scholarly journals Laparoscopic orchidopexy and its outcome in the management of nonpalpable testis

2020 ◽  
Vol 7 (8) ◽  
pp. 2605
Author(s):  
Dinesh Prasad ◽  
Savan Jivani
Keyword(s):  
Visual Information ◽  
Diagnostic Laparoscopy ◽  
Therapeutic Option ◽  
Case Series ◽  
Blind Ending ◽  
Port Site Hernia ◽  
Impalpable Testis ◽  
Scrotal Hematoma ◽  
Nonpalpable Testis ◽  
Laparoscopic Orchidopexy

Background: Management of impalpable testis represents a significant diagnostic and operative challenge. The aim of this work was to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of impalpable testis.Methods: 51 patients with 58 nonpalpable were included in our study. Study design was case series. We have conducted this study at Surat Municipal Institute for Medical Education and Research, Surat. For each patient laparoscopy orchidopexy was performed and either testis or blind ending cord structure are searched for. The testis either brought down to the scrotum or removed depending on the condition. The patients were followed up for 12 months.Results: On diagnostic laparoscopy the number of testis found normal 54, followed by 3 hypoplastic and 1 atrophic. There were 8 testis found to be present at high intraabdominal (>2 cm from deep ring), 46 were present at low intra-abdominal (<2 cm from deep ring), intracanalicular 4. Postoperative complication included minor wound infection in one patient, none of them were diagnosed scrotal hematoma, port site hernia, and testicular atrophy.Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with nonpalpable testis. Intraabdominal dissection allows more testis to be brought down to scrotum. Laparoscopy clearly demonstrate the anatomy and provide visual information upon which a definitive decision can be made.

scholarly journals Laparoscopy and the impalpable testes: diagnosis, treatment options and the literature

2020 ◽  
Vol 8 (8) ◽  
pp. 2928
Author(s):  
Fayaz Ahmad Najar ◽  
Peer Hilal Ahmad Makhdoomi ◽  
Tajamul Rashid ◽  
Suhail Nazir Bhat
Keyword(s):  
Therapeutic Option ◽  
Treatment Options ◽  
Laparoscopic Approach ◽  
Oral Fluids ◽  
Blind Ending ◽  
Impalpable Testis ◽  
The Mean ◽  
Conventional Manner ◽  
Laparoscopic Orchidopexy

Background: Laparoscopy is the best available tool and method to manage impalpable undescended testes; management of the impalpable testis often pose a significant diagnostic and therapeutic challenge to a surgeon. The aim of this work was to elucidate and present the sensitivity and the value of laparoscopy, as a surgeon’s tool, for the diagnosis and treatment of the impalpable testis.Methods: From November 2015 to December 2018, 56 patients with 60 impalpable testes were operated upon by laparoscopic approach by a single surgeon. One-stage Fowler-Stephens laparoscopic orchidopexy was performed in 14 cases, while two-stage Fowler-Stephens laparoscopic orchidopexy was performed in 16 cases and Vessel-Intact Laparoscopic Orchidopexy (VILO) was done in 22 cases. In 2 cases vessel and vas was entering through deep ring and inguinal orchidopexy was done. Blind ending vessel/vas was noticed in 4 cases (vanishing/absent testes). Laparoscopic orchidectomy was required in 2 patients for nubin. No case of disorder of sexual dysfunction was (DSD) was found.Results: Laparoscopy was successfully completed in all the cases. 34 testicles were impalpable on right side, 18 on left side and other 4 cases (8 testicles) were bilaterally impalpable. Laparoscopic orchidopexy was carried out for 36 testes at the same. 16 needed a staged procedure. Orchidectomy was done in 2 cases/testes. In 4 cases testes was absent/vanishing. In 2 cases testes was canalicular, standard inguinal orchidopexy was done. The mean operative time was 48 minutes. Patients were allowed oral fluids 6 hours of the operation and were discharged at one day after the procedure.  None of the patients had wound infection. Patients were followed up for a mean period of 12 months. At follow-up, all but one of the testes were well down in the bottom of the scrotum. In one patient, the testis was in a high scrotal position. All testes were of normal size, no atrophy was seen so far and no malignant change is suspected in any case so far. No severe morbidity or death was observed in our study.Conclusions: Laparoscopy offers surgeons a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. No other imaging investigation is required, if well versed with basic laparoscopy. Intra-abdominal dissection allows more testes to be brought down to the scrotum. Even when open orchidopexy 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 mobilize the testicular vessels adequately. The procedure is best viewed as laparoscopy-assisted; as Orchidopexy has to be done in a conventional manner.

scholarly journals Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present?

