The Experts below are selected from a list of 984 Experts worldwide ranked by ideXlab platform
Louis R. Kavoussi - One of the best experts on this subject based on the ideXlab platform.
-
Laparoscopic orchidopexy in the prune belly syndrome: a case report and review of the literature.
Urology, 1995Co-Authors: Steven G. Docimo, Robert G. Moore, Louis R. KavoussiAbstract:The management of the testicles in the prune belly syndrome can be problematic after the neonatal period. Laparoscopic orchidopexy has been used for the intra-abdominal testis with success. A case of bilateral laparoscopic orchidopexy in a child with prune belly syndrome is presented. The testes were brought to the scrotum without division of the spermatic vessels, taking advantage of the extensive intra-abdominal dissection possible laparoscopically. This case demonstrates that therapeutic laparoscopic procedures are possible in the prune belly syndrome and that laparoscopic orchidopexy may have promise in older affected children or in those requiring no other concomitant surgery.
P G Ransley - One of the best experts on this subject based on the ideXlab platform.
-
long term outcome of fowler stephens Orchiopexy in boys with prune belly syndrome
The Journal of Urology, 2004Co-Authors: K K Patil, P G Duffy, Christopher R J Woodhouse, P G RansleyAbstract:ABSTRACTPurpose: Intra-abdominal testes in boys with prune-belly syndrome have been conventionally managed by 1 or 2-stage Orchiopexy with division of the gonadal vessels. We reviewed a series of adults with prune-belly syndrome to assess the morphological and functional outcome of Orchiopexy in childhood with specific reference to the spontaneous onset of puberty, hormonal profiles and sexual function.Materials and Methods: A total of 41 boys were divided into 3 groups depending on the type of Orchiopexy performed, namely group 1—20 with bilateral 1-stage Orchiopexy, group 2—10 with unilateral 1-stage and contralateral 2-stage Orchiopexy, and group 3—11 with bilateral 2-stage Orchiopexy.Results: In group 1 9 of 20 patients had good scrotal testes bilaterally, 6 had a good scrotal testis on 1 side and 3 had small testes on each side. Two boys required testosterone supplementation but 18 had normal hormonal and sexual function. In group 2 6 of 10 patients had good scrotal testes bilaterally and 4 had a goo...
Luis H Braga - One of the best experts on this subject based on the ideXlab platform.
-
gubernaculum testis and cremasteric vessel preservation during laparoscopic Orchiopexy for intra abdominal testes effect on testicular atrophy rates
The Journal of Urology, 2019Co-Authors: Luis H Braga, Forough Farrokhyar, Melissa Mcgrath, Armando J LorenzoAbstract:Purpose:Gubernaculum sparing laparoscopic Orchiopexy, which involves anatomical delivery of the testis through the internal inguinal ring, has been proposed as an alternative to conventional laparoscopic Fowler-Stephens Orchiopexy, maximizing collateral blood supply and potentially decreasing atrophy rates. We compared the 2 techniques to test this hypothesis.Materials and Methods:The primary (dependent) outcome of the study was rate of testicular atrophy, which was defined as palpation of a nubbin or inability to palpate a testis (complete atrophy) on postoperative physical examination at 3 and 12 months. Doppler ultrasound was obtained routinely to further confirm the diagnosis of testicular atrophy. Independent variables that were captured were age at surgery, type of procedure (conventional laparoscopic Fowler-Stephens Orchiopexy vs gubernaculum sparing laparoscopic Orchiopexy), surgical approach (single vs 2-stage), location of intra-abdominal testis (high vs low) and patency of the internal inguinal...
Georg Bartsch - One of the best experts on this subject based on the ideXlab platform.
-
neoadjuvant gonadotropin releasing hormone therapy before surgery may improve the fertility index in undescended testes a prospective randomized trial
The Journal of Urology, 2005Co-Authors: Christian Schwentner, Josef Oswald, Georg Bartsch, Alfons Kreczy, Andreas Lunacek, Martina Deibl, Christian RadmayrAbstract:PURPOSE: Subfertility is considered the principal consequence of cryptorchidism even after timely Orchiopexy. Gonadotropin-releasing hormone (GNRH) treatment appears to improve fertility later in life by inducing germ cell maturation. In a prospectively randomized trial we investigated whether preoperative GNRH therapy improves the fertility index in primary cryptorchidism. MATERIALS AND METHODS: A total of 42 boys 11 to 100 months old (median 33.5) with 63 undescended testes were prospectively assigned to 2 groups during a 6-month period. Patients were randomized to receive either Orchiopexy alone (21 patients) or with neoadjuvant GNRH therapy (21) as a nasal spray for 4 weeks at 1.2 mg per day. In both groups testicular biopsies were performed at the time of Orchiopexy and histopathological fertility index was determined. RESULTS: Mean fertility index in the group treated with GNRH before surgery was significantly higher (1.05, SD +/- 0.71) compared to the group without hormonal stimulation (0.52, SD +/- 0.39, p <0.05). The subgroup of neoadjuvant stimulated boys younger than 24 months achieved the best results compared to the age matched boys without hormonal treatment. CONCLUSIONS: Neoadjuvant GNRH treatment improves fertility index in prepubertal cryptorchidism. Consequently, preoperative hormone therapy should improve fertility in adulthood. Additionally, the nasal application is well tolerated, safe and already recommended in an adjuvant setting after Orchiopexy. Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life.
