The incidence of complications following primary inguinal herniotomy in babies weighing 5 kg or less

The aim of this study was to quantify the incidence of complications following inguinal herniotomy in small babies weighing 5 kg or less. This was a retrospective review of inguinal herniotomies performed in our unit between December 1997 and March 2002 on babies weighing 5 kg or less. A total of 154 patients underwent hernia repair, of which 125 patients (221 hernias) were available for review (81%). The median weight at surgery was 3.6 kg (range 1.7–5 kg) and 84 patients (67%) were classified as premature (< 36 weeks gestation). Thirty-three patients presented with an irreducible hernia, in whom all but one were successfully reduced prior to surgery. Patients were reassessed at a clinic following surgery and follow-up data was obtained from the clinic notes after a median follow-up of 3 months (range 1–60 months). Five cases of hernia recurrence occurred in four patients (2.3%) and the incidence of testicular atrophy was 2.7% (six patients). In the testicular atrophy group, four of the six patients presented with an incarcerated hernia and of these, three were noted to have evidence of ischaemia at operation. There were six cases of high testes requiring subsequent orchidopexy (2.7%). Although neonatal inguinal herniotomy is a technically demanding procedure, this series has demonstrated a low complication rate. Testicular atrophy was associated with a history of preoperative incarceration in the majority of cases.     

小儿精索静脉曲张的腹腔镜治疗及随访

目的探讨腹腔镜在小儿精索静脉曲张中的治疗作用，以及保留或切断睾丸动脉对睾丸功能的影响。方法采用腹腔镜技术对32例患儿行睾丸动、静脉高位结扎术。其中，26例保留睾丸动脉．6例切断睾丸动脉。结果术后1～3个月．29例阴囊内曲张的静脉团块完全消失。术后6个月时．24例患侧睾丸体积增加约20％～30％；15～24个月时，患侧睾丸发育程度与对侧相比，没有明显差异。所有患儿均未发生睾丸萎缩。结论应用腹腔镜技术行睾丸动、静脉结扎切断术，创伤小．并发症少。保留或切断睾丸动脉，对睾丸的发育没有明显影响．但其远期效果需进一步随访。     

腹腔镜睾丸下降固定术后睾丸萎缩的超声评估

目的 探讨超声检查对腹腔镜睾丸下降固定术后睾丸萎缩的评估价值,尝试建立睾丸萎缩的超声评分方法.方法 分别用腹腔镜行直接睾丸下降固定、Fowler-Stephen Ⅰ或Ⅱ期治疗不可触及隐睾,术后从不同时段对睾丸的体积(无改变、轻微缩小、明显缩小10%以上)、回声(均匀、不均匀)、边界(清晰、模糊、难确定)、实质内微结石(无、散在、弥漫)及血供(清晰、减少、无)等五方面的超声改变来评估睾丸萎缩情况,据此建立相对应超声评估方法,将术后睾丸萎缩进行分级:0级(无萎缩)、Ⅰ级(部分萎缩)、Ⅱ级(完全萎缩).结果 共施行43例(56侧)手术,超声检查能清晰反映睾丸内在情况,术后3～6个月睾丸的超声表现趋于稳定,睾丸萎缩0级42/56(75.0%)、Ⅰ级12/56(21.4%)、Ⅱ级2/56(3.6%).结论 超声检查可在术后3～6个月较为客观地评估腹腔镜睾丸下降固定术后睾丸萎缩情况;本文介绍的超声睾丸萎缩评分方法可应用于临床.     

