Abdelhalim Ahmed, Chamberlin Joshua D, Young Irene, Fahim Miriam, Chuang Kai-Wen, McAleer Irene M, Wehbi Elias, Stephany Heidi A, Khoury Antoine E
Department of Urology of the University of California, Irvine and the Children's Hospital of Orange County, CA; Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Department of Urology of the University of California, Irvine and the Children's Hospital of Orange County, CA.
Urology. 2019 May;127:113-118. doi: 10.1016/j.urology.2019.01.030. Epub 2019 Feb 16.
To study the effect of testicular vessel division on testicular volume during laparoscopic staged Fowler Stephens orchiopexy (LSFSO).
Testicular dimensions were prospectively measured intraoperatively at both first (S1) and second stages (S2) of LSFSO, and with scrotal ultrasound 3-12 months postoperatively. Testicular volumes were compared to reference ranges. Volume changes were tracked with a change of >20% considered clinically significant.
A total of 52 nonpalpable testes treated with LSFSO between 2008 and 2018 were included in the study. After a median follow-up of 6.8 (3-91.3) months, 46 (88.5%) testes were palpable in a scrotal location without adjunctive procedures and 39 (75%) maintained vascular flow on duplex ultrasound. One testis retracted to an inguinal position and was successfully treated with inguinal orchiopexy for an overall success of 90.4% (47/52). Of 36 testes with intra- and postoperative testicular volume documentation, only 2 (5.6%) had significant volume loss after S1. Both testes had catch-up growth after S2. Eight (22.2%) testes had significant volume loss after S2. At follow-up, 24 (66.7%) testes were smaller than the mean for age, of which 20 (83.3%) were small at baseline. Only 41.7% of testes larger than mean for age at follow-up, were small at baseline (P = .02).
Significant testicular volume loss does not occur after testicular vessel division at S1, but expected in approximately 1 quarter of testes after S2. We propose that testicular atrophy after LSFSO is primarily due to defective testicular development and rarely due to vascular compromise during S2.
研究腹腔镜分期福勒·斯蒂芬斯睾丸固定术（LSFSO）中睾丸血管离断对睾丸体积的影响。
前瞻性地在LSFSO的第一阶段（S1）和第二阶段（S2）术中测量睾丸尺寸，并在术后3 - 12个月进行阴囊超声检查。将睾丸体积与参考范围进行比较。跟踪体积变化，变化>20%被认为具有临床意义。
本研究纳入了2008年至2018年间接受LSFSO治疗的52例不可触及睾丸。中位随访6.8（3 - 91.3）个月后，46例（88.5%）睾丸在阴囊位置可触及，无需辅助手术，39例（75%）在双功超声检查中保持血流。1例睾丸回缩至腹股沟位置，经腹股沟睾丸固定术成功治疗，总体成功率为90.4%（47/52）。在36例有术中及术后睾丸体积记录的睾丸中，只有2例（5.6%）在S1后有明显体积丢失。两个睾丸在S2后均有追赶性生长。8例（22.2%）睾丸在S2后有明显体积丢失。随访时，24例（66.7%）睾丸小于年龄均值，其中20例（83.3%）在基线时就较小。随访时大于年龄均值的睾丸中，只有41.7%在基线时较小（P = 0.02）。
S1期睾丸血管离断后不会发生明显的睾丸体积丢失，但S2期后约四分之一的睾丸会出现这种情况。我们认为LSFSO后睾丸萎缩主要是由于睾丸发育缺陷，很少是由于S2期血管受损。
