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Laparoscopic orchidopexy for persistent müllerian duct syndromme
804
INTERNATIONAL
Two-stage orchiopexy in 18 boys included a bilateral procedure in two, one of which was asynchronous and one was synchronous. The average operating time was 55 minutes for stage 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were performed on an outpatient basis in 18 and 17 (94%) boys. respectively. There were no complications after stage 1, and one wound infection developed after stage 2. One testis with no vas deferens was determined to be nonviable at stage 2. The remaining 19 testes (95%) were considered viable at a follow-up of 6 months or more. Viability was based on testicular size and consistency similar to those of the contralateral testis. Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intraabdominal testis.-George W Holcomb, Jr High Scrotal Orchidopexyfor A.J. Jawnd. Br J Urol80:331-333,
Palpable (August),
Maldescended 1997.
Testes.
From their experience with high scrotal orchidopexy (HSO) in 96 boys, the authors conclude that this approach is satisfactory, having the advantage of a single incision and excellent cosmesis with less dissection and anatomic disruption of the inguinal region. One hundred six HSOs were performed in 96 boys (mean age, 41 months; range, 14 months to 11 years) between 1991 and 1995. Regardless of initial position, all orchidopexies were started with a high scrotal incision. Eighty-seven percent of testes were placed satisfactorily in the scrotum, but 13% required a second inguinal incision. At the mean follow-up period of 16 months (range, 8 months to 5 years), 80% showed a good cosmetic result and five required repeat conventional orchidopexy. Three showed atrophic changes and were excised. Eleven of the 14 testes that required two incisions have shown good results.-MN. de la Hunt Laparoscopic drome. J.WT tember), 1997.
Orchidopexy Ng, and G.H.
for Persistent Miillerian Duct Koh. Pediatr Surg Int 12:522-525,
Syn(Sep-
Two men (21 and 22 years old) with undescended testes and persistent miillerian duct syndrome are presented. Both patients were man aged with laparoscopic orchidopexy. The authors base their management on two principles. The first is to perform orchidopexy if technically possible, because the risk for malignancy is greater in patients with persistent mtillerian duct syndrome. Orchidopexy also will optimize the potential for fertility. The second principle is to recognize that resecting the persistent mtillerian structures is not essential, because no risk for malignancy has been reported.--Prem Puri Impact of Early Orchidopexy on Testicular and R. Haddad. Br J Urol80:334-335, (August),
Growth. 1997.
H. Nagar
Testicular size was assessed before and after operation in 190 boys undergoing orchidopexy for unilateral maldescent at 1 week to 15 years of age. Testicular size was measured with cailipers, and growth was defined as an increase in the size ratio of maldescended to normal testis of at least 15%. Compared with the normally descended testis, the cryptorchid testis increased in 11.6% and decreased in 2.6%. Testicular growth was more common in children operated on before 18 months of age (17 of 79 compared with 5 of 93; P = .016).-MN. de la Hunt Proximal Urinary Diversion in the Management of Posterior Urethral Valves: Is It Necessary? D.N. Tietjen, J.M. Gloor; and D.A. Hzwmmn. J Urol 158:1008-1010, (September), 1997. In infants with posterior urethral valves in whom renal function fails to normalize after decompression of the lower urinary tract, supravesical urinary diversion is customarily recommended for presumed concomitant ureterovesical junction obstruction. The authors evaluated 26 patients with posterior urethral valves treated by supravesical urinary
ABSTRACTS
diversion. The mean gestational age at birth was 35 weeks (range, 27 to 40). After initial decompression via an indwelling catheter for a median of 7 days (range, 4 to 18), persistently high serum creatinine was present (median, 2.5 mg/dL; range 1.9 to 3.5). One month after proximal urinary diversion the median creatinine was 1.3 mg/dL (range, 0.5 to 2.8). At one year the median nadir creatinine was 1.0 mg/dL (range, 0.3 to 2.5). At the time of reconstruction, a Whitaker test in all 26 patients (52 renal units) demonstrated fixed ureterovesical junction obstruction in two units (4%). Renal biopsy in 44 of the 52 renal units (85%) showed renal dysplasia. At the median follow-up period of 9 years (range 1 to 14), end-stage renal disease had developed in 11 patients (42%). It is concluded that in neonates with posterior urethral valves who undergo proximal urinary diversion, fixed ureterovesical junction obstruction is rare, renal biopsy invariably demonstrates areas of renal dysplasia, and end-stage renal disease develops frequently despite proximal diversion. These findings question the necessity of supravesical urinary diversion.-George W Holcomb, Jr Increased Renal Echogenicity: A Sonographic Sign for Differentiating Between Obstructive and Nonobstructive Etiologies of In Utero Bladder Distension. 