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Cryptorchidism is one of the common diseases in children’s genitourinary system. Surgery is the first choice for clinical treatment. Testicular atrophy is a serious complication after operation. The related risk factors of testicular atrophy include the age of operation, the position of testis before operation and the mode of operation. At present, the possible treatments for testicular atrophy are hormone therapy, stem cell therapy and so on. This article reviews the related risk factors, fertility, diagnosis and treatment of testicular atrophy after orchiopexy in children.
ABSTRACT
Cryptorchidism is the most common developmental abnormality of male genitourinary system and the most common cause of non-obstructive azoospermia in adults. This article reviews the research progress on the correlation between the age, unilateral and bilateral, position, hormone adjuvant therapy of childhood cryptorchidism and adult infertility and the mechanism of infertility, in order to improve the protection of the prepubertal testis by clinicians. Orchiopexy is recommended as early as possible at the age of 6 to 12 months, in order to maintain spermatogenesis and improve the fertility of adults.
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Objective To evaluate the clinical effect of treatment for high intra-abdominal cryptorchidism of children with transumbilical single-site and multichannel laparoscopic single stage Fowler-Stephens (F-S) orchiopexy.Methods The case records of the intra-abdominal cryptorchidism of children who had undergone transumbilical single-site laparoscopic single stage F-S orchiopexy were reviewed retrospectively in Children's Hospital Affiliated to Capital Institute of Pediatrics between January 2011 and January 2017,were assigned as the observation group,whose age ranged from 1 to 8 years and average age was 18 months,with 22 unilateral and 8 bilateral,38 testis in total.A total of 31 children with intra-abdominal cryptorchidism who had undergone laparoscopic two stage F-S orchiopexy were assigned as the control group,whose age was from 11 months to 9 years and average age was 20 months,with 23 unilateral and 8 bilateral,39 testis in total.Postoperative follow-ups were conducted with the evaluation index included the testical position,with or without atrophy.The procedure effect and postoperative complications were observed,and the difference between two operation methods was evaluated.Results Operations in all cases were successful in both groups without intraoperative complication.A total of 38 testis were operated with single stage F-S orchiopexy in the observation group,and 39 testis were operated with two stage F-S orchiopexy in the control group.Postoperative complications included scrotum wound infection one case and scrotum hematoma in one case in the observation group,and abdominal wall emphysema in one case,intestinal obstruction in one case as well as umbilicus infection 1 case in control group.Follow-ups ranged from 6 months to 6 years,median 24 months.All testicals were within the scrotum,and each group had 1 case of testical atrophy.The difference of postoperative complication and effect between two groups had no statistical significance(x2 =0.184,0.107,all P ＞ 0.05).Conclusions Outcomes between single stage and two stage F-S orchiopexy are similar.The transumbilical single-site laparoscopic F-S orchiopexy not only has the satisfactory effect,but also saves some patients from reoperation and secondary anaesthesia,but doctors must be aware of the indications and contraindications of this procedure should be brought to attention.
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Objective To explore the choice of handling methods for bilateral internal ring during the transumbilical single-site laparoscopic orchiopexy for cryptorchidism with bilateral processus vaginalis unclosed in children,and evaluate the clinical effect.Methods Retrospective analysis was conducted for the clinical data of 102 children with cryptorchidism and bilateral processus vaginalis unclosed who were hospitalized at Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2011 to January 2016.They were divided into the observation group (55 cases) and the control group(47 cases).In the observation group,the internal rings of the affected side were destroyed and stitched with a needle between the edge of arcuate of musculus trasversus abdominis and fascia trans versalis of posterior peritoneum.If the diameter of opposite internal ring was less than 0.5 cm,only a circle was destroyed.Otherwise,a circle was destroyed and sutured with a needle.In the control group,the processing methods for orchiopexy and affected side internal ring were same as the observation group.Purse string suture was done for opposite internal rings of all cases in the control group.The parameters of operative duration,intraoperative blood loss,postoperative hospital stay,postoperative complications were compared between 2 groups.Results All operations were successful in both groups,spermatic cords were reserved and testicles were in scrotum of all cases.Operative duration was significantly shorter in the observation group than that in the control group [(42.02 ± 3.21) min vs.(48.43 ± 4.18) min,t =-8.739,P ＜ 0.01].The differences in intraoperative blood loss,postoperative hospital stay and postoperative complications between 2 groups were not statistically significant[(4.38 ± 1.42) mL vs.(4.80 ± 1.37) mL,t =-1.533,P ＞0.05;(2.87 ±0.64) dvs.(2.98 ±0.61) d,t =-0.853,P ＞0.05;1.8％ (1/55 cases) vs.2.1％(1/47 cases),x2 =0.013,P ＞ 0.05].During a mean follow-up of 30(12-72) months,there was no case of testicular ascent or atrophy,or hernia,or hydrocele.Conclusions The transumbilical single-site 3-port laparoscopic orchiopexy for cryptorchidism has stable efficacy.The improved method for bilateral internal ring is simple and has satisfactory effect,which is worthy of clinical promotion.