Effects of laparoscopic division of spermatic vessels on histological changes of testes: long-term observation in the model of prepubertal rat

Laparoscopic Fowler-Stephens and Palomo procedures are now commonly performed in children with high positioned intra-abdominal cryptorchidism and varicocele, respectively. During the procedures, the spermatic vessels are ligated and therefore the question of risk related to testicular atrophy is often raised. The long-term follow-up of the histology after the procedures is rare. In this study, we simulated a laparoscopic spermatic vessels clipping and division (SVCD) in a prepubertal rat model, and examined the histological alterations of the testes with regard to spermatogenic arrest between prepuberty and middle age. Thirty-day-old Wistar rats divided randomly into three groups underwent laparoscopic sham operation, unilateral SVCD and unilateral SVCD with additional contralateral orchiectomy, respectively. Histological investigations observed on semithin and paraffin sections were performed at seven different postoperative intervals between day 9 and day 540. We defined partial, most and complete spermatogenic arrest of the seminiferous tubules to correspond with mild, severe spermatogenic arrest and atrophy, respectively. Laparoscopic SVCD induced testicular spermatogenic arrest in a total of 85% of the operated testes with different severity; 27% of operated testes with mild or severe spermatogenic arrest were seen between puberty and middle age (day 45–540 postoperative), and their size was only slightly reduced. Of the operated testes, 51% showed atrophic signs with a striking decrease in size, and their contralateral testes revealed in all cases mild or severe spermatogenic arrest started as early as day 45 postoperatively. Parallel to the spermatogenic arrest, Leydig cell hyperplasia developed frequently in impaired testes, especially in those without contralateral testes, finally reaching a typical adenoma size. Laparoscopic SVCD in prepubertal rats could disturb spermatogenesis with differing severity in most cases. This impairment could persist from peripuberty to middle age, and even involve the contralateral testes, in the case of operated testes and show complete spermatogenic arrest. This study showed that laparoscopic SVCD may have high risk in compromising the operated testis.     

Experience with laparoscopy in nonpalpable testis.

AIM: The aim of this study was to investigate the feasibility and benefits of diagnosis and interventional laparoscopy in those paediatric patients with nonpalpable testes (NPT). PATIENTS AND METHODS: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated. RESULTS: According to the laparoscopic findings 4 groups of testes were identified: Vanishing testis (n = 32), low abdominal testis (< 2 cm to the internal ring) (n = 26), high abdominal testis (> 2 cm to the internal ring) (n = 24) and intersex patients (n = 4). Of the first group, 19 testes (one bilateral) had blind-ending spermatic cord and vessels and if an atrophic testicular tissue was identified, it was removed laparoscopically. For those with spermatic cord and vessels beyond the internal ring (13 testes), atrophic testes were removed through a high scrotal incision. 19 testes of the second group had a laparoscopy-assisted orchidopexy. In the same group a laparoscopic orchidopexy was performed on 7 testes. 24 testes in the 3rd group had a Fowler-Stephens (FS) stage 1 and 18 testes had a laparotomy performed for FS stage 2 procedure (laparotomy and orchidopexy) after 6 months. At laparotomy there was no evidence of testicular atrophy in all but one testis, which was removed and the FS stage 2 procedure was completed in 17 testes. The follow-up period was between 6 months and 4 years, and two more testicular atrophies were noted after FS stage 2. The results were satisfactory in 15 out of 18 testes (83%). In the intersex group, the patient with testicular feminization underwent laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified as having an uterus and two intraabdominally located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes, confirming the diagnosis of a true hermaphrodite. CONCLUSION: We are of the opinion that laparoscopy decreases the number of laparotomies in NPT, allows a single-stage procedure in low abdominal testis, and facilitates clip ligation of the testicular artery in high abdominal testis. Laparoscopy also provides diagnostic and therapeutic options for vanishing testis and intersex patients.     

