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

Caracterización clínico-epidemiológica de criptorquidia en pacientes internados del Hospital del Niño Ovidio Aliaga Uría / Clinical and epidemiological characterization of cryptorquidsm in patients of the Hospital del Niño Ovidio Aliaga Uría

OBJETIVO: Establecer las características clínico epidemiológicas de criptorquidia en pacientes internados en los meses de septiembre a diciembre de 2016 DISEÑO: estudio descriptivo y prospectivo donde se realizó la recolección de datos de una serie de casos de pacientes internados con criptorquidia LUGAR: Hospital del Niño "Dr. Ovidio Aliaga Uría" (La Paz- Bolivia) MÉTODOS: Se incluyeron 64 pacientes de edades entre 1 y 10 años. Se realizó una entrevista estructurada a los padres aplicando un instrumento precodificado, previo consentimiento verbal. Luego se realizó una revisión del expediente clínico para completar datos. Se ingresó los datos a una base Excel, se procedió al análisis de los mismos a través del uso de la estadística descriptiva. RESULTADOS: El rango de edad de tratamiento fue 1 año a 10 años y 2meses, con promedio de 3 años y 8 meses; la edad al momento del diagnóstico en promedio fue 2 años y 9 meses. El tiempo transcurrido entre diagnóstico y tratamiento fue 11 meses. La criptorquidia derecha fue más frecuente con 53%. El hallazgo diagnóstico se realizó en primera instancia por un familiar en 28% y en 72% por un personal de salud. El 68% fue diagnosticado en el primer nivel, 9% en segundo y 23% en el tercero. CONCLUSIONES: La edad en la que se opera y diagnostica la criptorquidia en nuestro medio no está dentro de las recomendaciones americanas y europeas.

OBJECTIVE: To establish the clinical epidemiological characteristics of cryptorchidism in hospitalized patients from September to December 2016 DESIGN: descriptive and prospective study where the data collection of a series of inpatient cases with cryptorchidism PLACE: Hospital del Niño "Dr. Ovidio Aliaga Uría "(La Paz- Bolivia) METHODS: We included 64 patients aged 1 to 10 years. A structured interview was conducted with parents using a pre-coded instrument, with prior verbal consent. A review of the clinical file was completed to complete data. The data were entered into an Excel database, and the analysis was performed through the use of descriptive statistics. RESULTS: The age range of treatment was 1 year to 10 years and 2 months, with an average of 3 years and 8 months; The average age at diagnosis was 2 years and 9 months. The time elapsed between diagnosis and treatment was 11 months. The most common type of cryptorchidism was the right one with 53%. The diagnostic finding was made in the first instance by a relative in 28% and in 72% by a health personnel. 68% were diagnosed in the first level, 9% in the second and 23% in the third. CONCLUSIONS: The age at which cryptorchidism is operated and diagnosed in our country is not within the American and European recommendations.

Changes of calcific density in pediatric patients with testicular microlithiasis

PURPOSE: Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. MATERIALS AND METHODS: We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. RESULTS: The mean age at diagnosis was 11.3+/-4.6 years, and the follow-up period was 79.1+/-38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%+/-6.0% vs. 3.06%+/-4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. CONCLUSIONS: Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.

La prise en charge de l'ectopie testiculaire a l'hopital central de Yaounde : a propos de 171 cas

