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PubMed2006

Laparoscopic versus open orchiopexy in the management of abdominal testis: a descriptive study.

AIMS: Treatment of patients with abdominal non-palpable testis (NPT) is still controversial among pediatric urologists. This is a prospective randomized comparative study between open and laparoscopic orchiopexy for management of abdominal testis. The aim of this study was to evaluate the success rate and morbidity of both approaches. METHODS: Eighty-two patients with a mean age of 5.3 years were evaluated by laparoscopy for 87 NPT. Patients with viable abdominal testes were randomly treated with either open or laparoscopic orchiopexy procedures. RESULTS: On laparoscopy, 75 viable abdominal testes were found. According to location: 41 (47.1%) testes were high abdominal, 27 (31%) testes were low abdominal and 7 (8%) testes were peeping from the internal ring. Laparoscopic first stage Fowler-Stephens orchiopexy was done initially for those with high abdominal testes. For further management, all patients were divided randomly into open (36 cases) and laparoscopic (39 cases) groups where primary (with spermatic vessel preservation) or second stage Fowler-Stephens orchiopexy was done. Statistical analysis was done using Student's t-test. Laparoscopic procedures showed significant less morbidity than the open counterparts. Follow up ranged from 9 to 31 months and included evaluation of testicular site and size. All testes were located satisfactorily inside the scrotum. Five cases of testicular atrophy were encountered (three and two testes with open and laparoscopic second stage Fowler-Stephens orchiopexy respectively) after 1 year follow up. CONCLUSION: Results of open versus laparoscopic orchiopexy procedures (primary or staged) are fairly comparable. However, laparoscopy provides significantly less morbidity.

Adolescent↗
PubMed2006

The effects of orchiopexy on serum anti-Müllerian hormone levels in unilateral cryptorchid infants.

BACKGROUND/PURPOSE: In males, serum anti-Müllerian hormone (AMH) reflects Sertoli cell function and provides an estimate of seminiferous tubular integrity. It has been suggested that comparison of AMH levels before and after surgery could be useful to determine effectiveness of the treatment. In this study, we determined the serum AMH levels in infants with unilateral cryptorchidism before and after orchiopexy procedure and compared these data with the AMH values in age-matched controls. METHODS: The study population was 20 cryptorchid children with unilateral palpable testes who underwent orchiopexy as a cryptorchid group, and 20 healthy children who underwent circumcision as a control group. All children are 12 months of age. Serum AMH levels were measured at just before surgery (at 12 month old) and 6 months after surgery (at 18 month old). RESULTS AND CONCLUSIONS: All undescended testes were found to be normal in size and in the superficial inguinal pouch or subcutaneous region of the groin at surgery. With regard to the preoperative serum AMH levels, there was a significant difference between the cryptorchid and the control groups (40.04 +/- 4.97 ng/ml versus 53.46 +/- 7.51 ng/ml) (P < 0.05). Similarly, the postoperative serum AMH levels were lower in cryptorchid children than in controls (39.27 +/- 4.58 ng/ml versus 52.79 +/- 6.27 ng/ml) (P < 0.05). In cryptorchid children, serum AMH levels measured at 6 months after orchiopexy were similar with preoperative basal levels (40.04 +/- 4.97 ng/ml versus 39.27 +/- 4.58 ng/ml) (P > 0.05). AMH levels in children with unilateral palpable undescended testes remain unchanged 6 months after orchiopexy performed at 1 year of age. This is the first report in literature regarding the effect of orchiopexy on the serum AMH levels.

Anti-Mullerian Hormone↗
PubMed1999

Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood.