Division of the genitofemoral nerve in normal scrotal testicular rats

The role of the genitofemoral nerve (GFN) on testicular descent has been clearly shown. It has also been suggested that in unilateral cryptorchid rats, after division of the ipsilateral GFN fertility rates are higher, i.e., transection of the GFN prevents contralateral testicular damage, but the mechanism is unclear. The purpose of this study was to investigate the effect of dividing the GFN on the normal scrotal testes. Thirty male Wistar albino rats were divided into three groups: group A, transection of right GFN; group B, bilateral transection of the GFN; and group C, sham operations, all at the age of 30 days. The animals were killed at 90 days of age and the testes were removed. Each excised testis was weighed and fixed for histological studies. Mean seminiferous tubular diameter was measured and germinal epithelium maturity was determined using the modified Johnsen testicular-biopsy score. In all groups, all three parameters were similar, suggesting that division of the GFN had no effect on normal testes. Accepted: 12 January 2000     

Reoperative orchiopexy: surgical aspects and functional outcome

Over a 14-year period, a total of 40 patients underwent surgical revision after an unsuccessful orchiopexy attempt. Overall, 34 reorchiopexies (1 bilateral) and 7 orchiectomies were performed. All reorchiopexies were carried out using extensive mobilization of the testis and spermatic cord. This approach was sufficient for scrotal placement of the testis in 23 instances; however, it was necessary to transpose the spermatic vessels medially in the remaining 11 (incision of the transversalis fascia in 5, incision of the transversalis fascia and division of the inferior epigastric vessels in 6). Only 1 prepuberal boy developed testicular atrophy (2%). Functional long-term assessment was done in 20 postpuberal patients using testicular ultrasound and sperm analysis. The reoperated cryptorchid testes were significantly smaller than the controls (P < 0.005), but decreased fertility was only noted in 3 patients (18.7%). We conclude that testicular volume in adulthood is not directly related to fertility, so that accurate reorchiopexy seems to be the best way to preserve fertility in this special group of cryptorchid patients. Accepted: 20 April 2000     

腹腔镜下精索血管高位离断后大鼠睾丸的形态学改变

目的观察腹腔镜FowlerStephens(FS)手术对青春发育前、中、后期睾丸形态结构的影响。方法30d龄Wistar大鼠麻醉后建立CO2气腹,分别行右侧精索血管游离术(对照组)、右侧腹腔内精索血管离断术(FS组),术后将每大组大鼠再分成7个小组(对照组每小组5只;FS组每小组8～12只),分别在术后第9d(青春发育期前)、20d和45d(青春发育期)、90d和180d(性发育成熟期)、360d和540d(中年期),获取睾丸进行详尽的组织形态学研究。结果FS手术可以引起术后不同时期共85%手术侧睾丸出现轻度(血睾屏障受损为主)、重度(唯支持细胞综合征为主)和完全萎缩(丧失睾丸基本结构,无生殖细胞存活);当轻度或重度萎缩,对侧睾丸未受累;当完全萎缩(49%),对侧睾丸在手术45d后,100%出现轻度(青春发育期后)或重度(中年期)萎缩;间质细胞增生或腺瘤可发生于轻、重和完全萎缩睾丸中(P<0.001)。结论腹腔镜FS动物模型可用幼年大鼠建立;该手术可以引起从青春发育前期至中年期较高比例、不同程度的睾丸萎缩,其中完全萎缩可以影响到对(健)侧睾丸,而可能引起青春发育期后生殖力下降或丧失;睾丸间质肿瘤可以较高比例地发生于不同程度萎缩睾丸中。     

超声检查在大鼠腹腔镜Fowler-Stephens术后睾丸萎缩中的诊断价值

目的　探讨超声检查包括灰阶影像和能量多普勒在大鼠腹腔镜Fowler Stephens(F S)术后睾丸萎缩中的诊断价值。方法　 30d龄幼年Wistar大鼠行腹腔镜下右侧F S术 (精索血管腹腔内离断 ) ,术后从 9～ 5 4 0d 7个时段 (青春发育前期至中年期 ) ,分别用睾丸触诊和超声检查来判断睾丸萎缩情况 ,并与组织学检查结果进行对比。结果　腹腔镜F S术后该三种检查的睾丸萎缩检出率分别为 6 6 .7%、6 9.4 %和 84 .7% (P <0 .0 5 )。按超声诊断睾丸萎缩可分为三度 (0、Ⅰ、Ⅱ ) ,其相应组织学变化分别为正常或轻度萎缩、重度萎缩和完全萎缩。超声检查对重度和完全睾丸萎缩的检出率为 96 .0 %。用超声检查观察睾丸体积、边界、内部回声均匀情况、微结石和血流信号等指标可最早在术后 9d和 4 5d发现组织学上表现为完全萎缩和重度萎缩的睾丸。而睾丸触诊仅能发现术后 4 5d及其后的完全睾丸萎缩。结论　用超声检测睾丸体积、内部回声均匀于否、微结石和血流下降等指标能无损伤、客观地反映F S手术后不同阶段睾丸萎缩情况。F S术后的常规检查应为超声而非触诊     

