Is excision of testicular nubbin necessary in vanishing testis syndrome?

Woodford, Evangeline; Eliezer, Dilharan; Deshpande, Aniruddh V.; Kumar, Rajendra

doi:10.1016/j.jpedsurg.2018.08.011

Cited by 21 publications

(23 citation statements)

References 13 publications

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“…in a systematic review regarding the presence of viable germ cells in remnants concluded that there is no solid evidence to establish that its routine excision is indicated even in an inguinal or scrotal position [20]. Laparoscopic observations, along with anatomical and pathological findings (such as calcifications and atrophic residual tissue), support the hypothesis that the disappearance of the testis occurs as a result of a vascular accident during the descent of the testicles into the inguinal canal under hormonal control [19,20]. e existing literature clearly highlights the importance of the anatomical aspect during surgery when investigating the spermatic vessels and the internal inguinal ring.…”

Section: Discussionmentioning

confidence: 99%

In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

Papparella

Umano

Romano

et al. 2022

Minimally Invasive Surgery

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Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. The main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. The patients’ mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler–Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the anatomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient.

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Section: Discussionmentioning

confidence: 99%

In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

Papparella

Umano

Romano

et al. 2022

Minimally Invasive Surgery

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“…Natajara et al reported that viable germ cells and seminiferous tubules are found in 1 in 10 and 1 in 20, respectively, in inguinal/scrotal nubbins [8]. Some researchers differ and argue that the risk of malignancy development from nubbin tissues is very low and that the defined samples are not strong, thus finding is no strong evidence for routine nubbin excision [8,25]. In our study, it was observed that the testicular vessels ended blindly before entering the inguinal canal in 3 of the cases where no intra-abdominal testis was detected.…”

Section: Discussionmentioning

confidence: 99%

Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

et al. 2021

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Amaç: Palpe edilemeyen testis, erkek bir hastada testisin inguinal kanal ve skrotum içerisinde bulunmaması şeklinde tanımlanır. Hastada infertilite ve testiste malign transformasyon gelişim riskini engellemek için palpe edilemeyen testisin yerleşimi ve durumunun tanımlanması önemlidir. Amacımız, palpe edilemeyen testis tanılı çocuk hastalarda tedavide uyguladığımız laparoskopik yaklaşımın sonuçlarını değerlendirmekti. Yöntemler: Üçüncü basamak bir çocuk cerrahisi merkezinde palpe edilemeyen testis tanısı konulmuş ve laparoskopik yaklaşım ile tedavi edilmiş hastalar geriye dönük olarak incelendi. Hastaların özelliklerine göre tedavi protokolünde, laparoskopik abdominal eksplorasyon, iki aşamalı Fowler-Stephens laparoskopik orşiopeksi, primer laparoskopik orşiopeksi ve inguinal eksplorasyon uygulandı. Bulgular: Kırk beş çocuk hastadaki 54 testise ait veriler incelendi. Vakaların %46.2'sinde intra abdominal yerleşimli saptanan testislerin %88'i internal inguinal ring girişinde yerleşimliydi. Laparoskopik abdominal eksplorasyondan sonra testislerin 7 (%28)'sine iki aşamalı Fowler-Stephens, 18 (%72)'ine primer laparoskopik orşiopeksi uygulandı. Testis bulunamayan 27 (%50) vakaya inguinal eksplorasyon uygulandı. Skrotuma indirilen 23 testisin 17 (%73.9)'si normal iken, 6 (%26)'sında atrofi gelişti. Eksize edilen 27 inguinal nubbinde testis ait canlı hücreler saptanmadı. Sonuçlar: Palpe edilemeyen testisin tanı konulması ve tedavisinde laparaskopi güvenilir ve etkili bir yöntemdir. Abdomen içi testislerin yerleşim yeri, öncelikli cerrahi yaklaşım olarak inguinal eksplorasyonun düşünülmesini destekleyebilir.

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“…Woodford et al evaluated the histopathological findings of the excised testicular nubbins. None of the patient was found to have viable germ cells [8]. Based on this, they suggested that the concerns of development of malignant germ cell tumour in the retained testicular nubbins are unfounded and there is no need to excise the testicular nubbins.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

et al. 2019

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Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.

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Is excision of testicular nubbin necessary in vanishing testis syndrome?

Cited by 21 publications

References 13 publications

In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis?

Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

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