PURPOSE: We determined whether there are differences in hormone levels, such as inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone and testosterone, and sperm density in men with a history of unilateral cryptorchidism as stratified by age at orchiopexy. MATERIALS AND METHODS: A total of 84 men with a history of unilateral cryptorchidism presented to our institution for serum hormone measurement and semen analysis. These parameters were compared using Pearson's correlations and analysis of variance among 4 groups stratified according to age at orchiopexy (range 1 month to 11 years). RESULTS: Comparison by Pearson's correlation analysis showed that age at orchiopexy significantly correlated inversely with inhibin B (r = -0.274, p = 0.012) and positively correlated with FSH (r = 0.229, p = 0.036). Comparison of mean hormone levels and sperm density by analysis of variance for linear trend revealed a significant relationship between age at surgery with inhibin B (p = 0.032) and testosterone (p = 0.029), while sperm density, FSH and luteinizing hormone were not significantly related. Post hoc comparison of individual means at surgery and at the time of this study demonstrated a significantly higher inhibin B level in the youngest age group than in 2 of the 3 older groups. CONCLUSIONS: Men who previously had unilateral cryptorchidism and who underwent orchiopexy by age 2 years have higher inhibin B and lower FSH profiles than those who underwent surgery later in life. This finding suggests an overall beneficial effect of early orchiopexy in boys born with unilateral cryptorchidism.

Adult↗
PubMed2002

Recovery of spermatogenesis by high dose gonadotropin-releasing hormone analogue treatment in rat cryptorchid testis after orchiopexy.

PURPOSE: Cryptorchidism is an adverse condition of spermatogenesis in many mammals. Surgical cryptorchidism in rats lasting more than a few weeks is so detrimental that spermatogenesis cannot be completely recovered even after orchiopexy. We evaluated the efficacy of the high dose gonadotropin-releasing hormone (Gn-RH) agonist leuprorelin acetate on damaged spermatogenesis in rat cryptorchid testes. MATERIALS AND METHODS: Male Fisher rats were divided into 2 groups of 6 each and bilateral cryptorchidism was artificially produced. Five weeks later all rats underwent bilateral orchiopexy. One group served as the control, while the other received Gn-RH agonist injections at orchiopexy and 4 weeks later. The animals were sacrificed 15 weeks after orchiopexy. The weight of the body, testis and epididymis was measured and the histology of spermatogenesis was examined. For statistical analysis the Student t test was applied. RESULTS: Testes in the Gn-RH group rats showed significant recovery of spermatogenesis up to complete spermatozoa formation, while those in control rats remained almost degenerated. The mean incidence of seminiferous tubules with recovered spermatogenesis plus or minus standard deviation was significantly higher in the Gn-RH than in the control group (87.8% +/- 6.0% versus 12.5% +/- 7.7%, p <0.001). CONCLUSIONS: Administering the high dose Gn-RH agonist leuprorelin acetate after orchiopexy greatly enhanced the recovery of spermatogenesis in rats. This finding is in accordance with other recent reports that treatment with Gn-RH analogues promotes the regeneration of once damaged spermatogenesis. On the other hand, these findings may cause one to question supplementation therapy now used in regular practice to boys with cryptorchidism.

Animals↗
PubMed1979

Germinal cell tumors of the testis after orchiopexy.

A review of the literature revealed 220 cases of germinal cell tumor of the testis that has occurred after orchiopexy. Of these cases 97 were accurately documented in regard to scrotal placement of the undescended testis and the subsequent tumor. Only 6 cases were reported after orchiopexy in children less than 10 years old. Since the number of patients at risk is unknown the possible protection of early orchiopexy against subsequent malignant degeneration cannot be established. The small number of cases reported after orchiopexy in children less than 10 years old is encouraging. The accumulated reports of germinal cell tumors of the testes after orchiopexy in patients between 10 and 20 years old militate against such a procedure in patients with a unilateral underscended testis.

Adolescent↗
PubMed2003

A stereological study of the effects of experimental inguinal cryptorchidism and subsequent orchiopexy on spermatogenesis in adult monkeys.

