Date Published: November 22, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Fábio César Miranda Torricelli, Marco Antonio Arap, Ricardo Jordão Duarte, Anuar Ibrahim Mitre, Miguel Srougi.
Purpose. To present the results in a midterm followup of laparoscopic testicular preservation in adults with intra-abdominal cryptorchidism. Methods. We analyzed 14 adult patients with cryptorchidism (19 testes) submitted to transabdominal laparoscopic evaluation and treatment of the condition. Data was collected retrospectively from a prospective database from August 2005 to May 2010. It analyzed patient age, affected side, procedure, mean operative time, mean hospital stay, postoperative testis position, intra- and postoperative complications, presence of malignancy in the removed testis, and midterm outcomes: size of the testis, development of tumors, and fertility. Results. Mean patient age was 29 (18–54) years. Thirteen (68.4%) testes were preserved. There were no intra- or postoperative complications. After a mean followup of 48.7 (20–64) months, all patients submitted to orchiopexy had the organs correctly positioned, although 2 testes were significantly smaller than before the procedure. No patient presented any signs of malignancy during the followup. Fertility was not preserved in bilateral cases. Conclusion. Laparoscopic testicular evaluation and eventual preservation are feasible and safe. In a midterm followup, testicular tumor is not a concern, and unfortunately, fertility may not be preserved in bilateral cases.
Cryptorchidism is a condition that affects about 1% to 2% of boys, making it one of the most common congenital abnormalities of the genitourinary tract in infants. It is unilateral in 80% of cases [1, 2], and in approximately 20% of cases the testis is not palpable. When it is impalpable, half are intra-abdominal and half are absent or atrophic [2–5]. This disease is commonly diagnosed during childhood and prompt investigation and treatment are the rule. However, in some cases, usually in developing countries, diagnosis may be late due to ignorance or inaccessibility to health care and an adulthood presentation is seen.
Data was collected retrospectively from a prospectively maintained database from August 2005 to May 2010. In our institution, we have an electronic chart of all patients submitted to any kind of intervention in the urology division with demographic and disease-related data. This chart is prospectively maintained, and it was used for acquisition of our data. Laparoscopic orchiopexy and laparoscopic orchiectomy were the keywords searched. Fourteen adult patients with impalpable cryptorchidism submitted to transabdominal laparoscopic evaluation and treatment of the condition were analyzed. A total of 19 impalpable testes were found. All patients were previously submitted to ultrasound to evaluate the presence of testis in inguinal canal. One patient had a CT identifying an intra-abdominal left testis, and one patient had a magnetic resonance identifying an intra-abdominal left testis. Both evaluations were performed elsewhere before these patients were referred to our clinic.
Mean patient age was 29 (18–54) years. Median age was 25.5 years. Five (35.7%) patients had left-side cryptorchidism, four (28.6%) right-side, and five (35.7%) bilateral. A total of 19 testes were evaluated. Testis identification was immediate in all cases, and all organs were intra-abdominal. Thirteen (68.4%) testes were preserved. Six testes were resected because of small size (<2.0 cm diameter) or difficult dissection. Two of these patients had bilateral cryptorchidism, and both testes were removed (one case had a seminoma in situ in the biopsy and the other case had both testes too small). Both patients were young men (23 and 26 years old), they did not have kids, and until now did not present any concern about that. The others three patients with bilateral cryptorchidism were treated as follows: one case with first-stage Fowler-Stephens in one side and single-stage orchiopexy in the other one; two cases with bilateral single-stage orchiopexy. Untreated cryptorchidism in adults is a very rare condition, and the gold standard evaluation and management is still controversial. In this paper, we studied testicular preservation feasibility through laparoscopy and analyzed its consequences, such as testicular size, testicular tumor development, and fertility. Laparoscopic testicular evaluation and eventual preservation are feasible and safe. In a midterm followup testicular tumor is not a concern, and, unfortunately, fertility may not be preserved in bilateral cases. Source: http://doi.org/10.1155/2012/329237