The effect of scrotal versus inguinal orchiopexy on the testicular function of children with clinically palpable, inguinal undescended testis: a randomized controlled trial / 亚洲男科学杂志(英文版)

To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism, a randomized controlled trial was conducted involving boys who were 6-12 months old at surgery and were diagnosed with clinically palpable, inguinal undescended testis. Between June 2021 and December 2021, these boys at Fujian Maternity and Child Health Hospital (Fuzhou, China) and Fujian Children's Hospital (Fuzhou, China) were enrolled. Block randomization with a 1:1 allocation ratio was employed. The primary outcome was testicular function assessed by testicular volume, serum testosterone, anti-Müllerian hormone (AMH), and inhibin B (InhB) levels. Secondary outcomes included operative time, amount of intraoperative bleeding, and postoperative complications. Among 577 screened patients, 100 (17.3%) were considered eligible and enrolled in the study. Of the 100 children who completed the 1-year follow-up, 50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy. The testicular volume, serum testosterone, AMH, and InhB levels in both groups increased markedly after surgery (all P < 0.05), but there were no apparent differences between groups at 6 months and 12 months after operation (all P > 0.05). No differences between the scrotal and inguinal groups were noted regarding the operative time ( P = 0.987) and amount of intraoperative bleeding ( P = 0.746). The overall complication rate (2.0%) of the scrotal group was slightly lower than that of the inguinal group (8.0%), although this difference was not statistically significant ( P > 0.05). Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism, with similar operative status and postoperative complications. Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism.

Unilateral testicular torsion in a neonate / Torsão testicular unilateral em neonato

A male neonate born at gestational age of 40 weeks was found to have an enlarged and darkened right hemiscrotum after birth. Left testicle was descended and normal. No clinical signs of distress were evident. A color Doppler ultrasound showed an absence of testicular blood flow, consistent with perinatal testicular torsion. The patient underwent a bilateral scrotal exploration through an inguinal incision and a necrotic right testicle was found. A right orchiectomy and left orchiopexy were performed. Perinatal testicular torsion is a rare but severe condition. A high clinical suspicion is required since most of perinatal testicular torsion are intrauterine and can often be asymptomatic, only with localized findings of the affected testis. The management of perinatal testicular torsion is still controversial; however, the most consensual approach is a prompt testicle exploration with orchiectomy of the necrotic testicle and contralateral orchiopexy

Recém-nascido do sexo masculino com idade gestacional de 40 semanas, com edema e escurecimento cutâneo do hemiescroto direito constatados após o nascimento. O testículo esquerdo era palpável na bolsa escrotal e não apresentava alterações. A ecografia escrotal com Doppler revelou ausência de fluxo vascular no testículo direito, achado compatível com torção testicular perinatal. O doente foi submetido a exploração escrotal bilateral através de abordagem por via inguinal, tendo sido confirmada a necrose do testículo direito. Foi realizada orquidectomia direita e orquidopexia esquerda. A torção testicular perinatal corresponde a uma patologia rara, mas com possíveis consequências graves. O seu diagnóstico requer elevada suspeição clínica, uma vez que a maioria dos casos ocorre no período pré-natal, podendo ser assintomáticos após o nascimento e manifestar-se com alterações localizadas ao testículo afetado. A abordagem da torção testicular perinatal é ainda controversa, sendo mais consensual uma exploração escrotal célere com orquidectomia do testículo necrosado e orquidopexia contralateral

Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis - a narrative review

ABSTRACT Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.

Modified stepwise mini-incision microdissection testicular sperm extraction: a useful technique for patients with a history of orchidopexy affected by non-obstructive azoospermia / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Non-obstructive azoospermia (NOA), which is defined as the absence of spermatozoa in the ejaculate secondary to impaired spermatogenesis within the testis, may be caused by a variety of etiologies, including varicocele-induced testicular damage, cryptorchidism, prior testicular torsion, post-pubertal mumps orchitis, gonadotoxic effects from medications, genetic abnormalities, chemotherapy/radiation, and other unknown causes currently classified as idiopathic (Cocuzza et al., 2013). The microdissection testicular sperm extraction (micro-TESE) technique involves a meticulous microsurgical exploration of the testicular parenchyma to identify and selectively extract larger seminiferous tubules that carry a higher probability of complete spermatogenesis (Schlegel, 1999). The Cornell group evaluated the efficacy of micro-TESE in 152 NOA patients with an associated history of cryptorchidism. In their series, spermatozoa were successfully retrieved in 116/181 attempts (64%), and the resulting pregnancy rate was 50% with a delivery rate of 38% (Dabaja and Schlegel, 2013). Franco et al. (2016) described a stepwise micro-TESE approach in NOA patients, which was considered to reduce the cost, time, and effort associated with the surgery. Alrabeeah et al. (2016) further reported that a mini-incision micro-TESE, carried through a 1-cm equatorial testicular incision, can be useful for micro-TESE candidates, particularly in patients with cryptozoospermia. We conducted a retrospective study of 20 consecutive NOA patients with a history of orchidopexy from May 2015 to March 2017.

