Does the transscrotal mobilization of processus vaginalis of peritoneum reduce the frequency of testicular atrophy after the second stage of Fowler-Stephens procedure?
- Autores: Kogan M.I1, Sizonov V.V1,2, Orlov V.M1, Shaldenko O.A2
-
Afiliações:
- SBEI HPE «Rostov State Medical University» of RMPH
- SBI RR «Regional Children 's Hospital» of RMPH
- Edição: Nº 4 (2014)
- Páginas: 80-83
- Seção: Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/280254
- ID: 280254
Citar
Texto integral
![Acesso aberto](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_open.png)
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_unlock.png)
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
Resumo
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.
Palavras-chave
Texto integral
![Acesso é fechado](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
Sobre autores
M. Kogan
SBEI HPE «Rostov State Medical University» of RMPH
V. Sizonov
SBEI HPE «Rostov State Medical University» of RMPH; SBI RR «Regional Children 's Hospital» of RMPH
V. Orlov
SBEI HPE «Rostov State Medical University» of RMPH
Email: diggyboo@bk.ru
O. Shaldenko
SBI RR «Regional Children 's Hospital» of RMPH
Bibliografia
- Berkowitz G.S., Lapinski R.H., Dolgin S.E. et al. Prevalence and natural history of cryptorchidism. Pediatrics. 1993; 92(1): 44-49.
- Pierik F.H., Burdorf A., de Muinck Keizer-Schrama S.M. et al. The cryptorchidism prevalence among infants in the general population of Rotterdam, the Netherlands. Int. J Androl. 2005; 28(4): 248-252.
- Levitt S.B., Kogan S.J., Engel R.M. et al. The impalpable testis: a rational approach to management. J. Urol. 1978; 120: 515.
- Smolko M.J., Kaplan G.W., Brock W.A. Location and fate of the nonpalpable testis in children. J Urol 1983; 129: 1204e6.
- Docimo S.G. The results of surgical therapy for cryptorchidism: a literature review and analysis. J. Urol. 1995; 154: 1148.
- Radmayr C., Oswald J., Schwentner C. et al. Long-term outcome of laparoscopically managed nonpalpable testes. J Urol. 2003; 170(6 Pt 1): 2409-2411.
- Hvistendahl G.M., Poulsen E.U. Laparoscopy for the impalpable testes: experience with 80 intra-abdominal testes. J Pediatr. Urol. 2009; 5(5): 389-392.
- Ang C.W., Forrest J. Diagnostic laparoscopy and management of the impalpable testis - a review of 10 years' practice at a non-paediatric specialist centre. J Pediatr. Urol. 2008; 4(3): 214-217.
- Fowler R., Stephens F.D. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust. N. Z. J. Surg. 1959; 29: 92-106.
- Cortesi N., Ferrari P., Zambarda E. et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976; 8: 33-34.
- Ransley P.G., Vordermark J.S., Caldamone A.A. et al. Preliminary ligation of the gonadal vessels prior to orchidopexy for the intraabdominal testicle. A staged Fowler-Stephens procedure. World J. Urol. 1984; 2: 266.
- Bloom D.A. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J. Urol. 1991; 145: 1030-1033.
- Elder J.S. Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes. J. Urol. 1992; 148(4): 1239-1241.
- Kirsch A.J., Escala J., Duckett J.W. et al. 3rd. Surgical management of the nonpalpable testis: the Children's Hospital of Philadelphia experience. J Urol. 1998; 159(4): 1340-1343.
- Lindgren B.W., Darby E.C., Faiella L. et al. Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J. Urol. 1998; 159(6): 2132-2135.
- Elyas R., Guerra L.A., Pike J. et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010; 183(5): 2012-2018.
- Smith J.A., Howards S.S., Preminger G.M. Hinman's Atlas of Urologic Surgery, 3rd Edition, Philadelphia, PA, 2012.
- Dave S., Manaboriboon N., Braga L.H. et al. Open versus laparoscopic staged Fowler-Stephens orchiopexy: impact of long loop vas. J Urol. 2009; 182(5): 2435-2439.
- Shalaby M.M., Shoma A.M., Elanany F.G. et al. Management of the looping vas deferens during laparoscopic orchiopexy. J Urol. 2011; 185(6 Suppl.): 2455-2457.
- Wolffenbuttel K.P., Scheepe J.R., van der Toorn F. et al. Epididymal anomalies in 82 boys with cryptorchidism. J Pediatr. Urol. 2010; 6(Suppl. 1): 70-71.
Arquivos suplementares
![](/img/style/loading.gif)