INTRODUCTION:L'ectopie testiculaire est frequente. Le diagnostic et la prise en charge precoces sont necessaires a cause des risques d'atrophie; de cancerisation; de subfertilite; et les consequences psychologiques en rapport avec l'absence d'un testicule dans une bourse. Cette prise en charge est tardive dans notre milieu. Le but de ce travail etait d'etudier les facteurs interferant avec cette prise en charge. MeTHODOLOGIE Nous avons revu 172 dossiers des patients operes d'ectopie testiculaire de 1999 a 2012. Nous avons etudie l'age au moment de l'operation; la qualification de la personne ayant assure l'accouchement; les facteurs interferant avec la prise en charge et les resultats de cette prise en charge. ReSULTATS L'age des patients au moment de la chirurgie variait de 1 a 48 ans; avec une moyenne de 8 ans. Seuls 21 patients avaient ete operes dans les delais recommandes. L'information medicale avait ete erronee ou insuffisante dans 93 cas. L'on retrouvait la peur de l'operation dans 42 cas; les problemes financiers dans 14 cas; l'ignorance des parents dans 7 cas. CONCLUSION Le manque d'information des soignants ou des parents; la peur de l'operation et le manque de moyens financiers sont les principales causes de delai dans la prise en charge de l'ectopie testiculaire. Ce travail fait ressortir la responsabilite du personnel de sante dans le la prise en charge precoce de l'ectopie testiculaire

Criptorquidismo em jaguatirica de vida livre capturada no Parque Estadual do Rio Doce, Brasil / Cryptorchidism in free-living ocelot captured in the Parque Estadual do Rio Doce, Brazil

O presente trabalho consiste no primeiro relato de criptorquidismo em uma jaguatirica, adulta, de vida livre. Para a captura foram empregadas armadilhas com desarme de guilhotina, usando como isca vísceras de bovino. O animal foi contido quimicamente por meio de dardos anestésicos e mantido sob anestesia, utilizando a associação de cloridrato de quetamina e cloridrato de xilazina. Durante o exame andrológico, observou-se que o testículo esquerdo localizava-se subcutâneo, próximo à região inguinal, caracterizando-se criptorquidismo unilateral. Esse testículo apresentava-se flácido, com volume de 2,57mL, enquanto o testículo contralateral apresentava consistência firme e volume de 11,50mL. A área ocupada pelas espículas penianas mostrou-se compatível com a de animais reprodutores. O criptorquidismo é uma condição hereditária ligada à baixa variabilidade genética, já relatada em felinos silvestres consanguíneos. Nesse sentido, devido ao crescente isolamento populacional em fragmentos florestais, este achado torna-se preocupante, uma vez que pode ser indicativo de endogamia em populações de jaguatiricas de vida livre.

This paper is the first report of unilateral cryptorchidism in an adult wildlife ocelot, captured in Parque Estadual do Rio Doce. Cage traps were used to capture the animal, using bovine offal as bait. The animal was anesthetized with anesthetic darts and kept under anesthesia through a combination of ketamine and xylazine. The andrologycal examination showed that the left testicle was located subcutaneously near the inguinal region. In this case of unilateral cryptorchidism, the testis was soft and had a volume of 2.57mL, while the contralateral testis had a firm consistency and volume of 11.50mL. The length of the region occupied by the penile spikes was similar to other breeding animals. Cryptorchidism is an inherited condition linked to low genetic variability previously reported in consanguineous wild cats. Due to the increasing isolation of wild population in forest fragments, this finding is concerning because it can be indicative of inbreeding in wild ocelot populations.

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children. Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. The pre-operative clinical and ultrasound findings were compared with the findings on surgical exploration. Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Forty-six (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasound evaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specificity of 33.3%, PPV of 95.7% and a NPV of 16.7%. Conclusion: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69 percent) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53 percent) cases, it was totally attached to the testis in 54 (37.76 percent) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Causes of delay in proper treatment of patients with undescended testis

Undescended testis [UDT] is the most common endocrine disorder in male children. Delayed diagnosis and treatment of UDT lead to complications such as infertility, malignancy and testis rotation. The aim of this study was to evaluate the causes of delay in proper treatment of patients with undescended testis in our population. An observational, descriptive, cross sectional study of 143 male patients, who applied to Shahid Sadoughi University Hospitals for orchiopexy operation was performed. The maximum recommended age for orchiopexy was 18 months. The mean age at referral was 5.34 years. Only 44 [30.8%] cases were operated on before the age of 18 months. The most common reasons of delay in treatment were absence of early diagnose [42.5%], parent's unawareness of surgery necessity and its complications associated [33.7%] and parent's disregard [23.5%]. Only 19.6% of patients were diagnosed at born in the hospital. 49% of parents had the correct information for proper operation age and 40.6% of them had enough information about necessity of surgery and side effects of disease. Parent's literacy, place of living and type of cryptorchidism had no significant relation with delay diagnosis [p> 0.05]. These results revealed that late diagnosis by physician and lack of insight of parents are the main reasons in delayed diagnosis and treatment of UDT. Therefore, education of parents and careful physical examination of the babies at birth and regular follow-up until 18 months can prevent the delay in diagnosis