2017 ◽  
Vol 13 (4) ◽  
pp. 392.e1-392.e6 ◽  
Author(s):  
Renea Sturm ◽  
Eric Kurzrock ◽  
Gregory Amend ◽  
Rachel Shannon ◽  
Edward Gong ◽  
...  
Keyword(s):  
Diagnostic Laparoscopy ◽  
Blind Ending ◽  
Nonpalpable Testis

scholarly journals Undescended Testes and Laparoscopy: Experience from the Developing World

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Shabir Ahmad Dar ◽  
Rajandeep Singh Bali ◽  
Yawar Zahoor ◽  
Arshad Rashid Kema ◽  
Rajni Bhardwaj
Keyword(s):  
Visual Information ◽  
Operative Time ◽  
Standard Procedure ◽  
Undescended Testes ◽  
Postoperative Wound ◽  
The Mean ◽  
Nonpalpable Testis ◽  
A Prospective Study ◽  
Laparoscopic Techniques ◽  
Laparoscopic Orchidopexy

Background. Cryptorchidism or undescended testes is the most common disorder of the male endocrine glands in children. With the advancements in laparoscopic techniques and instruments, laparoscopic orchidopexy has become the standard procedure in the management of nonpalpable undescended testes. Aim. To evaluate and determine the therapeutic role, sensitivity, and specificity of laparoscopy in localizing nonpalpable testes and the mean operative time, the conversion rate (and reasons thereof), postoperative wound infection, postoperative stay, and time taken for return to daily activities following laparoscopic orchidopexy or orchidectomy. Materials and Methods. This was a prospective study carried out in the Postgraduate Department of Surgery, Government Medical College, Srinagar, J&K, India, from May 2008 to August 2011. All patients who presented to the outpatient department with complaints of absent testes were examined, and the ones with nonpalpable testes were included in the study. Results. The mean operative time for bilateral and unilateral nonpalpable testis was 102.76 and 53.67 minutes, respectively. Minor postoperative wound infections were noted in 4 of our patients. Mean duration of hospital stay was 14.23 hrs for unilateral cases and 16.27 hrs for bilateral cases. Patients who underwent laparoscopic orchidopexy resumed their normal activities within 4 ± 1 days. Conclusion. Laparoscopy clearly demonstrates the anatomy and provides visual information upon which a definitive decision can be made for further management of the undescended nonpalpable testis.

scholarly journals Laparoscopic management of non-palpable un-descended testes: our experience

2019 ◽  
Vol 6 (9) ◽  
pp. 3188
Author(s):  
Zahid M. Rather ◽  
Nighat Ara Majid ◽  
Raja Waseem M. ◽  
M. Nazrull Islam
Keyword(s):  
Diagnostic Laparoscopy ◽  
Operative Time ◽  
Normal Activity ◽  
Ultra Sound ◽  
Blind Ending ◽  
Surgical Emphysema ◽  
The Mean ◽  
Laparoscopic Orchidopexy ◽  
Time Of Admission ◽  
Abdominal Testis

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis >2 cm from deep inguinal ring in 20, near deep ring <2 cm in 20 and at inguinal canal in 6 patients. In the diagnostic laparoscopy, high intra-abdominal testis found in 34, low intra-abdominal testis in 24, blind ending of vas and vessels in 2 patients. The operative procedures performed are diagnostic laparoscopy, laparoscopic orchidopexy, laparoscopic orchidectomy, conversion to open orchidopexy and open orchidectomy. The mean operative time was 53.67±2.37 for unilateral and 102.76±5.38 for bilateral cases. The postoperative complications include surgical emphysema, wound infection and scrotal haematoma. The mean hospital stay was 14.23±2.37 hours for unilateral and 16.27±5.38 hours for bilateral.Conclusions: Laparoscopic orchidopexy appears to be a feasible, minimally invasive, less postoperative pain and trauma, faster convalesce and return to normal activity and an effective technique for the management of low intra-abdominal testes.

scholarly journals LAPAROSCOPIC ORCHIDOPEXY

2008 ◽  
Vol 15 (01) ◽  
pp. 168-170
Author(s):  
MUHAMMAD ZUBAIR ◽  
SULTAN MEHMOOD ◽  
SUMAIRA KANWAL ◽  
Riaz Hussain Dab
Keyword(s):  
Gold Standard ◽  
Undescended Testis ◽  
Pediatric Population ◽  
Case Series ◽  
Two Stage ◽  
Surgical Department ◽  
One Stage ◽  
Design Case ◽  
Nonpalpable Testis ◽  
Laparoscopic Orchidopexy

Design Case series. Setting: Pediatric surgical department of B V Hospital(QAMC) Bahawalpur and Allied Hospital Faisalabad. Period: From April 2005 to Mar 2007. Material & Methods:Cryptorchidism is most frequent presentation in pediatric population. Laparoscopy has become “Gold Standard” in thediagnosis and therapy of nonpalpable undescended testis. We present our two year experience in the managementof 40 cases at two centers. The age of the patients ranged from 9 months to 12 years. Laparoscopy was done tolocalize the testis prior to surgery. Thirty four patients underwent one stage laparoscopic orchidopexy, 7 patients hadopen orchidopexy and 3 needed two stage Fowler-Stephen orchiodopexy. Laparoscopy is a valuable tool in bothdiagnosis and treatment of nonpalpable testis.

