Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları
Abstract
Amaç: Palpe edilemeyen testis, erkek bir hastada testisin inguinal kanal ve skrotum içerisinde bulunmaması şeklinde tanımlanır. Hastada infertilite ve testiste malign transformasyon gelişim riskini engellemek için palpe edilemeyen testisin yerleşimi ve durumunun tanımlanması önemlidir. Amacımız, palpe edilemeyen testis tanılı çocuk hastalarda tedavide uyguladığımız laparoskopik yaklaşımın sonuçlarını değerlendirmekti.
Yöntemler: Üçüncü basamak bir çocuk cerrahisi merkezinde palpe edilemeyen testis tanısı konulmuş ve laparoskopik yaklaşım ile tedavi edilmiş hastalar geriye dönük olarak incelendi. Hastaların özelliklerine göre tedavi protokolünde, laparoskopik abdominal eksplorasyon, iki aşamalı Fowler-Stephens laparoskopik orşiopeksi, primer laparoskopik orşiopeksi ve inguinal eksplorasyon uygulandı.
Bulgular: Kırk beş çocuk hastadaki 54 testise ait veriler incelendi. Vakaların %46.2’sinde intra abdominal yerleşimli saptanan testislerin %88’i internal inguinal ring girişinde yerleşimliydi. Laparoskopik abdominal eksplorasyondan sonra testislerin 7 (%28)’sine iki aşamalı Fowler-Stephens, 18 (%72)’ine primer laparoskopik orşiopeksi uygulandı. Testis bulunamayan 27 (%50) vakaya inguinal eksplorasyon uygulandı. Skrotuma indirilen 23 testisin 17 (%73.9)’si normal iken, 6 (%26)’sında atrofi gelişti. Eksize edilen 27 inguinal nubbinde testis ait canlı hücreler saptanmadı.
Sonuç: Palpe edilemeyen testisin tanı konulması ve tedavisinde laparaskopi güvenilir ve etkili bir yöntemdir. Abdomen içi testislerin yerleşim yeri, öncelikli cerrahi yaklaşım olarak inguinal eksplorasyonun düşünülmesini destekleyebilir.
Keywords
References
- 1. Smolko MJ, Kaplan GW, Brock WA. Location and fate of the nonpalpable testis in children. J Urol. 1983;129(6):1204-6. DOI: 10.1016/s0022-5347(17)52643-9.
- 2. Tasian GE, Hittelman AB, Kim GE, DiSandro MJ, Baskin LS. Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol. 2009;182(2):704-9. DOI: 10.1016/j.juro.2009.04.032.
- 3. Giwercman A, Bruun E, Frimodt-Møller C, Skakkebaek NE. Prevalence of carcinoma in situ and other histopathological abnormalities in testes of men with a history of cryptorchidism. J Urol. 1989;142(4):998-1001: discussion 1001-2. DOI: 10.1016/s0022-5347(17)38967-x.
- 4. Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics. 2011;127(1):119-28. DOI: 10.1542/peds.2010-1800.
- 5. Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et.al. American Urological Assocation. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337-45. DOI: 10.1016/j.juro.2014.05.005.
- 6. Mah LW, Durbin-Johnson B, Kurzrock EA. Non-palpable testis: is management consistent and objective? J Pediatr Urol. 2020;16(1):62-8. DOI: 10.1016/j.jpurol.2019.11.015.
- 7. Callewaert PR, Rahnama'i MS, Biallosterski BT, van Kerrebroeck PE. Scrotal approach to both palpable and impalpable undescended testes: should it become our first choice? Urology. 2010;76(1):73-6. DOI: 10.1016/j.urology.2009.09.096.
- 8. Nataraja RM, Yeap E, Healy CJ, Nandhra IS, Murphy FL, Hutson JM, et al. Presence of viable germ cells in testicular regression syndrome remnants: Is routine excision indicated? A systematic review. Pediatr Surg Int. 2018;34(3):353-61. DOI: 10.1007/s00383-017-4206-0.
- 9. Igarashi A, Kikuchi K, Ogushi K, Hasegawa M, Hatanaka M, Fujino J, et al. Surgical exploration for impalpable testis: Which should be first, inguinal exploration or laparoscopic abdominal exploration? J Pediatr Surg. 2018;53(9):1766-9. DOI: 10.1016/j.jpedsurg.2017.10.046.
- 10. Hamidi N, Telli O, Bagci U, Esen B, Karagoz MA, Hascicek AM, et al. Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes. Front Pediatr. 2016;4:13. DOI: 10.3389/fped.2016.00013. 11. Geuvbashian G, Jednak R, Capolicchio JP, El-Sherbiny M. Outcome of surgical management of non-palpable testes. Urol Ann. 2013;5(4):273-6. DOI: 10.4103/0974-7796.120306.
