Age at orchiopexy for undescended testis in the United States

Purpose

Undescended testis (UDT) is the most common congenital anomaly of the male genitalia. The American Urological Association guidelines recommend orchiopexy by age 18 months to ameliorate the risk of subfertility. The study aim was to assess adherence to these guidelines on a national level.

Laparoscopy for impalpable testis: classification-based management

BACKGROUND: The undescended testis represents one of the most common disorders of childhood. The authors evaluated the safety and efficacy of laparoscopy for the abdominal testis and present a classification of the laparoscopic diagnostic findings to facilitate decision making. METHODS: Between 2000 and 2005, 95 patients (22 bilateral and 73 unilateral testes, for a total of 117 impalpable testes) with a mean age of 5 years underwent laparoscopy. The testis was managed according to a special classification of the diagnostic findings. Testicular position, size, and viability according to technetium-99m ((99m)Tc) were assessed during the follow-up evaluation. RESULTS: The laparoscopic findings were classified into six types: type 0 (no testis or vanished testis proximal to the internal ring; 9 patients [7.5%]); type 1 (atrophic intracanalicular testis; 6 patients [5.4%], for whom no further intervention was administered); type 2 (testis at the internal ring with looping vas; 15 patients [14.5%], for whom laparoscopic orchiopexy was performed); type 3 (testis at the internal ring without looping of the vas; 29 patients [24.7%], for whom laparoscopic orchiopexy also was performed; type 4 (high abdominal testes; 49 patients [41.9%], with Staged Fowler-Stephens orchiopexy performed for 47 testes and laparoscopic orchidectomy for 2 testes; and type 5 (persistence of Müllerian duct structures [PMDS] or other abnormalities; 7 testes [6%]). After a mean follow-up period of 3 years, the laparoscopic orchiopexy testes were of good size and viable, but four testes (8.7%) were at the neck of the scrotum. The laparoscopically staged Fowler-Stephens orchiopexy group showed atrophy in two testes (4.3%), and all were in the bottom of the scrotum. CONCLUSIONS: Classification of the laparoscopic findings facilitates decision making. Laparoscopic orchiopexy is a natural extension of diagnostic laparoscopy for the intraabdominal testis at the internal ring or that seen peeping from it. Laparoscopically staged Fowler-Stephens orchiopexy is the procedure of choice for the high intraabdominal testis not amenable to the one-stage procedure.     

Laparoscopic versus open orchiopexy in the management of abdominal testis: A descriptive study

AIMS: Treatment of patients with abdominal non-palpable testis (NPT) is still controversial among pediatric urologists. This is a prospective randomized comparative study between open and laparoscopic orchiopexy for management of abdominal testis. The aim of this study was to evaluate the success rate and morbidity of both approaches. METHODS: Eighty-two patients with a mean age of 5.3 years were evaluated by laparoscopy for 87 NPT. Patients with viable abdominal testes were randomly treated with either open or laparoscopic orchiopexy procedures. RESULTS: On laparoscopy, 75 viable abdominal testes were found. According to location: 41 (47.1%) testes were high abdominal, 27 (31%) testes were low abdominal and 7 (8%) testes were peeping from the internal ring. Laparoscopic first stage Fowler-Stephens orchiopexy was done initially for those with high abdominal testes. For further management, all patients were divided randomly into open (36 cases) and laparoscopic (39 cases) groups where primary (with spermatic vessel preservation) or second stage Fowler-Stephens orchiopexy was done. Statistical analysis was done using Student's t-test. Laparoscopic procedures showed significant less morbidity than the open counterparts. Follow up ranged from 9 to 31 months and included evaluation of testicular site and size. All testes were located satisfactorily inside the scrotum. Five cases of testicular atrophy were encountered (three and two testes with open and laparoscopic second stage Fowler-Stephens orchiopexy respectively) after 1 year follow up. CONCLUSION: Results of open versus laparoscopic orchiopexy procedures (primary or staged) are fairly comparable. However, laparoscopy provides significantly less morbidity.     

腹腔镜治疗高位隐睾18例报告

目的:探讨腹腔镜手术治疗高位隐睾的临床应用价值。方法:回顾分析18例患者的临床资料。结果:18例患者全部治愈,无1例中转手术,手术时间40~60min,平均50min,无并发症发生。住院3~7d,随访0.5~2年。结论:腹腔镜隐睾固定术可望成为治疗高位隐睾的首选方法。     

Autorevascularization of the testicle and spermatic vessels by bladder pedicle flap: an experimental study

Purpose

The aim of the study was to investigate revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap in rabbits.