Balloon inflation-created subdartos pouch during orchiopexy: a new simplified technique

Purpose  Creation of subdartos pouch is an integral part of orchidopexy. The objective of this study was to describe and evaluate the results that can be achieved by using a new simplified technique (creation of subdartos pouch by balloon inflation of small sized Foley’s or Fogarty catheter during orchiopexy). Materials and methods  Seventy-five boys with undescended testicle had been operated upon at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia in the period from April 2007 to April 2008. The technique will be described in detail. All patients were followed up for 12 months on average, range (2–12) months. Results  They were 75 boys with undescended testicle, 53(71%) palpable cases [48(64%) unilateral, 5(7%) bilateral] and 22(29%) impalpable cases [20(26%) unilateral, 2(3%) bilateral]. Mean age of 13 ± 1.47 months (range, 9–36 months). The mean operative time was 11.5 ± 1.12 min. (range, 10–15 min) for each orchiopexy; whereas, the mean operative time for creation of subdartos pouch was 23.7 ± 1.12 s (range, 20–30 s). There were no intraoperative or early postoperative complications (hematoma or infection). There was no evidence of testicular atrophy by testicular ultrasound among cases of palpable testes. Only two testes among the cases of impalpable testes became smaller in size but viable after 12 months. However, almost all families were happy with good esthetic appearance of the scrotum. Conclusion  The new technique of balloon inflation-created subdartos pouch during orchiopexy is an easy, safe bloodless and quick technique with good cosmetic outcome.     

Testicular torsion: a 15-year single-centre clinical and histological analysis

Aim: This study reviewed the demographic, epidemiological and clinical factors of boys seen at a single centre who underwent surgical exploration for testicular torsion. Methods: Retrospective single‐centre review of boys with testicular torsion between 1996 and 2011 was made. Results: Testicular torsion (right n = 43, left n = 60, bilateral n = 1) was identified in 104 boys between 0 and 18 years. Ten newborns presented with 11 intrauterine torsions. Nine torsions presented in undescended inguinal testes (one intrauterine). In 94 boys with descended testes, presentation included pain (76%), scrotal swelling (65%) and abdominal symptoms (22%). Ultrasonography was performed in 85 patients with false‐negative results in 4 (4.7%). Orchiectomy was performed during initial exploration in 41, with significantly higher rates of orchiectomies in patients with late (>6 h) versus patients with early referrals (<6 h) (56% vs. 9.1%). Histological evaluation was carried out in 68 testes, with 43 resected testes demonstrating haemorrhagic necrosis. In 25 biopsied testes, histology revealed acute parenchymal bleeding (n = 14), onset of parenchymal infarction (n = 8), orchitis (n = 1) and normal tissue (n = 2). Eighty‐two patients were followed up with pathological findings in four patients: testicular atrophies requiring orchiectomy (n = 2), testicular autolysis (n = 1) and small testicular vein thrombosis (n = 1). Conclusion: Chances of testicular salvage after torsion are higher if patients present early. The majority of patients presenting late (>6 h) require orchiectomy owing to testicular necrosis.     

