Comparison of inguinal and laparoscopic approaches in the treatment of varicocele.

To determine the pros and cons of inguinal and laparoscopic varix ligation techniques, we reviewed 53 patients who underwent inguinal (n = 35) and laparoscopic (n = 18) varicocelectomy at two centers. Intraoperative complications were not observed in either of the groups. There was 1 recurrence and 1 persistence in the laparoscopically treated patients. The inguinal approach had the advantage of shorter operating time (19.1 versus 52.8 min), ability to ligate the external spermatic veins, and it could be performed as an outpatient procedure. However, the laparoscopic approach seemed superior for preserving the spermatic artery (88.8% versus 68.5%) and had lesser postoperative morbidity.

Microsurgical vaso-epididymostomy in 2 layers.

Eleven patients with epididymal obstruction were treated with microsurgical techniques. A 2-layer, end-to-side anastomosis between the vas deferens and a single loop of the epididymal duct was created. At follow-up, 9 patients had spermatozoa in their ejaculate and 3 of them achieved pregnancies with their partners. The technique described not only yields better results through the application of microsurgery but also gives a better understanding of epididymal function and pre- and per-operative diagnosic proceedings.

Vascular corrosion casts of the dog testis after experimental microvascular surgical orchiopexy. A scanning electron microscope study.

Five mongrel dogs underwent microvascular surgical orchiopexy by anastomosing the testicular artery and vein with the respective caudal epigastric vessels. In order to assess the effect of a 40 to 50-min period of warm ischaemia (the time required to make the anastomosis) on the testicular blood vasculature, plastic corrosion casts were made of the operated testes and compared with non-operated control specimens. The resulting blood vessel casts were inspected in the scanning electron microscope. One case of testicular atrophy developed, caused by a postoperative wound abscess. Comparing operated with non-operated testes, no differences in vascularisation, pattern or density of arterial supply, capillary network and venous drainage were seen. These findings are in agreement with data from the literature concerning histological, hormonal and clinical results.

Use of laparoscopy for the localization of impalpable testes.

Laparoscopy is a simple, safe and sure diagnostic method in order to visualize an abdominal testis. When there is no abdominal testis at laparoscopy, the vas deferens and the testicular vessels have to be looked for very carefully. When both these structures pass through the internal inguinal ring, operation can be limited to the inguinal region. The results of laparoscopy are reported in nine patients with impalpable testis.

Microvascular surgical orchiopexy in the treatment of high-lying undescended testes.

Extensive laboratory experiments in animals have led us to believe that autotransplantation of the testis in the human is feasible. To date, nine of our patients (aged 4-13 years) with undescended intra-abdominal testes have undergone autotransplantation. Using a microvascular surgical technique to anastomose the testicular vessels to the inferior epigastric vessels, it has been possible to place the testis in a scrotal position in every case. No postoperative complications have been noted. Follow-up varied from 9 to 18 months and no atrophy of the testis was observed in this period. Doppler investigations on all of the transplanted testes continue to demonstrate good arterial flow. The aim of surgery on the undescended testis is not only to increase the chances of fertility and to diminish the possibility of malignant transformation but also, more importantly perhaps, to prevent possible abnormal psychosexual development in the child.

Effect of experimental microvascular orchidopexy on spermatogenic cell differentiation in the testes of the dog.

Experimental microsurgical orchidopexy was undertaken in 15 healthy mongrel dogs by anastomosing the testicular artery and vein to the ipsilateral caudal epigastric vessels. At pre-selected post-operative intervals of 4 weeks, 5 or 8 months the results were morphologically and histologically evaluated by the 'testicular biopsy score count' method. This method is based on the presence of the main spermatogenic types arranged in order of maturity. Between the mean scores of the normal and the operated testes there was a significant difference. The differentiation of the spermatogenic epithelium of the reconnected testis is slightly hampered, but not seriously.

Effect of experimental microvascular orchidopexy on testosterone secretion in the dog.

This study was undertaken to investigate the endocrine function of the testis that was autotransplanted by microvascular techniques in 10 healthy dogs. After a control period of 4 weeks, hemicastration was carried out, and 4 weeks later the experimental orchidopexy was done. Finally, the transplanted testis was removed after another 4 weeks. Peripheral blood testosterone levels were measured at weekly intervals during the control period, after hemicastration, after autotransplantation and after removal of the transplanted testis. 1 week before each operation, 500 IU human chorionic gonadotrophin (HCG) was given intravenously and the peripheral testosterone levels were determined after 2 and 24 h. During each operation a testicular venous blood sample was taken for testosterone measurements. No differences were found between the basal and HCG-stimulated peripheral plasma levels of testosterone after the hemicastration and the orchidopexy in comparison with the values during the control period. There was a statistically significant positive correlation between the testosterone levels in the testicular venous and peripheral plasma samples. It was concluded that microvascular anastomosis was successful in every case.