Laparoscopy for nonpalpable testes

Purpose

Laparoscopy is now considered integral to the management of nonpalpable testes, although its benefits are not clearly documented. The authors prospectively determined the value of laparoscopy in patients with nonpalpable testes.

Methods

Between December 1997 and October 2001, 37 patients with 40 nonpalpable testes were scheduled for laparoscopy followed by definitive treatment. Laparoscopy was cancelled in 4 patients (5 testes) because their testes became palpable under anesthesia. In the remaining 33 patients (35 testes), it was determined at the time of surgery whether, as a consequence of laparoscopy: (1) retroperitoneal exploration was avoided (2) definitive treatment was facilitated.

Results

Laparoscopy did not alter the management of 27 testes (77%) that were treated through an inguinal incision with orchiopexy for 17 testes (6 intraabdominal and 9 at the deep ring) and removal of 10 atrophic nubbins. It was only useful in avoiding retroperitoneal dissection for 5 (14%) vanishing testes, and it may have been of benefit for 3 testes treated with a 2-stage Fowler-Stephens orchiopexy.

Conclusions

The majority of our patients with nonpalpable testes could have been treated through an inguinal incision with laparoscopy being reserved for situations in which the testis was not identified on inguinal exploration.     

Persistent mullerian duct syndrome and transverse testicular ectopia: embryology, presentation, and management

Background

The finding of persistent mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE) is rare. We present nonidentical triplets with PMDS with TTE.

Cases

Triplet A presented with a right inguinal hernia and left nonpalpable testis at 4 months of age. Ultrasound demonstrated 1 testis in the right hemiscrotum. Laparoscopy revealed both testes in the right inguinal canal with a thick midline structure. Triplet B presented at 6 months of age in the exact manner with similar intraoperative findings as triplet A. No additional mullerian structures were identified in triplets A and B. Both underwent laparoscopic left orchiopexy and open right inguinal herniorraphy/orchiopexy. A portion of vas was noted in the path specimen of triplet B. Triplet C presented at 7 months of age with a nonpalpable left testis. Laparoscopy demonstrated bilateral fallopian tubes and a midline uterine remnant. Open bilateral orchiopexy was performed, and bilateral biopsies confirmed testes. All 3 were 46-X,Y.

Conclusion

Persistent mullerian duct syndrome with TTE may be encountered when performing laparoscopy for patients with nonpalpable testis. The persistent mullerian remnants vary among individuals and alter the normal anatomy, thus may complicate diagnosis and surgical management.     

Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis?

Purpose

There are no formal guidelines for the management of boys with nonpalpable testis. In this article, we report our experience in treating all nonpalpable intraabdominal testis (NPIT) with standard inguinal orchidopexy without dividing the spermatic vessels stating that the Fowler-Stephens technique is no longer indicated for the treatment of the intraabdominal testis.

Methods

Between June 2003 and April 2008, we treated 23 boys with NPIT confirmed by ultrasound or laparoscopy. All cases were treated through an inguinal orchidopexy without division of the spermatic vessels by fixing the testis to the scrotum by 2 absorbable stitches even if there was an upward retraction of the scrotal skin. Location and size of testis were reported at 1 week, 1 month, 3 months, and 6 months through physical examination.

Results

Average age at presentation was 24 months. Ten patients (43%) had the NPIT on the right side, 8 (35%) on the left side, and 5 (22%) were bilateral. We had no intraoperative complications. All patients were discharged on the same day. In all cases, the testis was normal in size and found in the scrotum after 6 months of follow-up.

Conclusion

On the basis of our experience, we believe that the Fowler-Stephens procedure is not indicated anymore in the management of NPIT. Orchidopexy without division of the spermatic vessels should be the treatment of choice even for the cases of very high intraabdominal testis because it does not affect normal testicular vascularization and is minimally invasive.     

Long-term outcome of Fowler-Stephens orchiopexy in boys with prune-belly syndrome

Purpose

Intra-abdominal testes in boys with prune-belly syndrome have been conventionally managed by 1 or 2-stage orchiopexy with division of the gonadal vessels. We reviewed a series of adults with prune-belly syndrome to assess the morphological and functional outcome of orchiopexy in childhood with specific reference to the spontaneous onset of puberty, hormonal profiles and sexual function.

