Successful autotransplantation of an intra-abdominal testis by microsurgery

An intra-abdominal testis in a 12-year-old child was successfully transplanted to the scrotum by a microvascular technique. The result after 12 months is promising. Problems of ischaemia in testicular autotransplantation and technical problems in testes with a short spermatic pedicle are emphasized.     

Successful autotransplantation of an intra-abdominal testis to the scrotum by microvascular technique.

An intra-abdominal testis in a child with prune belly syndrome was successfully transplanted to the scrotum by a microvascular technique. Immediate results were good with no palpable atrophy of the testis. Long-term results (fertility) will not be known for many years. The technique of microvascular anastomosis and its application to orchiopexy are described.     

The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation

BACKGROUND AND PURPOSE: Treatment of the high intra-abdominal testis is often a challenging problem. We present our technique of and results with laparoscopically assisted testicular autotransplantation (LATA) for treatment of the high intra-abdominal testis. PATIENTS AND METHODS: We reviewed the medical records of 15 patients with a high intra-abdominal testis who underwent procedures between 1993 and 1999 in which intra-abdominal dissection and testicular mobilization was performed laparoscopically. The LATA technique is described. RESULTS: The 15 patients underwent 17 LATA procedures. Age at surgery ranged from 6 months to 13 years (mean 3.6 years; median 2.5 years). Two of these patients had undergone failed contralateral orchidopexy for an intra-abdominal testis, and two patients underwent metachronous bilateral procedures. The laparoscopic dissection and microvascular anastomoses were successful in all patients. There were no postoperative complications. The involved testis remained viable with adequate growth in 15 of 17 procedures (88%) during a median 42-month (range 7-70 months) follow-up. Successful procedures included those in the two patients with contralateral atrophic testes and the two who underwent bilateral procedures. CONCLUSIONS: The LATA demonstrated a good long-term surgical outcome and may be the technique of choice in patients with bilateral intra-abdominal testes or patients who have contralateral testis atrophy following unsuccessful orchidopexy.     

Testicular autotransplantation in children

A series of 10 microvascular autotransfers of impalpable intraabdominal testes has been reported. The viability rate was 60 percent as determined by growth and size of the transferred testis. Long-term endocrine and fertility studies are needed to determine the function of these gonads. The spermatic vasculature was unpredictable and showed many variations. Indications should be very carefully individualized.     

The intra-abdominal testes: microvascular autotransplantation

Four patients with high intraperitoneal testes underwent autotransplantation to the scrotum by division of the spermatic vessels. On one side a microsurgical reanastomosis was performed. No reanastomosis was performed on the other side. Microsurgical reanastomosis prevented atrophy.     

Laparoscopic orchiectomy for unilateral intra-abdominal testis.

We present 2 cases of laparoscopic removal of a unilateral intra-abdominal testis. Removal of a unilateral intra-abdominal testis is indicated in patients more than 10 years old because the malignant potential of an intra-abdominal testis outweighs any cosmetic benefit of orchiopexy. Laparoscopic orchiectomy is a safe and effective surgical procedure for adolescents and adults with this disease entity providing outpatient therapy and prompt rehabilitation.     

Torsion of an intra-abdominal testis

To present a case of torsion of a nonneoplastic intra-abdominal testis with an unusual clinical presentation.A 26-year-old active duty Navy Petty Officer presented to the emergency department on 3 occasions over a 5-day period with lower abdominal pain. Physical examination demonstrated acute tenderness in the left lower quadrant with sugestion of a normal spermatic cord and atrophic testis in the left scrotum. Computed tomography scan demonstrated an intra-abdominal lesion near the internal inguinal ring. The patient underwent surgical exploration through an inguinal incision. Torsion of a nonviable intra-abdominal testis was present. The scrotum contained only the vas deferens and cremasteric muscle. An orchiectomy was performed with removal of the vas deferens and other cord structures.The unusual clinical finding of acute torsion of an intra-abdominal testis, associated with an apparent atrophic scrotal testis, presented a confusing clinical picture. Computed tomography scan did not clarify the issue sufficiently to establish a definite preoperative diagnosis. Clinical suspicion prompted early surgical intervention. Review of the current literature produced 60 reported cases of torsion of an intra-abdominal testis. Two thirds of these involved testicular neoplasm, usually seminoma. Although the clinical presentation varied, most patients had recent onset of lower abdominal pain associated with tenderness and, in half the cases, a mass. Patients almost always presented with an absent scrotal testis on the involved side, and not infrequently reported previous surgery thought to be an orchiectomy.Diagnosis of an intra-abdominal testicular torsion is rare, particularly when no neoplasm is present. A high index of suspicion must be maintained whenever there is abdominal pain and undescended testis. The surgical history and imaging studies may not clarify a confusing clinical picture.     