Evaluación del bloqueo del cuadrado lumbar transmuscular ecoguiado en pediatría / Efficacy of ultrasound-guided transmuscular quadratus lumborum block in children

OBJECTIVES:Transmuscular quadratus lumborum block (TQLB) is a novel regional anaesthesia technique that has proven to be effective for postoperative pain reduction in different abdominal surgical procedures. The present study evaluated its efficacy on pain intensity and analgesic consumption in children undergoing low abdominal surgery. METHODS: The study included forty patients, aged 1 to 6 years, scheduled for low abdominal surgery (hernia repair or orchiopexy) under general anaesthesia. They were enrolled in two groups: TQLB block plus systemic analgesia (group 1; n = 20) wound infiltration done by the surgeon plus systemic analgesia (Group 2; n = 20). All blocks were performed by the same anesthesiologist under general anaesthesia before surgery. Both groups received the same systemic analgesia protocol. Analgesic consumption (ibuprofen) within the first 24 postoperative hours, pain intensity scores (FLACC scale) at 60 minutes, 2, 6 and 24 hours after surgery, time in which the first analgesia was required, satisfaction levels of the parents (0-10), adverse events related to systemic analgesia and time to hospital discharge were evaluated and registered. RESULTS: We found differences between both groups in ibuprofen consumption (80 mg 185 mg; p < 0.05) and pain scores (FLACC) within the first 24 postoperative hours at each interval (p < 0.05 for every point in time analyzed). Time in which the first analgesia was required was longer for the TQLB group (18 10 hours; p < 0.05). Satisfaction levels of the parents were also higher in the first group (p < 0.05). Adverse events related to medication and time to hospital discharge showed similar results. Further investigation comparing the TQLB with different approaches of QLB or conventional TAP block could be interesting and is required in a near future.

INTRODUCCIÓN: El bloqueo del cuadrado lumbar transmuscular (TQL) es una técnica de anestesia regional ecoguiada que demostró ser efectiva en cirugía abdominal abierta y laparoscópica como parte de un esquema multimodal de analgesia postoperatoria. La presente investigación evaluó su eficacia en cirugía de hernia inguinal y testículo no descendido en población pediátrica (de 1-6 años de edad). MATERIALES Y MÉTODOS: El estudio fue diseñado como un ensayo clínico controlado, aleatorizado en 2 ramas: grupo protocolo bloqueo TQL (Grupo 1; n = 20) grupo protocolo infiltración local por cirujano (Grupo 2; n = 20), simple ciego que incluyó a 40 pacientes pediátricos sometidos a una cirugía de hernia inguinal u orquidopexia unilateral. Todos los bloqueos fueron realizados bajo anestesia general antes del inicio de procedimiento quirúrgico. Ambos grupos recibieron el mismo esquema de analgesia endovenosa y oral postoperatoria. Consumo de analgésicos durante las primeras 24 horas (mg de ibuprofeno), intensidad de dolor con escala FLACC a tiempo 1, 2, 6 y 24 horas postoperatorias, tiempo transcurrido a la primera administración de ibuprofeno, escala de satisfacción parental (0-10) e incidencia de náuseas y vómitos fueron evaluados y registrados. Se consideró como significativa una p < 0,05. RESULTADOS: El consumo promedio de ibuprofeno en las primeras 24 horas fue de 80 mg para el grupo bloqueo TQL y de 185 mg para el segundo grupo, diferencia estadísticamente significativa (p < 0,05). El tiempo transcurrido a la primera administración de ibuprofeno fue mayor en el grupo TQL (18 10 horas), p < 0,05. Las escalas de dolor por FLACC a los 60 y 120 minutos y a las 6 y 24 horas. postcirugía fueron menores comparadas con el grupo de infiltración local por el cirujano (p < 0,05 en cada punto de análisis). Las escalas de satisfacción parental mostraron puntajes más elevados para el grupo que recibió el bloqueo TQL (p < 0,05). No se hallaron diferencias significativas en la incidencia de episodios de náuseas y/o vómitos en las primeras 24 horas. postoperatorias (p > 0,2). No se reportaron complicaciones asociadas al bloqueo. CONCLUSIONES: Este estudio muestra que el bloqueo TQL aporta beneficios adicionales respecto al plan de analgesia estándar empleado en cirugía de hernia inguinal unilateral u orquidopexia, disminuyendo el requerimiento de analgésicos y la intensidad de dolor en las primeras 24 horas postoperatorias, así como también incrementando la satisfacción de los cuidadores respecto al estado postoperatorio del niño. Sería interesante llevar a cabo nuevas investigaciones comparando esta técnica con otros abordajes del bloqueo de cuadrado lumbar y con el cuestionado bloqueo TAP convencional.