Methods

Thirty male rabbits were used in the study. In 10 animals, the Fowler-Stephens (FS) procedure was applied to the right testicles (FS group). The FS procedure and revascularization of the testicle by a bladder pedicle flap were applied to the right testicles in 10 animals (FSO group). No surgical procedure was performed in the control group. Scintigraphic study was performed 3 weeks after the high ligation procedure in the FS and FSO groups. Both testicles were evaluated by radionuclide scintigraphy in all the animals. Macroscopic testicle weights were evaluated. Testicular biopsy scores and mean seminiferous tubule diameters were determined in the histopathologic study.

Results

The testicular blood flow of the FSO group was better than the FS group (P < .05), but there was no statistically significant difference between the FSO and the control groups (P > .01). Testicle weights, testicular biopsy scores, and seminiferous tubule diameters in the FSO group were detected, and there was a statistically significant difference when compared with the FS group (P < .05) but not with the control group (P > .01).

Conclusion

We suppose that the surgical model of revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap can be an alternative to the FS procedure in abdominal and high canalicular undescended testicles.     

Results of the use of autotransplantation of the intraabdominal testis using microsurgical vascular anastomosis

This study indicates that where facilities are available, the use of autotransplantation of the intraabdominal testis with microsurgical anastomosis to vessels of the groin is an acceptable, and possibly the best, alternative to orchidectomy for the intraabdominal testis. It is certainly justifiable in the case of the bilateral intraabdominal testis but in the case of the unilateral intraabdominal testis with a normally descended and apparently normal testis in the opposite hemiscrotum, the incresed incidence of neoplasia in intraabdominal testes should be taken into account in the decision on the method of treatment.     

A longitudinal follow-up using the high trans-scrotal approach for inguinal and scrotal abnormalities in boys

The popular incision for surgical approach to pediatric inguinal pathologies has been the suprapubic transverse inguinal incision. Yet alternative incisions may be considered. A prospectively randomized study of a consecutive series of 256 male infants and children with various inguinal pathologies (mainly indirect inguinal hernias) were treated surgically using the "high trans-scrotal skin-crease incision," over a period of 84 months (7 years) and were compared and found to be clinically better than age- and sex-matched 278 controls with suprapubic transverse inguinal incisions for wound healing/infection, edema, seroma, hematoma, malpositioning or atrophy of testes and recurrence of the primary pathology. The results in the study group were cosmetically and clinically more favorable, and better than the control group. Nosocomial infections, complications of incarceration, and emergency surgery have resulted in an acceptable morbidity rate of approximately 5%. Popularized use of the high trans-scrotal incision and further clinical experience is recommended to facilitate even better results.     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例(52条)四肢血管损伤患者,男35例,女9例,年龄14~58岁,平均27·3岁,分别采用自体血管(42条)和人造血管(10条)移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例（52条）四肢血管损伤患者,男35例,女9例,年龄14⁵8岁,平均27·3岁,分别采用自体血管（42条）和人造血管（10条）移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

A stereological study of the effects of experimental inguinal cryptorchidism and subsequent orchiopexy on spermatogenesis in adult monkeys

Our previous study demonstrated that experimental intra-abdominal cryptorchidism in adult rabbits for 13 weeks resulted in severe spermatogenic arrest: type A spermatogonia was the only germ cell type seen in the seminiferous epithelium and its number per testis was reduced by 84%. Seven weeks following orchiopexy, the type A spermatogonial number returned to the near-normal range in most animals and spermatogenesis partially recovered (Reproduction 2002, 124, 95-105). This study aimed to determine whether inguinal cryptorchidism would produce less-severe damage to spermatogenesis and whether subsequent orchiopexy would better restore spermatogenesis. Five normal adult male rhesus monkeys (Macaca mulatta) underwent bilateral artificial inguinal cryptorchidism. Half a year later, one testis together with the ipsilateral epididymis were removed from each animal and then unilateral orchiopexy was performed on the contralateral side, with the remaining testis and epididymis being removed another half a year later. A contemporary unbiased and efficient stereological tool, the optical disector, was used to estimate numbers of all types of spermatogenic cells in the testis and spermatozoa in the epididymis. Spermatogenic arrest was induced by cryptorchidism at the stage of spermatogonia (n = 1), spermatocytes (n = 2) or early spermatids (n = 1), with the type A spermatogonial numbers per testis being reduced to 14.8-57.2% of the control average; in one of the five cryptorchid animals, however, spermatogenesis remained normal. Subsequent orchiopexy, which was successfully performed on two animals with cryptorchidism-induced spermatogenic arrest, brought on a full or partial recovery of spermatogenesis. In conclusion, inguinal cryptorchidism induces less severe (in comparison with an intra-abdominal one) and variable damage to spermatogenesis, which is restored, at least in part, by subsequent orchiopexy.     

Techniques for coverage of infected vascular grafts in the groin

Plastic surgeons expertise is requested for treatment of vascular graft exposures. Exposure within the femoral triangle (Scarpa) represents the majority of those cases.

