Staged laparoscopic traction orchiopexy for intra-abdominal testis: Is it always feasible?

Elsherbeny, Mohammed; Abdallah, Ahmed; AbouZeid, Amr Abdelhamid; Ghanem, Wael; Zaki, A.

doi:10.1016/j.jpurol.2018.01.021

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…This study presents the first results of SLTO performed in the UK to date, and confirms similar outcomes to the available international literature [22][23][24]. The study was limited, however, by a small sample size and short follow-up.…”

Section: Discussionsupporting

confidence: 84%

“…More recently, the same authors replicated their technique on 34 IAT with similar slippage rates and 100% of fixed testes were seen to be well vascularized on Doppler ultrasound at follow-up [23]. Further studies investigating the feasibility of SLTO have reported suture slippage and failure of elongation of the vascular pedicle each at 9% with 0% atrophy [24]. The principal of the FSLO is that collateral blood supply develops from the gubernaculum, vas, and cremasteric vessels.…”

Section: Discussionmentioning

confidence: 87%

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Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

2019

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Purpose Laparoscopy is the gold standard to assess for presence of an intra-abdominal testis. However, techniques for the subsequent orchidopexy vary, and include the recently described staged laparoscopic traction orchidopexy (SLTO) (Shehata in Pediatr Surg 51(2):211-215, 2016). SLTO enables elongation of the testicular vessels without division, with initial success rates reportedly superior to Fowler-Stephens. We present the first UK data following a preliminary study using SLTO. Methods 19 boys prospectively presenting with 22 intra-abdominal testes (IAT) underwent STLO in a single centre, with a median age of 2.5 years (IQR 1.4-5.2) at first stage. 3/19 (16%) boys had bilateral IAT and nine (41%) were left-sided. Pneumoperitoneum was established using 5 mm umbilical and 3 mm accessory ports in bilateral iliac fossae. The gubernaculum and lateral peritoneal attachments were divided prior to securing the intra-abdominal testis to the contralateral anterior abdominal wall with 2/0 Ti-cron™. Second-stage procedures were planned for 3-6 months later. The securing stitch was cut; an 11 mm STEP port was placed trans-scrotally to retrieve the testis and secured in a sub-dartos pouch. Outcome measures included palpable testes in the scrotum and surgical complications. Results 13/22 IAT have undergone follow-up. Twelve (92%) IAT were palpable in the scrotum following SLTO. There was one diathermy-related bladder injury necessitating laparoscopic repair, and 3/22 (13.6%) slipped sutures, requiring repeat first-stage procedures. Conclusions Staged laparoscopic traction orchidopexy is a feasible technique, which can be performed as an alternative to Fowler-Stephens procedure, with potentially better outcomes for the testis. The complications described should be preventable as the technique evolves.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 87%

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

2019

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“…23 Since then, several clinical trials have shown positive outcomes and the authors argue that an update of the EAU/ESPU guidelines might be necessary to incorporate this new evidence. 24,25 Of note, no randomized controlled trials comparing the Fowler-Stephens to the Shehata technique have been conducted, contributing to the clinical equipoise in the field.…”

Section: Discussionmentioning

confidence: 99%

European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes

Aubert,

Zaidan,

Garnier

et al. 2023

Eur J Pediatr Surg

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Introduction The aim of this study was to assess the adherence to the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU) 2016 guidelines in the management of undescended testes (UDT). Materials and Methods An online questionnaire was sent in 2023 to members of the European Paediatric Surgeons' Association (EUPSA). Results Among 157 members, 46 and 44% perform orchidopexy before 12 and 18 months, respectively. In total, 92% recommend conservative management of retractile testes and 58% offer close follow-up. In case of nonpalpable testes, 78% favor laparoscopy and 18% ultrasonography. If a peeping testicle is identified at laparoscopy, 76% perform a single-stage orchidopexy. In case of a high testicle, a staged procedure is preferred (84%). Management of blind-ending spermatic vessel is heterogenous with a majority ending the operation, followed by exploration of the inguinal canal and removal of the testicular nubbin with optional fixation of the contralateral testis. Only a minority recommends hormonal therapy to improve fertility potential in bilateral UDT. A majority (59%) discuss testis removal in UDT in postpubertal boys. In addition, 77% declare following the EAU/ESPU guidelines. Unawareness of guidelines was the most common reason cited for nonadherence. International guidelines were found to have the greatest influence on clinical practice; however, personal experience and institutional practice seem to play an important role. Conclusion Most recommendations of the EAU/ESPU guidelines are being followed by EUPSA members; however, personal and institutional practice impact decision making. Hormonal therapy in bilateral UDT, management of vanishing testes, and UDT in postpubertal boys could be improved.

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“…Going through the result of our meta-analysis concerning testicular atrophy, even though there is no atrophy among the ST group and the different rate of atrophy among the ST and FS group is statistically insignificant. Case series by various authors,[ 25 26 ] including Shehata et al .,[ 15 ] have also reported no testicular atrophy among their operated cases by the ST of orchidopexy. In Stage I of ST, the testes are anchored to the anterior abdominal wall, so there is a possibility of internal herniation of the bowel behind the testicular vessels; however, none of the studies included in the metanalysis or any other studies[ 25 26 ] have reported this complication.…”

Section: Discussionmentioning

confidence: 99%

Techniques of staged laparoscopic orchidopexy for high intra-abdominal testes in children: A systematic review and meta-analysis

Borkar,

Tiwari,

Mohanty

et al. 2023

Urology Annals

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Background: Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis. Materials and Methods: The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy. Results: The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures. Conclusion: Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.

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Staged laparoscopic traction orchiopexy for intra-abdominal testis: Is it always feasible?

Cited by 17 publications

References 15 publications

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

European Paediatric Surgeons' Association Survey on the Adherence to EAU/ESPU Guidelines in the Management of Undescended Testes

Techniques of staged laparoscopic orchidopexy for high intra-abdominal testes in children: A systematic review and meta-analysis

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