Does the transscrotal mobilization of processus vaginalis of peritoneum reduce the frequency of testicular atrophy after the second stage of Fowler-Stephens procedure?


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Abstract

Cryptorchidism is the most common abnormality of the male genitalia. Improvement of the technology of the second stage of Fowler-Stephens procedure, the most commonly surgery used in this disease, has allowed to reduce the incidence of postoperative testicular atrophy from 20 to 15 %. However, there are technological resources, which may result in improved results of the intervention. From 2006 to 2013, 167 boys with cryptorchidism (209 nonpalpable testes) underwent surgery in our clinic. Unilateral cryptorchidism was diagnosed in 125 (74.9 %) patients, bilateral cryptorchidism - in 42 (25.1 %). Average age was 53.7 ± 34.7 months. All patients underwent Fowler-Stephens procedure. During the first stage of the operation, abdominally located testes were revealed in 97 (46.4 %) cases, among them long loop of vas deferens was detected in 29 (29.9%); for 36 (37.1%) gonads, the presence of long loop of vas deferens was impossible to reliably exclude; obliterated processus vaginalis was detected in 3 (3.1%) cases. Patients were divided into two groups according to the type of second stage of intervention. The Group 1 included 27 boys (34 testes) who underwent surgery by the standard method; the Group 2 - 51 boys (63 gonads) who underwent surgery by modified technique. In order to evaluate the results of surgery, position and volume of cryptorchidic testes were defined intraoperatively and 6 months after. Testicular atrophy was revealed in 5 (15.2%) and 2 (3.3%) patients at the group 1 and Group 2, respectively (P <0.05). Author’s experience shows the feasibility of a scrotal mobilization of vaginal process of the peritoneum, if any, during the second stage of the Fowler-Stephens procedure, regardless of presence of loop of vas deferens. The use of proposed approach simplifies the mobilization of testes and reduces the incidence of subsequent testicular atrophy.

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About the authors

M. I Kogan

SBEI HPE «Rostov State Medical University» of RMPH

V. V Sizonov

SBEI HPE «Rostov State Medical University» of RMPH; SBI RR «Regional Children 's Hospital» of RMPH

V. M Orlov

SBEI HPE «Rostov State Medical University» of RMPH

Email: diggyboo@bk.ru

O. A Shaldenko

SBI RR «Regional Children 's Hospital» of RMPH

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