Ele Gelmeyen Testisin Laparoskopik Yönetimi: On Yıllık Deneyim

Year 2021, Volume: 74 Issue: 3, 269 - 272, 17.09.2021

Gunay Ekberli

Abstract

Amaç: Palpe edilemeyen testis yönetimi hala çocuk cerrahisinin tartışmalı konularından biridir. Son yıllarda laparoskopik eksplorasyon palpe edilemeyen testis tanı ve tedavisinde altın standart olarak karakterize edilmektedir. Bu çalışmada ele gelmeyen testiste tanısal laparoskopi deneyimimizi paylaşmayı amaçladık.

Gereç ve Yöntem: Çalışmaya Haziran 2006 - Aralık 2017 tarihleri arasında kliniğimizde ele gelmeyen testis tanısı ile tedavi edilen 73 hasta dahil edilmiştir. Tüm hastalara tanısal laparoskopi uygulandı. Tanısal laparoskopi sonucunda edinilen bilgilere istinaden ele gelmeyen testis tedavisinin bir sonraki basamağı planlandı. Tanı yaşı, etkilenen taraf, ameliyat tekniği ve sonuçlar kaydedildi.

Bulgular: Hastaların yaş aralığı 6-197 ay idi. Ortanca yaş 46,7 ay idi. Klinik takip süresi 1-96 ay arasında ve ortalama 19 ay idi. Ele gelmeyen testis yerleşimi fizik muayene ile belirlenmiş olup, tanısal laparoskopi ile teyit edilmiştir. Yirmi beş testis sağ ve 41 testis sol olmak üzere 66 hastada tek taraflı inmemiş testis vardı. Geri kalan 7 hastada bilateral intra-abdominal testis vardı.

Sonuç: Ele gelmeyen testis yönetimindeki tartışma ve birçok farklı öneriye rağmen laparoskopinin önemi sebat etmektedir. Laparoskopi yardımlı ele gelmeyen testis yönetimi sadece testis lokalizasyonunu belirleme ve bir sonraki basamağın planlamasına yardımcı olmakla kalmayıp gereksiz cerrahi müdahaleyi de önlemektedir.

Keywords

Ele Gelmeyen Testis, Çocuk, Tanısal Laparoskopi

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

Laparoscopic Management of Non-palpable Testes: Ten Year Experience

Abstract

Objectives: Management of non-palpable testes is still one of the controversial topics of pediatric surgery. Laparoscopic exploration has been characterized as a gold standard in the diagnosis and management of undescended testes in recent years. In this study, we aimed to share our experience of diagnostic laparoscopy in non-palpable testes.

Materials and Methods: Seventy-three patients with non-palpable testes diagnosis, who were treated in the clinic between June 2006 and December 2017, were included in the study. Diagnostic laparoscopy was applied to all patients. According to findings determined during diagnostic laparoscopy, the next step of non-palpable testes management was planned. Age at presentation, affected side, operative techniques and results were recorded.

Results: The age of the children ranged from 6 to 197 months. The median age of patients was 46.7 months. The mean period of clinical follow-up was 19 months, ranging from 1 to 96 months. Laterality of non-palpable testes was determined through physical examination and confirmed via diagnostic laparoscopy. Sixty-six patients had unilateral non-palpable testes: Twenty-five testicular units were right-sided and 41 testicular units were left-sided. Other seven patients had bilateral non-palpable intra-abdominal testes.

Conclusion: Despite controversies and different advised techniques in the management of non-palpable testes, laparoscopy remains to be important. Laparoscopic assistance in the management of non-palpable testes not only leads to determination of localization and decision of next step procedure, but also helps to avoid unnecessary surgical attempts.

Keywords

Non-palpable Testes, Children, Diagnostic Laparoscopy

Ethical Statement

Ethics Committee Approval: Ankara University Faculty of Medicine, Clinical Research Ethics Committee approval was provided for the study (approval no: 09-723-1). Informed Consent: Retrospective study. Peer-reviewed: Externally peer-reviewed.

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. Kim J, Min GE, Kim KS. Laparoscopic orchiopexy for a nonpalpable testis. Korean J Urol. 2010;51:106-110.
• 2. Scorer CG. The Descent of the Testis. Arch Dis Child. 1964;39:605-609.
• 3. Levitt SB, Kogan SJ, Engel RM, et al. The impalpable testis: a rational approach to management. J Urol. 1978;120:515-520.
• 4. Choi KY, Park TH, Kim KS. Laparoscopic orchiopexy for intra-abdominal testis: complications and technical aspects. Korean J Urol 2000;41:420-424.
• 5. Dar SA, Bali RS, Zahoor Y, et al. Undescended Testes and Laparoscopy: Experience from the Developing World. Adv Urol. 2018;2018:1620470.
• 6. Smolko MJ, Kaplan GW, Brock WA. Location and fate of the nonpalpable testis in children. J Urol. 1983;129:1204-1206.
• 7. Denes FT, Saito FJ, Silva FA, et al. Laparoscopic diagnosis and treatment of nonpalpable testis. Int Braz J Urol. 2008;34:329-334.
• 8. Jamalalail YA, Guerra LA, Leonard MP. Selective use of laparoscopy in nonpalpable undescended testes. Urol Ann. 2016;8:81-83.
• 9. Lamesch A. L’anorchidie unilatérale ou monorchidie [Unilateral anorchidismor monorchidism]. Chirurgie. 1992;118:328-332. 10. Tennenbaum SY, Lerner SE, McAleer IM, et al. Preoperative laparoscopic localization of the nonpalpable testis: a critical analysis of a 10-year experience. J Urol. 1994;151:732-734.
• 11. Wayne C, Chan E, Nasr A; Canadian Association of Paediatric Surgeons Evidence-Based Resource. What is the ideal surgical approach for intraabdominal testes? A systematic review. Pediatr Surg Int. 2015;31:327-338.
• 12. Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976;8:33-34.
• 13. Chan KW, Lee KH, Wong HY, et al. Use of laparoscopy as the initial surgical approach of impalpable testes: 10-year experience. World J Clin Pediatr. 2015;4:155-159.
• 14. Chandrasekharam VV. Laparoscopy vs inguinal exploration for nonpalpable undescended testis. Indian J Pediatr. 2005;72:1021-1023.
• 15. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995;154:1148-1152.
• 16. Daher P, Nabbout P, Feghali J, et al. Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis? J Pediatr Surg. 2009;44:1999-2003.