Nonpalpabl Testislerde Tanısal Laparoskopi; Tek Merkez Klinik Sonuçlarımız

Abstract

Amaç: Nonpalpabl testis tanı ve tedavisinde laparoskopi altın standart yöntemdir. Bu çalışmamızda nonpalpabl testis olgularında laparoskopinin tanı ve tedavideki yerini, etkinliğini ve sonuçlarını tartışmayı amaçladık.
Materyal ve Metod: Nonpalpabl testis tanısı ile laparoskopi planlanan 56 hasta çalışmaya dahil edildi. Hastaların yaşı, özgeçmişi, fizik muayene bulguları, laboratuar bulguları, ultrasonografi ve manyetik rezorans görüntüleme bulguları incelendi. Tüm hastalara genel anestezi altında tekrar muayene yapıldı. Nonpalpabl testis tanısı teyit edilen hastalara tanısal laparoskopi uygulandı. Laparoskopi bulguları, cerrahi prosedür ve komplikasyonlar değerlendirildi.
Bulgular: Çalışmaya dahil edilen 56 hastanın yaş ortalaması 15,3±2,1 yıl idi. Hastaların 28’inde sağ, 22’sinde sol, 6’sında ise her iki testis palpe edilemedi. Sekiz hastada genel anestezi sonrası yapılan muayenede testislerin palpe edilmesi üzerine laparoskopi uygulanmadan orşiopeksi yapıldı. Testisleri palpe edilemeyen 48 hastaya ise tanısal laparoskopi uygulandı. 24 hastada spermatik kordun inguinal kanala girdiği, 15 hastada testislerin intra-abdominal yerleşimli olduğu, 7 hastada kör sonlanan spermatik kord ve 2 hastada ise testis bulunmamakla birlikte müllerien yapılar görüldü. İntra-abdominal testis bulunan hastalardan 9’una laparoskopik orşiopeksi, 6’sına ise laparoskopik orşiektomi uygulandı. Spermatik kordun inguinal kanala girdiği görülen 24 hastaya inguinal eksplorasyon yapıldı. Komplikasyon oranı %4,2 olarak bulundu.
Sonuç: Nonpalpabl testis olgularında hem tanı hem de tedavi amacıyla kullanılabilen laparoskopi, düşük komplikasyon oranları ile standart olarak önerilen ve yaygın kabul gören bir yöntemdir. 

Keywords

• Nonpalpabl testis,İnmemiş testis,tanısal laparoskopi

Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results

Abstract

Background: Laparoscopy is the gold standard method for the diagnosis and treatment of nonpalpable testes. In this study we reviewed the place of diagnostic laparoscopy and evaluated the results and effectiveness of laparoscopy in the diagnosis and management of nonpalpable testis.
Materials and Methods: Fifty-six patients who were scheduled for laparoscopy with a diagnosis of nonpalpable testis were included in the present study. Patients’ age, history, physical examination findings, laboratory findings, ultrasonographic and magnetic resonance imaging findings were examined. All patients were re-examined under general anesthesia. Diagnostic laparoscopy was performed in the patients in whom the diagnosis of nonpalpable testis was confirmed. Laparoscopic findings, surgical procedure and complications were evaluated.
Results: The mean age of 56 patients included in the current study was 15.3 (1-36) years. The right testicle could not be palpated in 28 patients, the left testicle could not be palpated in 22 patients, and both testicles could not be palpated in 6 of the patients. Orchiopexy was performed without laparoscopy in 8 of the patients upon palpation of the testicles during the examination performed under general anesthesia. Diagnostic laparoscopy was performed in 48 patients whose testicles could not be palpated. It was seen that the spermatic cord entered the inguinal canal in 24 patients, the testicles were located intra-abdominally in 15 patients, 7 patients had a blind-ending spermatic cord, and there were no testicles but Müllerian structures in 2 patients. Laparoscopic orchiopexy was performed in 9 of the patients with intra-abdominal testicles, and laparoscopic orchiectomy was performed in 6 of these patients. Inguinal exploration was performed in 24 patients, whose spermatic cord appeared to enter the inguinal canal. The rate of complications was found to be 4.2%.
Conclusions: Laparoscopy, which can be used for both diagnostic and therapeutic purposes in cases of nonpalpable testis, is the recommended standard method that is widely accepted with low complication rates.

Keywords

• Nonpalpable Testes,Undescended testes,Diagnostic laparoscopy

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