Dynamics of the testicle volume after scrotal and trans-inguinal orchiopexy in children aged 6–18 months

Abstract

BACKGROUND: Currently, scrotal and inguinal approaches are widely used for the treatment of low-positioned palpable forms of cryptorchidism. In the literature, available data demonstrate the comparability of the results obtained after using both techniques; however, the effectiveness reported in the literature was obtained based on rough criteria, such as the presence or absence of atrophy and malposition of the testis in the postoperative period.

AIM: To study the dynamics of the testicular volume in the postoperative period after performing scrotal and trans-inguinal orchiopexy.

MATERIALS AND METHODS: The study was based on the experience of treating 139 patients with palpable unilateral, low-positioned testis, aged up to 18 months, who underwent surgery within the period from 2010 to 2020. The low-positioned ones were those testicles that, during traction, could be descended beyond the superficial inguinal ring; however, the testis did not descend into the scrotum. By mechanical sampling, the patients were divided into two groups. Group I included 69 (49.6%) boys (median age, 17 [15–17] months) who used scrotal access, whereas group II included 70 (50.4%) patients (median age, 15 [14–17] months) with trans-inguinal access. The volume of the undescended testis was determined in both groups before surgery and after 1, 3, and 12 months.

RESULTS: Patients who had testicular atrophy and malposition that developed after surgery, wound infection, and hematoma, and did not show up for at least one of the scheduled examinations were excluded from the study. After applying the exclusion criteria, 22 boys remained in group I and 29 boys in group II. The volume of a normal testicle before surgery was 2.09 cm³ [1.25; 2.58] group I and 1.69 cm³ [1.41; 2.22] in group II (p = 0.537). In group I, a significant increase was found in the testicular volume from 0.5 cm³ [0.4; 0.8] before surgery to 1.3 cm³ [0.7; 1.8] (p < 0.001) a year after orchiopexy. In group II, the testicular volume increased from 0.6 cm³ [0.3; 0.8] before surgery to 0.7 cm³ [0.4; 1.0] after surgery.

CONCLUSIONS: Scrotal access in the treatment of a palpable, low-positioned undescended testis in children aged 6–18 months provides a greater increase in the volume of the operated testicle in a year compared with trans-inguinal access 1 year after surgery. The results suggest that transcrotal access has some advantages over trans-inguinal access.

Keywords

cryptorchidism / orchiopexy / scrotal access / inguinal access / children

References

[1] Cobellis G, Noviello C, Nino F, et al. Spermatogenesis and cryptorchidism. Front Endocrinol (Lausanne). 2014;5:63. DOI: 10.3389/fendo.2014.00063

[2] Cobellis G., Noviello C., Nino F., et al. Spermatogenesis and cryptorchidism // Front Endocrinol (Lausanne). 2014. Vol. 5. P. 63. DOI: 10.3389/fendo.2014.00063

[3] Sijstermans K, Hack WW, Meijer RW, et al. The frequency of undescended testis from birth to adulthood: a review. Int J Androl. 2008;31(1):1–11. DOI: 10.1111/j.1365-2605.2007.00770.x

[4] Sijstermans K., Hack W.W., Meijer R.W., et al. The frequency of undescended testis from birth to adulthood: a review // Int J Androl. 2008. Vol. 31, No. 1. P. 1–11. DOI.org/10.1111/j.1365-2605.2007.00770.x

[5] Detskaja hirurgija: Nacionalnoe rukovodstvo / pod red. ch.-kor. RAN A.Ju. Razumovskogo. 2-e izd., dop. i pererab. Moscow: GEOTAR-Media; 2021. P. 670–671. (In Russ.)

[6] Российская ассоциация детских хирургов. Детская хирургия: Национальное руководство / под ред. чл.-кор. РАН А.Ю. Разумовского. 2-е изд., доп. и перераб. Москва: ГЭОТАР-Медиа, 2021. С. 670–671.

