Original Articles
Undescended Testis a Common Problem in Children Difficult to Assess Stage Surgery in Non Palpable Testes | |
Dr. Pankaj Shastri, Dr. Advait Prakash | |
Background: Undescended testis (UDT) is very common problem in children age group 6 months to 2 years. UDT best mode of treatment remains controversial. However, after study published by different groups of researchers to set out guidelines on management of patients with UDT. (1) Hormonal treatment is not recommended, considering both the immediate results (only 15–20%) of retained testes descend and the possible long-term adverse effects on spermatogenesis. (2) Surgery is the treatment of choice; orchiopexy is successful in about 95% of UDT, with a low rate of complications (about 1%). (3) Orchiopexy should be performed between 6 months to 12 months.or at first contact if diagnosed later. (4)Laparoscopic Orchiopexy can be done in two stage if testis is non palpableand present intraabdominal. Methods: Undescended testis is very common problem in children . We common across very frequently palpable undescended testes . In this study we are presenting cases of non palpable undescended testis (UDT ). UDT Non Palpable Testis we do ultrasound of the abdomen and inguinal region . Very often in sonography we are able to trace the exact location if the testis . USG is very useful tool of investigation in our study .we don’t recommend MRI in children for non palpable testis. We do routine investigation and preop profile for anaesthesia fitness. Result: None of the testis atrophied after two-stage Fowler — Stephens laparoscopic orchiopexy, while 30 cases of single-stage orchiopexies one testes atrophied. Conclusion: Laparoscopy is the best way to diagnose impalpable undescended testes. M.R.I and other imaging investigations not needed. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler — Stephensorchiopexy has excellent results. Minimum 6 months gap between first and second stage of laparoscopic Fowler — Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately. |
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