Follow up of Patients with Eagle-Barett (Prune Belly) Syndrome Treated with Single-Stage Abdominoplasty and Total Genitourinary Tract Reconstruction / Seguimiento de pacientes con síndrome de Eagle-Barret (prune belly) tratados con abdominoplastia en un solo tiempo y reconstrucción total del tracto genitourinario

Introduction The Prune Belly Syndrome (PBS) is the deficiency or congenital hypoplasia of the abdominal muscles accompanied with disorders of the urinary tract. The surgical treatment for the uropathy of the PBS seeks to correct the anatomical defects that induce damage to the urinary tract, including the improvement of the bladder emptying. The correction of the abdominal wall defect must be considered as an important part of the treatment. Objective To describe of the most relevant clinic characteristics and outcomes of a group of eight patients with PBS managed with abdominoplasty and reconstructive urologic surgery. Methods Retrospective review of the medical charts of patients with PBS at Hospital Universitario San Ignacio, Hospital Militar Central of Bogotá, Clinica Infantil Colsubsidio and Fundación Oftalmológica Ardila Lulle of Bucaramanga, (Colombia) that were managed with reconstructive surgery of the urinary tract and Monfort technique abdominoplasty (between 2006 and 2016) by one of the authors (JPN). The evaluated variables included: phenotypic appearance, renal function, bowel movements, and urinary tract infection (UTI) episodes. These variables as well as the abdominal wall aspect, were evaluated postoperatively. Results There were 11 patients identified with PBS between 2006 and 2016. Eight (8) of them underwent reconstructive urologic surgery, orchidopexy and Monfort technique abdominoplasty. After the procedures, none of the patients presented deterioration of the renal function, and they reported a better quality of the stools according to the Bristol scale; there were also less episodes of UTI. The phenotypic aspect of the abdominal wall was qualified as satisfactory in all cases. Conclusions Reconstructive urologic surgery and abdominoplasty in patients with PBS is an excellent choice of management that reduces the number of UTIs, improves bowel movements according to the Bristol scale, and preserves the renal function. This management approach also improves the phenotypic aspect of the abdominal wall. All of this leads to higher survival rate and better quality of life.

Introducción El Síndrome de Prune Belly (SPB) es la deficiencia o hipoplasia congénita de los músculos abdominales acompañada de desórdenes del tracto genitourinario. El manejo quirúrgico de la uropatía del SPB busca corregir los defectos anatómicos que inducen daño al tracto urinario, incluyendo la mejora del vaciamiento vesical. La corrección del defecto de la pared abdominal debe considerarse como una parte importante del manejo. Objetivos Describir las características clínicas más relevantes y el desenlace de un grupo de 8 pacientes con SPB manejados con abdominoplastia y cirugía urológica reconstructiva. Materiales y Métodos Revisión retrospectiva de las historias clínicas de los pacientes con SPB del Hospital Universitario San Ignacio, Hospital Militar Central de Bogotá, Clínica Infantil Colsubsidio, y Fundación Oftalmológica Carlos Ardila Lulle de Bucaramanga (Colombia), manejados con cirugía reconstructiva de las vías urinarias y abdominoplastia tipo Monfort entre los años 2008 y 2016 por uno de los autores (JPN). Las variables incluidas fueron: aspecto fenotípico, función renal, hábito intestinal y características de las deposiciones, y episodios de infección urinaria. El desenlace de estas variables y el aspecto de la pared abdominal fueron evaluados en el postoperatorio. Resultados se identificaron 11 pacientes con SPB entre 2006 y 2016. Ocho (8) fueron sometidos a cirugía reconstructiva de las vías urinarias, orquidopexia y abdominoplastia tipo Monfort. Después de los procedimientos, ninguno de los pacientes presentó deterioro de la función renal; los pacientes refieren mejor calidad de las deposiciones según la escala de Bristol; se presentaron menos episodios de infección de vías urinarias. El aspecto fenotípico fue calificado como satisfactorio en todos los casos. Conclusiones La cirugía urológica reconstructiva acompañada de abdominoplastia en pacientes con SPB es una excelente forma de manejo que reduce el número de infecciones urinarias, mejora la calidad del hábito intestinal según la escala de Bristol, y conserva la función renal. Este manejo mejora además el aspecto fenotípico de la pared abdominal. Todo esto lleva a una mayor sobrevida y mejor calidad de vida.

Torsión de cordón espermático: análisis de situación en un período de 4 años en la Clínica Quirúrgica Pediátrica del Centro Hospitalario Pereira Rossell, Montevideo, Uruguay / Torsion of spermatic cord: situation analysis over a period of 4 years in Pediatric Surgical Clinic of the Pereira Rossell Hospital Center, Montevideo, Uruguay / Torção do cordão espermático: análise da situação ao longo de um período de 4 anos em Clinica Cirúrgica Pediátrica do Centro Hospitalar Pereira Rossell, Montevideo, Uruguai