Our previous study demonstrated that experimental intra-abdominal cryptorchidism in adult rabbits for 13 weeks resulted in severe spermatogenic arrest: type A spermatogonia was the only germ cell type seen in the seminiferous epithelium and its number per testis was reduced by 84%. Seven weeks following orchiopexy, the type A spermatogonial number returned to the near-normal range in most animals and spermatogenesis partially recovered (Reproduction 2002, 124, 95-105). This study aimed to determine whether inguinal cryptorchidism would produce less-severe damage to spermatogenesis and whether subsequent orchiopexy would better restore spermatogenesis. Five normal adult male rhesus monkeys (Macaca mulatta) underwent bilateral artificial inguinal cryptorchidism. Half a year later, one testis together with the ipsilateral epididymis were removed from each animal and then unilateral orchiopexy was performed on the contralateral side, with the remaining testis and epididymis being removed another half a year later. A contemporary unbiased and efficient stereological tool, the optical disector, was used to estimate numbers of all types of spermatogenic cells in the testis and spermatozoa in the epididymis. Spermatogenic arrest was induced by cryptorchidism at the stage of spermatogonia (n = 1), spermatocytes (n = 2) or early spermatids (n = 1), with the type A spermatogonial numbers per testis being reduced to 14.8-57.2% of the control average; in one of the five cryptorchid animals, however, spermatogenesis remained normal. Subsequent orchiopexy, which was successfully performed on two animals with cryptorchidism-induced spermatogenic arrest, brought on a full or partial recovery of spermatogenesis. In conclusion, inguinal cryptorchidism induces less severe (in comparison with an intra-abdominal one) and variable damage to spermatogenesis, which is restored, at least in part, by subsequent orchiopexy.

Animals↗
PubMed2006

Routine contralateral orchiopexy for children with a vanished testis.

AIM: The aim was to determine whether routine contralateral orchiopexy is justified in a child with a vanished testis from intrauterine torsion. METHODS: A retrospective study of thirty-one consecutive boys with a vanished testis who underwent contralateral orchiopexy with the sutureless technique over an eight-year (1995 - 2002 inclusive) period was carried out. Operative findings were analyzed. All patients have been followed to date and interviewed by telephone. RESULTS: Of the thirty-one patients, 22 had testicular abnormalities (71 %). Five patients (16 %) had abnormalities that could predispose them to metachronous torsion. These included bell clapper deformity (3), horizontal lie (1), and ectopic testis (1). Other abnormalities were abnormal epididymal-testicular fusion (2), hydrocele (2), and one testis did not show compensatory hypertrophy. CONCLUSIONS: Sixteen percent of patients had testicular abnormalities that could predispose them to metachronous torsion. There was no morbidity from the operation and no post-orchiopexy torsion on follow-up. Therefore, routine contralateral orchiopexy in a boy with a vanished testis appears to be safe and effective. A large multicenter trial should be done to investigate these preliminary findings. If confirmed, contralateral orchiopexy should be advocated.

Child↗
PubMed1997

Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life.

PURPOSE: Infertility has been considered a principal complication associated with cryptorchidism. A particularly high incidence of cryptorchid boys lack the priming effect during the first 3 months of life due to low concentrations of gonadotropins and testosterone (inadequate perinatal stimulation of the testes, which causes infertility). This condition causes impaired transformation of gonocytes into fetal spermatogonia. More pronounced hypogonadotropic hypogonadism results in fewer germ cells. Most importantly, cryptorchid boys with fewer than 0.2 cells per tubular cross section have a high probability of being infertile in adulthood, regardless of whether the condition is unilateral or bilateral and despite apparently successful orchiopexy. MATERIALS AND METHODS: To counteract the paucity of priming hormones, cryptorchid patients with unilateral or bilateral cryptorchidism and a severe paucity of germ cells were treated with a low dose of the luteinizing hormone-releasing hormone analogue buserelin after successful orchiopexy. We analyzed the spermiograms of these patients, who are now young adults, and compared them to those of 23 other men who also had cryptorchidism with a comparable severe paucity of germ cells but who had not received hormonal treatment after successful orchiopexy. RESULTS: Patients who received hormonal therapy after orchiopexy had significantly improved spermiograms compared to those in the control group. Treatment with buserelin increased the number of spermatozoa, improved motility and increased the number of normal forms of spermatozoa. CONCLUSIONS: The luteinizing hormone-releasing hormone analogue buserelin, administered as a nasal spray every other day for 6 months following successful orchiopexy, appears to have a long lasting, positive effect on germ cells. Consequently, the prognosis of fertility has been greatly enhanced in patients treated with buserelin.

Buserelin↗
PubMed2004

Failed orchiopexy.

