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Laparoscopic Orchiopexy for High Intra Abdominal Undescended Testis , One Stage or Two Stages Fowler-Stephens Orchiopexy ; A Comparative Study

Authors: Laparoscopic Orchiopexy for High Intra Abdominal Undescended Testis , One Stage or Two Stages Fowler-Stephens Orchiopexy ; A Comparative Study --- Amar H. Howidi**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 581-586
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Laparoscopic management of the high intra abdominal testis is still a matter of controversy. Laparoscopic Fowler-Stephens orchidopexy (FSO) is performed either by one stage (laparoscopic clipping and division of the spermatic vessel and proceed for orchiopexy at the same time) or by two stages FSO (laparoscopic clipping and division of the spermatic vessel only and performing laparoscopic release of the testis along with orchiopexy 3-6 months later ).OBJECTIVE:To study the outcome of Laparoscopic one stage and two stages FSO for the management of high intra abdominal testes.PATIENTS AND METHODS:A prospective comparative clinical Study included 25 patients (21 unilateral and 4 bilateral non palpable abdominal testes , 29 testes in total) and laparoscopic surgical procedures (One stage FSO was done for 18 testicles and Two stages FSO was done for 11 testicles) were performed at the urology department ,Medical city complex, Iraq , during the period between December 2010 and March 2013 . Their mean age was 3.2 years.The comparative criteria include; Time of surgery, postoperative complications, testicular position, and testicular viability.RESULTS:Testicular Doppler study revealed four atrophied testes of one stage F.S.O. (22.2%), two atrophied testes among two stages FSO group (18 %) ,this difference was statistically non significant . The difference in the proper scrotal position also was not significant. The operative time difference was significant between both groups (86.6 ± 10.1 min. for one stage vs 122.7 ± 13.5 min. for two stages FSO).CONCLUSION:One-stage FSO avoids repeated anesthesia and the potential for extensive, sometimes tedious, dissection that is occasionally required during re operation, and shorter operative time, making it more optimal than two stages FSO.


Article
Laparoscopic Orchidopexy: Current Surgical Opinion

Author: Saad Dakhil F
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 232-237
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:With the use of diagnostic laparoscopy widely accepted in the setting of the non palpable testes, now day's laparoscopic orchidopexy is an efficient and logical alternative to open orchidopexy.OBJECTIVE:We reviewed the efficacy of laparoscopy for diagnosing the intra abdominal testes.Also we review the efficacy of primary orchidopexy, one stage and two stages laparoscopic orchidopexy for the management of the intra abdominal testes.PATIENTS AND METHODS:Prospective Study includes 20 boys with 23 impalpable testes (3 patients were bilateral). underwent laparoscopy for a non palpable testes at urosurgical department between June 2007 and February 2009.Their age ranged between 3years and 7 years. Eight patients had primary laparoscopic orchidopaxy without division of spermatic vessels .twelve patients had one stage Fowler Stephen method, and Two patients had two stages Fowler Stephen method.RESULTS:During diagnostic laparoscopy: Bilateral abdominal testes was found in 3 patients, Left intra abdominal tests was found in 10 patients, while right intra abdominal testes was found in 7 patients .With the use of laparoscopic orchidopexy : twenty two testes were brought down to the scrotum: sixteen testes (72.7%) brought down to the normal scrotal site, while six testes (27.2 %) were placed at high scrotal position. Orchidectomy was done for one (4.3%) intra abdominal testis.CONCLUSION:Laparoscopy is extremely effective for diagnosis and treatment of patients with non palpable testes.Laparoscopic orchidopexy is the logic extension of diagnostic laparoscopy for intra abdominal testes.


Article
How to Reduce Time Delays in Presentation and Treatment of Testicular Torsion; the Role of Public and Practitioners Education

Author: Saad Dakhil Farhan Daraji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2014 Volume: 13 Issue: 4 Pages: 499-503
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Testicular torsion (TT) requires prompt diagnosis and treatment to avoid testicular Loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. A long response time to the scrotal pain was related to high orchidectomy rate during surgery for acute torsion.OBJECTIVE:We attempted here to highlight the causes behind high orchidectomy rate during the surgery for testicular torsion and the advices to decrease this problem.PATIENTS AND METHODS: Surgical exploration which was done for suspected testicular torsion in 50 consecutive males with their age (range 1-20 years. All patients were evaluated with detailed history, physical examination and Basic Laparotory investigations, some patients underwent scrotal ultrasound scan with color-Doppler preoperatively when possible. Patient age, site of pain, duration of symptoms, ultrasound finding, approximate time from admission to surgery, operative findings, and type of the operation and causes of delay for orchidectomy group were recorded.RESULTS: Intra operative Testicular torsion was documented in 36 patients, orchidectomy and orchidopexy was performed equally, Delays to reach the hospital for more than 4 hours after the onset of pain significantly associated with increase the risk of orchidectomy .The risk of orchidectomy significantly increased with increased patient age. Parents neglect appear the most important cause for small age group while self ignorance, social fear and false medical advices for older ages.CONCLUSION: A long response time to the scrotal pain and a high orchidectomy rate were exposed by this study. This was thought to be due to ignorance, which could be eliminated through public education.

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