Introducción: El sindrome escrotal agudo es una causa frecuente de consulta en la urgencia pediátrica y el diagnóstico de su etiología puede ser realmente un desafío para el pediatra y el cirujano. Existen múltiples etiologías posibles, siendo la torsión de cordón espermático la más importante, porque el retraso en su diagnóstico y tratamiento conlleva una alta incidencia de necrosis gonadal. Esta patología debe considerarse una emergencia quirúrgica. El objetivo de este artículo es conocer la situación de la torsión de cordón espermático en nuestro medio ya que existe un único estudio sobre esta patología realizado hace más de 30 años. Material y método: Se realizó un estudio observacional descriptivo y retrospectivo. Se identificaron todas las escrototomías realizadas con planteo clínico de síndrome escrotal agudo con la sospecha de una torsión de cordón espermático, en el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018. Se analizó la edad de los pacientes, patología diagnosticada en el intraoperatorio, lado afectado, sentido de la rotación y procedimiento realizado. Resultados: En el período comprendido entre el 1.º de enero de 2015 y el 31 de diciembre de 2018 se intervinieron quirúrgicamente 68 pacientes con diagnóstico de sindrome escrotal agudo. Del total, 49 pacientes (72 %) presentaron una torsión de cordón espermático, y a 16 (32,6 %) se les realizó orquiectomía. A todos se les realizó pexia testicular contralateral en el mismo acto quirúrgico. Conclusiones: En el período analizado fueron intervenidos 49 pacientes con torsión de cordón espermático. En 16 casos se realizó orquiectomía. Se identificó una leve predominancia del lado derecho, y el sentido de la rotación fue principalmente interno, si bien existe un importante subregistro de dicho dato en las descripciones operatorias. En el 72 % de los pacientes en quienes se decidió conservar la gónada, el cirujano describe una importante isquemia testicular, por lo que resulta fundamental realizar, para un futuro artículo, el seguimiento de estos pacientes para conocer su evolución.

Introduction: Acute scrotal syndrome is a frequent cause of consultation in the pediatric emergency and the diagnosis of its etiology can really be a challenge for the pediatrician and the surgeon. There are multiple possible etiologies, with torsion of the spermatic cord being the most important due to the high incidence of gonadal necrosis that the delay in diagnosis and treatment entails. This pathology should be considered a surgical emergency. The objective of this article is to know the situation of spermatic cord torsion in our environment since there is only one study done on this pathology more than 30 years ago. Material and method: A descriptive and retrospective observational study was carried out. All scrototomies performed with a clinical approach to acute scrotal syndrome were identified with the suspicion of spermatic cord torsion in the period between January 1, 2015 and December 31, 2018. The patients' age, pathology was analyzed. Diagnosed intraoperatively, affected side, direction of rotation and procedure performed. Results: In the period between January 1, 2015 and December 31, 2018, 68 patients were diagnosed with a diagnosis of acute scrotal syndrome. Of the total, 49 patients (72 %) had spermatic cord torsion, and 16 (32.6 %) had orchiectomy. All of them underwent contralateral testicular pexia in the same surgical act. Conclusions: In the analyzed period, 49 patients with spermatic cord torsion were operated. In 16 cases orchiectomy was performed. A slight predominance of the right side was identified, and the direction of rotation was mainly internal, although there is an important underreporting of this data in the operative descriptions. In 72 % of the patients in whom it was decided to preserve the gonad, the surgeon describes an important testicular ischemia, so it is essential for a future article to monitor these patients to know their evolution.

Introdução: A síndrome escrotal aguda é uma causa freqüente de consulta na emergência pediátrica e o diagnóstico de sua etiologia pode realmente ser um desafio para o pediatra e o cirurgião. Existem múltiplas etiologias possíveis, sendo a torção do cordão espermático a mais importante devido à alta incidência de necrose gonadal que o atraso no diagnóstico e tratamento acarreta. Essa patologia deve ser considerada uma emergência cirúrgica. O objetivo deste artigo é conhecer a situação de torção do cordão espermático em nosso ambiente, uma vez que existe apenas um estudo sobre essa patologia há mais de 30 anos. Material e método: Foi realizado um estudo observacional descritivo e retrospectivo. Todas as escrototomias realizadas com abordagem clínica da síndrome escrotal aguda foram identificadas com suspeita de torção espermática no período de 1 de janeiro de 2015 a 31 de dezembro de 2018. A idade dos pacientes foi analisada. diagnosticado no intraoperatório, lado afetado, direção da rotação e procedimento realizado. Resultados: No período de 1 de janeiro de 2015 a 31 de dezembro de 2018, 68 pacientes foram diagnosticados com diagnóstico de síndrome escrotal aguda. Do total, 49 pacientes (72 %) apresentaram torção espermática e 16 (32,6 %) tiveram orquiectomia. Todos foram submetidos a pexia testicular contralateral no mesmo ato cirúrgico. Conclusões: No período analisado, foram operados 49 pacientes com torção espermática. Em 16 casos, foi realizada orquiectomia. Foi identificada uma ligeira predominância do lado direito, e o sentido de rotação era principalmente interno, embora exista uma importante subnotificação desses dados nas descrições operatórias. Em 72 % dos pacientes nos quais foi decidido preservar a gônada, o cirurgião descreve uma importante isquemia testicular, por isso é essencial que um artigo futuro monitore esses pacientes para conhecer sua evolução.

Cerebellar infarct following orchidopexy under spinal anesthesia / Infarto cerebelar após orquidopexia sob raquianestesia

Abstract The report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75 mg.day-1, following which his vision started improving after 2 weeks. Possible mechanisms of development of stroke in the peri-operative period are discussed, but, even after extensive investigations, the etiology of infarct may be difficult to determine. Acute infarct after elective non-cardiac, non-neurological surgery is rare; it may not be possible to identify the etiology in all cases. Clinicians must have a high index of suspicion to diagnose such unexpected complications even after routine surgical procedures in order to decrease the morbidity and long term sequelae.