Role of diagnostic laparoscopy: a study of 58 patients

To evaluate the role of diagnostic laparoscopy in undiagnosed abdominal diseases. Prospective nonrandomized descriptive study. Fauji Foundation Hospital Rawalpindi, from l[st] January 2007 till 31[st] December, 2009. All the patients of undiagnosed intermittent or chronic pain abdomen and other pathologies presenting to the department of surgery who were candidates for laparoscopy were included in the study. Total of 58 patients [42 females and 16 males] were included in the study. Appendicular pathology, abdominal tuberculosis and pelvic inflammatory disease each was found in 8 patients [13.79%] and adhesions in 6 patients [10.33%]. Other less common pathologies included undescended intraabdominal testes, endometriosis, gall bladder pathology and mesenteric lymphadenopathy. In 14 patients [24.13%] no pathology was detected. Diagnostic laparoscopy is an important diagnostic tool in the armamentarium of surgeons which can be employed for diagnosis of obscure abdominal conditions. Where appropriate therapeutic measures if indicated can be adopted at the same time

Unilateral cryptorchidism in Nigerian sahel bucks / Criptorquidia unilateral en cabras sahel nigerianas

Out of 1608 Nigerian Sahel male goats (bucks) examined for cryptorchidism in an abattoir, 9 (0.6 percent) had right unilateral cryptorchidism. The coat colour-specific prevalence was highest among the brown bucks (2.1 percent); and was 0.8 percent, 0.6 percent, and 0.3 percent among black, white, back-and-white bucks, respectively. The condition was not found among bucks with brown-and-black, brown-and-white, and multiple coat colours. The right and left testes of normal bucks and the descended testes of cryptorchid bucks had comparable gross testicular measurements, but the retained cryptorchid testes were smaller in size. The estimates of the testicular measurements showed that testicular weights (with the entire epididymes), peripheral longitudinal lengths and mid-circumferences of the cryptorchids were reduced by 5.8-6.5, 1.8-1.9, and 1.7-1.8 folds, respectively, when compared with the normal values; an indication that reduction in weight was the most remarkable index of change in testicular size. In 2 cases (20 percent), cryptorchid testes were at a subcutaneous location, embedded in a subcutaneous fascia in the ventral perineal region, while in the other 8 cryptorchid cases (80 percent), the testes were in the abdomen. Histopathological changes in the cryptorchid testes included hypoplasia, degeneration, interstitial non-suppurative inflammation and fibroplasia. This is the first report of cryptorchidism in the Sahel goat and the first evidence that cryptorchid testis may be located subcutaneously in the goat.