Materials and Methods

A total of 41 boys were divided into 3 groups depending on the type of orchiopexy performed, namely group 1—20 with bilateral 1-stage orchiopexy, group 2—10 with unilateral 1-stage and contralateral 2-stage orchiopexy, and group 3—11 with bilateral 2-stage orchiopexy.

Results

In group 1 9 of 20 patients had good scrotal testes bilaterally, 6 had a good scrotal testis on 1 side and 3 had small testes on each side. Two boys required testosterone supplementation but 18 had normal hormonal and sexual function. In group 2 6 of 10 patients had good scrotal testes bilaterally and 4 had a good scrotal testis on 1 side. All patients underwent spontaneous puberty with good sexual function. In group 3 7 of 11 boys had good scrotal testes bilaterally and 3 had 1 good testis with normal puberty and sexual function. These 10 patients underwent spontaneous puberty with good sexual function.

Conclusions

The majority of boys with prune-belly syndrome had a satisfactory outcome after orchiopexy with division of the gonadal vessels with testicular function sufficient to induce puberty and maintain satisfactory sexual function in adult life.     

Laparoscopic orchidopexy: the easy way to go

Background/Purpose

Intraabdominal testes represent less than 10% of cryptorchid testicles, and yet, they are the most challenging to correct. In the last 15 years, the two-stage Fowler-Stephens orchidopexy has gained popularity. The traditional approach includes laparoscopic or open clipping of the testicular vessels (first stage) and open inguinal orchidopexy (second stage). We present our experience with 2-stage orchidopexy with both stages done through a laparoscopic approach.

Materials and Methods

Over a recent 5-year period, we reviewed patients operated for intraabdominal testis using a two-stage laparoscopic orchidopexy with a minimum of 1-year follow-up. In this study, success is defined as a nonatrophic, intrascrotal testis. Fifteen patients met the inclusion criteria, and none were lost to follow-up.

Results

In the 15 patients, 11 had a unilateral intraabdominal testis, and 4 had bilateral cryptorchidism, with one of the 2 testes intraabdominal. The first stage was done at a mean age of 32 months, and the average time between the two stages was 9.7 months. All procedures (31) were done on an outpatient basis. Only 2 complications occurred, one scrotal hematoma and one redo first stage because of unsuccessful clipping noted at the time of planned second stage. The success rate is 93.3% (14/15). All testicles are intrascrotal, and all but 1 have maintained preoperative volume.

Conclusion

Two-stage laparoscopic orchidopexy is a fairly easy surgical procedure with minimum morbidity and high short term success rate. A larger cohort of patients with long-term follow-up is needed to substantiate these findings.     

Surgical findings in acquired undescended testis

Background/purpose

The aim of this study was to retrospectively review the findings at orchidopexy in acquired undescended testis (UDT).

Methods

The authors reviewed a 14-year (1986 through 1999) surgical experience in 360 boys in whom 461 orchidopexies were performed for acquired-UDT. The operative notes were reviewed to determine at operation testis position and volume, persistence of patent processus vaginalis (PV), and attachment of the gubernaculum. Also, testis position after orchidopexy was evaluated.

Results

Age at operation ranged from 2 to 19 years (mean, 8.9 years), 205 of the 461 orchidopexies (44.5%) had been performed between 9 and 12 years of age. In 327 of the 461 cases (70.9%), testis position was documented as intraoperative; in 281 of these cases (86.0%), the testis was located in the superficial inguinal pouch (SIP). A note was made regarding the presence or absence of a hernial sac in 207 of the cases: 113 (54.6%) were associated with an open PV, which usually was slightly open. In 122 of the 461 cases (26.5%), the gubernacular attachment was assessed; in 121 of these (99.2%), a normal attachment of the gubernaculum was noted. At the end of orchidopexy, in 438 of the 461 cases (95.0%), testis position was recorded. Three hundred eighty-two of these testes (87.2%) were at the bottom of the scrotum.

