Nonpalpabl Testislerde Tanısal Laparoskopi; Tek Merkez Klinik Sonuçlarımız

Yıl 2020, Cilt: 17 Sayı: 1, 1 - 5, 29.04.2020

Mehmet Demir İsmail Yağmur Bülent Katı Eyyup Sabri Pelit Abdurrahim Dusak Halil Çiftçi

https://doi.org/10.35440/hutfd.645863

Cited By: 1

Öz

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. 

Anahtar Kelimeler

Nonpalpabl testis, İnmemiş testis, tanısal laparoskopi

Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results

Öz

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.

Anahtar Kelimeler

Nonpalpable Testes, Undescended testes, Diagnostic laparoscopy

Kaynakça

• Ahmed Zaki Mohamed Anwar,Tarek Khalaf Fathelbab, Amr Mohamed Abdelhamid, Ehab Mohmed Galal, Mostafa Magdi Ali, Ehab Rifat Tawfiek, Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience. International Urology and Nephrology (2018) 50:2139–2144.
• Perez-Brayfield M, Kirsch AJ, Baseman AG. Pediatric Cryptorchidism Surgery. Medscape.Available.from:http://www.emedicine.medscape.com/article/1017420-overview#4. [Last accessed on 2016 Oct 21; Last updated on 2015 Jul 27].
• Başaklar C. İnmemiş Testis. In: Başaklar C (Editör). Bebek ve Çocukların Cerrahi ve Ürolojik Hastalıkları. 2. Cilt. Ankara: Palme Yayıncılık, 2006:1717-52.
• Elder JS. Ultrasonography is unnecessary in evaluating boys with a nonpalpable testis. Pediatrics 2002;110:748-51.
• Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976;8:33-4.
• Tennenbaum SY, Lerner SE, McAleer IM, Packer MG, Scherz HC, Kaplan GW. Preoperative laparoscopic localization of the nonpalpable testis: A critical analysis of a 10-year experience. J Urol 1994;151:732-4
• Baillie CT, Fearns G, Kitteringham L, Turnock RR. Management of the impalpable testis: The role of laparoscopy. Arch Dis Child 1998;79:419-22.
• Jared D. Christensen, MD, and Vikram S. Dogra, MD. The Undescended Testis. Semin Ultrasound CT MRI 28:307-316 © 2007
• Fowler R Jr, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Zeal J Surg 29:92.
• Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB (1998) Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 160:1145–1149.11. Zakaria OM, Hokka E, El Kadi KE, Al Buali WH, Zakaria HM, Daoud MY et al (2013) Examination under anesthesia for management of impalpable undescended testis: A traditional technique revisited. World J Surg 37:1125–1129.
• Breyer BN, DiSandro M, Baskin LS, Hsieh MH (2009) Obesity does not decrease the accuracy of testicular examination in anesthetized boys with cryptorchidism. J Urol 18:830 834.
• Vikraman J, Hutson JM, Li R, Thorup J. The undescended testis: Clinical management and scientific advances. Semin Pediatr Surg. 2016 Aug;25(4):241-8.
• Aykut Kefi, Elnur Mammadov. Diagnostic Management of Undescended Testis. Turk Urol Sem 2010; 1: 60-2.
• Tasian GE, Copp HL (2011) Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics 127:119–128.
• Kantarci M, Doganay S, Yalcin A et al (2010) Diagnostic performance of diffusion-weighted MRI in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings. AJR Am J Roentgenol 195:W268–W273.
• Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086.
• Kolon TF, Herndon A, Baker LA, Baskin LS, Baxter CG, Cheng EY et al (2014) Evaluation and Treatment of Cryptorchidism: AUA Guideline. J urol 192:337–345.
• Bae KH, Park JS, Jung HJ, Shin HS (2014) Inguinal approach for the management of unilateral non-palpable testis: is diagnostic laparoscopy necessary? J Pediatr Urol 10:233–236.
• Snodgrass WT, Yucel S, Ziada A (2007) Scrotal exploration for unilateral nonpalpable testis. J Urol 178:1718–172.
• Ueda N, Shiroyanagi Y, Suzuki H, Kim WJ, Yamazaki Y, Tanaka Y (2013) The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis. J Pediatr Surg 48:542–546.
• Yamazaki Y, Suzuki M, Shiroyanagi Y, Matsunol D, Tanaka Y (2009) Scrotal nubbins associated with blind-ending spermatic vessels and a normal vas deferens on laparoscopy. Int J Urol 16:902–904.
• Snodgrass WT, Chen K, Harrison C (2004) Initial scrotal incision for unilateral nonpalpable testis. J Urol 172:1742–1745.
• R. M. Nataraja, C. M. Asher, R. Nash, and F. L. Murphy, “Is routine excision of testicular remnants in testicular regression syndrome indicated?” Journal of Pediatric Urology, vol. 11, p. 151, 2015.
• D. Storm, T. Redden, M. Aguiar, M. Wilkerson, G. Jordan, and J. Sumfest, “Histologic Evaluation of the Testicular Remnant Associated with the Vanishing Testes Syndrome: Is Surgical Management Necessary?” Urology, vol. 70, no. 6, pp. 1204–1206, 2007.
• P. K. Hegarty, I. Mushtaq, and N. J. Sebire, “Natural history of testicular regression syndrome and consequences for clinical management,” Journal of Pediatric Urology, vol. 3, no. 3, pp. 206–208, 2007.
• Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, McDermott TE, et al. The role of orchiectomy in the management of postpubertal cryptorchidism. The Journal of urology. 1998 1998/ Mar;159(3):851-4.
• Walsh TJ, Dall’Era MA, Croughan MS, Carroll PR, Turek PJ. Prepubertal orchiopexy for cryptorchidism may be associated with lower risk of testicular cancer. J Urol. 2007 Oct;178(4 Pt 1):1440- 6; discussion 6.