Pediatric Surgery Department, Ain Shams University Children's Hospital, Egypt.
Radiology Department, Ain Shams University Children's Hospital, Egypt.
J Pediatr Surg. 2020 Sep;55(9):1925-1932. doi: 10.1016/j.jpedsurg.2019.11.016. Epub 2019 Dec 27.
To review the role of various ultrasound (US) modalities in their ability to determine testicular viability in prepubertal testes following Fowler-Stephens orchiopexy (FSO).
MATERIAL & METHODS: Our prospective study included all patients from the year 2012 to 2017 with intra-abdominal testes (IAT) who had one-stage or staged FSO in our tertiary centre. Follow-up was done at 6 months to assess testicular viability and testicular position by clinical examination, and this was correlated with conventional and Doppler US results then.
This study included 28 IAT in total, who had one-stage (n = 16) and staged (n = 12) laparoscopic FSO. Median age was 1.27 years. Testicular atrophy was noted by clinical examination in 6 testes. In these 6 testes, conventional US confirmed an atrophic testicular nubbin and both Color Doppler US (CDU) and Power Doppler US (PDU) failed to show any parenchymal testicular vessels. Spectral Mode Analysis (SMA) also showed no significant arterial waveform. As for the remaining 22 viable testes by clinical examination, conventional US showed normal testicular morphology in all, while CDU and PDU confirmed adequate parenchymal blood flow in only 15 and 20 testes respectively. SMA revealed a normal arterial resistive index in only 21 testes.
There is no evident role for US in the follow-up of prepubertal testes post-FSO as US results are strongly correlated to clinical examination findings. Blood flow assessment in prepubertal testes following FSO can be difficult, unclear and undetectable in cases. This can be due to the prepubertal testicular stage, technique or unrecognized testicular atrophy despite normal morphology.
Level IV: Case series with no comparison group.
回顾各种超声（US）模式在 Fowler-Stephens 睾丸固定术（FSO）后评估青春期前睾丸活力的能力。
我们的前瞻性研究纳入了 2012 年至 2017 年间在我们的三级中心接受一期或分期腹腔镜 FSO 的所有腹腔内睾丸（IAT）患者。通过临床检查在 6 个月时进行随访，以评估睾丸活力和睾丸位置，并将其与常规和多普勒超声结果相关联。
这项研究共纳入 28 例 IAT，其中 16 例接受一期 FSO，12 例接受分期 FSO。中位年龄为 1.27 岁。临床检查发现 6 个睾丸存在睾丸萎缩。在这 6 个睾丸中，常规 US 证实为萎缩性睾丸小结节，且彩色多普勒超声（CDU）和功率多普勒超声（PDU）均未能显示任何实质睾丸血管。频谱模式分析（SMA）也未显示明显的动脉波形。对于通过临床检查发现的其余 22 个存活睾丸，常规 US 显示所有睾丸形态均正常，而 CDU 和 PDU 仅分别在 15 和 20 个睾丸中证实了足够的实质血流。SMA 仅在 21 个睾丸中显示正常的动脉阻力指数。
FSO 后青春期前睾丸的随访中，超声没有明显作用，因为超声结果与临床检查结果密切相关。在某些情况下，FSO 后青春期前睾丸的血流评估可能较为困难、不明确或无法检测到。这可能是由于青春期前睾丸的阶段、技术或尽管形态正常但仍未被识别的睾丸萎缩。
IV 级：无对照组的病例系列研究。