Conclusions

Acquired UDT usually is characterized by SIP position, closed or (small) open PV, and normal gubernaculum attachment. The results of surgery seem excellent.     

Inguinal cordopexy: a simple and effective new technique for securing the testes in reoperative orchiopexy

BACKGROUND/PURPOSE: A new procedure is described for securing the testis in the scrotum in patients with a past history of inguinal sugery and testes in an unsatisfactory position. METHODS: Twenty-seven patients with 29 abnormally positioned testes (two bilateral) were evaluated. All patients had a past history of inguinal surgery, and ages ranged between 4 and 16 years (mean, 7.2). Previous surgical procedures included 23 orchiopexies, 4 inguinal herniorrhaphies, and 2 testicular detorsions of undescended testis. In all reoperations an attempt was made to fix a strip (two nonabsorbable stitches) of the fascia attached to the cord, to the pubic bone, or to the tendinosous part of the gracilis muscles (cordopexy), so that the distal part of the cord and the testis lay freely in the scrotum without tension. Patients underwent follow-up every 6 months after the operation with physical and ultrasound examinations. RESULTS: Cordopexy was possible in 11 (38%) of the 29 inguinal reoperations. In all cases, orchiopexy was the previous surgical procedure. One hundred percent of the testes remain within the scrotum after a mean follow-up of 21 months (range, 8 to 38). CONCLUSION: When feasible, inguinal cordopexy is a simple and effective technique for securing testicles in reoperative orchiopexy procedures.     

Undescended testis in older boys: further evidence that ascending testes are common

Introduction

We recommend orchiopexy between 9 and 18 months of age for surgical, testicular, and psychological reasons. However, in practice, we observed many patients coming to orchiopexy at a later age. To understand this difference better, we reviewed our experience with patients undergoing late orchiopexy.

Methods

We reviewed retrospectively the office medical records of all boys who had undergone an orchiopexy between July 1997 and April 2006. We defined a “late” orchiopexy as that performed at 4 years of age or later. Each boy was examined carefully by a pediatric urologist, and preoperative, intraoperative, and postoperative findings were reviewed.

Results

There were 191 late orchiopexies in 177 patients (from a total of 587 orchiopexies in 552 patients). Median age at the operation was 7.2 years (range, 4.0-16.2). Preoperatively, the testes were palpable in 140 (72%) and nonpalpable in 51 (28%). The apparent reason for the late orchiopexy was an ascending testis (previously descended) in 85 (45%), parental delay in 41 (22%), late referral in 39 (20%), and iatrogenic cryptorchidism in 18 (9%). Ascended testes were more likely to have a history of being retractile (85% vs 30%), to have a patent processus vaginalis (78% vs 54%), and to be localized to the superficial inguinal area (87% vs 50%).

Conclusions

Primary care provider and parent education on the benefits of early orchiopexy is important, but in addition, ascending testes are much more common than previously thought. Patients with retractile testes should be followed regularly.     

Laparoscopic Orchidopexy: The Treatment of Choice for the Impalpable Undescended Testis

Objective:

Management of the impalpable testis often represents a significant diagnostic and therapeutic challenge for the radiologist and surgeon. The aim of this work is to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of the impalpable testis.

Methods and Procedures:

Thirty-three patients with 43 impalpable testes are included in this study. For each patient, magnetic resonance imaging (MRI) then laparoscopy were performed. Either the testis or blindending cord structures are searched for. The testis was either brought down to the scrotum or removed depending on the condition of each patient.

Results:

MRI detected 16 out of 43 impalpable testes (37.2%). Laparoscopy, on the other hand, detected 18 intra-abdominal testes, 7 inguinal and 16 blindending cord structures either above or below the internal inguinal ring. Blindending cord structures suggested a vanished testis. Orchidopexy was done for 23 cases, orchidectomy in 18 cases and laparoscopy only in 2 cases.

Conclusion:

Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. Intra-abdominal dissection allows more testes to be brought down to the scrotum. The procedure is best viewed as laparoscopy-assisted, as Orchidopexy has to be done in a conventional manner.     