Resumo O presente relato descreve um caso de acidente vascular cerebral perioperatório que resultou em diplopia e dificuldade de marcha no segundo dia após orquidopexia de rotina sob raquianestesia em um jovem, em outros aspectos, saudável. Ressonância magnética cerebral revelou infarto agudo em hemisférios cerebelares bilaterais, metade esquerda do bulbo e tálamo esquerdo. Um diagnóstico de acidente vascular cerebral agudo (infarto) foi feito e o paciente começou a receber tratamento com aspirina oral (75 mg.dia-1), após o qual sua visão começou a melhorar após duas semanas. Possíveis mecanismos de desenvolvimento de acidente vascular cerebral no período perioperatório são discutidos, mas, mesmo após extensas investigações, a etiologia do infarto pode ser difícil de determinar. O infarto agudo após cirurgia eletiva não cardíaca e não neurológica é raro; talvez não seja possível identificar a etiologia em todos os casos. Os médicos devem ter um elevado grau de suspeita para diagnosticar essas complicações inesperadas, mesmo após procedimentos cirúrgicos de rotina, para diminuir a morbidade e as sequelas em longo prazo.

Clinical and socioeconomic factors associated with delayed orchidopexy in cryptorchid boys in China: a retrospective study of 2423 cases / 亚洲男科学杂志(英文版)

We investigated the associations of clinical and socioeconomic factors with delayed orchidopexy for cryptorchidism in China. A retrospective study was conducted on cryptorchid boys who underwent orchidopexy at Children's Hospital at Chongqing Medical University in China from January 2012 to December 2017. Of 2423 patients, 410 (16.9%) received timely repair by 18 months of age, beyond which surgery was considered delayed. Univariate analysis suggested that the laterality of cryptorchidism (P = 0.001), comorbidities including inguinal hernia/scrotal hydrocele (P < 0.001) or urinary tract disease (P = 0.016), and whether patients lived in a poverty county (P < 0.001) could influence whether orchidopexy was timely or delayed. Logistic regression analysis suggested that the following factors were associated with delayed repair: unilateral rather than bilateral cryptorchidism (odds ratio [OR] = 1.752, P < 0.001), absence of inguinal hernia or hydrocele (OR = 2.027, P = 0.019), absence of urinary tract disease (OR = 3.712, P < 0.001), and living in a poverty county (OR = 2.005, P < 0.001). The duration of postoperative hospital stay and hospital costs increased with the patient's age at the time of surgery.

Neutrophil-Lymphocyte Ratio Predicts Organ Salvage in Testicular Torsion with Marginal Diagnostic Delay

PURPOSE: Though prompt diagnosis to minimize symptom duration (SD) is highly associated with organ salvage in cases of testicular torsion (TT), SD is subjective and hard to determine. We thus investigated the clinical implications of systemic inflammatory responses (SIRs) as potential surrogates of SD to improve testis survival. MATERIALS AND METHODS: Sixty men with TT that underwent immediate operation among orchiectomy and orchiopexy following a visit to a single emergency department were retrospectively enrolled. Mandatory laboratory tests conducted included neutrophil, lymphocyte, and platelet counts. RESULTS: Mean age and SD was 15.7±3.7 years and 8.27±4.98 hours, respectively. Thirty-eight (63.3%) underwent orchiectomy and the remaining 22 underwent orchiopexy. Leukocytosis (p=0.001) and neutrophil-lymphocyte ratio (NLR, p < 0.001) were significantly lower in the orchiopexy group as was SD (3.27±1.88 vs. 11.16±3.80, p < 0.001). Although multivariate model showed that the only single variable associated with receipt of orchiopexy was SD (odds ratio [OR]=0.259, p < 0.001), it also revealed NLR as a sole SIR associated with SD (B=0.894, p < 0.001). While 93.3% with a SD of within 3 hours underwent orchiopexy, only 26.6% of affected testes were preserved between 3 to 12 hours (n=30). When multivariable analysis was applied to those with window period, NLR alone predicted orchiopexy rather than orchiectomy (p=0.034, OR=0.635, p=0.013). The area under curve between SD (0.882) and NLR (0.756) was similar (p=0.14). CONCLUSIONS: This study showed NLR independently predicted testis survival by proper surgical correction particularly for patients with marginally delayed diagnosis, which suggest the clinical usefulness for identifying candidates for orchiopexy in emergency setting.