- 12. Denes FT, Saito FJ, Silva FA, Giron AM, Machado M, Srougi M. Laparoscopic diagnosis and treatment of nonpalpable testis. Int Braz J Urol. 2008;34(3):329-34; discussion 335. DOI: 10.1590/s1677-55382008000300010.
- 13. Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay S, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol. 2016;12(6):335-43. DOI: 10.1016/j.jpurol.2016.07.014.
- 14. Marret JB, Ravasse P, Boullier M, Blouet M, Dolet N, Petit T, et al. Surgery for no palpable testis before the age of one year: a risk for the testis? J Pediatr Urol. 2019;15(4):377.e1-377.e6. DOI: 10.1016/j.jpurol.2019.03.019.
- 15. Sturm R, Kurzrock E, Amend G, Shannon R, Gong E, Cheng E. Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present? J Pediatr Urol. 2017;13(4):392.e1-392.e6. DOI: 10.1016/j.jpurol.2017.04.010.
- 16. Elyas R, Guerra LA, Pike J, DeCarli C, Betolli M, Bass J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010;183(5):2012-8. DOI: 10.1016/j.juro.2010.01.035.
- 17. Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A. Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg. 2016;51(2):211-5. DOI: 10.1016/j.jpedsurg.2015.10.063.
- 18. Dessanti A, Falchetti D, Iannuccelli M, Milianti S, Altana C, Tanca AR, et al. Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels. J Urol. 2009;182(3):1163-7. DOI: 10.1016/j.juro.2009.05.050.
- 19. Tackett LD, Wacksman J, Billmire D, Sheldon CA, Minevich E. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. J Endourol. 2002;16(6):359-61. DOI: 10.1089/089277902760261383.
- 20. Fowler R, Stephens FD. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg. 1959;29:92-106. DOI: 10.1111/j.1445-2197.1959.tb03826.x.
- 21. Ransley, PG, Vordermark JS, Caldamone AA, Bellinger MF. Preliminary ligation of the gonadal vessels prior to orchidopexy for the intra-abdominal testicle. World J Urol 1984;2:266–8. DOI: 10.1007/BF00326700.
- 22. Esposito C, Vallone G, Savanelli A, Settimi A. Long-term outcome of laparoscopic Fowler-Stephens orchiopexy in boys with intra-abdominal testis. J Urol. 2009;181(4):1851-6. DOI: 10.1016/j.juro.2008.12.003.
- 23. Kim J, Min GE, Kim KS. Laparoscopic orchiopexy for a nonpalpable testis. Korean J Urol. 2010;51(2):106-10. DOI: 10.4111/kju.2010.51.2.106.
- 24. Rozanski TA, Wojno KJ, Bloom DA. The remnant orchiectomy. J Urol. 1996;155(2):712-3; discussion 714. DOI: 10.1016/S0022-5347(01)66507-8.
- 25. Woodford E, Eliezer D, Deshpande A, Kumar R. Is excision of testicular nubbin necessary in vanishing testis syndrome? J Pediatr Surg. 2018;53(12):2495-7. DOI: 10.1016/j.jpedsurg.2018.08.011.
Clinical outcomes of laparoscopic treatment of non-palpable testis in children at a tertiary pediatric surgery center
Abstract
Aim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes.
Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics.
Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins.
Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.
References
- 1. Smolko MJ, Kaplan GW, Brock WA. Location and fate of the nonpalpable testis in children. J Urol. 1983;129(6):1204-6. DOI: 10.1016/s0022-5347(17)52643-9.
- 2. Tasian GE, Hittelman AB, Kim GE, DiSandro MJ, Baskin LS. Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol. 2009;182(2):704-9. DOI: 10.1016/j.juro.2009.04.032.
- 3. Giwercman A, Bruun E, Frimodt-Møller C, Skakkebaek NE. Prevalence of carcinoma in situ and other histopathological abnormalities in testes of men with a history of cryptorchidism. J Urol. 1989;142(4):998-1001: discussion 1001-2. DOI: 10.1016/s0022-5347(17)38967-x.
- 4. Tasian GE, Copp HL. Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics. 2011;127(1):119-28. DOI: 10.1542/peds.2010-1800.
- 5. Kolon TF, Herndon CD, Baker LA, Baskin LS, Baxter CG, Cheng EY, et.al. American Urological Assocation. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337-45. DOI: 10.1016/j.juro.2014.05.005.
- 6. Mah LW, Durbin-Johnson B, Kurzrock EA. Non-palpable testis: is management consistent and objective? J Pediatr Urol. 2020;16(1):62-8. DOI: 10.1016/j.jpurol.2019.11.015.
- 7. Callewaert PR, Rahnama'i MS, Biallosterski BT, van Kerrebroeck PE. Scrotal approach to both palpable and impalpable undescended testes: should it become our first choice? Urology. 2010;76(1):73-6. DOI: 10.1016/j.urology.2009.09.096.
