Laparoscopically Assisted Gradual Controlled Traction on the Testicular Vessels: A New Concept in the Management of Abdominal Testis. A Preliminary Report

Abstract

Introduction: The study was performed to assess the benefit of gradual traction for the management of abdominal testis by lengthening instead of dividing the testicular vessels. Patients and Methods: After approval by the ethical committee of the Faculty of Medicine of the University of Alexandria, and after parents signed a detailed informed consent, ten children with unilateral intra-abdominal testis were operated upon laparoscopically. The gubernaculum and the lower pole of the testis were attached with a 2/0 Prolene stitch which exited above the contralateral anterior superior spine. Gradual traction on the tension stitch was achieved over 14 days. A laparoscopy was performed after 14 days to check the new position of the testis and to locate the testis intrascrotally. Follow-up was done after 6–12 months to check the position and size of the testis, and color Doppler was performed to check the vascularity. Results: Ages ranged between 1 and 5 years (mean 2.3 yrs). Three testes were right-sided and 7 left-sided. In one case slipping of the traction suture occurred and the patient had conversion to a conventional Fowler-Stephens technique. Nine cases showed adequate elongation after traction and were successfully positioned in the scrotum. Follow-up was 6–12 months (mean 8.7 months). On follow-up, 9 testes were found intrascrotally with a normal size and consistency. Doppler study showed normal vascularity, both venous and arterial. Conclusion: This preliminary study showed that the technique of gradual controlled traction on the testicular vessels is very promising to achieve elongation and medialization of the testicular vessels instead of division. The measurable elongation allowed intrascrotal placement of the testis without tension. The technique cannot yet be recommended for routine use. Further comparative studies with a larger patient series are mandatory before the technique can be generally recommended.

Key words

laparoscopy - traction - abdominal testis - Prentiss maneuver - Fowler‐Stephens

References

• 1 Cabot H, Nesbit R M. Undescended testis.  Arch Surg. 1931;  22 850
• 2 Elder J S. Laparoscopy and Fowler-Stephens orchiopexy in the management of the impalpable testis.  Urol Clin North Am. 1989;  16 399-411
• 3 Elemen L. An old technique for surgery of “high” undescended testis revisited.  J Pediatr Urol. 2008;  4 330-332
• 4 Huang E J, Kelly Jr R E. et al . Effects of simulated Fowler-Stephens orchiopexy on testicular structure and function in rats.  Am Surg. 1992;  58 153-157
• 5 Huang E J, Liu H W. et al . [Testicular morphological and biochemical changes after Fowler-Stephens orchiopexy in rats].  J Formos Med Assoc. 1990;  89 829-834
• 6 Kelly Jr R E, Phillips J D. et al . Fertility after simulated Fowler-Stephens orchiopexy in rats.  Am J Surg. 1992;  163 270-272
• 7 Khan K M, Sabati A A. et al . The effect of traction on esophageal structure in children with long-gap esophageal atresia.  Dig Dis Sci. 2006;  51 1917-1921
• 8 Ortolano V, Nasrallah P F. Spermatic vessel ligation (Fowler-Stephens maneuver): experimental results with regard to fertility.  J Urol. 1986;  136 211-213
• 9 Prentiss R J, Mullenix R B. et al . The medical and surgical treatment of cryptorchidism.  Postgrad Semin Am Urol Assoc North Cent. 1954;  70 164-169
• 10 Stephens F D. Fowler-Stephens orchiopexy.  Semin Urol. 1988;  6 103-106
• 11 Torek F. Orchiopexy for undescended testicle.  Ann Surg. 1931;  94 97-110