Orquidopexia tardía en niños con criptorquidia y aumento del riesgo de cáncer testicular / Late orchiopexy in boys with cryptorchidism and increased risk of testicular cancer

La criptorquidia se define como la falta de descenso a la porción inferior del escroto de uno o ambos testículos. Constituye el trastorno endocrinológico más frecuente en el varón y puede formar parte de enfermedades sindrómicas diversas o presentarse de manera aislada. La criptorquidia es un reconocido factor de riesgo asociado a infertilidad y cáncer testicular en la adultez. Sin embargo, no hay consenso sobre el momento óptimo para efectuar la orquidopexia y así disminuir el riesgo de cáncer testicular. Realizamos una revisión sistemática de la literatura en las bases norteamericana Medline y latinoamericana Lilacs con el objetivo de analizar la evidencia existente sobre el riesgo de desarrollar cáncer testicular asociado a una orquidopexia tardía en pacientes con antecedente de criptorquidia. Para llevar a cabo la búsqueda utilizamos las siguientes palabras claves: "Cryptorchidism", "Testicular neoplasm" y "Orchidopexy". Luego de filtrar y analizar los trabajos hallados, cuatro cumplieron con todos los criterios de la búsqueda. Esta revisión sistemática nos permite concluir que los pacientes con antecedente de criptorquidia presentan un riesgo incrementado de cáncer testicular y que dicho riesgo se incrementa a medida que la corrección de la criptorquidia se posterga, aunque se realice antes del inicio puberal

Cryptorchidism is defined as the lack of testicular descent to the lower part of the scrotum and can involve one or both testicles. It represents the most frequent endocrine disease in male children and it can occur as an isolated disorder or as a syndromic disease feature. Cryptorchidism is a highly recognized risk factor for infertility and testicular cancer in adulthood. Nevertheless, there is no consensus about the ideal time for orchidopexy aimed to decrease testicular cancer risk. We developed a systematic review of the literature through two databases: the North American Medline and the Latin American Lilacs to analyse the available evidence up to now about testicular cancer risk linked to delayed orchidopexy in patients with cryptorchidism. We used "Cryptorchidism", "Testicular neoplasm" and "Orchidopexy" as key words to conduct our search. We then filtered and evaluated the articles matching our search and four of them fulfilled the search criteria. This systematic review allows us to conclude that there is an increased risk for testicular cancer in patients with cryptorchidism and that risk is higher when treatment is delayed despite being accomplished before puberty

Impact of testicular sperm extraction and testicular sperm aspiration on gonadal function in an experimental rat model

ABSTRACT Purpose To assess the impact of sperm retrieval on the gonadal function of rats with impaired spermatogenesis by comparing testicular sperm extraction (TESE) to aspiration (TESA). The efficacy of these procedures to sperm obtainment was also compared. Materials and Methods A pilot study showed impaired spermatogenesis, but normal testosterone (T) production after a bilateral orchidopexy applied to 26 rats, which were randomly assigned into four groups: TESE (n=7), TESA (n=7), SHAM (n=6) and Control (n=6). The T levels were measured through comparative analysis after the orchidopexy. Results There was no statistical difference in the animal's baseline T levels after orchidopexy in comparison to the controls: the TESE and TESA groups, 6.66±4.67ng/mL; the SHAM group (orchidopexy only), 4.99±1.96ng/mL; and the Control, 4.75±1.45ng/mL, p=0.27. Accordingly, no difference was found in the postoperative T levels: TESE, 5.35±4.65ng/mL; TESA, 3.96±0.80ng/mL; SHAM, 3.70±1.27ng/mL; p=0.4. The number of sperm cells found through TESE (41.0±7.0) was significantly larger than that found through TESA (21.3±8.1, p=0.001). Moreover, higher tissue weight was found through TESE (0.09±0.02g versus 0.04±0.04g, p=0.04). Conclusions The testicular sperm capture performed in rats through extraction or aspiration, after orchidopexy, did not significantly decrease the T levels. The amount of sperm found through testicular sperm extraction was higher than that through testicular sperm aspiration.

Is Preoperative Ultrasonography Necessary in Pediatric Inguinal Hernia?

PURPOSE: Preoperative ultrasonography (USG) in pediatric inguinal hernia has controversy. In this study, we analyzed the cases of pediatric inguinal hernia with/without preoperative USG and discussed whether USG is necessary. METHODS: We reviewed medical records of 1,441 patients who underwent inguinal hernia repair in Seoul National University Children's Hospital between January 2011 and August 2016 retrospectively. RESULTS: Male were 69.3% and age at operation was 37.8±36.5 months old. There were 150 patients (10.4%) performed USG preoperatively. The department ordered to perform USG included department of surgery (n=71), emergency medicine (n=42), pediatrics (n=26), urology (n=10) and outside hospital (n=1). The reasons of performing USG included evaluation for hernia laterality (n=82), incarceration (n=28), testis (n=15), request of parents (n=14), scrotal mass (n=6) and incidentally found during evaluation for another disease (n=5). Excepting 5 cases of incidental finding, of 145 cases with USG, 12 (8.3%) cases changed the surgical plan; change to bilateral repair from unilateral repair (n=5), emergency operation due to incarceration (n=4) which include 1 salpingo-oophorectomy, 1 open abdomen surgery and 2 hernia repair after reduction of ovary, change to co-operation of orchiopexy (n=2) and change to laparoscopic surgery from open surgery due to herniation of both ovaries into one inguinal canal (n=1). In group without USG (n=1,291), 5 patients (0.4%) had unexpected problems during operation; 2 co-operation of orchiopexy because of transverse testicular ectopia (n=1) and right undescended testis (n=1), 2 hypertrophy of major labia and 1 retroperitoneal lymphangioma at inguinal area misdiagnosed as inguinal hernia. CONCLUSION: It was difficult to interpret the meaning of preoperative USG because not all patients had performed it. In this study, 10.4% of patients performed USG and 8.3% of them changed surgical plan. About 0.4% of patients without preoperative USG would have benefited from it for surgery if they had performed it. Since the percentage is too low, it is unreasonable to conclude that USG has diagnostic utility in inguinal hernia in this study.