Natural course of undescended testes after inguinoscrotal surgery

Purpose

The purpose of the study is to study the natural course of undescended testes after inguinoscrotal surgery.

Methods

From 2003–2010, 24 boys were observed with 26 undescended testes after inguinoscrotal surgery; 12 had previously undergone inguinal hernia repair and 12 orchidopexy. Spontaneous descent was awaited and (re-)orchidopexy would only be performed in case of non-descent at puberty. The boys were assessed annually for testis position and for testis volume as measured by ultrasound.

Results

At the end of the study period, 19 testes had reached scrotal position; of these, 13 (68%) had descended spontaneously and 6 (32%) had been (re-)orchidopexied. No difference was found in the rate of spontaneous descent after previous orchidopexy or inguinal hernia repair (P = 0.419).

Conclusion

Spontaneous descent of undescended testes after inguinoscrotal surgery occurs regularly. In this study, it was observed in two out of every three cases.     

The role of smooth muscle cell differentiation in the mechanism of obliteration of processus vaginalis

Background/Purpose

Development of indirect inguinal hernia and hydrocele in childhood is readily explained by the persistence of smooth muscle component around the processus vaginalis (PV) after the descent of the testis into the scrotum. The aim of this study was to investigate the expression of smooth muscle myosin heavy chain (SM MHC) isoforms as the markers of smooth muscle cell (SMC) differentiation in childhood inguinal hernia and hydrocele and in age-matched controls.

Methods

The authors analyzed sacs from patients with inguinal hernia (male, 10; female, 10) and hydrocele (n = 10) immunohistochemically using monoclonal antibodies against α-smooth muscle actin, SM1, SM2 and SMemb. Peritoneal samples (male, 5; female, 5) obtained from age-matched patients served as controls. Immunostaining was evaluated with semiquantitative scoring and χ² test.

Results

The expression pattern of SM MHC isoforms did not differ among sacs obtained from female inguinal hernia when compared with that of controls. However, strong expression of SMemb within the sac walls of male inguinal hernia and SM1 in hydrocele groups were observed.

Conclusions

Our results indicate that SMC differentiation may play an important role in the obliteration of processus vaginalis in male inguinal hernia and hydrocele after the descent of the testis.     

Laparoscopic-Assisted Management of Impalpable Testis in Patients Older than 10 Years

Objective:

Cryptorchidism affects 1% of male births. The majority of patients with undescended testis are identified and treated in childhood, but a significant proportion of them especially in third-world countries are neglected and present late. Herein, we present our initial experience of managing impalpable testis in older children and adults with laparoscopic assistance.

Patients and Methods:

This study was conducted from 2003 through 2008 at LUMHS Jamshoro. Thirty-two patients with 40 impalpable testes were included in this study. Diagnostic laparoscopy was performed in 32 anesthetized patients. Laparoscopic-assisted orchiopexy or orchiectomy was performed in patients with intraabdominal testis. Testicular vessels and vas deferens were mobilized and after obtaining sufficient length were brought through the posterior wall of the inguinal canal by creating a neo-inguinal ring medial to the epigastric vessels after a small inguinal incision.

Results:

Of 40 impalpable testis, ultrasound localized 16 (40%) of them, and on laparoscopy, 36 (90%) were localized, 30 (75%) as intraabdominal and in 6 (15%) cases vas and vessels were entering into the internal inguinal ring (intracanalicular). The remaining 4 patients were diagnosed as having vanishing testis (anorchia). Laparoscopic orchiectomy was performed in 14 (35%) of these testes, while single-stage laparoscopic-assisted orchiopexy using Prentiss'' maneuver was performed in 16 (40%) testis. No major complications occurred. Seven testes were associated with ipsilateral hernias and were simultaneously repaired laparoscopically.

Conclusion:

Laparoscopic-assisted single-stage orchiopexy is a safe and successful procedure for intraabdominal testis in adolescents and older patients. The additional benefit of shortening the usual course of spermatic cord was beneficial to fix the testis in the scrotum without tension.     

