Sahin Coskun, Artan Mehmet, Aksoy Yilmaz
Department of Urology, Ataturk University, Erzurum, Turkey.
J Laparoendosc Adv Surg Tech A. 2002 Oct;12(5):327-31. doi: 10.1089/109264202320884063.
In this study, we investigated the effects of one- and two-staged orchiopexy on testicular volume and serum testosterone levels in cases with high, abdominally localized, bilateral nonpalpable testes. Between March 1996 and April 2001, orchiopexy was performed on 46 testes in 23 patients with bilateral nonpalpable testes. In 15 of the 23 patients, a two-stage Fowler-Stephens orchiopexy was performed, and in 8 of the 23 patients, a one-stage laparoscopic orchiopexy was performed. For one patient who lacked both testes, bilateral prosthetic testes were inserted. The patients' ages were between 20 and 23 years (average, 21 years). In the first stage of the two-stage orchiopexy, the spermatic artery was ligated laparoscopically. Six months later, open surgery orchiopexy was performed. Patients were followed for 2 to 16 months (average, 10 months) and were evaluated for testicular atrophy, serum testosterone levels, and complications. In all the patients, the preoperative secondary sexual characteristics and serum testosterone levels were normal. Among the postoperative controls, evaluated at months 3 and 6, one patient's testes were found at the pubic area. Testicular atrophy was not observed in any of the patients, and the serum testosterone levels were in the normal range. In the two-stage orchiopexy group, 5 (33%) of the 15 patients had an average 30% volume decrease, and in the one-stage group, 2 (25%) of the 8 patients had an average 40% volume decrease. In this study, it was shown that either two-stage Fowler-Stephens orchiopexy or laparoscopic orchiopexy can be successfully performed in patients with bilateral abdominal testes, and that the testes can be fixed to their palpable original positions without interfering with the secretion of testosterone. Although the results are similar, our experience suggests that single-stage laparoscopic orchiopexy is the preferable method.
在本研究中，我们调查了一期和二期睾丸固定术对高位、位于腹部、双侧不可触及睾丸患者的睾丸体积和血清睾酮水平的影响。1996年3月至2001年4月期间，对23例双侧不可触及睾丸患者的46个睾丸进行了睾丸固定术。23例患者中的15例接受了二期Fowler-Stephens睾丸固定术，23例患者中的8例接受了一期腹腔镜睾丸固定术。对于1例双侧睾丸缺如的患者，植入了双侧假体睾丸。患者年龄在20至23岁之间（平均21岁）。在二期睾丸固定术的第一阶段，通过腹腔镜结扎精索动脉。6个月后，进行开放手术睾丸固定术。对患者进行了2至16个月（平均10个月）的随访，并评估了睾丸萎缩、血清睾酮水平及并发症情况。所有患者术前第二性征和血清睾酮水平均正常。在术后3个月和6个月进行评估的对照组中，发现1例患者的睾丸位于耻骨区。所有患者均未观察到睾丸萎缩，血清睾酮水平在正常范围内。在二期睾丸固定术组中，15例患者中有5例（33%）平均体积缩小30%，在一期组中，8例患者中有2例（25%）平均体积缩小40%。本研究表明，二期Fowler-Stephens睾丸固定术或腹腔镜睾丸固定术均可成功应用于双侧腹腔内睾丸患者，且可将睾丸固定至可触及的原位置，而不影响睾酮分泌。虽然结果相似，但我们的经验表明，一期腹腔镜睾丸固定术是更可取的方法。