INTRODUCTION: Failure after orchiopexy or cryptorchidism after inguinal surgery are not so rarely encountered conditions. Reoperative orchiopexies are technically demanding procedures. In our study, we aimed to examine the causes of failures and outcomes of reorchiopexies. PATIENTS AND METHODS: Between 1993 and 2003, a total of 28 children who underwent reoperative orchiopexy were included into the study. Undescended testes was detected as unilateral in 24 and bilateral in 4 cases. The mean age of patients at the time of second operation was 6.8 years. The mean period of time between the first and the second operations was 3.2 (1-13 years) years. RESULTS: The first operations were orchiopexies in all patients. After the first operations, 15 testes were found to be localized at the high scrotal position, 8 at the level of the external ring and 9 within the inguinal canal. Overall, reorchiopexies were performed on 32 testes in 28 patients. During the second operation, patent processus vaginalis was detected in 11 (34.4%), and unsuccessful hernia repair in 9 (28.1%) cases. After reorchiopexies, two testes with preoperative inguinal location could only be brought to high scrotal position and in another case orchiectomy was performed to an atrophic testis. Overall, after a mean follow-up period of 3.8 (1-7 years) years following the second operations, 29 (93.5%) testes were scrotal without evidence of atrophy. CONCLUSION: In our series, inadequate repair of inguinal hernia or patent processus vaginalis, as noted in 62.5% of the cases, was determined as an important factor leading to failure after surgical treatment of undescended testis. Adequate dissection and correction of inguinal hernia increase the success rate after orchiopexies.

Child↗
PubMed2000

The anatomical approach to inguinal orchiopexy.

PURPOSE: Achieving a scrotally positioned testis with no iatrogenic atrophy is the primary goal of the surgical treatment of cryptorchidism. The success rate is associated with preoperative testicular position and the technique used. Our success rate with inguinal orchiopexy for abdominal testis is higher than those previously published and may be due to our anatomical approach to retroperitoneal dissection. We review the relevant anatomy and discuss the surgical technique of inguinal orchiopexy. MATERIALS AND METHODS: We researched and reviewed the relevant technical and anatomical literature on inguinal orchiopexy, and describe the anatomical approach to orchiopexy in detail. RESULTS: An understanding of the retroperitoneal fascial layers is the key to understanding surgery of the retroperitoneum. Dividing the internal spermatic fascia is required for the surgeon to separate the processus vaginalis from the vas and vessels. CONCLUSIONS: The average age of children undergoing cryptorchid surgery has decreased dramatically during the last 40 years. In such young patients extensive mobilization of the vas and vessels may be accomplished through a relatively small incision. We believe that our success rate with inguinal orchiopexy for abdominal testis is associated with our anatomical approach to retroperitoneal dissection.

Cryptorchidism↗
PubMed2005

[Clinical study of unilateral intravaginal testicular torsion and anatomicalcomparative study of bilateral testes in orchiopexy].

Fourty-eight patients were operated on for unilateral intravaginal testicular torsion at Yokohama Red Cross Hospital during the period between July 1976 and December 2001. Orchiopexy was carried out on 20 out of 48 patients. Only 8 patients could receive orchiopexy within 8 hours after the onset of symptoms. Although, 24 of the 48 patients had visited a medical doctor within 8 hours after the onset. Therefore, the less the testes might be sacrificed if these patients could be immediately sent to a clinic with an urologic speciality. The contralateral uninvolved testis has been said to require orchiopexy because it has an anatomical structure similar to the testis with torsion. However, the contralateral testes in 5 out of 20 patients with ipsilateral orchiopexy turned out to have a normal anatomical structure according to our classification of intravaginal testicular torsion. This suggests that no orchiopexy is necessary if the contralateral uninvolved testis has a normal anatomical structure from the standpoint of torsion type.

Adult↗
PubMed2026

Gonadal function and fertility outcomes after orchiopexy versus orchiectomy for testicular torsion: A systematic review and meta-analysis.