Torsion du cordon spermatique chez l'adulte. Aspects diagnostiques, thérapeutiques et pronostiques au Centre Hospitalier et Universitaire Sylvanus Olympio de Lomé

Objectifs : Etudier les aspects diagnostiques, thérapeutiques et pronostiques des torsions du cordon spermatique. Patients et méthodes : Il s'agissait d'une étude prospective, et était inclus dans l'étude tous les patients de plus de 15 ans admis en urgence pour une douleur scrotale aiguë et chez qui le diagnostic d'une torsion du cordon spermatique était suspecté durant la période d'étude.Résultats : Sur une période de 12 mois allant du 1er janvier 2015 au 31 décembre 2015, 22 patients étaient colligés. L'âge moyen des patients était de 22 ans avec des extrêmes allant de 17 à 35 ans. Le diagnostic était clinique dans tous les cas et dans 100% des cas les constatations per opératoires étaient en faveur d'une torsion du cordon spermatique. Le tour maximum de spire était de 4 tours. L'orchidectomie avait été réalisée chez 4 patients. Dans tous les autres cas une orchidopexie bilatérale était réalisée.Conclusion : La vitalité du testicule dans les torsions du cordon spermatique est surtout fonction de la durée de la torsion et du degré de la torsion

Surgical correction of ectopic penis and scrotum associated with bilateral orchidopexy / Correção cirúrgica de pênis e escroto ectópicos associada à orquidopexia bilateral

ABSTRACT Ectopic penis is usually associated with penoscrotal transposition, and it is rarely observed in isolation. We report a surgical approach for an extremely rare case. A 10-year-old male patient with bilateral cryptorchidism and ectopic penis and scrotum in perineal area, with no penoscrotal transposition, representing an association not yet described in literature. A previous orchiopexy failed due to ectopic scrotum. By means of an inverted Y incision, the penis was mobilized and a perineal skin flap in form of a testicular sac was prepared. Finally orchiopexy was performed. The surgery was essential to treat cryptorchidism and to improve the self-image of the patient.

RESUMO O pênis ectópico geralmente ocorre associado à transposição peno-escrotal, sendo raro isoladamente. Relatamos uma abordagem cirúrgica para um caso extremamente raro. Tratava-se de paciente do sexo masculino, 10 anos, com criptorquidia bilateral e pênis e escroto ectópicos, na região perineal, sem transposição peno-escrotal, representando uma associação ainda não descrita na literatura. Orquidopexia prévia sem sucesso, devido à ectopia do escroto. Por meio de uma incisão em Y invertido, mobilizou-se o pênis e preparou-se um retalho da pele perineal em forma de bolsa testicular. Por fim, realizou-se a orquidopexia. A cirurgia foi fundamental para tratar a criptorquidia e promover ganho na autoimagem do paciente.

Single scrotal-incision orchidopexy without ligation of processus vaginalis for palpable undescended testis / 中华男科学杂志

Objective@#To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT).@*METHODS@#This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B.@*RESULTS@#The median age of the PUDT patients was 1.4 (0.6－11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele.@*CONCLUSIONS@#Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.

Orchidopexy increases the levels of serum anti-Müllerian hormone and inhibin B in cryptorchidism patients / 中华男科学杂志

Objective@#To investigate the levels of serum anti-Müllerian hormone (AMH) and inhibin B (INHB) in patients with unilateral cryptorchidism before and after orchidopexy.@*METHODS@#This study included 58 cases of unilateral cryptorchidism treated by orchidopexy and 32 healthy controls. Before and at 6 months after surgery, we measured the length and circumference of the penis, the volume of the undescended testis, and levels of serum AMH and INHB.@*RESULTS@#There were statistically significant differences between the unilateral cryptorchidism and healthy control groups in the levels of serum AMH (［102.80 ± 17.35 vs 108.76 ± 13.64］ ng/ml, P0.05; INHB: ［75.76 ± 5.94］ vs ［77.63 ± 5.99］ pg/ml, P>0.05). No remarkable differences were observed between the unilateral cryptorchidism and healthy control groups in the preoperative penile length (［2.05 ± 0.23］ vs ［2.11 ± 0.22］ cm, P>0.05), penile circumference (［3.91 ± 0.23］ vs ［3.99 ± 0.20］ cm, P>0.05) and volume of the undescended testis (［0.45 ± 0.02］ vs ［0.46 ± 0.02］ ml, P>0.05), or in the postoperative penile length (［2.09 ± 0.23］ vs ［2.16 ± 0.22］ cm, P>0.05), penile circumference (［4.00 ± 0.25］ vs ［3.98 ± 0.19］ cm, P>0.05) and volume of the undescended testis (［0.45 ± 0.02］ vs ［0.45 ± 0.02］ ml, P>0.05). Compared with the baseline, the cryptorchidism patients showed markedly increased levels of serum AMH (［102.80 ± 17.35］ vs ［109.76 ± 17.25］ ng/ml, P<0.05) and INHB (［70.24 ± 5.73］ vs ［75.76 ± 5.94］ pg/ml, P<0.05) after orchidopexy.@*CONCLUSIONS@#Orchidopexy can elevate the levels of serum AMH and INHB and protect the testicular function of cryptorchidism patients.