De las 1608 cabras Sahel Nigerianas macho examinadas para criptorquidismo en un matadero, 9 (0,6 por ciento) tuvieron criptorquidia unilateral derecha. La prevalencia en relación al color específico del pelaje fue mayor entre las cabras marrones (2,1 por ciento), y fue de 0,8 por ciento, 0,6 por ciento y 0,3 por ciento entre cabras de color negro, blanco, y blanco/negro respectivamente. La condición no fue encontrada entre las cabras con pelajes marrón y negro, marrón y blanco, y pelajes de múltiples colores. Los testículos derecho e izquierdo de las cabras normales y los testículos descendentes de las cabras con criptorquídia tuvieron mediciones testiculares comparables, pero los testículos retenidos por criptorquídia fueron de menor tamaño. Las estimaciones de las mediciones testiculares mostraron que los pesos testiculares (con todo el epidídimo), la longitud periférica y la circunferencia media de las criptorquídicas fueron reducidas por 5,8-6,5; 1,8-1,9 y 1,7-1,8 pliegues respectivamente, en comparación con el los valores normales; una indicación que la reducción de peso fue el índice de cambio más notable en el tamaño testicular. En 2 casos (20 por ciento), los testículos criptorquídicos se encontraron en una ubicación subcutánea, inmersos en una fascia subcutánea en la región perineal ventral, mientras que en los otros 8 casos criptorquídicos (80 por ciento), los testículos fueron encontrados en el abdomen. Cambios histopatológicos en los testículos criptorquídicos incluyeron hipoplasia, degeneración, inflamación intersticial no supurativa y fibroplasia. Este es el primer informe de criptorquidia en cabras Sahel y la primera evidencia de que los testículos criptorquídicos pueden ser localizados por vía subcutánea en la cabra.

Abordaje laparoscópico en el testículo no palpable / Laparoscopic approach in the management of non-palpable testes

Objective: To evaluate our experience in laparoscopic management as the procedure of choice for nonpalpable testes (NPT). Methods: Review of charts of all boys with NPT who underwent laparoscopy (January 2000 December 2005). Demographic data, ultrasound (US) results, surgical details were documented. Results: Sixty-three patients (74 NPT) were identified; 25 left, 26 right and 12 bilateral. Mean age at diagnosis was 3.6y (lm-13y). Thirty-seven cases had a pre-op US; in 29 (78 percent) the testis was not found; 7(22 percent) an intra-canalicular teste was described. All were impalpable at evaluation under anesthesia (EUA). Mean age at surgery was 4.9y (2 m-17 y). Laparoscopic findings were; intra-abdominal teste (n = 24, 33 percent), vanishing teste (n = 12, 16 percent) and vas-vessels entering inguinal ring (n = 38, 51 percent). 16/24 underwent a 2-stage Fowler-Stephens orchyopexy and 8/24 a laparoscopic-assisted single stage orchypexy. When vas-vessels entered inguinal ring, inguinal exploration was performed; 23 cases underwent orchyopexy; 13 had orchydectomy (atrophic-vanishing). After follow-up, 3 testes are atrophic. Conclusions: 36/74 NPT were not in the inguinal canal (24 intraabdominal and 12 vanishing). When vas-vessels entered inguinal ring, 13 were vanishing-atrophic and not identifiable (EUA or US). Hence, in 49 cases (66 percent) laparoscopic exploration was critical in teste location, therefore this approach may be the procedure of choice for NPT.

Objetivo: Revisar nuestra experiencia en el abordaje laparoscópico como primer procedimiento en el estudio de teste no palpable (TNP). Método: Todas las fichas de niños con diagnóstico de TNP sometidos a laparoscopia entre Enero 2000 y Diciembre 2005 fueron revisadas. Se documentó detalles demográficos, ecográficos, laparoscópicos y de la cirugía realizada. Resultados: 63 pacientes con 74 TNP fueron identificados; todos fueron no palpados al examen bajo anestesia (EBA). Bajo visión laparoscópica, en 38/ 74 (51 por ciento) el conducto deferente y los vasos se introducían en el orificio inguinal profundo, realizándose una exploración inguinal abierta; 13/38 eran atrofíeos/evanescentes, en 23 se realizó orquidopexia, en 1 se realizó un primer tiempo de Fowler-Stephens y 1 no fue descrito. De los 36 (49 por ciento) testes intra-abdominales, 12 eran evanescentes, en 8 se realizó una orquidopexia asistida por laparoscopia y los otros 16/36 se sometieron a un primer tiempo de F-S. En el post-operatorio hubo 3 testes atrofíeos; 2 luego de un segundo tiempo de F-S y 1 luego de una orquidopexia en primer tiempo fallida. Conclusiones: De los 74 TNP, 36 no estaban en el canal inguinal (24 intrabdominales y 12 atrofíeos/evanescentes). De los casos en que los vasos y deferente se dirigían al anillo inguinal (n = 38), 13 eran atrofíeos/evanescentes, lo que explicaría por qué no fueron detectados al EBA y/o ecografía. Por lo tanto, en 66 por ciento (49/74) de los niños en esta serie, la exploración laparoscópica fue crítica en determinar la localización testicular, lo que la hace recomendable para el enfrentamiento del TNP.

