Laparoscopy and the impalpable testes: diagnosis, treatment options and the literature

Background: Laparoscopy is the best available tool and method to manage impalpable undescended testes; management of the impalpable testis often pose a significant diagnostic and therapeutic challenge to a surgeon. The aim of this work was to elucidate and present the sensitivity and the value of laparoscopy, as a surgeon’s tool, for the diagnosis and treatment of the impalpable testis.Methods: From November 2015 to December 2018, 56 patients with 60 impalpable testes were operated upon by laparoscopic approach by a single surgeon. One-stage Fowler-Stephens laparoscopic orchidopexy was performed in 14 cases, while two-stage Fowler-Stephens laparoscopic orchidopexy was performed in 16 cases and Vessel-Intact Laparoscopic Orchidopexy (VILO) was done in 22 cases. In 2 cases vessel and vas was entering through deep ring and inguinal orchidopexy was done. Blind ending vessel/vas was noticed in 4 cases (vanishing/absent testes). Laparoscopic orchidectomy was required in 2 patients for nubin. No case of disorder of sexual dysfunction was (DSD) was found.Results: Laparoscopy was successfully completed in all the cases. 34 testicles were impalpable on right side, 18 on left side and other 4 cases (8 testicles) were bilaterally impalpable. Laparoscopic orchidopexy was carried out for 36 testes at the same. 16 needed a staged procedure. Orchidectomy was done in 2 cases/testes. In 4 cases testes was absent/vanishing. In 2 cases testes was canalicular, standard inguinal orchidopexy was done. The mean operative time was 48 minutes. Patients were allowed oral fluids 6 hours of the operation and were discharged at one day after the procedure.  None of the patients had wound infection. Patients were followed up for a mean period of 12 months. At follow-up, all but one of the testes were well down in the bottom of the scrotum. In one patient, the testis was in a high scrotal position. All testes were of normal size, no atrophy was seen so far and no malignant change is suspected in any case so far. No severe morbidity or death was observed in our study.Conclusions: Laparoscopy offers surgeons a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. No other imaging investigation is required, if well versed with basic laparoscopy. Intra-abdominal dissection allows more testes to be brought down to the scrotum. Even when open orchidopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilize the testicular vessels adequately. The procedure is best viewed as laparoscopy-assisted; as Orchidopexy has to be done in a conventional manner.

Lower Midline Syndrome with Undescended Testes in the Tobacco Agricultural Environment: A Case Report

@#Lower midline syndrome is a rare congenital anomaly associated with omphalocele. Undescended testes is a congenital absence of one or both testes in the scrotum. Both of lower midline syndrome and undescended testes incidence have a positive correlation with exposure of cigarette and pesticide. Tobacco agricultural environment is a vulnerable area exposed by pesticides and cigarettes. This is the case report to associated tobacco agricultural environment’s exposure with lower midline syndrome and undescended testes. We describe a case of lower midline syndrome and undescended testes that occurs in the tobacco agricultural environment. In this case we found the exposures of paternal heavy smoker, second-hand smoker, pesticides from tobacco agricultural environment and daily use of bug spray in the house. As conclusion, the exposures from tobacco agricultural environment may take a contribution to lower midline syndrome and undescended testes incidence.

The known and unknown about the testicular descent and undescended testes / 中华实用儿科临床杂志

The mechanism of testicular descent in development of testis in embryonic period is very complex,and undescended testes(cryptorchidism) is a very common anomaly of the male genitalia.As it is close relatively with the later impaired fertility and cancer risk,involving reproduction,development,endocrinology and psychology,et al,the explorations of the mechanisms of testicular descent are continuing,and the studies on undescended testes such as the exact cause,pathogenesis,proper strategies for diagnosis and treatment are in progress.Along with some muddle becoming clear,the new puzzles often emerged.Perhaps this is getting closer to the truth.This paper is basically outlining the current research situation from the known and unknown aspects.

Evaluation and management of the infant with abnormalities in the area of inguinal canal and scrotum / 中华实用儿科临床杂志

The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.

The known and unknown about the testicular descent and undescended testes / 中华实用儿科临床杂志

The mechanism of testicular descent in development of testis in embryonic period is very complex,and undescended testes(cryptorchidism) is a very common anomaly of the male genitalia.As it is close relatively with the later impaired fertility and cancer risk,involving reproduction,development,endocrinology and psychology,et al,the explorations of the mechanisms of testicular descent are continuing,and the studies on undescended testes such as the exact cause,pathogenesis,proper strategies for diagnosis and treatment are in progress.Along with some muddle becoming clear,the new puzzles often emerged.Perhaps this is getting closer to the truth.This paper is basically outlining the current research situation from the known and unknown aspects.