Modified Bianchi orchiopexy for median or low cryptorchidism / 中华男科学杂志

Objective@#To investigate the effect of modified Bianchi (single incision in the midline of the scrotum) orchiopexy (MBO) versus that of traditional surgery in the treatment of median or low cryptorchidism.@*METHODS@#Eighty-two children with median or low cryptorchidism were treated from February 2013 to February 2014, 46 (53 testes) by MBO and the other 36 by the traditional method of inguinal incision (control, 40 testes). Comparisons were made in the operation time and postoperative complications between the two surgical strategies.@*RESULTS@#The mean operation time was significantly shorter in the MBO group than in the control (［25±6］ vs ［35±4］ min, P0.05). The incision scar was obvious in all the controls, with 1 case of postoperative inguinal hematoma, but almost invisible in all the MBO cases.@*CONCLUSIONS@#Modified Bianchi orchiopexy is superior to traditional surgery in the treatment of median or low cryptorchidism for its advantages of short operation time, few complications, and satisfactory appearance of the healed incision.

Bloqueio ilioinguinal e ílio-hipogástrico em anestesia pediátrica: comparação da analgesia entre as técnicas de visualização direta e a guiada por ultrassom / Ilioinguinal and iliohypogastric nerve block in pediatric anesthesia: a comparison of analgesia between direct and ultrasound-guided visualization techniques

Introdução: Comparar o grau de dor em pacientes pediátricos que foram submetidos a bloqueio dos nervos ilioinguinal e ílio-hipogástrico, através das técnicas de visualização direta e guiada por ultrassom em cirurgias de herniorrafia e orquidopexia em intervalos de 30 minutos, 3 e 6 horas após a saída da sala cirúrgica. Métodos: Foi realizado um ensaio clínico, randomizado, com 38 pacientes submetidos às cirurgias propostas, divididos em 2 grupos através de sorteio aleatório: grupo 1 bloqueio por visualização direta e grupo 2 por ultrassom. Os pacientes foram avaliados em 3 fases, nos intervalos aventados pelo estudo com a utilização das escalas FLACC e Comfort-Behavior, aplicadas de maneira observacional. Para a associação entre as variáveis de interesse, foram utilizados o teste de qui-quadrado de Pearson e o teste t de Student para a comparação entre médias. Os dados foram inseridos no Epi InfoT 3.5.4 e SPSS 18.0. Para verificar as variáveis de interesse, foram utilizados os testes de qui-quadrado e teste t de Student, sendo considerado nível de significância de 5%. Resultados: Participaram do estudo 38 pacientes, com média de 3,44 anos de idade. A cirurgia mais realizada foi a de hérnia inguinal bilateral em 17 (44,7%) dos pacientes. 52,5% dos pacientes utilizaram analgésico, sendo que desses, 19 fizeram uso somente uma vez, desses, 8 necessitaram de analgesia 30 minutos após a saída da sala cirúrgica. Conclusão: O trabalho evidenciou superioridade na técnica de visualização direta na redução da dor no pós-operatório em relação à técnica por ultrassom (AU)

Introduction: To compare the degree of pain in pediatric patients who underwent ilioinguinal and iliohypogastric nerve block through direct and ultrasound-guided visualization techniques in herniorrhaphy and orchidopexy surgeries at 30-minute intervals, 3 and 6 hours after leaving the operating room. Methods: A randomized clinical trial was conducted with 38 patients submitted to the proposed surgeries, divided randomly into 2 groups, group 1 block by direct visualization and group 2 by ultrasound. The patients were evaluated in 3 phases, at the intervals proposed by the study, using the FLACC and Comfort-Behavior scales applied observationally. For the association between the variables of interest, the Pearson chi-square test and Student's t-test were used to compare the means. The data was entered into Epi InfoT 3.5.4 and SPSS 18.0. Chi-square and Student's t-tests were used to verify the variables of interest. A level of significance of 5% was considered. Results: Thirty-eight patients with a mean of 3.44 years of age participated in the study. The most commonly performed surgery was for bilateral inguinal hernia in 17 (44.7%) of the patients. Analgesics were used by 52.5% of the patients, of whom 19 used them only once, and of these, 8 required analgesia 30 minutes after leaving the operating room. Conclusion: The work showed superiority of the technique of direct visualization in reducing postoperative pain as compared to the ultrasound technique (AU)