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Objective To explore treatment scheme and surgery for hypospadias with small glans.Methods Between January 2014 and January 2017,40 cases of hypospadias with small glans were enrolled in the study including 13 cases with penile hypospadias and 27 cases with penoscrotal hypospadias.The boys's average age was 1.5 years,aged from 1 to 5 years old.The boys whoes glans width less than 10 mm received the treatment of topical testosterone propionate smeared on penis once a day for 1 or 2 months.The patients received operation when their glans width reached 10 mm to 14 mm.Among of 27 cases of severe penile recurvation patients,17 cases received staging operation,one-stage was correction of penile recurvation and two-stage was Tubularized incised plate with pull-through procedure,10 cases received adopted modified Duplay combined with Duckett operation,then overturn split-skin graft for incision in the urethra located in glans penis.Among of 13 cases with mild and moderate recurvation,after penile correction,3 cases received Tubularized incised plate urethroplasty and 10 cases received Onlay island flap urethroplasty.All of the patients received modified plastic surgery for glans.Results All of patients were followed-up,from 3 months to 3 years.The surgical success rate was 70％ (28/40).12 cases got operative complications,including urinary fistula 6 cases and glans dehiscence 1 case,who were cured by reoperation,external orifice stricture 1 case and urethral stricture 4 cases who were healed by Urethra dilatation.All patients acquired good appearance glans and satisfied void stream.Conclusions Topical use testosterone propionate for hypospadias with small glans helps the growth of penis.Individualized diagnosis and treatment plan should be made for the particular case of hypospadias with small glans.The modified plastic surgery of glans is suitable for hypospadias with small glans,which could improve surgery success rate and reduce the postoperative complication.
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Objective To assess the feasibility and efficacy of renal pelvis drainage and ureteral stent of laparoscopic pyeloplasty in treatment of ureteropelvic junction obstruction.Methods Eighteen patients(14 boys and 4girls) with ureteropelvic junction obstruction,the average patient age was 66 months (range 3-182 months),who underwent transabdominal laparoscopic Anderson-Hynes pyeloplasty in Capital Institute of Pediatrics from Aug.2011 to Oct.2012 were selected.The ureteral stent and renal pelvis drainage were installed during the performance of surgery.They were removed in 7 days and 9 days after operation respectively.Results Eighteen cases successfully underwent laparoscopic pyeloplasty,without conversion to open surgery.The mean operating time was 102.8 minutes (ranging between 90 and 150 minutes).Two cases had complications on postoperative day 3,one patients ureteral stent was inadver-tentely pulled out,another was removed because of blood clots.No patient had postoperative urinary leakage or anastomotic stenosis.Postoperative follow-up time was 6 months.The hydronephrosis vanished in 13 patients,reduced obvious ly in 5 patients as revealed by ultrasound examination.Conclusions Intraoperatively,renal pelvis drainage and ureteral stent for postoperative drainage is effective,and it is worthy of application in a large scale.Patients can avoid further anesthesia for removing stents and the complications of long-term indwelling stent tubes,and have an improved quality of life.
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Objective To investigate the therapeutic effect of modified transperitoneal laparoscopic dismembered pyeloplasty in children with with ureteropelvic junction obstruction (UPJO).Methods The clinical data of 27 children with UPJO treated with transperitoneal laparoscopic dismembered pyeloplasty were analyzed retrospectively.The age ranged from 5 to 104 months (mean,37 months).All cases were diagnosed by ultrasonography,IVU,CT and/or renal radionuclide scanning.The antero-posterior pelvic diameter was more than 3 cm by ultrasound in all cases.Indications of surgery were as followings:symptoms of upper abdominal pain or low back pain and/or split renal function ＜40％ and/or progressive dilatation.Modified transperitoneal laparoscopic dismembered pyeloplasty was performed.Double hitch stitches were transfixed at the top of pelvis and ureter to be anastomosed,and a 6 F urethral catheter was inserted as a ureteral stent percutaneously through the puncture hole and was removed 7-9 days postoperatively without double-J stent.Results All operations were completed laparoscopically without conversion to open surgery.The mean operative time was 118 min (range,85 to 176),the mean blood loss was 16 ml (range,10 to 30) and the mean postoperative hospital stay was 10.5 days (range 9 to 13).The perinephric urine drainage occurred in 2 patients with about 200 ml/d,and reduced to 6 ml/d and 4 ml/d 5 to 6 days after operation.During the follow-up period for 12 to 36 months(mean,22 months) in 27 cases,there was no stricture at UPJ and the hydronephrosis reduced significantly or disappeared.Conclusion Laparoscopic dismembered pyeloplasty with double hitch stitches and an ordinary urethral catheter as an ureteral stent is an easy method with high successful rate and less operative time,which avoids reoperation to remove the double-J stent and is worthy of clinical popularization.
