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

Management of iatrogenic ureteral injury and fistula

Thirty-three patients with iatrogenic ureteral were treated over 8-year period. Gynecologic, urologic and abdominal operations were the antecedent procedures in 63.6%, 21.2% and 15.2%, respectively. The diagnosis was made immediately in 7 cases, concomitantly repaired and within the first 4 weeks in 24 cases all fistulating into the skin, vagina or the bowel and fixation of a double-j stent either through a retrograde or antegrade route was successful only in 6. Surgical repair after an average 4 weeks from percutaneous nephrostomy was successful in 18 cases, but 2 obstructive cases were repaired without diversion. Surgically induced ureteric injuries must be managed immediately and 25% of the fistulating cases can be treated only with ureteral stenting. Percutaneous nephrostomy in addition to fascilitating rerouting and stenting of ureteric fistula, have also a profound effect in minimizing obstructive changes and seepage of urine in all the cases. Furthermore it allows an earlier surgical repair with minimal fibrosis at the site of fistula

selection of surgical procedures for bilharzial ureters

Obstructive ureteropathy affects nearly all bilharzial patients, and 90% of these are mainly due to stricture lesions with the effects of active and passive dilatation. To avoid unsatisfactory postoperative results, meticulous preoperative assessment plus certain technical precautions are mandatory. We have reviewed 85 patients with 109 bilharzial ureters managed from January 1982 to Decemter 1985. Routine investigations were carried out together with micturating cysto-urethrography to detect vesico-ureteral reflux, renal scan, renogram and cystoscopy with bougienage as the final diagnostic tools. A variety of reconstructive procedures were performed, preceded by percutaneous nephrostomy in 12 cases with poor kidney function. We concluded that surgical failures were partly due to active disease, excessive devascularization of the ureter, haematoma, and secondary infection but were mainly due to an inappropriate choice of technique for the individual patient. Better results can be obtained by categorizing the multiple pathologies and devising appropriate operations to suit them