Un caso de criptorquidia / A case of cryptorchism

Tomando como excusa un caso de criptorquidia, los autores describen la epidemiología, el pronóstico y las dos alternativas terapéuticas de esta condición clínica (quirúrgica y hormonal). Se explayan sobre la eficacia del tratamiento en términos de disminuir las principales complicaciones de la criptorquidia -infertilidad y cáncer testicular- y del mejor momento de instituirlos.

Laparoscopic orchidopexy: current surgical opinion

With the use of diagnostic laparoscopy widely accepted in the setting of the non palpable testes, nowaday's laparoscopic orchidopexy is an efficient and logical alternative to open orchidopexy. We reviewed the efficacy of laparoscopy for diagnosing the intra abdominal testes. Also we review the efficacy of primary orchidopexy, one stage and two stages laparoscopic orchidopexy for the management of the intra abdominal testes. Prospective Study includes 20 boys with 23 impalpable testes [3 patients were bilateral]. underwent laparoscopy for a non palpable testes at urosurgical department between June 2007 and February 2009. Their age ranged between 3years and 7 years. Eight patients had primary laparoscopic orchidopaxy without division of spermatic vessels twelve patients had one stage Fowler Stephen method, and Two patients had two stages Fowler Stephen method. During diagnostic laparoscopy: Bilateral abdominal testes was found in 3 patients, Left intra abdominal tests was found in 10 patients, while right intra abdominal testes was found in 7 patients With the use of laparoscopic orchidopexy: twenty two testes were brought down to the scrotum: sixteen testes [72.7%] brought down to the normal scrotal site, while six testes [27.2%] were placed at high scrotal position. Orchidectomy was done for one [4.3%] intra abdominal testis. Laparoscopy is extremely effective for diagnosis and treatment of patients with non palpable testes. Laparoscopic orchidopexy is the logic extension of diagnostic laparoscopy for intra abdominal testes

Delayed diagnosis for undescended testes.

Delayed diagnosis of undescended testes is a major problem. A retrospective review of 298 testes units was performed to assess the age at referral, age at operation, complications and final outcome. The mean age at referral was 57 months. Only 24% of cases were operated below 2 years. A similar pattern of delayed orchidopexy has been reported by many other centres. As orchidopexy is recommended soon after 6-7 months of age, there is an urgent need for increased awareness of undescended testes and its consequences at all levels of child health care.

Laparoscopic diagnosis and treatment of nonpalpable testis

INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20 percent of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1 percent) had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88 percent success rate with the 2 stage Fowler-Stephens approach and only 33 percent rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

Laparoscopic orchidopexy

Case series. Pediatric surgical department of B V Hospital [QAMC] Bahawalpur and Allied Hospital Faisalabad. From April 2005 to Mar 2007. Cryptorchidism is most frequent presentation in pediatric population. Laparoscopy has become [Gold Standard] in the diagnosis and therapy of nonpalpable undescended testis. We present our two year experience in the management of 40 cases at two centers. The age of the patients ranged from 9 months to 12 years. Laparoscopy was done to localize the testis prior to surgery. Thirty four patients underwent one stage laparoscopic orchidopexy, 7 patients had open orchidopexy and 3 needed two stage Fowler-Stephen orchiodopexy. Laparoscopy is a valuable tool in both diagnosis and treatment of nonpalpable testis

Herramientas diagnósticas en testículo no palpable / Diagnostic tools in non palpable testis

