Laparoscopic diagnosis and treatment of nonpalpable testis

Abstract

Introduction: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. Materials and Methods:We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1%) had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. Results: We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

Effectiveness of Hormonal and Surgical Therapies for Cryptorchidism: A Systematic Review

“…In 2013, diagnostic laparoscopy is almost always the approach of choice when attempting to localize a nonpalpable cryptorchid testicle thought to be potentially located in the abdomen. As evidence, all but 1 of the studies in our review published in the past 5 years that included assessment of the abdomen fora nonpalpable testicle 28,32,[36][37][38]43,47,51 used laparoscopy for this part of the procedure, even if they used an open technique to repair the cryptorchidism.…”

“…Four studies were judged good quality, 27,45,49,52 1 fair quality, 32 and the remainder poor quality. [28][29][30][31][33][34][35][36][37][38][39][40][42][43][44][46][47][48]50,51,53 Eleven studies reported outcomes after either 1-stage FS orchiopexy, 2-stage FS orchiopexy, or primary orchiopexy. [36][37][38][39][40][42][43][44][45]47,48 Nine of these studies, all retrospective cohorts, provided success rates by surgical procedure, although the choice of surgical method is made clinically and not with the intent of comparative effectiveness.…”

Canadian Urological Association-Pediatric Urologists of Canada (CUA-PUC) guideline for the diagnosis, management, and followup of cryptorchidism

“…50 The laparoscopic FS orchidopexy entails division of the gonadal vessels and cremasteric collaterals during advancement of the IAT medial to the inferior epigastric vessels or obliterated umbilical artery. Despite its widespread use, [51][52][53][54] either as a one-or two-stage procedure, atrophy rates can be as high as 33%, probably due to failure of developing adequate collateral blood supply through the deferential artery. The presence of a long looping vas deferens may increase this risk, especially when the procedure is done laparoscopically.…”

Declarative process mining in healthcare

“…We carried out a literature analysis aimed at finding the main scientific evidences about the process: we examined some of the main articles related to the topic stored in the Database PubMed 7 , as [45,46,47,48,49,50,51,52] and also the Guidelines of the European Association of Urology (EAU). 8 Based on this information, we designed the corresponding Declare model.…”