Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 3
Erişkinde ele gelmeyen testisli olgularda testis ve eklerine ait laparoskopik ve açık eksplorasyon bulguları: 114 olgunun retrospektif analizi
- Sayfa
- 327–331
- DOI
- —
Özet
Bu çalışmada ele gelmeyen testis nedeni ile laparoskopik ve açık eksplorasyon uygulanan olgularda gözlenen testis, epididim, vas deferens bulguları değerlendirildi. Ocak 1996 ve Ekim 2002 tarihleri arasında 114 ele gelmeyen testisli olgu değerlendirildi. Olguların yaşları 20 ile 27 (Ort. 22) arasında idi. Ele gelmeyen testisli olguların yirmi üçü iki taraflı, doksan biri tek taraflı idi. Eksplorasyonlar ilk 22 olguda inguinal insizyon ile açık, sonraki 92 olguda ise laparoskopik olarak yapıldı. Tek taraflı 22 olgu vanishing testis olarak değerlendirildi. Bu olgulardan ikisinde Vas deferens batın içerisinde, dördünde inguinal kanalda diğerlerinde ise skrotum içerisinde sonlanıyordu. Eksplorasyonlarda toplam 138 testis bulundu (23 olgu iki taraflı, 22 olgu vanishing testisli) Testisler bir olguda inguinal kanalda atrofik, bir olguda sağ renal pedikül seviyesinde atipik yapıda diğer 136 olguda ise internal ringin önünde, ana iliak damarların üzerinde veya küçük pelviste normalden küçük hacimde bulundu. Bir olguda epididim yoktu. Diğer 137 testisin 94’ünde (%69); epididim testise sadece baş ve kuyruk kısmı ile yapışık iken, 43’ünde ise (%31) baş, gövde ve kuyruk kısmı ile tamamen yapışıktı. Sonuç olarak; abdominal testisli olgularda başta epididim olmak üzere testis ve vas deferens anomalilerinin belirgin arttığı ve bu artışın yüksek abdominal testisli olgularda en yüksek seviyede olduğu görüldü.
Abstract
Introduction: Cryptorchidism is the most frequently seen congenital anomaly in children. The anomaly incidence of the testis and its additions in nonpalpable testes is highly common. It is known that, there is a meaningful correlation between the testis localization and the malformations of the testis and its additions in cryptorchidism. The higher the nonpalpable testis is localized, the more frequently the anomalies are seen. In this study, the laparoscopic and open explorative findings of the testis, epididym and vas deference of the adult population were presented. Materials and Methods: Between January 1996 and October 2002, 114 cases with nonpalpable testes were evaluated. Cases were aged between 20 and 27 (average: 22) years. Of the 114 cases, 23 had bilateral and 91 had unilateral nonpalpable testes. Explorations were performed by open inguinal incision on the initial 22 patients and by laparoscopy on the other 92 patients. Open incisions were performed through Gibson incision. Laparoscopic interventions were carried out via three ports, of which one was subumblical and the other two were pararectal. Pararectal ports were not needed in the cases which were considered as vanishing testis. In the cases with unilateral nonpalpable testis orchiectomy was performed as for in the cases with bilateral nonpalpable testis orchiopexy was carried out. Testicular diameters were measured via graphic method. The presence of the carcinoma in-situ was explored in the cases having had orchiectomy. Results: During the explorations 138 testes were found. In 1 case testis was found in the inguinal canal, and it was atrophic. In one case it was at the right renal pedicle level with atypical structure. In 136 cases testes were localized as anterior to the internal ring between the bladder and the common iliac vessels at a smaller size than the normal. In two of these cases, vas deference was ending inside the abdomen, in four of the cases, vas deference was ending inside inguinal canal, and in the others, they were ending inside the scrotum. Testicular volumes of all the cases with intraabdomınal testis were determined as 12.5-22.5 ml (mean 17.5 ml). While their consistency in three cases was hard, in the other cases they were softer than normal. In one case there was no epididym. While in 74 of the other 137 testes epididyms were attached to the testes on the head and tail, in 40 cases they were attached to the testes completely. Twenty-two of the unilateral cases were accepted as vanishing testis. Viable testicular tissue was found in only 2 of the 22 vanishing testes. No carcinoma in-situ was reported in the cases having had laparoscopic orchiectomy. Conclusion: In adults, nonpalpable testes were found smaller and softer than the normal. The incidence of upper localized testes were determined as extremely low, however, incidence of the testis-epididym anomaly was observed as higher. It was demonstrated that in the cases with nonpalpable testes, classical inguinal incision sometimes might not be sufficient, and highly localized abdominal nonpalpable testes might be missed.