Evaluation and management of the infant with abnormalities in the area of inguinal canal and scrotum / 中华实用儿科临床杂志

The area of inguinal canal and scrotum is complex and concealment where many clinical problems especially congenital abnormalities in infant occur.As the reasons of embryonic development and anatomy,most of the clinical problems have close inner link and external relationship.Evaluation and management of the infant with abnormalities in this area involves in structural restoration,prevention and treatment of severe emergencies,or in fertility and testicular tumorigenesis after puberty.As the structure and the long-term function and influence of this area,the studies on here are still focused and the knowledge always update.

Prevalence of undescended testes (Cryptorchidism) from birth to six months in Benin City, Nigeria

Although an undescended testes (UDT) is the most common developmental anomaly of the urogenital organ in males, they have often been regarded as mild malformation and as a consequence have been poorly reported despite its association with increased risk of infertility and testicular cancer in later life. In Nigeria, data on its prevalence is scarce. The objective of the study was to determine the prevalence rates of undescended testes at birth, 3 months and 6 months of age respectively. A prospective hospital-based cohort study was conducted to determine the prevalence rates of UDT at birth, 3 months and 6 months of age. The infants were examined at birth for UDT, using standardized technique. The infants who were identified at birth to have undescended testes were re-examined at the ages of 3 and 6 months respectively. To minimize inter-observer error, one physician examined all the infants. The gestational age, birth weight and birth position of each the neonates were recorded. The maternal age, parity, educational attainment and occupation of the parents were noted. The season in which each of the infants was born was recorded. At birth, 2.8% (39 of 1,394) of live-born male infants had undescended testes (UDT). This prevalence rate declined to 1.2% at the age of 3 months and 0.6% at the age of 6 months with an overall spontaneous testicular descent rate of 79.5% (31 of 39 cases). The prevalence rates were significantly elevated for low birth weight and preterm infants. The frequency of spontaneous descent of the testes was higher in both low birth weight and preterm infants compared to normal birth weight and full-term infants respectively. Comparing twin and non-twin infants, the prevalence of UDT was 3.8% (2 of 52) versus 2.8% (37 of 1,342); p>0.05. At birth, low birth weight and preterm infants had a significantly higher prevalence than their full-term as well as preterm counterparts with preterm infants having a greater tendency to achieve spontaneous descent of the testicles than full-term infants.

Laparoscopic orchiopexy for inguinal cryptorchidism / 中华泌尿外科杂志

Objective To investigate the feasibility and efficacy of laparoscopic orchiopexy for inguinal palpable undescended testes. Methods Ninety patients with 103 inguinal undescended pal-pable testes were treated by laparoscopic orchiopexy performed by the same surgeon. There were 24 (26.7 %) left and 53 (58. 9%) right palpable cryptorchidism cases, plus 13 cases (14.4 % ) with bilat-eral undescended testes. The mean age of the patients was 17 months (range 8 months-6 years). The surgical procedures were described as following. First, the peritoneum was opened at the anterior sur-face of the spermatic vessels and vas deferens before the testis was pulled into the abdominal cavity so that the spermatic vessels and vas deferens were released and easily manipulated. Second, the inter-space between internal spermatic fascia (transversalic fascia) and processus vaginalis was divided so, that the testis could be pulled into the abdominal cavity. Finally, the trocar which was inserted from scrotum was placed through the outer ring. Finally, the testis was placed at position and fixed. Re-suits The mean operative time was 32.7±5.2 min. The processus vaginalis unclose was found in 93 (90.3%) cases; and contralateral process us vaginalis unclose were found in 12 (15.6%) cases of 77 unilateral undescended testes. The complication rate was 3(3.3%)cases, all in bilateral cases. All 103 testes were descended by laparoscopy. On follow-up ranging 6-12 months, all testes maintained good size and a proper position. Conclusions The laparoscopic approach may be a safe way to descend the inguinal palpable testes. Orchiopexy of palpable undescended testes can be done with advantages in the laparoscopic approach.

Analysis of cytogenetic nature in 21 children with undescended testes

Study on 21 children with bilaterally or unilaterally undescended testes at Vietnam National hospital of Pediatrics. These children were from 6 months to 15 years old, 90,5% of them was ≥ 3 years old. There wasn’t any disorder in quantity and structure of chromosome in all patients. They were analysed Barr bodies and results were nagative. The results were correspond to karyotyp 46, XY All patients had coresponding in clinical diagnosis and cytogenetic test diagnosis