Microsurgical autotransplantation of abdominal testis]

A 32-year-old man who had bilateral non-palpable testis underwent microsurgical orchidopexy of the right abdominal testis. Inferior epigastric vessels were used for the recipient vessels. Ischemic time during the operation was 40 minutes. Postoperative doppler readings revealed excellent blood flow to the testis, and HCG-stimulating test revealed good response. Now, 2 years after surgery, no sign of atrophy is found.     

Late results of testis autotransplantation]

Seven patients with bilateral undescended testes (9 intraabdominal testes and 5 inguinal testes), aged 7 to 29 years, were treated surgically. Testis autotransplantation was done for 9 intra-abdominal testes, and cryptorchidopexy was done for 5 inguinal testes. Follow-up for 5 to 9 years showed that the transplanted testes survived except 1 atrophied helf a year after operation. The size of the transplanted was as big as that of international testis model 15, and their hardness was moderate. Obvious improvement of secondary sex character and sexual function were observed in 6 of the 7 patients. The value of serum testosterone was norma (1450-600ng/dl) in 4 patients. In 4 patients, sperms were found in semen. The wives of 2 of those patients bore a boy and a girl respectively in 2-3 years after operation. Operative treatment and optimal age for testis autotransplantation are discussed.     

Testicular venography in impalpable testis

77 venographic studies of impalpable testes have been reviewed. All patients subsequently underwent surgical exploration. In 28 studies a pampiniform plexus was identified and in 27 a testis was present at the site of the pampiniform plexus. In 20 studies the testicular vein was blind-ending and in only 1 was testicular tissue present at the site of the blind-ending vein. Testicular tissue was absent in the remaining 19. There were 29 technical failures or an inability to identify the full length of the testicular vein because of patent valves. Testicular venography is most useful in localising the position of an impalpable testis but does not determine in all cases whether testicular tissue is present.     

Torsion of intra-abdominal seminoma of testis

Torsion of an intra-abdominal seminoma was discovered in an eighteen-year-old man who had abdominal pain. Review of the literature disclosed 21 similar cases. The risk of testicular torsion and malignant tumor is greatly increased by testicular maldescent.     

Leydig cell tumor of intra-abdominal testis

A patient with bilateral cryptorchidism and gynecomastia due to Leydig cell tumor involving the left intra-abdominal testis is described. Raised serum estrogen, low serum testosterone, and ultrasonic demonstration of a tumor in the left testis allowed the diagnosis to be suspected preoperatively. The relevant literature is reviewed.     

Microsurgical testis autotransplantation. A critical review

Abdominal testes represent 15 to 25% of all cases of cryptorchidism. In 5% the testis is so high in the abdomen that it is impossible to perform a conventional orchidopexy. The authors report an experience of 5 cases of testicular autotransplantation achieved by temporarily severing the testicular vessels and then reanastomosing them to the inferior epigastric vessels using a microsurgical technique with an operating microscope at 25 times magnification. Compared to traditional methods, autotransplantation permits an easy replacement of an ectopic testis into the scrotum and a more physiological blood supply to the testis. The authors discuss surgical and microsurgical techniques, testicular ischemia time and follow-up of patients who have undergone autotransplantation.     

Testicular microlithiasis occurring in postorchiopexy testis

Testicular microlithiasis occurring in a postorchiopexy testis is described. The histologic characteristics of this uncommon entity are presented, and its etiology and clinical significance are briefly reviewed.     

Seminoma of intra-abdominal testis in sixty-seven-year-old man

A sixty-seven-year-old man found to have a seminoma of an undescended intraabdominal testis is believed to be the oldest reported patient with this presentation. This case emphasizes the importance of careful palpation of the testis as part of the routine physical examination at any age. Testicular tumor or metastases should be included in the differential diagnosis of retroperitoneal mass.