cases,and 6 th operation in 2 cases.The procedure of Onlay island flap urethro-plasty +tubularized incised plate (Onlay +TIP)urethroplasty was performed in 4 patients,and the other 1 1 cases were treated with urethral mouth basal vascular skin tube urethroplasty (Mathieu)+TIP urethroplasty.F8 or F1 0 silicone balloon catheter were used as stent in new urethra,outer dressing after operation was replaced every 2 to 3 d,the outer dressing was demolished 6 -8 d after operation.Results All patients were followed up after surgery until March 20, 201 6,the follow -up time was 4 -26 months.In these 1 5 patients,the success rate of operation was 86.7%(1 3 /1 5 ca-ses),among them,3 cases were success and 1 case was failed in Onlay +TIP group,and 1 0 cases were success and 1 case was failed in Mathieu +TIP group.The patients with successful operation were with beautiful appearance of the pe-nis,normal position of the meatus urinarius and normal urination.No peristome of urethra,urethrovaginal fistula or ure-thral diverticulum was found after surgery.However,urethral cracking of the glans of penis appeared in 2 operation failed patients,and the orificium urethrae externum was low -set,and urethroplasty was needed 1 year postoperatively. Conclusions For some failure cases with hypospadias showing suitable anatomy conditions,Onlay +TIP or Mathieu +TIP combined with penile and scrotal flap may be a good choice for the completion of reoperation.
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Objective To investigate the indications and complications of onlay island flap urethroplasty in hypospadias.Methods Retrospective analysis 51 cases who received the onlay urethroplasty from Mar.2005 to Sep.2012 at the First Affiliated Hospital of Guangxi Medical University.Their ages were from 2 years to 12 years,the median age was 4 years and 3 months.Forty-three cases received the operation for the first time,8 cases were re-operation.The prepuce island flaps were implemented in all cases.Factors which contributed to the successful operation ratio were compared,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation,the size of glans.Results The operation achievement ratio was 82.4％ (42/51 cases).There were 7 cases urethrocutaneous fistula(6 cases were then cured by reoperation,1 case healed naturally).One case had urinary meatus had retraction.There was another case with persisting penile curvature.Some differences in factors had no statistical significance,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation (x2 =0.249,0.287,1.208 ; all P ＞ 0.05).The difference in glans size had statistical significance (x2 =3.393,P ＜ 0.05).Conclusions Onlay urethroplasty was suitable for the cases of coronary sulcus of penis and extremitas anterior penis,but for proximal cases,this therapy must be applied very carefully because of persisting penile curvature.For some reconstruction cases,Onlay urethroplasty was suitable,but the island flap must be designed flexibly.Urethrocutaneous fistula was the most complication,especially in some small flat glans.