Comparative evaluation of the results of two-stage abdominal testicle reduction by Fowler–Stephens and a one-stage method with preservation of testicular vessels
- Authors: Kagantsov I.M.1,2, Logval A.A.3
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Affiliations:
- Almazov National Medical Research Centre
- North-Western State Medical University named after I.I. Mechnikov
- Vologda Regional Children’s Hospital No. 2
- Issue: Vol 13, No 4 (2023)
- Pages: 383-389
- Section: Original articles
- URL: https://journals.eco-vector.com/uroved/article/view/606053
- DOI: https://doi.org/10.17816/uroved606053
- ID: 606053
Cite item
Abstract
BACKGROUND: Normal testicular function is only possible if it is located in the scrotum; if the testicle is undescended, fertility decreases and the risk of malignancy increases.
AIM: Aim of the study is to compare the results of a one-stage bringing down of the abdominal testicle with preservation of the testicular vessels and a two-stage Fowler–Stephens operation regarding the risk of atrophy of the reduced gonad.
MATERIALS AND METHODS: A total of 241 patients with a non-palpable testicle in the scrotum were observed, of which 125 (51.87%) patients the testicles were brought down with laparoscopic assistance. Three groups of patients were identified. The first group consisted of 105 (84%) patients who underwent testicular bringing down in two stages using the Fowler–Stephens technique with an interval of at least 6 months. The second group consisted of 20 (16%) patients whose underwent laparoscopic bringing down in one stage with preservation of the testicular vessels. The main criterion for effectiveness was the size of the gonad 6 months after surgery according to ultrasound. The third group included 116 (48.13%) patients with absent testicle.
RESULTS: In the first group the average duration of the first stage of the operation was 19.07 [10; 65] minutes, second stage 48.59 [20; 160] minutes. A total of 117 testicles were brought down to the scrotum. 77 (65.81%) hypoplastic gonads were identified, of which in 6 (5.13%) cases the volume of the testicle increased after the first stage of the operation, 8 (6.84%) gonads decreased in volume and 1 (0.85%) testicle atrophied after completing the second stage. In 62 (52.30%) testicles the size did not change between the stages of the operation. Subsequently, these gonads remained hypoplastic. In 40 (34.19%) gonads there was no decrease in volume, but between the stages of intervention, an increase in the volume of the organ was noted in 3 (2.56%) cases, in 7 (5.98%) cases a decrease in the volume of the gonads, in 29 (24.79%) of patients, the size of the testicles did not change between the stages of the operation, 1 (0.85%) of the gonad atrophied after the second stage of the operation. In the second group the average duration of the operation was 42.59 [20; 100] minutes. A total of 22 gonads were brought down, of which 6 (27.27%) testicles were not hypoplastic and did not decrease in size after being brought down into the scrotum, 16 (72.73%) — were initially hypoplastic. Of these, 1 (4.55%) gonad increased in volume, 1 (4.55%) — decreased, 14 (63.64%) — remained unchanged after surgery. There was no testicular atrophy after descent. In patients of the third group, in 40 (34.48%) cases, the vessels ended blindly in the abdominal cavity. In 3 (2.59%) boys, testicular buds located in the abdominal cavity were removed. The vessels of the testicle went into the inguinal canal in 73 (62.93%) cases, of which in 34 (29.31%) — the vessels ended blindly and 39 (33.62%) testicular rudiments were found, which were removed.
CONCLUSIONS: Bringing down of the testicle with preservation of its own vessels is more preferable compared to a two-stage operation due to the absence of the need for a second intervention on the gonad, a greater degree of preservation of testicular volume after its brought down and, in our case, the absence of gonadal atrophy after its descending.
Full Text
About the authors
Iliya M. Kagantsov
Almazov National Medical Research Centre; North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: ilkagan@rambler.ru
ORCID iD: 0000-0002-3957-1615
SPIN-code: 7936-8722
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Saint Petersburg; Saint PetersburgAleksei A. Logval
Vologda Regional Children’s Hospital No. 2
Email: alex.logval@yandex.ru
ORCID iD: 0000-0002-3797-1156
Russian Federation, Cherepovets, Vologda Region
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