Intrauterine testicular torsion: a surgical emergency

Background

Intrauterine torsion of testes (IUTT) is a very rare condition that is being recognized with increasing frequency. The exact cause of IUTT is not known, and controversies still continue regarding the need for urgent exploration as well as the necessity of contralateral orchidopexy. This is a review of our experience with 11 cases of IUTT, highlighting aspects of diagnosis and management.

Patients and Methods

From 1990 to 2005, we treated 11 newborns with IUTT. Their mean birth weight was 3.50 kg (range, 2.6-4.12 kg). Their age at presentation ranged from 2 hours to 10 days (mean, 45 hours). All underwent emergency exploration. There were 6 left-sided, 4 right-sided, and 1 bilateral torsion.

Results

In all, the affected testis was enlarged, tender, firm in consistency, and higher in position, and the overlying skin was dark red in color. Exploration revealed extravaginal torsion in all. In 1, there was partial torsion and the testis was enlarged, congested, but not gangrenous. Another child had complete torsion, but the testis was found enlarged, congested with hemorrhage, but not gangrenous. Both were treated with detorsion and preservation of testes and bilateral orchidopexy. On follow-up, both testes were viable, of good size, and in normal position. The patient with bilateral torsion had frankly necrotic left testis that was removed, but the right testis was smaller in size and ischemic but not frankly necrotic, so it was preserved, but on follow-up, it was found atrophic. One of our patients was evaluated few hours after delivery and found to have normal testes. On the second day, he was found to have enlarged, tender left testis. Emergency exploration revealed extravaginal torsion with slightly enlarged left testis that was ischemic but not frankly necrotic. This was preserved and bilateral orchidopexy was done. On follow-up, both testes were viable, of good size, and normal position. In the remaining 7 patients, the testes were frankly necrotic. They were treated with orchidectomy and contralateral orchidopexy. Histology of the removed testes was variable. In 6, the testes were totally necrotic without any viable testicular tissue, whereas in the remaining 2, there was preservation of some semineferous tubules and hemorrhage with ischemic infarction.

Conclusion

Intrauterine torsion of testes should be treated as an emergency. To obviate the risk of anorchia, we advocate early recognition of IUTT, expeditious exploration and simultaneous contralateral orchidopexy.     

Perioperative surgical findings in congenital and acquired undescended testis

Purpose

Perioperative surgical findings in congenital and acquired undescended testis (UDT) were prospectively assessed.

Methods

We included all boys with congenital or acquired UDT who underwent orchidopexy at our hospital between January 2006 and August 2009. Perioperatively, we scored the position and volume of the testis, the insertion of the gubernaculum, the patency of the processus vaginalis, and the obtained position.

Results

We included 69 boys (aged 0.9-14.6 years) with 76 congenital UDT and 28 boys (aged 2.2-18.5 years) with 30 acquired UDT. In the congenital group, the testis was in intracanalicular position in 55 cases (72%), whereas in the acquired UDT group, this was in 11 cases (37%; P < .001). The insertion of the gubernaculum was at the bottom of the scrotum in 13 cases (17%) of the congenital UDT group and in 12 cases (40%) of the acquired UDT group (P < .05). The processus vaginalis was open in 63 cases (83%) of the congenital and in 9 cases (30%) of the acquired UDT group (P < .001).

Conclusion

Compared to congenital UDT, acquired UDT are more likely to be situated in the superficial inguinal pouch, to have a normal insertion of the gubernaculums, and to have a closed processus vaginalis.     

Surgical exploration for impalpable testis: Which should be first,inguinal exploration or laparoscopic abdominal exploration?

Purpose

To discuss an optimal surgical approach for impalpable testis in children, our own treatment results and those reported in the literature were reviewed.

SURGICAL MANAGEMENT OF THE NONPALPABLE TESTIS: THE CHILDREN'S HOSPITAL OF PHILADELPHIA EXPERIENCE

Purpose

The management of the nonpalpable testis permits an individualized operative approach. We analyze the results of surgical management of a large series of patients with a nonpalpable testis.

