Orchidopexy restores morphometric-stereologic changes in the caput epididymis and daily sperm production in cryptorchidic mice, although sperm transit time and fertility parameters remain impaired

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Laparoscopic evaluation and treatment of the impalpable testis

Objectives: To evaluate the laparoscopic technique as a diagnostic and therapeutic tool in the management of patients with impalpable testis. Material and Methods: Fifty-nine patients with mean age of 6.3 years underwent laparoscopy to evaluate 85 impalpable testes that were classified as absent, canalicular and intra-abdominal. In the case of testicular absence, the procedure was terminated. In the case of canalicular testis, open inguinal exploration was performed. In intra-abdominal testis, either laparoscopic orchiopexy or orchiectomy was performed. According to the length of the vascular pedicle, orchipexy was performed either with or without vascular ligature. Post-operatively, the treated testes were evaluated according to size and location in the scrotum. Results: Seventeen (20%) of the 85 impalpable testes were diagnosed as absent, 21 (24.7%) as canalicular and 47 (55.3%) as intra-abdominal. Of the canalicular testes, 20 were explored by inguinotomy and one by laparoscopy. All the intra-abdominal testes were treated initially by laparoscopy, four being removed due to atrophy, 31 submitted to vascular ligature and 12 to primary orchipexy. Of those submitted to vascular ligature, 22 underwent a second stage orchipexy, of which 18 laparoscopically and 4 by inguinotomy. Of the 18 testes brought to the scrotum by staged laparoscopic orchipexy, 15 (83.3%) presented normal characteristics in the late follow-up, while of the 12 submitted to primary laparoscopic orchipexy, 8 (66.6%) were normal. There were no perioperative or late complications. Conclusions: Laparoscopy is a minimally invasive procedure with low morbidity that enables precise diagnosis of the impalpable testes. When intra-abdominal testes are found, either immediate laparoscopic orchiectomy, or primary and staged orchipexy are possible, with results equivalent to open procedures, with the advantage of smaller surgical incisions and shorter postoperative recovery.

Criptorquidia e exposição in utero ao di(n-butil)-ftalato e à acrilamida: avaliação morfológica do dano testicular

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação de células germinativas e células de Sertoli em modelo experimental de criptorquidia e orquidopexia

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background: Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency. Objectives: The aim of this study is to evaluate the second look exploration and outcomes in TT. Patients and Methods: Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed. Results: Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration. Conclusions: TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.

Efectos hemodinámicos en bloqueo caudal con bupivacaína en niños/as sometidos a cirugía de hemicuerpo inferior. Hospital José Carrasco Arteaga, Cuenca. Enero 2014 – julio 2015

Antecedentes: el bloqueo caudal con bupivacaína, es una técnica anestésica ampliamente utilizada en niños, debido a su fácil uso, que se realiza bajo anestesia general en plano superficial; sin embargo, puede haber fenómenos de cardiotoxicidad como taquicardia, además de neurotoxicidad como convulsiones, dependiendo de la dosis usada y comorbilidades asociadas. Objetivo: determinar los efectos hemodinámicos en bloqueo caudal con bupivacaína en niños/as sometidos a cirugía de hemicuerpo inferior. Hospital José Carrasco Arteaga de Cuenca, de enero del 2014 a julio del 2015. Antecedentes: el bloqueo caudal con bupivacaína, es una técnica anestésica ampliamente utilizada en niños, debido a su fácil uso, que se realiza bajo anestesia general en plano superficial; sin embargo, puede haber fenómenos de cardiotoxicidad como taquicardia, además de neurotoxicidad como convulsiones, dependiendo de la dosis usada y comorbilidades asociadas. Objetivo: determinar los efectos hemodinámicos en bloqueo caudal con bupivacaína en niños/as sometidos a cirugía de hemicuerpo inferior. Hospital José Carrasco Arteaga de Cuenca, de enero del 2014 a julio del 2015. Metodología: estudio descriptivo, retrospectivo, de corte transversal. Los datos fueron recolectados de los registros intraoperatorios del HJCA, ingresados en formularios y tabulados en el programa SPSS V.15, mediante frecuencia, media, y porcentajes. Se presentaron resultados por medio de tablas y gráficos, y cumpliendo con los objetivos planteados. Resultados: la edad frecuente estuvo entre 2 a 3 años, y media de 4,59 ± 3,1 años; peso frecuente entre 10 - 19 kilogramos, media de 18.3 ± 8,6 kg, sexo predominante fue masculino con 78%. La cirugía más frecuente: la circuncisión con 31,3 %. La modificación de la frecuencia cardiaca fue la disminución de hasta 10% en la mayoría de variables. Y la modificación de la presión arterial sistólica y diastólica fue la disminución entre 11 y 20%. Conclusiones: las variables hemodinámicas tuvieron similares comportamientos en relación con las características personales. La cirugía con mayor variación hemodinámica fue la orquidopexia; la cirugía más frecuente con bloqueo caudal fue la circuncisión, la dosis de bupivacaina más usado fue 2mg/kg