-
long term outcome of laparoscopically managed nonpalpable testes
The Journal of Urology, 2003Co-Authors: Christian Radmayr, Josef Oswald, Christian Schwentner, Richard Neururer, Reinhard Peschel, Georg BartschAbstract:ABSTRACTPurpose: We evaluated laparoscopic diagnostic findings in 108 impalpable testes, and analyzed the success rate and long-term outcome of either direct laparoscopic Orchiopexy or the 2-stage Fowler-Stephens procedure.Materials and Methods: A total of 84 children with 108 impalpable testes and a mean age of 1.9 years underwent laparoscopy between 1992 and September 2000. Long-term outcome with regard to viability and location of the testes was evaluated.Results: Of the 108 testes 72 were located intra-abdominally, of which 28 were managed by direct laparoscopic Orchiopexy, 29 were managed by a 2-stage laparoscopic Fowler-Stephens procedure and 15 were vanishing. The remaining 36 testes were inguinally located during exploration and Orchiopexy, except for 5 vanishing testes. In all cases the operation proceeded as planned. After a mean followup of 6.2 years all laparoscopically managed testicles were in a normal scrotal position with normal perfusion as revealed by color flow Doppler sonography. Two t...
Gert R Dohle - One of the best experts on this subject based on the ideXlab platform.
-
acquired undescended testes and fertility potential is Orchiopexy at diagnosis better than awaiting spontaneous descent
Journal of Andrology, 2015Co-Authors: E M Van Der Plas, W W M Hack, J Van Brakel, Meijde A Vries, S M P F De Muinck Keizerschrama, Frans W J Hazebroek, Gert R DohleAbstract:Summary The aim of this study was to evaluate testicular function in men with previous acquired undescended testis (UDT) in whom Orchiopexy was performed at diagnosis compared with a similar group of men in whom spontaneous descent was awaited until puberty. Secondly, we examined the influence of age at Orchiopexy on fertility parameters in adult life. A total of 169 men of the ‘Orchiopexy at diagnosis’ group and 207 men of the ‘wait and see’ protocol group were invited for participation. All participants underwent an andrological evaluation, including medical history, physical examination, scrotal ultrasound, determination of reproductive hormones, and semen analysis. Results were compared for men in whom Orchiopexy was performed at diagnoses with men in whom spontaneous descent was awaited until puberty followed by Orchiopexy in case of non-descent. In the ‘Orchiopexy at diagnosis’ group, 63 men of whom 14 with bilateral UDT, and in the ‘wait and see’ protocol group, 65 men of whom 15 with bilateral UDT were included. For unilateral UDT Inhibin B was found to be significantly lower and median progressive motility was higher in men with Orchiopexy at diagnosis. For bilateral UDT, semen concentration and progressive motility showed a trend toward a favorable outcome for Orchiopexy at diagnosis. Age at Orchiopexy being under or above 10 years of age had no significant influence on the fertility potential. The outcome of physical examination, scrotal ultrasound, endocrine function, and semen analysis indicates a compromised fertility potential in men with previous acquired UDT. None of the protocols proved to be superior. For bilateral UDT, a trend toward favorable outcome of Orchiopexy at diagnosis was seen. Furthermore, age at Orchiopexy did not have an influence on fertility parameters. Therefore, in our opinion a ‘conservative policy’ is warranted for unilateral UDT, especially because over 50% of acquired UDT descend spontaneously.
-
fertility potential in a cohort of 65 men with previously acquired undescended testes
Journal of Pediatric Surgery, 2014Co-Authors: Jocelyn Van Brakel, W W M Hack, Ries Kranse, Sabine M P F De Muinck Keizerschrama, Emile A J Hendriks, Frank H De Jong, Laszla M Van Der Voortdoedens, Chris H Bangma, F W Hazebroek, Gert R DohleAbstract:Abstract Purpose To evaluate testicular function in men with previously acquired undescended testes (AUDT) in whom spontaneous descent was awaited until puberty followed by Orchiopexy in case of nondescent. Methods Andrological evaluation including paternity, scrotal ultrasound, reproductive hormones, and semen analysis was performed in three groups: men with AUDT, healthy controls, and men with previously congenital undescended testes (CUDT). Results In comparison with controls, men with AUDT more often had significantly abnormal testicular consistency, smaller testes, lower sperm concentration, and less motile sperm. Except for more often a normal testicular consistency in men with AUDT, no differences were found between men with AUDT and men with CUDT. Also, no differences were found between men with AUDT which had spontaneously descended and men who underwent Orchiopexy. Conclusions Fertility potential in men with AUDT is compromised in comparison with healthy controls, but comparable with men with CUDT. This suggests that congenital and acquired UDT share the same etiology. No significant difference was found between men who had spontaneous descent and men needing Orchiopexy. However, fertility potential is unknown for men after immediate surgery at diagnosis, and this should be a subject for future studies.