Laparoscopic orchiectomy and contralateral vasectomy in a patient with an abdominal testicle: a case report.

We present a case of a 38-year-old man with a unilateral intra-abdominal testicle and undesired fertility in whom orchiectomy and contralateral vasectomy were performed laparoscopically. Urologists have been using diagnostic laparoscopy in patients with nonpalpable testes to plan the definitive procedure when the testicle is present, and to avoid laparotomy in cases of testicular absence. This case of laparoscopic orchiectomy and vasectomy demonstrates that operative laparoscopy allows another subset of patients with cryptorchidism to avoid open laparotomy.

PIP: A case of a unilateral intra-abdominal testicle removed by laparoscopy in conjunction with abdominal unilateral vasectomy is described. The man, a 38-year-old Mexican-American, and a left pelvic testicle revealed by ultrasound 2 years before, had refused surgery, but now requested vasectomy. Under general anesthesia, CO2 pneumoperitoneum was induced, a 11-mm laparoscope was introduced, and the medial umbilical ligaments, bladder, right inguinal ring, right external iliac and external epigastric vessels, and vas deferens were all visualized and were normal. On the left, the testicle obscured the inguinal ring where it was attached to the anterior abdominal wall. The vas was seen running from the testicle to the pelvis. 2 5-mm trocars were introduced halfway between the umbilicus and the iliac crest, and 11-mm trocar on the midline 4 cm above the symphysis. While grasping and elevating the left medial umbilical ligament, the testicle and the left vas were dissected free from the spermatic vessels. The testicle was ligated and removed, cauterizing the pedicle. The right vas deferens was dissected from the peritoneum, hemoclipped and a 2-cm section excised. Finally, the testicle which had been left in the pelvis was removed simultaneously with the laparoscope, using a spoon forceps. All 4 skin incisions were closed, and the patient discharged in 24 hours. He resumed normal activities in a week. The testicle was atrophic, without spermatogenesis. The 29 orchiectomies reported in studies of 278 patients with anorchism examined by laparoscopy were discussed. No malignant testes were mentioned. Laparoscopic management of this condition is preferable for the patient in less pain, shorter hospitalization and recovery, but means a far greater investment in training time for the physician.

Evaluation of importance of cystoscopy in staging gynecologic carcinomas.

Of 265 patients with gynecologic carcinoma undergoing initial evaluation during a 5-year period 238 were staged prospectively with procedures that included cystoscopy. Endometrial carcinoma was noted in 98 patients, none of whom had evidence of bladder extension nor did the clinical stage of disease change after cystoscopy. Of 120 patients with carcinoma of the cervix 7 were found to have extension of tumor to the bladder. The clinical stage was elevated in 3 of these cases but remained unchanged in 4 because of the cytoscopic findings. Of all 238 patients with gynecologic carcinoma 3 (1 per cent) also were found to have unsuspected low grade transitional cell carcinoma of the bladder.