PURPOSE: To review the early and late changes in hormonal profiles, semen parameters, and clinical outcomes in patients treated with orchiopexy versus orchiectomy for testicular torsion. METHODS: A systematic search was conducted across MEDLINE, Scopus, Web of Science, Cochrane Library, and other databases, following PRISMA guidelines. PRIMARY OUTCOMES: FSH, LH, testosterone, inhibin-B, and semen parameters. Quality was assessed using the Newcastle-Ottawa Scale. Certainty of evidence was evaluated using the GRADE framework. Statistical analysis was performed using the random-effects model. RESULTS: Eleven studies involving 538 participants (197 orchiectomy, 341 orchiopexy) were included. Orchiectomy was associated with a significant increase in FSH (SMD: 1.63, P < 0.0001) and LH (SMD: 1.31, P < 0.0001) compared to orchiopexy. However, testosterone (MD: 0.31 ng/mL; P = 0.4) and inhibin-B (SMD: -0.14; P = 0.87) levels were comparable between groups. Regarding semen parameters, orchiectomy resulted in a significant reduction in sperm concentration (MD: -18 million/mL, P = 0.01). No significant differences were found in sperm count (MD: 13.9 million; P = 0.43), normal morphology (MD: 4.97%; P = 0.12), or total motility (MD: 4.05%; P = 0.49). The pooled rate for ipsilateral atrophy following orchiopexy was 38%, which likely depends on ischemia duration. CONCLUSION: Surgical choice in testicular torsion does not significantly affect the overall hormonal balance or most semen parameters due to compensatory mechanisms of the hypothalamic-pituitary-gonadal axis. Clinical decisions should consider individual case factors, as we lack reliable data on subsequent paternity rates.

Male↗
PubMed2026

Hydrodissection-assisted laparoscopic orchiopexy utilizing needle grasper for palpable undescended testes: Clinical efficacy analysis.

OBJECTIVE: Laparoscopic orchiopexy has emerged as a viable alternative for the treatment of palpable undescended testis (UDT). This study aims to evaluate the feasibility and efficacy of needle-grasper hydrodissection-assisted laparoscopic orchiopexy (NHLO) in comparison to conventional laparoscopic orchiopexy (CLO) for palpable UDT. METHODS: A cohort of 96 patients diagnosed with palpable UDT, admitted between January 2020 and April 2024, was included in this study. Among these, 54 patients underwent NHLO, while 42 patients were treated with CLO. In the NHLO procedure, normal saline was injected into the retroperitoneal space to create a hydrodissection barrier, facilitating the separation and protection of the vas deferens and spermatic cord. The vas deferens and spermatic cord were meticulously dissected following the principles of integrity and minimal tissue trauma. Outcome measures included final testicular position, testicular volume growth, testicular atrophy, success rate, and postoperative complications. RESULTS: No significant differences were observed between the NHLO and CLO groups in terms of age, laterality, operative time (NHLO: 38-46 min; CLO: 39-48 min), or complication rates (NHLO: 1.9 %; CLO: 0.0 %). At follow-up, all patients in both groups exhibited palpable testes in satisfactory scrotal positions. Notably, no visible abdominal scarring was observed in the NHLO group, whereas there were two noticeable scars on the abdomen in CLO. CONCLUSION: Needle-grasper hydrodissection-assisted laparoscopic orchiopexy is a safe, effective, and minimally invasive technique that provides optimal protection of the vas deferens and spermatic cord while achieving excellent cosmetic outcomes.

Humans↗
PubMed2005

An experimental study of the effect of two distinct surgical techniques of orchiopexy on spermatogenesis and testicular damage in cryptorchid testes.

OBJECTIVE: To compare the effect of two different techniques of testicular fixation on testicular function. DESIGN: Experimental study. SETTING: Surgical animal laboratory at an academic medical center. PATIENT(S): Sixteen mature golden hamsters underwent classic transfixation orchiopexy and true dartos pouch orchiopexy. INTERVENTION(S): Classic transfixation orchiopexy (CTO) involved transfixation of the testicular wall at two different points and fixation of the dartos fascia. True dartos pouch orchiopexy (TDPO) involved creating a window in the dartos fascia, passage of the testicle, and closure of the window from both sides of the testicle. MAIN OUTCOME MEASURE(S): Flow cytometric separation of testicular cells into haploid, diploid, and tetraploid fractions for histogram analysis. RESULT(S): A significant decrease in testicular weight was observed in 6 out of 16 animals undergoing CTO. Diploid cells comprised the main cell fraction, and almost no haploid or tetraploid cells were observed, while in the 16 animals undergoing TDPO no change from the control pattern was observed. CONCLUSION(S): This experimental work supports our clinical impression that TDPO should replace CTO as the method of choice for the treatment of an undescended testicle in children.