We intend to share our experience in the coverage of exposed vascular grafts: through the most common and safe procedures we are currently using, illustrated by some of our clinical cases. Our experience leaded us to formulate some guidelines and conclusions, to ensure vascular surgeons that coverage of a vascular graft can always be successfully done.     

Identification of a novel testis-specific gene and its potential roles in testis development／spermatogenesis

Aim: To identify and characterize a novel gene with potential roles in testis development and spermatogenesis.Methods: A cDNA microarray was constructed from a human testis large insert cDNA library and hybridized with probes of human or mouse adult and fetal testes. Differentially expressed genes were isolated and sequenced. RT-PCR was used to test the tissue distribution of the genes of interest and in situ hybridization was performed to localize the gene expression in the mouse testis. A range of bioinformatical programs including Gene Runner, SMART, NCBI Blast and Emboss CpGPlot were used to characterize the new gene‘s feature. Results: A novel testis-specific gene,NYD-SPS, was differentially expressed in fetal and adult testes. The deduced protein structure of NYD-SP5 was found to contain an IQ motif (a short calmodulin-binding motif containing conserved lie and Gin residues), a Carbamate kinase-like domain, a Zn-dependent exopeptidase domain and a lactate dehydrogenase (LDH) C-terminal-like domain. RT-PCR analysis revealed that NYD-SP5 was predominantly expressed in the testis but not in other 15 tissues examined. In situ hybridization and RT-PCR examinations revealed that the expression of NYD-SP5 was confined in the male germ cell but not present in the somatic cell in the testes. Conclusion: NYD-SP5 is a newly found testisspecific gene with potential roles in testis development and spermatogenesis through a calmodulin-activated enzyme.     

A novel technique for reinforcing the neourethra in hypospadias associated with bilateral undescended testis: use of the gubernaculum

The authors present 3 cases of proximal hypospadias associated with bilateral undescended testes (UDT) in which the gubernaculum was used to reinforce the neourethra to prevent urethrocutaneous fistula. This is the first report of the gubernaculum being used to reinforce the neourethra. The technique is simple and should be applicable to any hypospadias patient with concomitant UDT, especially in severe hypospadias. Good outcome is likely because of the excellent blood supply of the gubernaculum.     

一蒂串联皮瓣在手外科的应用

目的探讨一蒂串联皮瓣在手外科的应用价值。方法临床应用胫前-足背动脉及伴行静脉为蒂的前踝上皮瓣及足背皮瓣4例,胫后-足底内侧动脉及其伴行静脉为蒂的小腿内侧皮瓣、足内侧皮瓣5例。皮瓣的平均面积依次分别为16cm×8cm、15cm×7cm、10cm×9cm和9cm×6cm。结果9个病人所有皮瓣全部成活,较好地覆盖了手掌及手背或前臂大面积皮肤缺损。皮瓣质地薄,不臃肿。结论一蒂串联皮瓣是修复大面积手掌、手背皮肤缺损的有效方法;具有手术风险相对较低,手术成功率高的优点;但由于对小腿及足破坏较大应严格掌握适应证。     

Y-V血管蒂延长技术在(足母)甲瓣供区修复中的应用

目的 探讨Y-V血管蒂延长技术在<足母>甲瓣供区修复中的应用方法与效果.方法 15例躅甲瓣移植供区接受了局部岛状皮瓣修复手术,其中选用跗外侧皮瓣修复9例,选用跗内侧皮瓣5例,选用足底内侧皮瓣1例,所有皮瓣的血管蒂切取均采用了Y-V血管延长技术.结果 15例修复供区的逆转皮瓣全部成活,其中1例足底内侧皮瓣术后静脉危象,经局部放血3 d后恢复正常.术后随访6～12个月,平均10个月,修复后的躅趾长度接近正常,外观平整无臃肿,局部无溃疡和瘢痕形成,穿鞋和行走功能无影响.在3种皮瓣中,以跗内侧皮瓣修复效果最为满意.结论 Y-V血管延长技术用于<足母>甲瓣供区修复中,能使常规方法不能转移的足部局部皮瓣扩大应用范围,取得满意疗效.     

Variation in the vascular anatomy of anterolateral thigh flap and its management

The anterolateral thigh flap is one of the well-known flaps. Various types of tissues can be incorporated into this flap and can be used to reconstruct defects from head to toe. Its variable vascular anatomy is well known. We encountered two vessels of good caliber from different sources supplying the flap. Our suggestion is to anastomose both the vessels to two recipient vessels to improve the flap circulation as clamping the vessels stopped the perfusion of corresponding regions of the flap.     

Malignant mesothelioma of the tunica vaginalis testis: Report of a case

(Received for publication on Aug. 27, 1998; accepted on Mar. 11, 1999)