Undescended Testicle: Difference between revisions

Line 324:

* '''Inguinal'''

** '''Maneuvers to provide spermatic cord length include (4):'''

**# '''~~Transection of~~ lateral fascial bands along the cord'''

**# '''Divide lateral fascial bands along the cord and at the internal inguinal ring'''

**# '''~~Cranial~~ retroperitoneal ~~dissection~~'''

**# '''Blunt dissection of the cranial retroperitoneal spermatic vessels'''

**# '''Medial transposition of the testis beneath the epigastric vessels (Prentiss maneuver)'''

**# '''Cranial extension of the incision'''

*** '''Very rarely, the testis cannot be brought to dependent scrotal position after these maneuvers and a ~~two~~-~~stage procedure~~ may be considered''' as an alternative to orchiectomy, which is preferentially reserved for visibly abnormal or atrophic testes, postpubertal patients, or cases associated with insufficient vasal length.

*** '''Very rarely, the testis cannot be brought to dependent scrotal position after these maneuvers and a''' '''Fowler-Stephens (FS) orchidopexy''' '''may be considered''' as an alternative to orchiectomy, which is preferentially reserved for visibly abnormal or atrophic testes, postpubertal patients, or cases associated with insufficient vasal length.

** '''Complications'''

**'''Complications'''

*** '''Uncommon'''

*** '''Serious complications include testicular retraction and atrophy'''

Line 360:

* '''The feasibility of primary vs. Fowler-Stephens orchidopexy depends on the length of the vas and vessels, presence or absence of looping ductal structures, and age of the patient.'''

** Observed testicular position alone may correlate poorly with the ultimate length of the cord after mobilization.

* '''Inguinal approach for the high inguinal canalicular, or intra-abdominal testis'''

** '''Helpful maneuvers to bring a high testicle down to the scrotum while preserving its blood supply:'''

**# '''Divide the lateral fibrous attachments of the cord at the internal inguinal ring'''

**# '''Blunt dissection of the retroperitoneal spermatic vessels''' (which are usually the limiting factor) up to the lower pole of the kidney

**# '''Mobilization of the cord medial to the inferior epigastric vessels (Prentiss maneuver)'''

**# '''Despite these steps, if the testicle still does not reach the scrotum, a Fowler-Stephens (FS) orchidopexy may be performed.'''

* '''Fowler-Stephens orchidopexy'''

** Originally described as a single-stage open inguinal approach for the intra-abdominal testis in which the testicular artery and veins were too short to allow adequate testicular mobilization into the scrotum through standard orchidopexy

@@ Line 324: / Line 324: @@
 * '''<span style="color:#ff0000">Inguinal'''
 ** '''<span style="color:#ff0000">Maneuvers to provide spermatic cord length include (4):'''
-**# '''<span style="color:#ff0000">Transection of lateral fascial bands along the cord'''
+**# '''<span style="color:#ff0000">Divide lateral fascial bands along the cord and at the internal inguinal ring'''
-**# '''<span style="color:#ff0000">Cranial retroperitoneal dissection'''
+**# '''<span style="color:#ff0000">Blunt dissection of the cranial retroperitoneal spermatic vessels'''
 **# '''<span style="color:#ff0000">Medial transposition of the testis beneath the epigastric vessels (Prentiss maneuver)'''
 **# '''<span style="color:#ff0000">Cranial extension of the incision'''
-*** '''Very rarely, the testis cannot be brought to dependent scrotal position after these maneuvers and a two-stage procedure may be considered''' as an alternative to orchiectomy, which is preferentially reserved for visibly abnormal or atrophic testes, postpubertal patients, or cases associated with insufficient vasal length.
+*** '''Very rarely, the testis cannot be brought to dependent scrotal position after these maneuvers and a''' '''Fowler-Stephens (FS) orchidopexy''' '''may be considered''' as an alternative to orchiectomy, which is preferentially reserved for visibly abnormal or atrophic testes, postpubertal patients, or cases associated with insufficient vasal length.
-** '''Complications'''
+**'''Complications'''
 *** '''Uncommon'''
 *** '''Serious complications include testicular retraction and atrophy'''
@@ Line 360: / Line 360: @@
 * '''The feasibility of primary vs. Fowler-Stephens orchidopexy depends on the length of the vas and vessels, presence or absence of looping ductal structures, and age of the patient.'''
 ** Observed testicular position alone may correlate poorly with the ultimate length of the cord after mobilization.
-* '''Inguinal approach for the high inguinal canalicular, or intra-abdominal testis'''
-** '''Helpful maneuvers to bring a high testicle down to the scrotum while preserving its blood supply:'''
-**# '''Divide the lateral fibrous attachments of the cord at the internal inguinal ring'''
-**# '''Blunt dissection of the retroperitoneal spermatic vessels''' (which are usually the limiting factor) up to the lower pole of the kidney
-**# '''Mobilization of the cord medial to the inferior epigastric vessels (Prentiss maneuver)'''
-**# '''Despite these steps, if the testicle still does not reach the scrotum, a Fowler-Stephens (FS) orchidopexy may be performed.'''
 * '''Fowler-Stephens orchidopexy'''
 ** Originally described as a single-stage open inguinal approach for the intra-abdominal testis in which the testicular artery and veins were too short to allow adequate testicular mobilization into the scrotum through standard orchidopexy