Objetivo: Estimar la precisión de dos herramientas diagnósticas diferentes: el examen físico realizado por urólogo pediátrico y la ecografía inguino-escrotal, en la localización de un testículo no palpable(TNP) diagnosticado por médico pediatra. Material y Métodos: Se analizaron los datos de 46 pacientes derivados a urología pediátrica con el diagnóstico de testículo no palpable. A todos se les realizó una ecografía inguino-escrotal y resueltos quirúrgicamente según los resultados ultrasonográficos, entre exploración inguinal y laparoscopía.Se compararon los hallazgos clínicos por especialista, los resultados ecográficos y los hallazgos quirúrgicos. De este modo se estimó porcentualmente la precisión en la localización testicular del examen físico por urólogo pediátrico y de la ecografía en un TNP diagnosticado por manos no especializadas. Resultados: 46 pacientes con TNP referidos al urólogo pediátrico, de los cuales 36 eran unilateral y10 bilaterales, con un total de 56 gónadas evaluadas. Se realizó ultrasonografía en 50 casos (89 por ciento), todas en el mismo centro. De los 56 casos, 40 (71 por ciento) fueron sometidos a cirugía. De estas 56 gónadas estudiadas, 18 (32 por ciento) fueron palpables por el especialista, en todas la ecografías demostró igual localización; 14 de los 18 testículos se sometieron a cirugía, ninguno de ellos resultó ser falso positivo. De los 38 TNP para el urólogo, 24 (63 por ciento) fueron identificados por ecotomografía; 13inguinales y 11 intra-abdominales, resultando 3 de las 24 ser falsos positivos ecográficos al compararlos con los hallazgos quirúrgicos. La ecografía no logró identificar 14 (57 por ciento) de las 24 gónadas no palpables, 10 (71 por ciento) de ellas resultaron efectivamente ausentes en la laparoscopia y 4 (28 por ciento) falsos negativos; 2 inguinales (1 de tamaño normal, 1 de tamaño disminuido), 1 intra-abdominal y 1 ectópico perineal pequeño. Conclusión: La evaluación clínica del urólogo pediátrico...

Objective: To estimate the diagnostic accuracy of two different approaches to non-palpable testis (NPT): physical examination conducted by a pediatric urologist and inguino-scrotal ultrasound. Material and Methods: Data from 46 patients referred to the pediatric urologist with the diagnosis of non palpable testicle was prospectively analyzed. Every patient had clinical and imagenologic information. Surgical findings were matched to preoperative paraclinical evaluation. Surgery for NPT was performed either inguinally or laparoscopically. Percentage of accuracy in the location of testicle was estimated for every evaluation. Results: Forty six patients with NPT were referred to the pediatric urologist. Out of these 36 and 10presented with presented with unilateral and bilateral disease, respectively. A total of with 56 gonads were evaluated. Ultrasound was performed in 50 cases (89 percent) at the same site. Of these 56 cases, 40(71 percent) underwent surgery. Out of 56 of these gonads 18 (32 percent) were palpable by the specialist, all them confirmed the same location showed in the ultrasound ; 14 of the 18 testes underwent surgery, none of them turned out to be false positive. Of the 38 NPT evaluated by urologist, 24 (63 percent) were identified by ecotomography. Thirteen corresponded to inguinal and 11 intra abdominal. 3 false positives were verified when compared with sonographic findings. Ultrasound failed to identify 14 (57 percent) of 24non-palpable gonads, 10 (71 percent) of them were actually not found in laparoscopy and 4 (28 percent) were false negatives; 2 inguinal (1 normal size, reduced in size 1), 1 and 1 intra-abdominal perineal ectopic small. Conclusion: In one third of cases, the clinical re-evaluation of pediatric urologist identify NPT diagnosed by medical non specialists, with an excellent accuracy in testicular location, hence pre-operative ultrasound evaluation might not be mandatory. Inguino-scrotal ultrasonography identifies most of NPT...

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent