Efficacy of Laparoscopic Approach for Appendicectomy and Orchiopexy across the Pediatric Age and Size Spectrum

Context: It remains, as yet, an issue unsettled?by evidence that whether the younger age and smaller size of the pediatricpatient affect the efficacy of laparoscopy for appendicectomy and intraabdominal testes. Aims: To prospectively assess the level of difficulty, surgical stress and outcomes of two commonly done laparoscopic procedures?i.e., appendicectomy and orchiopexy for intraabdominal testes, across the pediatric age and size spectrum. Settings and Design: Prospective interventional study conducted in Pediatric Surgery department of a tertiary hospital.?Subjects and Methods: From April 2013 to August 2014, 60 children underwent either laparoscopic interval appendicectomy or orchiopexy (unilateral or bilateral) by same surgeon. Difficulty level, metabolic stress and other clinical outcomes of the laparoscopic procedures were compared across various age groups. Statistical Analysis: Kruskal-Wallis test was used to compare various age groups with respect to the study variables. Results: The patients were divided into three groups?with age ranges of 1 - 6 years, 6 - 9 years and 9 - 13 years. The three groups were very different (P?= 0.000) with respect to the body surface area of included children. Each of the three age groups had a similar set of 20 laparoscopic procedures?viz., 10 appendicectomies, 8 unilateral orchiopexies and 2 bilateral orchiopexies. The three groups had no difference in the total level of difficulty score, duration of capnoperitoneum, postop increase in serum CRP and blood glucose levels (surrogates for metabolic stress sustained due to surgery), time to full orals and postop hospital stay. Conclusion: The younger age and smaller size of patient do not affect the efficacy of laparoscopic appendicectomy and orchiopexy.

The effect of scrotal versus inguinal orchiopexy on the testicular function of children with clinically palpable,inguinal undescended testis:a randomized controlled trial

To compare the impact of the scrotal vs inguinal orchidopexy approach on the testicular function of infants with cryptorchidism,a randomized controlled trial was conducted involving boys who were 6–12 months old at surgery and were diagnosed with clinically palpable,inguinal undescended testis.Between June 2021 and December 2021,these boys at Fujian Maternity and Child Health Hospital(Fuzhou,China)and Fujian Children’s Hospital(Fuzhou,China)were enrolled.Block randomization with a 1:1 allocation ratio was employed.The primary outcome was testicular function assessed by testicular volume,serum testosterone,anti-Müllerian hormone(AMH),and inhibin B(InhB)levels.Secondary outcomes included operative time,amount of intraoperative bleeding,and postoperative complications.Among 577 screened patients,100(17.3%)were considered eligible and enrolled in the study.Of the 100 children who completed the 1-year follow-up,50 underwent scrotal orchidopexy and 50 underwent inguinal orchidopexy.The testicular volume,serum testosterone,AMH,and InhB levels in both groups increased markedly after surgery(all P<0.05),but there were no apparent differences between groups at 6 months and 12 months after operation(all P>0.05).No differences between the scrotal and inguinal groups were noted regarding the operative time(P=0.987)and amount of intraoperative bleeding(P=0.746).The overall complication rate(2.0%)of the scrotal group was slightly lower than that of the inguinal group(8.0%),although this difference was not statistically significant(P>0.05).Both scrotal and inguinal orchiopexy exerted protective effects on testicular function in children with cryptorchidism,with similar operative status and postoperative complications.Scrotal orchiopexy is an effective alternative to inguinal orchiopexy in children with cryptorchidism.

Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience

Objective:Testicular torsion is a common urological emergency,mainly in the younger population.Our aim is to evaluate the efficacy and value of testicular echogenicity in predicting testicular viability.Methods:Patients who were older than 13 years of age and were discharged with the diagnosis of testicular torsion were reviewed.Data obtained included demographic data,history,physical examination results,ultrasound findings including size,color Doppler flow,and echotexture,torsion degrees,and surgical procedure.In addition,the histopathological findings of patients who underwent orchiectomy were reviewed.Results:A total of 71 cases were diagnosed with testicular torsion between January 2016 to December 2018.The mean age at presentation was 20.4±7.0 years.The average time from the onset of pain until the presentation was 36.0±55.1 h.Out of the 71 ultrasound scans reviewed,45.1%showed homogenous echotexture and 54.9%showed heterogeneous echotexture of the affected testis.On scrotal exploration,the mean degree of torsion was 475.7±301.8 degrees;66.2%of the patients had a viable testis;and bilateral orchidopexy was done.The remaining 33.8%had a non-viable testis.Homogenous echotexture was after an average of 13.5 h of scrotal pain,while heterogeneous echotexture presented after 53.7 h of scrotal pain.There was a statistically significant difference between the time of presentation and echotexture changes on scrotal ultrasonography(p<0.01).The relationship between echotexture changes and testicular viability was statistically significant as well(p<0.001).Conclusion:A long time since the onset of pain coupled with heterogeneous changes in testicular parenchyma is a good indicator of non-viability.However,we still advocate for surgical exploration as the gold standard in diagnosis and management.

