Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism

Abstract

Objective: To clarify the role of peritoneography in assessing the patency of processus vaginalis (PV) in pediatric patients diagnosed with cryptorchidism. Materials and Methods:We designed a prospective clinical trial to evaluate the patency of PV in boys presenting cryptorchidism. Herniography was performed in 310 prepubertal boys. Data about the morphology of PV was compared with operative findings in those surgically treated patients. Retractile and ectopic testes were excluded from the study. Results: Of the 376 undescended testes (310 patients), 281 cases were associated with an obliterated PV. Herniography revealed 95 cases of open PV in cryptorchid boys. The 244 normally descended testes had associated patent processus vaginalis in only 31 cases. Conclusions: Herniography is the most relevant procedure for accurate diagnosis of persistent PV. The persistence of PV was significantly more frequent when the position of the testes is more cranial. The incidence of an open PV decreases with age.

For Better Orchiopexy, Processus Vaginalis Should Be Dissected and a High Ligation Should Be Performed

“…In patients aged <2 years, the prevalence of PPV was 68.7%. This percentage was dramatically lower at 27.2% in patients aged 2–6 years and lower still at 11.2% in patients aged 6–12 years 12. Undescended testis located cranial to the external inguinal ring was significantly more frequently associated with PPV than UT located more caudally.…”

“…Ninety-five of 376 patients with UT had PPV (25.3%), and 31 of 244 patients without UT had PPV (12.7%); the difference between these two groups of patients reached statistical significance ( P =0.0001). The incidence of PPV was higher at younger ages and reached 41.3% among all patients with NPT 12. In two other prospective studies of pediatric patients with UT (excluding those with clinically overt hernia and hydrocele), surgical exploration revealed a PPV prevalence of 71% and 77%, respectively 13,14.…”

“…Blackburn et al11 incised the indirect hernia sac but did not perform high ligation in their case series of Fowler–Stephens orchiopexy. On the other hand, Varela-Cives et al12 investigated PPV in patients with UT who underwent herniography. Ninety-five of 376 patients with UT had PPV (25.3%), and 31 of 244 patients without UT had PPV (12.7%); the difference between these two groups of patients reached statistical significance ( P =0.0001).…”

Undescended testis and the presence of concurrent inguinal hernia: A review

“…Fakat orşiyopeksi esnasında vakaların ne kadarında herni olduğunu belirtmemişler. Başka bir çalışmada inmemiş testislerin %25,3'ünde ve normal inişini gerçekleştirenlerin ise %12,7'sinde PV açıklığı saptanmıştır 38 . Diğer bir çalışmada ise bu oran %65 olarak tespit edilmiştir 39 .…”