The value of laparoscopy in the management of non-palpable testis.

OBJECT: To retrospectively review the value of laparoscopy in the management of impalpable testis. MATERIALS AND METHODS: In 1993-2006, 182 laparoscopies for impalpable testis were performed for a total of 194 testicular units. Five laparoscopic findings were considered: testicular ectopia, intra-abdominal testis, and cord structures that are blind ending, completely absent (agenesis) or entering the internal inguinal ring. RESULTS: In 62 cases an intra-abdominal testis was found; 18 were classified as high and managed by a laparoscopic Fowler-Stephens procedure. Cord structures entering the inguinal ring were observed in 77 patients and 45 underwent an inguinal exploration: a testis was found in 12 cases and in 33 a remnant was excised. In 35 cases, intra-abdominal blind ending vas and vessels were observed and eight showed testicular agenesis. No major surgical complications were recorded. Follow up ranged from 1 to 3 years. CONCLUSIONS: Our study confirms the value of laparoscopy in the management of non-palpable testis, providing a definitive diagnosis by the direct view of spermatic bundle and testis. Ninety-three patients were managed by laparoscopy only, and in 44 it was essential for the subsequent surgical approach. When the internal inguinal ring is patent and/or normal spermatic vessels are present an inguinal exploration is mandatory.

[Mouth mucosa free-flap grafts in repeat operations of hypospadias]. / Innesti di lembi liberi di mucosa buccale nei reinterventi di ipospadia.

BACKGROUND AND AIMS: Buccal mucosal grafts are widely used in the treatment of primary hypospadias and urethral stenosis owing to their elasticity, optimal attachment, possibility of generous harvesting and easy preparation. The aim of this study was to check whether buccal mucosal flaps are also valuable in redo surgery for hypospadias complicated by large breaks in the urethra and with scarce residual genital tissue. METHODS: Fourteen patients aged between 3 and 11 years old (mean age 6.6) were selected and operated between December 1993 and June 1999. The patients presented extensive fistulous tracts, roughly ellipsoidal in shape and with a maximum diameter of between 7 and 42 mm (mean length 18 mm). The original technique was: Duplay (7 patients); Onlay buccal graft (1 patient); Snodgrass (1 patient); Tubulised preputial flap (2 patients); Onlay preputial graft (2 patients); Tubulised vesical mucosal flap (1 patient). The mucosal flap, taken from the lower lip, was used to cover the gap as an onlay patch and recovered with residual genital skin with the interposition, where possible, of a de-epithelised flap. RESULTS: An optimal cosmetic and functional result was achieved in 10/14 cases with flowmetry > 25 percentile according to Toguri nomograms. Three patients presented fistulas: one punctiform fistula resolved spontaneously. The other two cases resolved after corrective surgery. One patient showed meatal regression with slight stenosis that was resolved with MAGPI. CONCLUSIONS: These results appear to be encouraging. Buccal mucosal graft may represent a valid alternative also in the treatment of secondary hypospadia with large breaks in the urethra. No complication was reported in the harvesting area, even if this was carried out at a second stage in the labial area.