Materials and Methods

Between January 1986 and June 1994 we treated 1,866 boys with undescended testes. There were 447 testes (24%) that were not palpable at presentation. Intraoperative data on these patients were collected for age at presentation, bilateral testes position, testicular size, associated inguinal anomalies (vas, epididymis and processus vaginalis) and surgical approach. For intra-abdominal testes postoperative results of 2 surgical techniques, the Fowler-Stephens procedure and Koop orchiopexy (retroperitoneal mobilization of spermatic vessels and vas) were compared in 76 patients with at least 18 months of followup.

Results

Average patient age at presentation was 34 months with 63% presenting before age 48 months. Of the impalpable testes 58% were on the left side, 35% were on the right side and 7% were bilateral. At operation 181 testes (41%) were atrophic or absent, 91 (20%) were intraabdominal with 14 (3.1%) bilateral, 136 (30%) were in the inguinal canal and 39 (9%) were in other locations, including 22 at the pubic tubercle, 2 in the upper scrotum, 13 in the superficial inguinal pouch and 2 in the perineum. Of the intra-abdominal group associated extratesticular malformations were identified in 36 cases (39%). Attachment of the vas deferens to the testis was abnormal in 23 of 64 cases (36%), including 10 that were completely detached and 13 with head or tail attachment only.Of the 91 evaluable cases in the intra-abdominal group 38 (42%) had been treated with the Fowler-Stephens repair (5 in 2 stages), 33 (36%) with inguinal orchiopexy and intraperitoneal dissection without dividing the spermatic vessels, 5 with 2-stage procedures and vessel preservation and 14 (15%) with orchiectomy. One testis was left in situ. The inguinal approach with intraperitoneal extension was successful in defining the testis location or blind-ending vas and vessels in 100% of the cases. A single operation to perform orchiopexy was successful in 92% of the cases. Overall, results were considered excellent or acceptable in 32 of 33 cases (97%) after Koop orchiopexy and 28 of 38 (74%) after the Fowler-Stephens orchiopexy.

Conclusions

Nonpalpable testes accounted for 24% of the patients presenting with undescended testes. At surgical exploration 39% of impalpable testes were distal to the external inguinal ring, 41% were atrophic or absent and 20% were intra-abdominal. All cases were treated through a standard inguinal incision. These data provide evidence that the inguinal approach to orchiopexy with transperitoneal mobilization of the vas and vessels without transection is highly successful for the intra-abdominal cryptorchid testis and, to date, is the preferred technique for the management of the intra-abdominal undescended testis.     

Neonatal testicular torsion: a survey of current practice amongst paediatric surgeons and urologists in the United Kingdom and Ireland

Purpose

Management of neonatal testicular torsion (NTT) is controversial, with varied opinion regarding the merit(s) and role of “emergent” testicular exploration and/or contralateral orchidopexy of the healthy testis.

Methods

A survey of consultant paediatric surgeons and urologists working in the United Kingdom and Ireland was conducted to ascertain views to guide best practice.

Results

A total of 148 questionnaires were mailed, of which 110 were returned (74% response rate). Of these, 60 (54.5%) surgeons considered NTT secondary to torsion of the spermatic cord and 8 (7.2%) thought primary vascular infarction of the testis responsible. Twelve (10.9%) use Doppler ultrasound to guide management and exclude tumour. Eighty-two surgeons (74.5%) explore the scrotum, and 59 (71.9%) perform ipsilateral orchidectomy and contralateral orchidopexy of the “healthy” testis. Few surgeons undertake emergent exploration. Only 11 (10%) surgeons have ever found a viable testis. Seven (6.4%) cases of synchronous NTT were reported. Twenty-four (21.8%) surgeons do not perform contralateral orchidopexy with concerns of damaging a healthy testis. Orchidopexy is favoured by 89 surgeons, with 46 (52%) using nonabsorbable suture fixation and 28 (31.4%) creating a sutureless extradartos pouch. In boys later found to have a “solitary scrotal testis” and a contralateral testicular remnant, 38 (36.5%) of 104 would always “pex” the testis to avert anorchia.