Comparative studies of fertility and histologic development of contralateral scrotal testes in two rat models of unilateral cryptorchidism

 Fertility and the development of the contralateral scrotal testis in patients with unilateral cryptorchidism (UCO) remain controversial. This study investigated these controversies in two different UCO rat models using 43 Wistar King A rats. The animals were divided into three groups: I: an endocrinologic model of UCO was obtained by injecting pregnant dams with flutamide 100 mg/kg per day on days 15–17 of gestation (n = 12); II (n = 21): a mechanical model of UCO was obtained by extra-abdominal fixation of the gubernaculum in the neonatal period, III (n = 10): non-treated rats were used as controls. At the age of 90 days, 5 rats from each group were segregated into individual cages and housed with two virgin adult females for 2 weeks. The occurrence of pregnancy and litter sizes were counted in order to study fertility. All the animals were then weighed and killed. The occurrence of testicular descent, growth of the external genitalia, and epididymal development were examined. Morphologic and histologic evaluations were performed in the cryptorchid and contralateral testes. In the endocrinologic model (group I) the 10 female rats failed to show any offspring (0%), while in the mechanical model (group II) 9 out of 10 rats had offspring (90%, P < 0.001); 10 out of 10 control rats showed offspring. All of the rats in groups I and II had UCO, and the undescended testes were located in the superficial inguinal position, while the contralateral and control testes descended into the scrotum. Hypospadias and a small epididymis were frequently noted in the flutamide-treated rats. Testicular weight, seminiferous tubular diameter, and spermatogenesis were all significantly reduced in the undescended testes (UDT) compared to the contralateral and control testes. Moreover, the development of the contralateral testis was inhibited in group I compared to groups II and III. Our observations showed that short-term exposure to flutamide in utero induced significantly reduced fertility and degenerated contralateral scrotal testes in UCO rats compared to mechanically-induced UCO rats by early adulthood. It is suggested that fertility potential and testicular development in unilateral UDT may be partially due to the factors that induce testicular maldescent, especially in cases due to intrauterine hormonal abnormalities. These cases may show inhibited fertility and testicular development even after orchiopexy. Accepted: 3 February 2000     

别嘌呤醇对睾丸扭转的治疗作用

目的 研究睾丸扭转以后组织的受损情况，观察别嘌呤醇药物对睾丸扭转的治疗意义。方法 以大鼠为研究对象，测定一侧睾丸扭转后两侧睾丸组织的脂质过氧化物含量。按扭转时间分组，分析睾丸扭转、复位、药物应用以后局部的损伤变化情况。结果 单侧睾丸扭转以后，两侧组织的脂质过氧化物含量都明显上升。脂质过氧化物的含量与扭转时间有关。别嘌呤醇应用后，能降低扭转2h以内的两侧睾丸脂质过氧化物产量，以及扭转6h以内的对侧睾丸脂质过氧化物含量。结论 别嘌呤醇对改善睾丸扭转损伤有治疗意义，临床上应提倡早期用药。     

Single stage Fowler–Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes

In this present study we aimed to discuss the surgical efficacy of single stage Fowler–Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.     

Laparoscopy for the impalpable testes: Experience with 80 intra-abdominal testes

ObjectiveTo evaluate two-stage laparoscopic Fowler–Stephens (FS) orchidopexy for intra-abdominal testes.Materials and methodsA retrospective analysis was performed of the clinical findings, interventions and outcomes in 111 boys undergoing laparoscopy for 132 impalpable testes.ResultsThe median age was 5.7 years (1.1–14.6 years). Twenty-seven testes were absent. Eighty testes were intra-abdominal, of which 10 were removed laparoscopically due to anatomical anomalies (4), short spermatic cord (5) or atresia (1). Twenty-five testes were located in the groin. Laparoscopic FS procedure was performed for 65 intra-abdominal testes: 60 two-stage operations and five where the testes were removed during FS second stage due to short vas or testicular atrophy. Outcome was successful in 80%. One-stage laparoscopic orchidopexy without vessel division was performed in five intra-abdominal testes with satisfactory results in three. In general, the success rate is higher in boys with bilateral intra-abdominal testes, probably due to younger age at operation.ConclusionsAt our centre two-stage laparoscopic Fowler–Stephens orchidopexy for intra-abdominal testes showed results comparable to most other studies, but less satisfactory than a couple of recent studies. The median age at referral was higher than recommended. Operation at an earlier age may further improve the results.     