[7] Shin J, Jeon GW. Comparison of diagnostic and treatment guidelines for undescended testis. Clin Exp Pediatr. 2020;63(11):415–421. DOI: 10.3345/cep.2019.01438

[8] Shin J., Jeon G.W. Comparison of diagnostic and treatment guidelines for undescended testis // Clinical and experimental pediatrics. 2020. Vol. 63, No. 11. P. 415–421. DOI: 10.3345/cep.2019.01438

[9] Leslie SW, Sajjad H, Villanueva CA. Cryptorchidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

[10] Leslie S.W., Sajjad H., Villanueva C.A. Cryptorchidism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC, 2022.

[11] Bianchi A. and Squire BR. Transscrotal orchidopexy: orchidopexy revised. Pediatr Surg Int. 2004;(4):189–192. DOI: 10.1007/BF00181983

[12] Bianchi A., Squire B.R. Transscrotal orchidopexy: orchidopexy revised // Pediatr Surg. 1989. Vol. 4, P. 189–192. DOI: 10.1007/BF00181983

[13] Kogan MI, Makarov AG, Sizonov VV, et al. The results of using the original technique of testicular fixation with transscrotal approach in the surgery of cryptorchidism in children. Experimental and Clinical Urology. 2021;14(1):151–155. (In Russ.) DOI: 10.29188/2222-8543-2021-14-1-151-155

[14] Коган М.И., Макаров А.Г., Сизонов В.В., и др. Результаты использования оригинальной техники фиксации яичка при трансскротальном доступе в хирургии крипторхизма у детей // Экспериментальная и клиническая урология. 2021. Т. 14, № 1. С. 151–155. DOI: 10.29188/2222-8543-2021-14-1-151-155

[15] Sotos JF, Tokar NJ. Appraisal of testicular volumes: volumes matching ultrasound values referenced to stages of genital development. Int J Pediatr Endocrinol. 2017;7. DOI: 10.1186/s13633-017-0046-x

[16] Sotos J.F., Tokar N.J. Appraisal of testicular volumes: volumes matching ultrasound values referenced to stages of genital development // Int J Pediatr Endocrinol. 2017. No. 7. DOI: 10.1186/s13633-017-0046-x

[17] Alam A, Delto JC, Blachman-Braun R, et al. Staged fowler-stephens and single-stage laparoscopic orchiopexy for intra-abdominal testes: is there a difference? A single institution experience. Urology. 2017;101:104–110. DOI: 10.1016/j.urology.2016.09.060

[18] Alam A., Delto J.C., Blachman-Braun R., et al. Staged fowler-stephens and single-stage laparoscopic orchiopexy for intra-abdominal testes: is there a difference? A single institution experience // Urology. 2017. Vol. 101. P.104–110. DOI:10.1016/j.urology.2016.09.060

[19] Wohlfahrt-Veje C, Boisen KA, Boas M, et al. Acquired cryptorchidism is frequent in infancy and childhood. Int J Androl. 2009;32(4):423–428. DOI: 10.1111/j.1365-2605.2008.00946.x

[20] Wohlfahrt-Veje C., Boisen K.A., Boas M., et al. Acquired cryptorchidism is frequent in infancy and childhood // Int J Androl. 2009. Vol. 32, No. 4. P 423–428. DOI: 10.1111/j.1365-2605.2008.00946.x

[21] Sizonov VV, Azashikov AH, Kogan MI. Did the choice of surgical approach for the treatment of children’s cryptorchism change? Russian Journal of Pediatric Surgery. 2013;(1):42–44. (In Russ.)

[22] Сизонов В.В., Азашиков А.Х., Коган М.И. Изменился ли подход к выбору хирургического доступа при оперативном лечении крипторхизма у детей? // Детская хирургия. 2013. № 1. С. 42–44.

[23] Akramov NR, Sizonov VV, Isroilov AA. Transskrotal’naya orkhopeksiya pri pakhovykh formakh dvukhstoronnego kriptorkhizma. Russian Journal of Pediatric Surgery Anesthesia and Intensive Care. 2020;10(S):13. (In Russ.)

[24] Акрамов Н.Р., Сизонов В.В., Исроилов А.А. Трансскротальная орхопексия при паховых формах двухстороннего крипторхизма // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2020. Т. 10, № S. C. 13.