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ObjectiveTo study the biological characterization and the genetic background of circulating CA16 strains in mainland of China for the purpose of CA16 vaccine development in the future.MethodsCA16 strains were isolated from throat swabs of patients with hand-foot-mouth disease and identified by neutralization assay and RT-PCR.The genotype of these isolates were determined by sequence alignment and phylogenetic analysis of VP1 gene.The proliferation dynamics and the plaque morphology were observed when propagated in Vero cells.The pathogenicity of these CA16 isolates was evaluated by challenging newborn mice.ResultsIn this study,six CA16 circulating isolates,BJ-1-6 were obtained.The RT-PCR products were 150 bp amplified with the general enterovirus primers and 210 bp with CA16 primers respectively,which cannot be amplified by EV71 primers.Additionally,these isolates were identified to display some obvious proliferation dynamics and plaque morphology when propagated for 96 h in Vero cells.The diameter of plaques were about 1.5 to 2 mm for BJ-1,BJ-2,BJ-4,BJ-6,4-5 mm for BJ-3 and 3 mm for BJ5,the plaques were regular except BJ-3.All the six isolates can be neutralized by the convalescent serum of patient infected with CA16.The virus titer of different isolates propagated for five passages in Vero cells was 7.0LgCCID50/ml.The sequence alignment of VP1 gene demonstrated that the genotypes of BJ-2,BJ-4,BJ5 were C1 and BJ-1,BJ-3,B J-6 were C,3 comparatively.The genetic distance of the VPI gene from theseisolates suggested that they were highly genetic identity with the homology of 90％ in nucleotide and 99％ in dedicated amino acid respectively.However,a distinctive difference in pathogenic ability in neonatal mice was found that the suckling mice challenged with BJ-3 & BJ-5 were paralyzed 4-5 d and dead 6-7d postchallenge,compared with the control group without any abnormality in the during of 14 d.ConclusionThe circulating CA16 isolates in China have different biological characteristics,different pathogenic ability and similar genetic backgrounds,which is helpful for the development of a CA16 vaccine in the future.
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Objective To compare the adjuvanticity of type-A,B and C CpG-ODN in mice.Methods Three types of CpG-ODN were identified through in vitro stimulation of murine splenocytes with various CpG-ODN.BALB/c mice were immunized with HBsAg,together with different types of CpG-ODN,and antigen-specific IgG.IgG1 and IgG2a titers were measured 4 weeks later by indirect ELISA.Resuits Compared with the control group.all 3 types of CpG-ODN enhanced humoral immune response to HBsAg.However,type-B and C CpG-ODN induced much higher levels of antigen-specific IgG and IgG2a than type A CpG-ODN.Type-C CpG-ODN induced a similar TH 1-biased immune response as type-B CpG-ODN,revealed by decreased IsG1 to IgG2a ratio.In contrast,although type-A CpG-ODN increased IgG titers,it did not switch the balance between TH1 and TH2 immune responses.Conclusion All 3 types of CpG-ODN can enhance the humoral immune response to vaccines,but their aaiuvanticity could be mediated through different mechanisms.
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Objective The aim of this study was to explore the minimally invasive treatment for palpable undescended testes in the inguinal area.Methods Between August 2007 and March 2008,60 cases(74 testicular units)with palpable undescended testes in the inguinal area were treated by scrotal incision orchiopexy or/and laparoscopic orchiopexy depending on the location of inguinal testes.Results Among the 60 patients,26 cases who had the testes located between the external inguinal ring and the upper scrotum,received scrotal incision orchiopexy,of which the testes were fixed at the bottom of the scrotum in 23 cases,and at the upper scrotum in 1 case;the other 2(both had the undescended testis at the right side,between the external inguinal ring and the upper scrotum)were converted to laparoscopic orchiopexy because of unsatisfying surgical outcomes.The other 34 cases received laparoscopic orchiopexy,of which the testes were located in the groin in 16(41.1%)cases,close to the external inguinal ring in 18(52.9%),and complicated with indirect inguinal hernia in 8(23.5%,ligation of the hernia sac was performed at the level of internal inguinal ring);the testes were fixed at the bottom scrotum in the cases.The 60 patients were followed up for 3-6 months(mean,4.3 months)by B-ultrasonography,none of them showed atrophy or retraction of the testes,or indirect inguinal hernia.ConclusionsScrotal incision orchiopexy is feasible for palpable inguinal testes if the testis can be pulled upon to the upper scrotum,if not or the testis cannot be fixed on the bottom scrotum,laparoscopic orchiopexy should be used.Both of the procedures are effective.