Spermatic venography in undescended testes

In patients with undescended testes the demonstration of the pampiniform plexus (i.e. venous network surrounding the testis) by selective retrograde contrast filling of the internal spermatic vein gives exact information about the existence and localization of the gonadal tissue. Especially with small hypoplastic testes and/or an intraabdominal position of the gonad the results of this technique are superior to those of ultrasound and computed tomography. The venographic information often helps to reduce the extent of the surgical exploration, most of all in those cases in which after an ineffective first procedure a second operation is planned. Venography can be done on an outpatient basis in children from an age of about 6 years upwards without general anesthesia and serious complications. Personal experiences with the spermatic venography in 11 patients (age: 7–32 years) with 18 undescended testes are demonstrated. Comparing the roentgenologic and surgical findings in 7 patients with 12 explored veins the results corresponded completely in 75%. In the remaining cases roentgenologic demonstration of one of the testicular veins with its pampinifom plexus suggested important information about the localization of the contralateral testis, surgically confirmed later.     

Effect of diclofenac on germ cell apoptosis following testicular ischemia-reperfusion injury in a rat

Recent evidence suggests that enhanced cell apoptosis is responsible for germ cell loss following testicular ischemia-reperfusion (IR) injury. A nonsteroidal anti-inflammatory drug diclofenac sodium (Voltaren) is a prostaglandin-synthesis inhibitor, which is widely used in many testicular disorders. The purpose of the present study was to examine the effect of diclofenac (DIC) on germ cell apoptosis in the ischemic and contralateral testes following testicular IR in a rat. Forty rats were divided randomly into four experimental groups of ten rats each: group A (Sham)—Sham operated animals; group B (Sham-DIC)—Sham operated rats that were treated with DIC given subcutaneously at a dose of 10 mg/kg, once daily, 24, 48 and 72 h following operation; group C (IR) underwent 90 min of unilateral testicular IR; group D (IR-DIC)—rats underwent 90 min of unilateral testicular IR and were treated with DIC similarly to group B. Ninety-six hours following operation, the rats were sacrificed and testes were harvested. Johnsen’s criteria and the number of germinal cell layers were used to categorize the spermatogenesis. TUNEL assay was used to determine germ cell apoptosis in both the ischemic and contralateral testes. Statistical analysis was performed using the non-parametric Kruskal–Wallis ANOVA test, with P less than 0.05 considered statistically significant. Testicular ischemia in rats led to histological damage in the ipsilateral testis. In the contralateral testis, minimal damage was observed. Germ cell apoptosis in both the ischemic and the contralateral testes increased significantly after IR. Treatment with DIC did not change histologic parameters of spermatogenesis in both the ischemic and contralateral testes, but decreased germ cell apoptosis in both testes following testicular IR. We conclude that testicular ischemia causes an increase in germ cell apoptosis in the contralateral testis. Diclofenac may be beneficial for spermatogenesis following testicular IR by decreasing germ cell apoptosis.     

腹腔镜下高位隐睾Ⅰ期下降固定术的探讨

目的 探讨高位隐睾腹腔镜I期固定术的应用.方法 回顾性研究2005年1月至2008年3月间所收治的35例高位隐睾患儿,年龄1～15岁,平均年龄2.6岁.左侧20例,右侧12例,双侧3例,总计38侧.根据睾丸位置高低,腹腔镜辅助下行精索松解I期睾丸固定或Fowler-Stephens(FS)I期睾丸固定手术.结果 在35例(38侧)患儿中,有33例(34侧)为低位腹腔内隐睾(89.5%),2例4侧(10.5%)为腹腔内高位隐睾.其中的34侧腹腔内低位睾丸及1侧高位睾丸经过松解精索血管或FSI期手术,将睾丸固定于患侧阴囊内;3侧高位睾丸经过松解精索血管I期将睾丸固定于外环口外与阴囊上极之间.手术成功率为92.1%.随访3～24个月(平均6个月),100%睾丸血运好无萎缩.结论 高位隐睾腹腔镜Ⅰ期固定手术效果良好,手术微创.     

