Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study.

BACKGROUND: Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques. OBJECTIVE: To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS). STUDY DESIGN: Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared. RESULTS: A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques. DISCUSSION: Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view. CONCLUSIONS: This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.

Trombosis espontánea de la vena espermática en la edad pediátrica: una entidad a tener en cuenta / Spontaneous spermatic vein thrombosis in pediatric patients: A condition to be considered

La trombosis de la vena espermática es una patología muy poco frecuente, con solo 25 casos publicados, 6 de los cuales menores de 15 años. De esta manera presentamos el caso de un varón, así como la revisión de la literatura. Un paciente de 12 años de edad acudió a Urgencias por dolor testicular de aumento progresivo, de 3 días de evolución. Mediante ecografía doppler abdominal se diagnosticó de trombosis de la vena espermática izquierda y síndrome de cascanueces. Se decidió ingreso y tratamiento con enoxaparina. La evolución del paciente fue satisfactoria, en la ecografía posterior se observó la desaparición del trombo. El paciente se encuentra en seguimiento y sin tratamiento. Existen varios tratamientos reflejados en la literatura, siendo el de elección el manejo conservador

Spermatic vein thrombosis is a very rare pathology, with 25 cases published only, 6 of which in patients under 15 years of age. We present the case of a male patient, as well as a review of the literature.A 12-year old boy presented at emergency with 3-day progressive testicular pain. Following abdominal Doppler ultrasound imaging, he was diagnosed with left spermatic vein thrombosis and nutcracker syndrome. Admission and enoxaparin treatment were decided upon. Patient evolution was satisfactory, with subsequent ultrasound imaging demonstrating the absence of thrombus. The patient is currently under follow-up and without treatment. Various treatments are mentioned in the literature, with conservative management being the treatment of choice

Trombosis de la vena espermática derecha. Revisión de la literatura a propósito de un caso / Right spermatic vein thrombosis. Revision of literature regarding a specific case

La tromboflebitis aguda de la vena espermática es una dolencia de muy baja frecuencia, con afectación mayoritaria del lado izquierdo, y de etiología desconocida en la mayoría de las ocasiones. Suele ser un hallazgo inesperado en el diagnóstico diferencial del dolor testicular agudo. Se trata de un varón de 29 años con un consumo abusivo de cocaína que acude con dolor testicular agudo. Se confirma la afectación de la vena espermática derecha mediante ecografía-doppler. Se optó por manejo conservador con anticoagulación y antiinflamatorios. La eco-doppler es la técnica con mayor especificidad y sensibilidad para diagnosticarlo, mientras que la TC puede completar su diagnóstico etiológico. El tratamiento de elección es conservador basado en la anticoagulación del paciente. Es imperativo un estudio hematológico en búsqueda de alteraciones de la coagulación (AU)

Acute thrombophlebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a a differential diagnosis in acute testicular pain. We introduce the case of a 29 years old male with abusive cocaine consumption, admitted to hospital due to severe testicular pain. Doppler-ultrasound examination was undertaken, showing right spermatic vein flux alteration. Conservative management was decided and anticoagulant and non-esteroidal anti-inflammatory drugs were started. Eco-doppler is the most specific and sensible technique for diagnosis of these cases, while TC can always confirm etiologic diagnosis. Treatment was initially conservative based on anticoagulation. Hematological study is necessary in order to determine coagulation alterations (AU)

Aspectos morfológicos dos componentes do funículo espermático do javali(sus scrofa) / Morphological aspects of the spermatic cord of wild boar ( sus scrofa)

Introdução - O estudo dos aspectos morfológicos dos funículos espermáticos do javali (Sus scrofa), adultos, busca subsídios necessários para o melhor conhecimento do aparelho reprodutor. Métodos - Para a descrição histológica utilizou-se seis pares de funículos espermáticos, corados com hematoxilina-eosina, tricômico de Masson, reticulina de Gordon, Verhoeff e Picrosirius, e um par para o estudo do arranjo vascular com a injeção de acetato de vinil. Resultados e Conclusões- Os componentes envolvidos pela túnica vaginal, sob esta, observamos tecido conjuntivo frouxo e adiposo. Artéria testicular apresenta-se sinuosa, lúmen amplo, túnica interna, média e externa, a qual é contínua ao tecido intervascular e adventícia das veias, há fibras elásticas interligando segmentos arteriais, função relacionada ao retorno venoso. As veias testiculares constituem o plexo pampiniforme, lumens irregulares, desprovidas de válvulas.(au)

Condideraçöes sobre a disposiçäo dos vasos sangüíneos no funículo espermático e no testículo do cäo (Canis familiaris, L) / On the arterial and venous patterns in the spermatic cord and testis of the dog (Canis familiaris, L)

Neste trabalho säo descritas observaçöes anatômicas macroscópicas e mesoscópicas sobre o suprimento arterial e a drenagem venosa testiculares no cäo. As disposiçöes dos vasos arteriais e venosos em nível da cápsula testicular e na intimidade do cordäo espermático säo comparadas com descriçöes preexistentes

Contribuiçäo ao estudo do funículo espermático em eqüinos sem raça definida (Equus caballus, L.) / Contribution to the study of the spermatic cord in crossbred horses

Utilizando 35 pares de funículos espermáticos de eqüinos sem raça definida, estudaram-se os aspectos histológicos dos envoltórios funiculares, dos vasos arteriais e venosos e dos tecidos intervasculares, assim como o seu arranjo vascular e o comprimento do segmento da artéria testicular nele contido