44. Kaejel; C.A. Peters, A.B. Retik, et al. J Urol 158: 1026-1029, (September), 1997. The authors reviewed the medical records and prenatal imaging studies of 18 cases of marked in utero bladder distension in which a diagnosis of posterior urethral valves, the megacystis-megaureter association, or prune-belly syndrome was confirmed postnatally. Amniotic fluid volume and renal echogenicity were assessed before knowledge of the specific diagnosis. Oligohydranmios was graded as mild, moderate, or severe. Increased renal echogenicity was defined as greater echogenicity of the renal cortex and/or medulla than of adjacent liver tissue. Postnatal imaging, clinical course, and outcome also were reviewed. The study included 15 cases with adequate follow-up, including eight in which a diagnosis of posterior urethral valves was confirmed postnatally. Nonobstntctive etiologies included the megacystis-megaureter association in six cases and prune-belly syndrome in one. Seven of the eight patients with posterior urethral valves had moderate to severe oligohydramnios, whereas all but one with a nonobstructive etiology had normal amniotic fluid. Seven of eight cases with posterior urethral valves had a marked bilateral increase in renal echogenicity; none of the nonobstructive cases had this finding. It is concluded that increased renal echogenicity and oligohydramnios in the setting of bladder distension are highly predictive (87%) of an obstructive etiology. This finding is important in the prenatal counseling and treatment of boys with bilateral hydronephrosis and marked bladder dilatation--George W Holcomb, Jr Renal Doppler Ultrasonography in Children With Equivocal Obstructive Uropathy: Effect of Intravenous Normal Saline Fluid Load and Frusemide. A.A. Shokeir; A.l? Provoost, M. El-Arab, et af. Br J Urol80:313-318, (August), 1997. The authors studied 19 kidneys with equivocal results from diuretic isotope renography (11 with suspected pelviureteric junction obstruction and 8 with nonrefluxing megaureter). Twelve children with unilateral (n = 5) or bilateral hydronephrosis (n = 7) underwent isotopic diuretic renography and Doppler ultrasonography. All the hydronephrotic kidneys had significantly lower glomerular filtration rate (GFR) and equivocal obstruction with half-time drainage (T/2) values of 10 to 20 minutes. Doppler studies were carried out before and after saline infusion and frusemide. The mean renal resistive index (RI) in hydronephrotic kidneys did not differ significantly from that of normal kidneys at rest but showed a variable response after diuresis. RI is lower during diuresis in normal kidneys. The mean RI was 0.71 before diuresis and 0.67 after diuresis. Of seven kidneys with an RI of greater than 0.7 both before and after diuresis. five eventually had deteriorating GFRs requir-
INTERNATIONAL
Two-stage orchiopexy in 18 boys included a bilateral procedure in two, one of which was asynchronous and one was synchronous. The average operating time was 55 minutes for stage 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were performed on an outpatient basis in 18 and 17 (94%) boys. respectively. There were no complications after stage 1, and one wound infection developed after stage 2. One testis with no vas deferens was determined to be nonviable at stage 2. The remaining 19 testes (95%) were considered viable at a follow-up of 6 months or more. Viability was based on testicular size and consistency similar to those of the contralateral testis. Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intraabdominal testis.-George W Holcomb, Jr High Scrotal Orchidopexyfor A.J. Jawnd. Br J Urol80:331-333,
Palpable (August),
Maldescended 1997.
Testes.
From their experience with high scrotal orchidopexy (HSO) in 96 boys, the authors conclude that this approach is satisfactory, having the advantage of a single incision and excellent cosmesis with less dissection and anatomic disruption of the inguinal region. One hundred six HSOs were performed in 96 boys (mean age, 41 months; range, 14 months to 11 years) between 1991 and 1995. Regardless of initial position, all orchidopexies were started with a high scrotal incision. Eighty-seven percent of testes were placed satisfactorily in the scrotum, but 13% required a second inguinal incision. At the mean follow-up period of 16 months (range, 8 months to 5 years), 80% showed a good cosmetic result and five required repeat conventional orchidopexy. Three showed atrophic changes and were excised. Eleven of the 14 testes that required two incisions have shown good results.-MN. de la Hunt Laparoscopic drome. J.WT tember), 1997.
Orchidopexy Ng, and G.H.
for Persistent Miillerian Duct Koh. Pediatr Surg Int 12:522-525,
Syn(Sep-
Two men (21 and 22 years old) with undescended testes and persistent miillerian duct syndrome are presented. Both patients were man aged with laparoscopic orchidopexy. The authors base their management on two principles. The first is to perform orchidopexy if technically possible, because the risk for malignancy is greater in patients with persistent mtillerian duct syndrome. Orchidopexy also will optimize the potential for fertility. The second principle is to recognize that resecting the persistent mtillerian structures is not essential, because no risk for malignancy has been reported.--Prem Puri Impact of Early Orchidopexy on Testicular and R. Haddad. Br J Urol80:334-335, (August),
Growth. 1997.