Conclusions

Surgeons' opinions with NTT in the United Kingdom and Ireland remain diverse. Strong argument can be made for scrotal exploration with/without contralateral orchidopexy. Parents should be counselled on the merits of varied strategies to gain better understanding of the long-term outcomes for their male child.     

Single-incision multiport laparoscopic orchidopexy: initial report

Purpose

We report the first use of single-incision multiport access to perform 1-stage laparoscopic orchidopexy in children without section of the spermatic vessels.

Material and methods

Three boys with cryptorchidism were submitted to primary laparoscopic 1-stage orchidopexy by using 3 ports (a 10-mm [or 5-mm] port placed using open technique and 2 additional 5-mm [or 3-mm] ports) inserted through the same periumbilical skin incision with different entrances through the abdominal wall. After dissection of the testicular vessels and vas deferens, a 5-mm port was placed in a tunnel from the scrotum to pull the remnant of the gubernaculum down and fix the testicle in a dartos pouch.

Results

The mean operative time was 83.3 minutes. The estimated blood loss was almost nil, and there were no intraoperative complications.

Conclusion

This approach was feasible and safe. However, as with any new technique, its use requires a larger number of cases and a longer follow-up to fully evaluate its benefits and limitations.     

The prevalence, postnatal descent, and complications of undescended testes among children who underwent neonatal circumcision in Benin City, Nigeria

Background/Purpose

The prevalence, age at postnatal descent, and age at which complications set in and, therefore, prevented by orchidopexy in undescended testes are controversial. This study sought to determine the prevalence, age at postnatal descent, and age at which complications occurred in undescended testes.

Methods

A prospective study was done on children who underwent neonatal circumcision at the University of Benin Teaching Hospital, Benin City, and Leadeks Medical Centre, both in Edo state, Nigeria, between January 2002 and December 2007. Those diagnosed with undescended testes were recruited for the study and followed up at the surgical outpatient clinic for 2 years; findings were documented on a structured proforma.

Results

A total of 178 neonates aged between 5 and 28 days (mean, 7.6 ± 4.2 days) and mean weight 3.9 ± 1.8 kg among 6180 children circumcised had 186 undescended testes. On follow-up, 65 (34.9%) testes mainly among preterm neonates (P = .2450) fully descended within 7 months with no testicular descent recorded thereafter. Prevalence rates of 2.9% in neonates and 1.8% at 2 years old were recorded. Reduction in testicular volume, epididymoorchitis, and testicular torsion were recorded in 52 (28%) undescended testes between 12 and 24 months on follow-up.

Conclusion

Neonates with undescended testis should be observed for postnatal descent at least 7 months but may be offered orchidopexy before 1 year.     

Retractile testes: an outcome analysis on 150 patients

Background/Purpose

Retractile testes are testicles that can be brought down into their normal position in the scrotum but then immediately retract upward and out of the scrotum. The purpose of this study is to provide data on the outcome of pediatric patients with retractile testes.

Methods

A retrospective analysis was conducted on prospectively collected data on the outcome of 150 consecutive patients with retractile testis examined and followed up by one pediatric surgeon from April 1982 to April 1999, inclusive.

Results

Age at presentation was 5.2 ± 3.0 years, and follow-up duration was 3.8 ± 3.0 years. The number of retractile testes was 205, right-sided for 58 patients (38.6%), left-sided for 37 (24.6%), and bilateral for 55 (36.7%). Family history of retractile testis was positive in 8 patients (5.3%). Thirty-four patients required surgery (22.7%); indication for surgery was given when retractile testes ascended and became cryptorchid or if testicular size decreased during follow-up. Orchidopexy was required more frequently (P < .001) in patients with an associated hernia (68.8% of cases) than in patients without hernias (9.2%). One patient with spontaneous testicular descent during follow-up had a testicular carcinoma.

Conclusions

These findings suggest that the majority of patients (77.3%) with retractile testes have a spontaneously favorable evolution by 14 years of age and do not require surgical treatment. The authors report the first case of testicular carcinoma in a patient with retractile testis, and this indicates that these patients should be followed up even after testicular descent.