- 8. Nataraja RM, Yeap E, Healy CJ, Nandhra IS, Murphy FL, Hutson JM, et al. Presence of viable germ cells in testicular regression syndrome remnants: Is routine excision indicated? A systematic review. Pediatr Surg Int. 2018;34(3):353-61. DOI: 10.1007/s00383-017-4206-0.
- 9. Igarashi A, Kikuchi K, Ogushi K, Hasegawa M, Hatanaka M, Fujino J, et al. Surgical exploration for impalpable testis: Which should be first, inguinal exploration or laparoscopic abdominal exploration? J Pediatr Surg. 2018;53(9):1766-9. DOI: 10.1016/j.jpedsurg.2017.10.046.
- 10. Hamidi N, Telli O, Bagci U, Esen B, Karagoz MA, Hascicek AM, et al. Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes. Front Pediatr. 2016;4:13. DOI: 10.3389/fped.2016.00013. 11. Geuvbashian G, Jednak R, Capolicchio JP, El-Sherbiny M. Outcome of surgical management of non-palpable testes. Urol Ann. 2013;5(4):273-6. DOI: 10.4103/0974-7796.120306.
- 12. Denes FT, Saito FJ, Silva FA, Giron AM, Machado M, Srougi M. Laparoscopic diagnosis and treatment of nonpalpable testis. Int Braz J Urol. 2008;34(3):329-34; discussion 335. DOI: 10.1590/s1677-55382008000300010.
- 13. Radmayr C, Dogan HS, Hoebeke P, Kocvara R, Nijman R, Silay S, et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol. 2016;12(6):335-43. DOI: 10.1016/j.jpurol.2016.07.014.
- 14. Marret JB, Ravasse P, Boullier M, Blouet M, Dolet N, Petit T, et al. Surgery for no palpable testis before the age of one year: a risk for the testis? J Pediatr Urol. 2019;15(4):377.e1-377.e6. DOI: 10.1016/j.jpurol.2019.03.019.
- 15. Sturm R, Kurzrock E, Amend G, Shannon R, Gong E, Cheng E. Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present? J Pediatr Urol. 2017;13(4):392.e1-392.e6. DOI: 10.1016/j.jpurol.2017.04.010.
- 16. Elyas R, Guerra LA, Pike J, DeCarli C, Betolli M, Bass J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010;183(5):2012-8. DOI: 10.1016/j.juro.2010.01.035.
- 17. Shehata S, Shalaby R, Ismail M, Abouheba M, Elrouby A. Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique): Stretching the limits for preservation of testicular vasculature. J Pediatr Surg. 2016;51(2):211-5. DOI: 10.1016/j.jpedsurg.2015.10.063.
- 18. Dessanti A, Falchetti D, Iannuccelli M, Milianti S, Altana C, Tanca AR, et al. Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels. J Urol. 2009;182(3):1163-7. DOI: 10.1016/j.juro.2009.05.050.
- 19. Tackett LD, Wacksman J, Billmire D, Sheldon CA, Minevich E. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. J Endourol. 2002;16(6):359-61. DOI: 10.1089/089277902760261383.
- 20. Fowler R, Stephens FD. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg. 1959;29:92-106. DOI: 10.1111/j.1445-2197.1959.tb03826.x.
- 21. Ransley, PG, Vordermark JS, Caldamone AA, Bellinger MF. Preliminary ligation of the gonadal vessels prior to orchidopexy for the intra-abdominal testicle. World J Urol 1984;2:266–8. DOI: 10.1007/BF00326700.
- 22. Esposito C, Vallone G, Savanelli A, Settimi A. Long-term outcome of laparoscopic Fowler-Stephens orchiopexy in boys with intra-abdominal testis. J Urol. 2009;181(4):1851-6. DOI: 10.1016/j.juro.2008.12.003.
- 23. Kim J, Min GE, Kim KS. Laparoscopic orchiopexy for a nonpalpable testis. Korean J Urol. 2010;51(2):106-10. DOI: 10.4111/kju.2010.51.2.106.
- 24. Rozanski TA, Wojno KJ, Bloom DA. The remnant orchiectomy. J Urol. 1996;155(2):712-3; discussion 714. DOI: 10.1016/S0022-5347(01)66507-8.
- 25. Woodford E, Eliezer D, Deshpande A, Kumar R. Is excision of testicular nubbin necessary in vanishing testis syndrome? J Pediatr Surg. 2018;53(12):2495-7. DOI: 10.1016/j.jpedsurg.2018.08.011.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 31, 2021 |
| Submission Date | June 29, 2021 |
| Acceptance Date | September 25, 2021 |
| Published in Issue | Year 2021 Volume: 5 Issue: 3 |
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