H. Nagar
Testicular size was assessed before and after operation in 190 boys undergoing orchidopexy for unilateral maldescent at 1 week to 15 years of age. Testicular size was measured with cailipers, and growth was defined as an increase in the size ratio of maldescended to normal testis of at least 15%. Compared with the normally descended testis, the cryptorchid testis increased in 11.6% and decreased in 2.6%. Testicular growth was more common in children operated on before 18 months of age (17 of 79 compared with 5 of 93; P = .016).-MN. de la Hunt Proximal Urinary Diversion in the Management of Posterior Urethral Valves: Is It Necessary? D.N. Tietjen, J.M. Gloor; and D.A. Hzwmmn. J Urol 158:1008-1010, (September), 1997. In infants with posterior urethral valves in whom renal function fails to normalize after decompression of the lower urinary tract, supravesical urinary diversion is customarily recommended for presumed concomitant ureterovesical junction obstruction. The authors evaluated 26 patients with posterior urethral valves treated by supravesical urinary
ABSTRACTS
diversion. The mean gestational age at birth was 35 weeks (range, 27 to 40). After initial decompression via an indwelling catheter for a median of 7 days (range, 4 to 18), persistently high serum creatinine was present (median, 2.5 mg/dL; range 1.9 to 3.5). One month after proximal urinary diversion the median creatinine was 1.3 mg/dL (range, 0.5 to 2.8). At one year the median nadir creatinine was 1.0 mg/dL (range, 0.3 to 2.5). At the time of reconstruction, a Whitaker test in all 26 patients (52 renal units) demonstrated fixed ureterovesical junction obstruction in two units (4%). Renal biopsy in 44 of the 52 renal units (85%) showed renal dysplasia. At the median follow-up period of 9 years (range 1 to 14), end-stage renal disease had developed in 11 patients (42%). It is concluded that in neonates with posterior urethral valves who undergo proximal urinary diversion, fixed ureterovesical junction obstruction is rare, renal biopsy invariably demonstrates areas of renal dysplasia, and end-stage renal disease develops frequently despite proximal diversion. These findings question the necessity of supravesical urinary diversion.-George W Holcomb, Jr Increased Renal Echogenicity: A Sonographic Sign for Differentiating Between Obstructive and Nonobstructive Etiologies of In Utero Bladder Distension. 44. Kaejel; C.A. Peters, A.B. Retik, et al. J Urol 158: 1026-1029, (September), 1997. The authors reviewed the medical records and prenatal imaging studies of 18 cases of marked in utero bladder distension in which a diagnosis of posterior urethral valves, the megacystis-megaureter association, or prune-belly syndrome was confirmed postnatally. Amniotic fluid volume and renal echogenicity were assessed before knowledge of the specific diagnosis. Oligohydranmios was graded as mild, moderate, or severe. Increased renal echogenicity was defined as greater echogenicity of the renal cortex and/or medulla than of adjacent liver tissue. Postnatal imaging, clinical course, and outcome also were reviewed. The study included 15 cases with adequate follow-up, including eight in which a diagnosis of posterior urethral valves was confirmed postnatally. Nonobstntctive etiologies included the megacystis-megaureter association in six cases and prune-belly syndrome in one. Seven of the eight patients with posterior urethral valves had moderate to severe oligohydramnios, whereas all but one with a nonobstructive etiology had normal amniotic fluid. Seven of eight cases with posterior urethral valves had a marked bilateral increase in renal echogenicity; none of the nonobstructive cases had this finding. It is concluded that increased renal echogenicity and oligohydramnios in the setting of bladder distension are highly predictive (87%) of an obstructive etiology. This finding is important in the prenatal counseling and treatment of boys with bilateral hydronephrosis and marked bladder dilatation--George W Holcomb, Jr Renal Doppler Ultrasonography in Children With Equivocal Obstructive Uropathy: Effect of Intravenous Normal Saline Fluid Load and Frusemide. A.A. Shokeir; A.l? Provoost, M. El-Arab, et af. Br J Urol80:313-318, (August), 1997. The authors studied 19 kidneys with equivocal results from diuretic isotope renography (11 with suspected pelviureteric junction obstruction and 8 with nonrefluxing megaureter). Twelve children with unilateral (n = 5) or bilateral hydronephrosis (n = 7) underwent isotopic diuretic renography and Doppler ultrasonography. All the hydronephrotic kidneys had significantly lower glomerular filtration rate (GFR) and equivocal obstruction with half-time drainage (T/2) values of 10 to 20 minutes. Doppler studies were carried out before and after saline infusion and frusemide. The mean renal resistive index (RI) in hydronephrotic kidneys did not differ significantly from that of normal kidneys at rest but showed a variable response after diuresis. RI is lower during diuresis in normal kidneys. The mean RI was 0.71 before diuresis and 0.67 after diuresis. Of seven kidneys with an RI of greater than 0.7 both before and after diuresis. five eventually had deteriorating GFRs requir-