Kucheria R, Sahai A, Sami T A, Challacombe B, Godbole H, Khan M S, Dasgupta P
Department of Robotics and Laparoscopic Urology, Guy's & St. Thomas Hospitals & GKT School of Medicine, London, UK.
Eur Urol. 2005 Sep;48(3):453-7; discussion 457. doi: 10.1016/j.eururo.2005.04.008. Epub 2005 Apr 25.
Little is reported on the management of impalpable testis in adults. We present the impact of laparoscopy in this patient group.
Twelve adult patients have been referred to our centre over the last year, with impalpable testis. Pre-operative assessment was by either ultrasound or magnetic resonance imaging (MRI) or both. Quality of life and patient satisfaction were assessed by validated SF8 and client satisfaction (CSQ-8) questionnaires. Patients were also administered a self constructed questionnaire specifically looking at the impact of a laparoscopic service on their condition.
The mean age was 29 yrs (range: 19-36). Two patients declined treatment. Of ten patients undergoing transperitoneal laparoscopy, five had intra-abdominal testes treated by laparoscopic orchidectomy (none malignant), two had the vas going into the deep ring and needed inguinal orchidectomy for an impalpable nubbin while in three cases there were blind ending vessels and vas. SF8 scores for physical HRQoL were unchanged but mental scores were significantly improved (p < 0.03). All patients were completely satisfied with a mean CSQ-8 score of 30.6 out of a possible 32. The majority of patients indicated that the availability of a laparoscopic service had prompted them to seek medical advice.
Laparoscopic examination and orchidectomy is a safe and reliable procedure. Excellent patient satisfaction and quality of life are achievable. In particular mental health scores improve as previous uncertainty is removed. The advent of laparoscopy has encouraged adult patients to seek advice regarding a condition that has been present since childhood. We advocate the use of laparoscopy in evaluating and treating adult patients with maldescended testes.
关于成人隐睾管理的报道较少。我们展示了腹腔镜检查在该患者群体中的影响。
在过去一年中，有12名成年患者因隐睾被转诊至我们中心。术前评估采用超声或磁共振成像（MRI）或两者结合。生活质量和患者满意度通过经过验证的SF8问卷和客户满意度（CSQ - 8）问卷进行评估。患者还填写了一份自行编制的问卷，专门考察腹腔镜服务对其病情的影响。
平均年龄为29岁（范围：19 - 36岁）。两名患者拒绝治疗。在接受经腹腹腔镜检查的10名患者中，5例腹内睾丸接受了腹腔镜睾丸切除术（均非恶性），2例输精管进入内环，因不可触及的小结节需要进行腹股沟睾丸切除术，3例存在盲端血管和输精管。身体健康相关生活质量的SF8评分未变，但心理评分显著改善（p < 0.03）。所有患者完全满意，CSQ - 8平均得分为30.6（满分32分）。大多数患者表示，腹腔镜服务的可及性促使他们寻求医疗建议。
腹腔镜检查和睾丸切除术是一种安全可靠的手术。可实现极佳的患者满意度和生活质量。特别是随着先前不确定性的消除，心理健康评分有所改善。腹腔镜检查的出现鼓励成年患者就自童年起就存在的疾病寻求建议。我们主张使用腹腔镜检查来评估和治疗成年隐睾患者。