[25] Savchuk MO, Pyattoev YuG. Through scrotal access when cryptorchidism in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2012;2(3):51–53. (In Russ.)

[26] Савчук М.О., Пяттоев Ю.Г. Трансскротальный доступ при крипторхизме у детей // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2012. Т. 2, № 3. С. 51–53.

[27] Al-Mandil M, Khoury AE, El-Hout Y, et al. Potential complications with the prescrotal approach for the palpable undescended testis? A comparison of single prescrotal incision to the traditional inguinal approach. J Urol. 2008;180(2):686–689. DOI: 10.1016/j.juro.2008.04.040

[28] Al-Mandil M., Khoury A.E., El-Hout Y., et al. Potential complications with the prescrotal approach for the palpable undescended testis? A comparison of single prescrotal incision to the traditional inguinal approach // J Urol. 2008. Vol. 180, No. 2. P. 686–689. DOI: 10.1016/j.juro.2008.04.040

[29] Russinko PJ, Siddiq FM, Tackett LD, Caldamone AA. Prescrotal orchiopexy: an alternative surgical approach for the palpable undescended testis. J Urol. 2003;170(6Pt 1):2436–2438. DOI: 10.1097/01.ju.0000097160.15802.23

[30] Russinko P.J., Siddiq F.M., Tackett L.D., Caldamone A.A. Prescrotal orchiopexy: an alternative surgical approach for the palpable undescended testis // J Urol. 2003. Vol. 170, No. 6. Pt. 1. P. 2436–2438. DOI: 10.1097/01.ju.0000097160.15802.23

[31] Rajimwale A, Brant WO, Koyle MA. High scrotal (Bianchi) single-incision orchidopexy: a “tailored” approach to the palpable undescended testis. Pediatr Surg Int. 2004;20(8):618–622. DOI: 10.1007/s00383-004-1243-2

[32] Rajimwale A., Brant W.O., Koyle M.A. High scrotal (Bianchi) single-incision orchidopexy: a “tailored” approach to the palpable undescended testis // Pediatr Surg Int. 2004. Vol. 20, No. 8. P. 618–622. DOI: 10.1007/s00383-004-1243-2

[33] Gordon M, Cervellione RM, Morabito A, Bianchi A. 20 years of transcrotal orchidopexy for undescended testis: results and outcomes. J Pediatr Urol. 2010;6(5):506–512. DOI: 10.1016/j.jpurol.2009.10.016

[34] Gordon M., Cervellione R.M., Morabito A., Bianchi A. 20 years of transcrotal orchidopexy for undescended testis: results and outcomes // J Pediatr Urol. 2010. Vol. 6, No. 5. P. 506–512. DOI:10.1016/j.jpurol.2009.10.016

[35] Eltayeb AA. Single high scrotal incision orchidopexy for unilateral palpable testis: a randomised controlled study. Afr J Paediatr Surg. 2014;11(2):143–146. DOI: 10.4103/0189-6725.132808

[36] Eltayeb A.A. Single high scrotal incision orchidopexy for unilateral palpable testis: a randomised controlled study // Afr J Paediatr Surg. 2014. Vol. 11, No. 2. P. 143–146. DOI: 10.4103/0189-6725.132808

[37] Cuda SP, Srinivasan AK, Kalisvaart J, Kirsch AJ. Evolution of single practice trends in the surgical approach to the undescended testicle. J Urol. 2011;185(6):2451–2454. DOI: 10.1016/j.juro.2011.01.010

[38] Cuda S.P., Srinivasan A.K., Kalisvaart J., Kirsch A.J. Evolution of single practice trends in the surgical approach to the undescended testicle // J Urol. 2011. Vol. 185, No. 6. P. 2451–2454. DOI:10.1016/j.juro.2011.01.010

[39] Jawad AJ. High scrotal orchidopexy for palpable maldescended testes. Br J Urol. 1997;80(2):331–333. DOI: 10.1046/j.1464-410x.1997.00256.x

[40] Jawad A.J. High scrotal orchidopexy for palpable maldescended testes // Br J Urol. 1997. Vol. 80, No. 2. P. 331–333. DOI: 10.1046/j.1464-410x.1997.00256.x