scholarly journals LATE IMPACT OF THE LAPAROSCOPIC TREATMENT OF DEEP INFILTRATING ENDOMETRIOSIS WITH SEGMENTAL COLORECTAL RESECTION

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Antonio Matos ROCHA ◽  
Maurício Mendes de ALBUQUERQUE ◽  
Eduardo Miguel SCHMIDT ◽  
Cristiano Denoni FREITAS ◽  
João Paulo FARIAS ◽  
...  
Keyword(s):  
Colorectal Resection ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Preoperative Period ◽  
Laparoscopic Treatment ◽  
Bowel Symptoms ◽  
Infiltrating Endometriosis

ABSTRACT Background: Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven. Aim: Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection. Methods: Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure. Results: Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%. Conclusion: The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.

scholarly journals Targeting Cytokine Storm in COVID-19: A Role of Online Hemodiafiltration with Asymmetric Cellulose Triacetate in Maintenance Hemodialysis Patients—A Report of 10 Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
José C. De La Flor ◽  
Francisco Valga ◽  
Alexander Marschall ◽  
Tania Monzon ◽  
Cristina Albarracín ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Case Series ◽  
Severe Pneumonia ◽  
Cellulose Triacetate ◽  
Blood Analysis ◽  
Maintenance Hemodialysis ◽  
Cytokine Storm ◽  
Dialysis Unit ◽  
New Generation

Early reports have suggested that maintenance hemodialysis (MHD) patients could be more susceptible to a severe course of COVID-19. Among the therapeutic approaches, the use of drugs that reduce the cytokine storm characteristic of this disease has been proposed. Some dialyzers, such as the new generation of asymmetric cellulose triacetate (ATA) membranes, could favor the effective elimination of medium-sized molecules and other inflammatory mediators. In this case series, we describe in depth the clinical, analytical, and radiological details, therapeutic aspects, and outcomes of the case series of 10 MHD patients of our dialysis unit, who tested positive for SARS-CoV-2 from 5 October to 30 November 2020. Furthermore, we evaluate the removal of hyperinflammatory parameters with the ATA membrane in postdilution online hemodiafiltration (OL-HDF) in these patients through a variety of biomarkers of systemic inflammation from the diagnosis until stripping. Biochemical blood analysis was carried out at baseline and at days 7 and 14 after diagnosis, respectively. 50% of the patients presented COVID-19 pneumonia and required hospital admission. Median hospitalization time was 21 days. A total of 4 patients developed severe pneumonia (3 of them died) and 1 patient developed moderate pneumonia. Patients who died (n = 3) were more likely to present bilateral pneumonia (100% vs 14.3%) at diagnosis and less reduction in interleukin 6 (IL-6) at day 14, as compared to those who survived. The use of the ATA membrane could be considered a therapeutic option, due to its immunomodulatory effect in MHD patients with SARS-CoV-2 infection, especially at the beginning of the disease, where the inflammatory component is predominant.

scholarly journals Cognitive Improvements in Children with Prader-Willi Syndrome Following Pitolisant Treatment—Patient Reports

2019 ◽  
Vol 24 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Lara C. Pullen ◽  
Maria Picone ◽  
Litjen Tan ◽  
Charles Johnston ◽  
Holger Stark
Keyword(s):  
Daytime Sleepiness ◽  
Therapeutic Option ◽  
Case Series ◽  
Poor Quality ◽  
Inverse Agonist ◽  
Prader Willi Syndrome ◽  
Cognitive Disability ◽  
Patient Reports ◽  
Nighttime Sleep ◽  
Receptor Inverse Agonist

While children with Prader-Willi Syndrome (PWS), a rare genetic disease with an incidence of 1:15,000, typically present with hypotonia and hyperphagia, their lives are made more difficult by an ever-present sleepiness as well as multiple neuro-cognitive dysfunctions, including cognitive defects. We describe a case series of 3 children who were treated with the histamine 3 receptor inverse agonist pitolisant. While this first-in-class inverse agonist is approved for another orphan disease (i.e., narcolepsy with or without cataplexy), we have observed that pediatric patients with PWS prescribed pitolisant demonstrate decreased daytime sleepiness and improved cognition, as evidenced by increased processing speed and improved mental clarity. Pitolisant may represent a novel therapeutic option that might relieve substantial PWS disease burden, including cognitive disability, excessive daytime sleepiness, and poor-quality nighttime sleep.

scholarly journals Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

2020 ◽  
Vol 33 (4) ◽  
pp. 297-305
Author(s):  
Mostafa Mahmoud ◽  
Ahmed Farag ◽  
Mostafa Farid ◽  
Ahmed Elserwi ◽  
Amr Abdelsamad ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Flow Diversion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

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