Surgical treatment of nonpalpable testis in children 
 

Voloshyn Yu. L.

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Zhytomyr Regional Children’s Clinical Hospital, Ukraine

Objective — to conduct a comparative analysis of surgeries using various laparoscopic techniques at nonpalpable testis syndrome in children. To analyze the long-term results of testicular ultrasound in different age groups of children.

Materials and methods. The paper summarizes experience of treating 119 patients with suspected abdominal cryptorchidism, who were treated at the surgical department of the Zhytomyr Regional Children’s Clinical Hospital in 2000–2015. Interventions were performed using laparoscope manufactured by Karl Storz, pediatric model. Anaesthetic stations used during surgical interventions are: Felix Visio Integra and Leon Heinen-Lцwenstein). Ultrasound examinations were carried out using ultrasound devices with Doppler effect (Philips HD 11XL with color Doppler (sensors: convex 5–2 and linear 12–3 MHz) and Siemens G5 with color Doppler (sensors: microconvex 5–8 and linear 5–10 MHz)), we assessed the state of the scrotal organs and spermatic cord, as well as blood flow to the testicles before surgery. To determine testicular volume, physico-mathematical modeling of its form was performed, which by the geometrical shape is ellipse cylinder. The main parameters of the cylinder are testicular perimeter: width, length, height. Testicular volume was determined by the formula: V = 2πabc. We used statistical methods of processing: Kruskal — Wallis criterion and statistical calculation by χ² formula. Definition of hypoplasia (testicular size widthwise and lengthwise) was conducted by the method of A.Yu. Vasyliev et al. (2008).

Results and discussion. Surgery by the method of one-stage orchiopexy was performed in 29 (24%) patients. By the method of Fowler — Stephenson, I stage, 43 (36%) children were operated. Using videoassisted orchiopexy (diagnostic laparoscopy + groin access), 23 (19.5%) children underwent surgery. Another group consisted of 24 (20.5%) children wasn’t included in the comparative analysis of surgical interventions methods, since in these surgical interventions, the testicle wasn’t visualized in the abdominal cavity, or hypoplasia, aplasia or anorchia were detected.

Conclusions. The comparative analysis of the methods for laparoscopic surgical treatment of cryptorchidism in children was performed. During the study of the immediate and long-term treatment results in children with abdominal cryptorchidism for a period of 2000–2015, it was found that results were positive in a group of children who underwent onestage orchiopexy by our own technique. In this group of patients 12 months after the surgery, testicular hypoplasia was not observed, resistance index, peak systolic velocity and end diastolic velocity were normal. However, in all other comparative groups (surgeries by Fowler — Stephens procedure and videoassisted orchiopexy), hypoplasia persisted one year after surgery. These techniques differ, and these differences are substantial and statistically significant (p<0.05).

Key words: cryptorchidism, children, laparoscopy, treatment.

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