Laparoscopic nephropexy: initial experience

To evaluate the efficacy of laparoscopic nephropexy as a minimally invasive procedure for treatment of cases with symptomatic nephroptosis. We have performed laparoscopic right nephropexy in 6 patients presenting with symptomatic nephroptosis documented by radiographic studies [IW] and/or renal scans. Exposure of the kidney was achieved via a transperitoneal laparoscopic approach. For kidney fixation, the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using an intracorporeal suturing technique; additionally, the anterior mid-portion of the renal capsule was sutured to the back muscle and its covering fascia using running sutures thereby, creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successful accomplished in all 6 patients. The average operative time was 4 hours. All patients resumed oral intake during the first postoperative day; the average amount of parenteral analgesia required postoperatively was 42.7 mg of morphine sulphate or its equivelant. Hospital stay averaged 2.5 days; return to usual activities occurred on average at 2.5 weeks postoperatively. Postoperative imaging studies confirmed reduction or elimination of nephroptosis in all patients; all patients have remained asymptomatic during an average follow-up of 11 months [range: 3 to 24 months]. Laparoscopic nephropexy appears to be a feasible minimally invasive treatment option for patients with symptomatic, documented nephroptosis. It can be safely and effectively accomplished with satisfactory anatomical and clinical results

Laparoscopic management of children with non-palpable testis

To show the advantages and limitations of laparoscopy in management of the non-palpable testis. Herein, we report our experience with diagnostic and interventional laparoscopic procedures in children with non-palpable testes. Between 1997 and 2001, 28 children underwent 30 laparoscopic procedures for evaluation and management of 36 non-palpable testes. Pneumoperitoneum was achieved using a Veress needle inserted infraumbilically in all cases. Examination of the abdomen and pelvis was performed with a 30°, 5 mm laparoscope. When intervention was deemed necessary, 2 to 3 additional 5 mm ports were inserted under direct visual control. For dissection, laparoscopic microscissors and electrosurgical dissection were used. The mean patient age was 3.6 years [12 months -14 years]. A total of 12 diagnostic procedures [localization] were performed on 12 patients and 15 inguinal exposures were done based on the laparoscopic findings [14 orchiopexy and 1 orchiectorny]. Tlie testes were absent in six more patients and farther surgery avoided. Twelve laparoscopic interventions were done on 10 patients: 9, one stage laparoscopically assisted orchiopexy, 1, two-staged orchiopexies, 1, laparoscopic Fowler-Stephen orchiopexy and, laparoscopic orchiectcmy. All procedures were performed on outpatient basis or with an overnight stay. There were 4 complications: injury of the spermatic vessels which did not affect the viability of the testis in one instance, two testes had atrophied at 4 weeks and 6 weeks follow-up, and one testis had retracted to the level of the pubic tubercle at 9 months. Laparoscopy is a useful tool in the management of the non-palpable testes. For an intracanalicular testis, an inguinal orchiopexy is recommended. For intra-abdominal testes, a laparoscopic orchiopexy is the technique of choice at our institution

Intrauterine insemination with avarian hperstimulation for treatment of comples with unexplained infertility

Treatment of couples with unexplained infertility includes many therapeutic modalities that range from expectant management to the most sophisticated assisted reproductive techniques [ARTs] as IVF and GIFT. As such, we evaluated the clinical efficacy of ovarian hyperstimulation with intrauterine insemination [IUI] as an easy and economic method of ARTs for treatment of couples with unexplained infertility. A total of 112 couples with unexplained infertility, despite of the normal finding of the infertility diagnostic work-up, were selected for this study. The male partner was evaluated by history taking, physical examination, scrotal doppler examination for varicocele, 3 consecutive semen analysis, and hormonal profile that included FSH, LH, prolactin and testosterone. The protocol of female evaluation included history taking, clinical examination, postcoital test, hormonal assay for serum prolactin, luteal phase of serum progesterone and thyroid function test, ultrasound pelvic examination with ovarian folliculometry, hysterosalpingography, premenstrual endometrial biopsy laparoscopy and hysteroscopy. All selected couples were managed by controlled ovarian hyperstimulation in combination with IUI for up to 3 cycles. Vaginal ultrasound scan was used for monitoring of the treatment cycles. A total of 171 treatment cycles were made and 27 clinical pregnancies were achieved [25 term and ongoing pregnancies and 2 spontaneous abortions]. The total pregnancy rate was 24.1% per patient and 15.8% per treatment cycle. The successful pregnancy rate was 22.3% and 14.6% per patient and per treatment cycle respectively. Controlled ovarian hyperstimulation in combination with IUI achieved a reasonable success rate in the treatment of couples with unexplained infertility and should be offered before considering the more sophisticated and expensive assisted reproductive techniques