高位隐睾应用“长袢输精管”睾丸固定术12例报告

对于高位隐睾不能Ⅰ期手术降入阴囊者采用了“长袢输精管”固定术,共治疗12例17侧隐睾,16侧效果满意。随访中对睾丸部位、大小、弹性作了估价。认为手术成功的关键在于高位切断精索、保留输精管血管及睾丸引带侧支。     

Pattern of presentation and management of patients with undescended testis at Kilimanjaro Christian Medical Center,Tanzania

ObjectiveTo assess the pattern or presentation, management and advice given to the parents or guardians of patients with undescended testes (UDT) at Kilimanjaro Christian Medical Center, Tanzania.Subjects and methodsFrom July 2010 to May 2011, 30 patients with UDT were prospectively evaluated regarding age at surgery, place of birth, information given to parents or guardians, side and site affected, results of ultrasonography, findings on surgical exploration, follow-up and surgical outcome.ResultsThe median age at surgery was 6 years (range 1–36 years), 4 patients (13.3%) had orchidopexy before 2 years of age, 6 (20%) before 5 years and 4 (13.3%) after 18 years of age. The UDT was on the right side in 56.7%, on the left side in 26.7%, bilateral in 16.7%, in the inguinal region in 70% and in the abdomen in 30%. An associated malformation was found in 53.5% of patients: a hernia sac in 13 (43.3%), hypospadias in 2 (6.7%) and a hydrocele in 1 (3.3%). The UDT was detected by the parents in 13 cases (43.3%), by the patient himself in 9 (30%) and by health care staff in 8 cases (26.7%). Only 10 parents (33.3%) received advice from health care staff: 6 were advised for surgery and 4 were advised to await spontaneous descent. Preoperative ultrasonography was false negative in 56% of cases. Orchidopexy was performed in 28 (93.3%) patients (the testis was secured in the scrotum in 23 and in the high inguino-scrotal position in 5), and 2 (6.7%) underwent orchidectomy. At 3-month follow-up the testes were situated in the scrotum (not retracted) in 25 patients (3 were lost to follow-up).ConclusionsThe late presentation detected in this study is alarming, because the majority of patients were diagnosed and treated after 2 years of age. The role of ultrasound in diagnosis of UDT is limited. Health care workers should perform neonatal examination to detect UDT and inform parents that early correction of UDT will decrease the risk of infertility and facilitate future examination to detect the development of testicular malignancy.     

Consequences of bilateral cryptorchidism in adults

Bilateral cryptorchidism treatment results are often shadowed by the majority of unilateral cases. We report the long‐term follow‐up results of boys treated for bilateral cryptorchidism during childhood. Patients treated in two main paediatric surgery centres were selected from medical registries and invited for a clinical examination including scrotal ultrasound, salivary testosterone measurement and a semen sample. Thirty‐six men (38.3%) replied to the written invitation, and 21 agreed to be examined. The mean age at orchidopexy was 74 months (range 24–138). Sperm count was 0.42 × 10⁶ (SD ± 0.64 × 10⁶) ml^?1. The correlation between total testicular volume and total sperm count was statistically significant (r = 0.481; P = 0.032). These results show that surgical treatment of bilateral cryptorchidism after the age of 2 years does not prevent infertility. Sperm count and endocrine evaluation advocated after the treatment of bilateral cryptorchidism in all adult patients.     

Transverse testicular ectopia

Described herein are six cases of transverse testicular ectopia. All patients who underwent orchidopexy at the one pediatric surgical unit between October 2001 and January 2008 were evaluated. The medical records of all patients diagnosed with transverse testicular ectopia were evaluated retrospectively. Five patients (84%) were admitted with a symptomatic right inguinal hernia and empty scrotum on the left side. Only one child (16%) had left‐sided hernia and right non‐palpable testis (age ranged from 1 month to 3 years). Four patients (66%) were diagnosed in the operating theatre and the last two (33%) on inguinal ultrasound preoperatively. Magnetic resonance imaging was also performed in the last patient. Herniorrhaphy with fixation of the ectopic gonad to the opposite hemiscrotum through a transseptal incision was performed in all patients. Postoperative complications were not observed.     

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.     

Previous testicular position in boys referred for an undescended testis: further explanation of the late orchidopexy enigma?

OBJECTIVE: To investigate the significance of the acquired undescended testis (UDT), which is differentiated into congenital and acquired forms, by assessing the previous testicular position in affected boys. PATIENTS AND METHODS: The study comprised 261 boys who had been referred for a non-scrotal testis to the outpatient clinic during an 8-year period (1993-2000). There was a bimodal distribution of age, with peaks at 2.0 and 10.0 years. In each boy with UDT the previous testicular position was ascertained. RESULTS: On referral, 340 testes were not in the scrotum (182 uni- and 79 bilateral). Of the 340 testes, 82 (24%) in 61 boys were diagnosed as retractile, whereas the remaining 258 in 221 boys were undescended. The previous testicular position was known in 208 of 221 boys (94%), with 244 UDTs. In 65 of these 244 (26.6%) the testis had never been scrotal (congenital UDT); in 179 (73.4%) a previous intrascrotal position was recorded in early childhood (acquired UDT) at least once, in 149 (61%) at least twice and in 117 (48%) at least three times. The mean age at referral for congenital UDT was 2.1 years and for acquired UDT was 8.4 years. CONCLUSIONS: These results show that acquired UDT is frequent, and occurs at about three times the rate of congenital UDT. Because these boys are referred for treatment later in childhood, the acquired UDT probably accounts for the high rate of (late) orchidopexy.     

Management of the impalpable testis: a six year review together with a national experience

The management of undescended testes remains variable, and the use of laparoscopy for localisation is controversial. This study reviews the need for laparoscopy and also assesses the current practice among a cohort of surgeons.A retrospective review of all patients undergoing orchidopexy was performed, together with a postal survey of all members of the Welsh Surgical Society. Of the 139 orchidopexies performed, the testis was deemed impalpable in 39 (28%) cases. All patients were treated with groin exploration, and only in two (5%) patients was the testis not located. From the survey, replies were received from 90 (81%) surgeons, of whom 65 (72%) were still performing orchidopexy. Forty eight (74%) surgeons performed orchidopexy between the age of 2 and 3, and only 32 (36%) performed preoperative investigations. The follow up period was variable with the majority of patients seen at six weeks. Laparoscopy for the impalpable testis is not initially warranted. An inguinal exploration is regarded as the definitive investigation. This has the advantage of providing the diagnosis and treatment in the majority of cases.