Undescended testes; operative mangement

ABSTRACT

Cryptorchidism literally means "hidden testis"and in general sense it refers to any testis that occupies an extra-scrotal position. Some authors further classify cryptorchid testes into dystopic [true undescended i.e. descent is arrested in the usual path] and ectopic [testis has deviated from the normal path of descent. [1]. To find out the age of presentation of the patients with undescended testis in our country. [2]. To analyze different operative procedures of cord lengthening and testicular fixation. [3]. To compare the histopathological appearance of the undescended testis in different age groups. SETTING: Federal Government Services Hospital Islamabad. PERIOD 3 years [1992 to 1995] PATIENTS AND METHODS: A standard protocol was prepared for every patient comprising history, physical examination, investigations, preoperative management, operative details i.e. cord lengthening procedure and fixation technique, postoperative course, histopathological report and final outcome. Total patients were 50, Youngest patient was 3 years old and the oldest was 46 years old. In 6[14%] cases simple retroperitoneal dissection was enough to attain adequate cord length. In 2[4.65%] cases inferior epigastric artery was sacrificed. In 8[18.6%] cases, Prentis maneuver was performed. In 3 [7%] cases, Fowler Stephen's procedure was done. In 13 [30.2%] patients, transfascial re-routing was to be performed. In the remaining 2 [4.65%] cases combined Fowler Stephen's and transfascial re-routing was done. in 9 [20.9%] cases, orchidectomy was done. No single technique can achieve optimum cord length in each and every case. Simple retro-peritoneal dissection is usually enough for low undescended testes. For high undescended testes, the best procedure for cord lengthening is transfascial re-routing of testicular vessels. For more difficult cases, Fowler-Stephen's procedure alone or combined with transfascial re-routing gives satisfactory results. A properly formed dartos pouch is the best testicular fixation technique as well as more comfortable to the patient than trans-scrotal fixation to the thigh