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INVESTIGATIVE
UROLOGY
doi: 10.1590/S1677-553820090006000022
Cryptorchidism
with short spermatic vessels: staged orchiopexy preserving spermatic vessels
Dessanti A, Falchetti D, Iannuccelli M, Milianti S, Altana C, Tanca AR,
Ubertazzi M, Strusi GP, Fusillo M
Department of Pediatric Surgery, Azienda Ospedaliero-Universitaria, University
of Sassari, Sassari, Italy
J Urol. 2009; 182: 1163-7
- Purpose:
Patients with cryptorchidism can have such short spermatic vessels that
it is impossible to place the testicle in a satisfactory scrotal position
using conventional orchiopexy. In these cases the most commonly used
operation is 1 to 2-stage Fowler-Stephens orchiopexy. We present our
surgical experience using staged inguinal orchiopexy without section
of the spermatic vessels in patients with short spermatic vessels.
Materials and Methods: We used 2-stage inguinal orchiopexy in 38 children
with intra-abdominal testis or testis peeping through the internal ring
and short spermatic vessels (7 bilateral). Spermatic vessels were not
sectioned, but were lengthened through progressive traction of the spermatic
cord wrapped in polytetrafluoroethylene pericardial membrane (Preclude).
In the first stage we mobilized the spermatic cord in the retroperitoneal
space and then wrapped it in the polytetrafluoroethylene membrane. We
subsequently attached the testis to the invaginated scrotal bottom.
At 9 to 12 months we performed the second stage, which involved removing
the polytetrafluoroethylene membrane.
Results: From the first to the second stage we observed progressive
descent of the testicle toward the scrotum. At 1 to 8-year followup
after the second stage all 45 testicles were palpable in a satisfactory
scrotal position with stable or increased testicular volume.
Conclusions: This technique represents an alternative to Fowler-Stephens
orchiopexy, which can be associated with a greater risk of testicular
ischemia.
- Editorial
Comment
The authors present their experience with cryptorchidism with short
spermatic vessels, where they applied a staged inguinal orchiopexy without
sectioning the spermatic vessels. The spermatic vessels were involved
in an anti-adhesion polytetrafluoroethylene pericardial membrane and
were progressively lengthened through traction. Of note, at long-term
follow-up all children demonstrated a gonad with a positive echo color
Doppler signal of spermatic vessels and stable or increased testicular
volume.
It was claimed by Snyder III (1,2) that the spermatic vessels and vas
are not short but embedded in the endopelvic fascia, in children with
cryptorchidism. This paper would be in line with this belief. Also,
extended mobilization could move the testis to the scrotum in almost
all cases (2). The present surgical technique would be a better alternative
to the Fowler-Stephens procedure, which can cause unacceptable rates
of testicular atrophy and therefore is out of use in most pediatric
urology departments.
References
- Hutcheson
JC, Cooper CS, Snyder HM III: The anatomical approach to inguinal orchiopexy.
J Urol. 2000; 164: 1702.
- Kirch
AJ, Escala J, Duckett JW, et al: Surgical management of the nonpalpable
testis: the Children’s Hospital of Philadelphia experience. J
Urol, 1998; 159: 1340.
Dr.
Francisco J. B. Sampaio
Full-Professor and Chair, Urogenital Research Unit
State University of Rio de Janeiro
Rio de Janeiro, RJ, Brazil
E-mail: sampaio@urogenitalresearch.org
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