Laparoscopic treatment of varicoceles in children. Multicentric prospective study of 90 cases.

PURPOSE: The aim of this study was to assess the results of the laparoscopic treatment of varicoceles. MATERIAL AND METHODS: 92 observations were received, however 5 patients underwent a simultaneous associated open surgery; 90 varicoceles were evaluated (3 bilateral varicoceles). The dilated spermatic veins were treated by clips and partial resection in 74.7 %, by coagulation and partial resection in 21 %, and by clips in 4.3 %. The spermatic artery was ligated in 60 varicoceles and preserved in 28; in 2 cases it was not specified. The results were studied with a mean follow-up of 11.1 months (2 to 36 months). RESULTS: The varicocele disappeared in 76 cases (84.4 %) and diminished significantly in 12 cases (13.2 %) where it was large before treatment. Two middle-sized varicoceles were not modified by the treatment. Therefore, the results must be considered good or excellent in 97.6 % of cases. The spermatic artery was preserved in 28 cases and the size of the varicocele was not good in 9 (32.1 %); it was ligated in 60 cases and the size of the varicocele was not good in 5 cases (8.4 %) -- p < 0.01. In 42 cases the testicular size was noted before and after treatment, and likewise the conservation or not of the spermatic artery; the 30 artery ligations produced no testicular atrophy; only 3 hypotrophic testes were noted with a loss of size of between 8.4 and 59 % with regard to the contralateral testis. In 27 cases, the testicular size remained normal or increased if it was hypotrophic before treatment; there was a good result in 90 % of cases with no atrophy. When the spermatic artery was preserved (12 cases), 1 hypotrophy occurred with a loss of size of 16.7 % -- NS. CONCLUSION: The laparoscopic treatment of varicoceles is an efficient technique and the complete ligation of the whole vascular spermatic pedicle above the vas deferens offers excellent success, without atrophy.     

Distributions of substance P- and VIP-immunoreactive nerve fibres in the colonic circular muscle in children

In children with severe chronic constipation, abnormal distribution of substance P (SP) and vasoactive intestinal peptide (VIP), which represent excitatory and inhibitory nerves, respectively, has been reported. The normal distribution of these neuropeptides, however, is not well known. The aim of this study was to determine the populations of SP- and VIP-immunoreactive nerve fibres in the circular muscle of the colon in children. Surgically resected specimens were collected from a 6-year-old girl with familial polyposis coli (total colon) and nine patients with anorectal malformations aged 0–4 years (sigmoid colon). Double-labelling immunofluorescence was employed using neuron-specific enolase (NSE) with SP and NSE with VIP to count the percentage of SP- or VIP-labelled nerve fibres. These specimens showed normal submucous and myenteric plexuses stained with NSE. The population of SP- immunoreactive fibres was 15%–21% throughout the colon, and VIP was 39% in the caecum and 63%–65% in the transverse, descending, and sigmoid colon. In the four neonatal specimens (day 1 to 4), the SP population was only 1%–6% and the VIP population was also low (22%–33%). After 3 weeks of age, the populations had stabilised at 18%–26% for SP and 52%–62% for VIP. SP-immunoreactive nerve fibres were scarce in the neonatal period, and showed a rapid increase by 3 weeks and a similar though less dramatic increase in VIP-immunoreactive fibres. VIP-immunoreactive fibres were fewer in the caecum that at other colonic levels, where they accounted for 60% of NSE-labelled fibres; the SP population, however, was comparable at all levels of the colon at about 20% of NSE-labelled fibres. Accepted: 28 April 1998