[41] Shaldenko OA, Orlov VM, Sizonov VV, Kogan MI. Evaluation of testicular volume following Bianchi – Shoemaker orchidopexy. Russian Journal of Pediatric Surgery. 2017;21(2):89–92. (In Russ.) DOI: 10.18821/1560-9510-2017-21-2-89-92

[42] Шалденко О.А., Орлов В.М., Сизонов В.В., Коган М.И. Оценка тестикулярного объема после орхидопексии по Бьянки и Шемакеру // Детская хирургия. 2017. Т. 21, № 2. C. 89–91. DOI: 10.18821/1560-9510-2017-21-2-89-92

[43] Takahashi M, Kurokawa Y, Nakanishi R, et al. Low transscrotal orchidopexy is a safe and effective approach for undescended testes distal to the external inguinal ring. Urol Int. 2009;82(1):92–96. DOI: 10.1159/000176033

[44] Takahashi M., Kurokawa Y., Nakanishi R., et al. Low transscrotal orchidopexy is a safe and effective approach for undescended testes distal to the external inguinal ring // Urol Int. 2009. Vol. 82, No. 1. P. 92–96. DOI: 10.1159/000176033

[45] Cloutier J, Moore K, Nadeau G, Bolduc S. Modified scrotal (Bianchi) mid raphe single incision orchiopexy for low palpable undescended testis: early outcomes. J Urol. 2011;185(3):1088–1092. DOI: 10.1016/j.juro.2010.10.039

[46] Cloutier J., Moore K., Nadeau G., Bolduc S. Modified scrotal (Bianchi) mid raphe single incision orchiopexy for low palpable undescended testis: early outcomes // J Urol. 2011. Vol. 185, No. 3. P. 1088–1092. DOI: 10.1016/j.juro.2010.10.039

[47] Neheman A, Levitt M, Steiner Z. A tailored surgical approach to the palpable undescended testis. J Pediatr Urol. 2019;15(1):59.e1–59.e5. DOI: 10.1016/j.jpurol.2018.08.022

[48] Neheman A., Levitt M., Steiner Z. A tailored surgical approach to the palpable undescended testis // J Pediatr Urol. 2019. Vol. 15, No. 1. P. 59.e1–59.e5. DOI: 10.1016/j.jpurol.2018.08.022

[49] Lee HR, Lee YS, Kim HS, et al. A comparison between single scrotal incision orchiopexy and the inguinal approach in patients with palpable undescended testes distal to the external inguinal ring. Korean J Urol. 2009;50(11):1133–1137. DOI: 10.4111/KJU.2009.50.11.1133

[50] Lee H.R., Lee Y.S., Kim H.S., et al. A comparison between single scrotal incision orchiopexy and the inguinal approach in patients with palpable undescended testes distal to the external inguinal ring // Korean J Urol. 2009. Vol. 50, No. 11. P. 1133–1137. DOI: 10.4111/KJU.2009.50.11.1133

[51] Ben Dhaou M, Zouari M, Zitouni H, et al. Comparison of the inguinal and scrotal approaches for the treatment of cryptorchidism in children. Prog Urol. 2015;25(10):598–602. (In French.) DOI: 10.1016/j.purol.2015.05.005

[52] Ben Dhaou M., Zouari M., Zitouni H., et al. Traitement chirurgical de la cryptorchidie chez l’enfant: comparaison des voies d’abord scrotale (Bianchi) et inguinale // Prog Urol. 2015. Vol. 25, No. 10. P. 598–602. DOI: 10.1016/j.purol.2015.05.005

[53] Gandhi J, Dagur G, Sheynkin YR, et al. Testicular compartment syndrome: an overview of pathophysiology, etiology, evaluation, and management. Transl Androl Urol. 2016;5(6):927–934. DOI: 10.21037/tau.2016.11.05

[54] Gandhi J., Dagur G., Sheynkin Y.R., et al. Testicular compartment syndrome: an overview of pathophysiology, etiology, evaluation, and management // Transl Androl Urol. 2016. Vol. 5, No. 6. P. 927–934. DOI: 10.21037/tau.2016.11.05

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