Clinical Findings of Patients Undergone Surgery for Testicular Torsion: A 12-Year Single Center Experience in Northern Iran

Introduction: Testicular torsion is a surgical emergency which requires early diagnosis and prompt surgical management to avoid testicular damage. The aim of this study is to survey the clinical findings and outcome of the patients treated for testicular torsion in a university hospital in Babol, northern Iran. Methods: In this cross sectional study, a retrospective survey of all cases presenting with acute scrotum and primarily diagnosed as testicular torsion was conducted during 2001 and 2012 in Babol, northern Iran. All 103 cases were reviewed and several clinical data, including duration of symptoms and operative findings were collected. Findings: Of 103 patients who presented to the emergency department with acute scrotum, the median age of the cases was 16.0 years. Thirty four percent of the patients presented emergency unit less than 6 hours from symptom exposure. Pain (95.1%) was the major symptom in all patients. Surgery revealed that 72 (70.9%) cases were diagnosed firmly as testicular torsion that 23 patients underwent orchidectomy for a necrotic torsed testis. There were significant differences between orchiectomized versus non-orchiectomized torsion cases in affected side, symptom presentation to operation time. Conclusion: According to our results more than half of the cases presented more than in the golden time. Late presentation to hospital was the major cause of delay leading to orchidectomy in patients with testicular torsion. Greater effort in health education and direct or selfreferal to hospital may reduce this delay.

High Undescended Testis Treatment with Distal Espermatic Vessel Ligation (Koff-Sethi Technique)

Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni- or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

Laparoscopic Management for Non-Palpable Testis

Purpose: To present our experience with laparoscopic management of the non-palpable undescended testis. Patients and Methods: Between Nov. 2010 and Oct. 2012, 47 non-palpable testes in 41 patients were evaluated prospectively by laparoscopy. The age of the patients at the time of surgery varied from 1 to 9 years with a mean age of 2.85 years. Testicular viability and location were evaluated by physical examination and Doppler ultrasonography after 1 and 3 months. Results: Out of 49 testicular units, 47 (95.9%) were successfully treated by laparoscopic orchiopexy. 45 testicular units (91.8%) were treated by one-stage laparoscopic orchiopexy, 2 (4.1%) were treated by two-stage laparoscopic orchiopexy and 2 (4.1%) diagnosed as vanishing testis with detection of blind end spermatic vessels and vas deferens during laparoscopy. Physical examination and Doppler study demonstrated that 46 of 47 testes (97.9%) were viable and 45 of 47 (95.7%) were located in the lower scrotum and 2 of 47 (4.3%) in the upper scrotum at the end of follow-up. Conclusion: The laparoscopy is a reliable technique for diagnosis and treatment of the non-palpable intra-abdominal testis with high success and survival rates of the testes.

Laparoscopic Management of Undescended Testis: Results and Outcomes in a Pediatric Population

Aim: This study aimed to evaluate the results of the laparoscopic treatment of high and intra-abdominal undescended testes. Methods: A retrospective study was carried out from 2014 to 2021 at the Centre medico-chirugicale d’urologie in Douala. We consulted the clinical records of 27 patients aged 6 - 15 years who underwent laparoscopic orchiopexy at our hospital. We included patients with unilateral or bilateral undescended testes as detected by palpation and excluded patients with incomplete clinical records. The data collected were entered into Microsoft Excel 2016 and exported to Epi info 7 for analysis. Continuous variables were presented as mean values and standard deviations while categorical variables were presented as frequencies and percentages. The threshold for statistical significance was set at p Results: The ages of the 27 participants ranged from 6 years to 15 years, with a mean age of 10.22 ± 2.68 years. Hypospadias was an associated abnormality in 7.41% of participants. The mean duration of the surgical procedure was 80.56 ± 30.30 minutes. The overall success rate of the laparoscopic procedure was 95.83%. The mean duration of postoperative hospital stay was 26.67 ± 7.69 hours. The only postoperative complication we encountered was testicular atrophy, which occurred in 7.41% of participants. All our patients underwent single-stage laparoscopic procedures. Conclusion: Laparoscopy, which is the technique of choice for the diagnosis and management of undescended testis, is more rapid, more effective, and characterized by a shorter hospital stay and fewer postoperative complications compared to open surgery. Single-stage procedures are as effective and safe as two-stage procedures.

Long-term follow-up results of testicular torsion in children

December 2020 to investigate the long-term follow-up results after testicular torsion(TT)in children.Boys with TT were divided into the salvage orchiopexy group and the orchiectomy group,and the baseline characteristics,ultrasonographic indications,intraoperative findings,testicular volumes,and adverse events during follow-up were compared.A total of 145 cases were included in this study.Approximately 56.6%of patients who underwent salvage orchiopexy had testicular atrophy(TA),and the median testicular volume loss of the testes was 57.4%.Age less than 6 years,delayed surgery,and intraoperative poor blood supply were associated with TA in pediatric TT after orchiopexy.Most atrophied testes appeared within 3-6 months after surgery.Compared with the corresponding age-matched healthy controls,the contralateral testicular volumes were larger in the orchiopexy(P=0.o01 without TA,and P=0.042 with TA)and orchiectomy groups(P=0.033).The adverse events were comparable in patients with orchiectomy or orchiopexy.In summary,follow-up before 3 months after surgery may not offer sufficient clinical value,while that 3 months after surgery should be regarded as the first follow-up time for testicular monitoring.The contralateral testes of patients with TT showed compensatory hypertrophy.We suggest performing orchiectomy when torsed testes are surgically assessed as Arda gradeⅢor inviable.