Animals↗
PubMed2006

Assessment of serum follicle-stimulating hormone level and testicular volume for prediction of paternity potential in pubertal boys who underwent bilateral orchiopexy in childhood.

PURPOSE: We examined infertile adults for the presence of spermatozoa in the testes, serum FSH level and testicular volume to predict paternity potential in pubertal boys who had undergone bilateral orchiopexy in childhood. MATERIALS AND METHODS: The study included 58 idiopathic infertile men (group 1), 14 infertile men who had undergone bilateral orchiopexy in childhood (group 2) and 21 pubertal boys who had undergone bilateral orchiopexy in childhood (group 3). We evaluated the correlation between FSH level and testicular volume in all groups. In groups 1 and 2 the testes were examined for the presence of spermatozoa using bilateral testicular biopsy samples. RESULTS: Judging from the presence of spermatozoa in the testes and correlation between FSH level and testicular volume, 14 patients in group 1 (24%) were categorized as being at high risk, 32 (55%) at intermediate risk and 12 (21%) at low risk for loss of paternity potential, with spermatozoa positive rates of 0%, 49% and 100%, respectively. In comparison, 4 patients in group 2 (29%) were categorized as being at high risk, 7 (50%) at intermediate risk and 3 (21%) at low risk, with spermatozoa positive rates of 0%, 43% and 100%, respectively. According to this categorization, 19% of pubertal boys in group 3 were at high risk and may already have lost their paternity potential. CONCLUSIONS: Despite bilateral orchiopexy in childhood, some male adolescents may not have the potential for paternity.

Adolescent↗
PubMed1994

Laparoscopic single stage and staged orchiopexy.

The initial series of laparoscopic single stage orchiopexy for the abdominal or emergent impalpable undescended testis is reported. The first laparoscopic orchiopexy was performed at our institution in October 1991. Between October 1991 and January 1993, 14 patients (16 testes) underwent minimally invasive surgery with 6 months of followup in all cases. No evidence of testicular loss or acute atrophy has occurred, with the entire procedure being accomplished by laparo-endoscopic techniques in all cases. Treatment of 3 of the 16 testicles consisted of stage 2 of staged orchiopexy, and to our knowledge these cases represent the first stage 2 orchiopexy completed by laparoscopic techniques. In those cases stage 1 was performed by laparoscopic clipping of the vessels. The details of the procedure as we now perform it are described.

Adolescent↗
PubMed1992

Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes.

Of 22 boys with an intra-abdominal testis 8 (12 testes) underwent the 2-stage Fowler-Stephens orchiopexy. During stage 1 the testicular artery and internal spermatic vein were ligated in situ 2 to 3 cm. superior to the intra-abdominal testis. The testicular vessels were transected inferior to the ligatures 6 months later and the testis was brought to the scrotum with the standard Fowler-Stephens orchiopexy technique. Patient age ranged from 1 to 6 years (mean 3.2 years). At followup 11 of 12 testes (92%) are in the scrotum and have a normal consistency and size, while 1 (8%) is atrophic. In this preliminary series the 2-stage Fowler-Stephens orchiopexy has a success rate equal or possibly superior to the standard Fowler-Stephens orchiopexy. Whether ultimate testicular function is improved, however, remains to be determined.

Child↗
PubMed1982

Outpatient orchiopexy.

Outpatient surgery in children has been recommended as a means to help contain the increasing cost of health care. In addition, the shorter the child's hospitalization the less psychologic trauma. This study examines the feasibility of performing outpatient orchiopexy based on preoperative evaluation, surgical success rate and cost-effectiveness. The records of 459 inpatient and 77 outpatient orchiopexies were reviewed with regard to patient age, medical history (including previous inguinal surgery), preoperative palpability and intraoperative location, anesthetic technique, complications, duration of hospitalization and hospital costs. The results indicate that at least 68 per cent of orchiopexies can be performed as outpatient procedures. Overnight hospital stay from the ambulatory surgery unit was necessary in 5 per cent. Followup revealed that, despite same day ambulation and lack of postoperative restrictions, surgical success was in no way compromised by an outpatient procedure. Cost analysis shows that an average savings of 50 per cent per hospitalization can result from outpatient orchiopexy.

Adolescent↗