UROLOGICAL SURVEY
Basic and Translation Urology
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.
MATHERIAL 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.
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
- 1. Hutcheson JC, Cooper CS, Snyder HM III: The anatomical approach to inguinal orchiopexy. J Urol. 2000; 164: 1702.
- 2. 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.
Publication Dates
-
Publication in this collection
15 Jan 2010 -
Date of issue
Dec 2009
