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The aim of this report is to present our initial experience with a new laparoscopic surgical technique for elongation of the spermatic vessels and orchidopexy for intra-abdominal undescended testis. We performed surgical elongation and orchidopexy in three patients with intra-abdominal undescended testis. Under direct laparoscopic vision, a non-absorbable suture was placed through the lower pole of the intra-abdominal undescended testicle. Using a Maryland grasper, the suture was brought through the inguinal channel all the way down to the scrotal skin. We took out the suture and performed progressive traction on the suture mobilizing the testicle downward without putting the spermatic vessels on appropriate maximum tension. The second stage was performed after a period of 3–6 months when we checked the elongation of the spermatic vessels. In two patients, the degree of elongation was enough so that scrotal orchidopexy was possible immediately. In one patient, an intermediate step of further traction and elongation was necessary. The definitive orchidopexy was possible 6 months later. We had no intraoperative incidents and no postoperative complications. In all three patients, we succeeded to mobilize and fix the undescended testicle in its scrotal, normal position. No signs of postoperative ischemia or testicle atrophy were noticed. This surgical technique seems to be a viable alternative to current procedures for intra-abdominal undescended testis. The procedure is safe and effective, all the natural testicular vascular supply is preserved and during the intermediate position the testicle is placed closer to its natural location.

Background Vasoepididymal anomalies are not rare among children with cryptorchidism. They may affect fertility following orchiopexy. Herein, we describe the cases of abnormalities of the vas deferens and epididymis in children undergoing orchidopexy for cryptorchidism. Data were collected retrospectively from six centers providing care for patients with undescended testicles from September 2017 to February 2019. All patients whose congenital anomalies of the epididymis or vas deferens were discovered incidentally during operative intervention for cryptorchidism and where photographs of the anomalies were taken were included. Results The total incidence of congenital anomalies on the 467 testicles which had operations was 13.2%. Congenital epididymal and vas deferens anomalies were more common on the left side than the right side in patients with cryptorchidism (P = 0.038). Attachment anomalies between the epididymis and testis were the most common epididymal anomaly (36.3%), while a vanished vas deferens was the most frequent vas deferens anomaly (18%). Three patients had absent vas deferens, two had curled vas deferens, two had vas deferens separated from the epididymis, and one had a duplicated vas deferens. Three patients had an epididymal cyst, one had an enlarged appendix of the epididymis, and one had epididymal agenesis. Conclusion Attention must be paid during any surgery on an undescended testicle as an anomaly of the vas deferens could lead to unexpected complications. Anomalies of the vas deferens or epididymis that present in cases of cryptorchidism occur mostly on the left side.

To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age. This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0–6 years, 7–9 years, 10–12 years, 13–15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes. For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age. While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities.

The two-stage Fowler-Stephens orchiopexy is a well-described surgical approach for most pediatric urologists tackling the high intra-abdominal testis. Testicular ascent is a well-reported outcome of the surgery and a problem that could be fixed with a repeat procedure. The purpose of this review is to determine the rate of subsequent testicular ascent and repeat surgery after a two-stage Fowler-Stephens using best available evidence. We selected 16 studies that pertained to our topic. 0–13% of testicles were deemed to be in an inappropriate position on follow-up (6–37 months). The definition of appropriate postoperative position varied between studies and rates of repeat procedures were sparsely available. Available data reports a repeat orchiopexy rate of 2.6–7.5% after two-stage Fowler-Stephens. Two-stage Fowler-Stephens orchiopexy is a highly successful surgical technique to manage high intra-abdominal testes. Rates of testicular ascent are difficult to ascertain due to varying definitions and small sample sizes. While repeat procedures are typically indicated, the actual rate of repeat orchiopexy is rarely reported and long-term outcomes following a third procedure is sparse.

Cryptorchidism is failure of one or both testes to descend completely into the scrotum. The testis can be located anywhere along its journey of descent, between the lower pole of the kidney and the inguinal canal. Objective: The aim of this study was to assess the effectiveness of chemical shift imaging and Dixon based fat suppression using low field MRI in non-palpable undescended testicle. Patients and methods: From July 2017 through February 2018, Twenty eight boys, presented by either unilateral or bilateral cryptorchidism, with total number of forty testicles, underwent MRI study using low field machine in T1-weighted dual gradient-echo in-phase and opposed-phase sequence with Dixon based fat suppression. Results: Based on the laparoscopic/operative data, twenty one testes were located at the inguinal region, whereas fifteen testes were pelvi-abdominal and four were absent. The whole image sets of CSI and Dixon fat suppression had the highest specificity and positive predictive value (100%) and the highest overall accuracy (95%) for detection of undescended testes. Conclusion: chemical shift imaging combined with Dixon based fat suppression is reliable imaging tool as a standalone technique for evaluating cryptorchidism, providing high specificity and diagnostic accuracy. Keywords: Chemical shift imaging, Cryptorchidism, Low field MRI

The purpose of this article is to review the approach to pediatric patients with scrotal pathology and the associated causes including inguinal hernia, cryptorchidism, hydrocele, varicocele, testicular torsion, trauma, and tumors. The reader will understand the diagnostic and treatment options and need for urgent surgical referral. Research has demonstrated the safety and efficacy of laparoscopic hernia repair in pediatric patients. Studies have failed to clarify the optimal timing of neonatal hernia repair and indications for bilateral exploration. Current clinical practice guidelines for cryptorchidism recommend surgical referral by 6 months of age and discourage the use of ultrasound. Most scrotal complaints are managed with low morbidity and preservation of fertility. Scrotal complaints of pain, swelling, bulging, and masses are common in pediatric patients. Management should be done in conjunction with a pediatric surgeon or urologist. Research is required to facilitate practice guidelines for scrotal pathology and address the practice variation that still exists.

We are reporting a case of an 18-month old male who presented with bilateral cryptorchidism. The patient underwent an explorative laparoscopy in which two gonads were identified in close proximity to the uterus and fallopian tubes. Biopsy of the gonads confirmed testicular tissue. Genetic analysis demonstrated a 46, XY male. Male external genitalia were appropriate for age with no evidence of female structures. Persistent Mullerian duct syndrome is extremely rare, with approximately 260 cases reported in the literature. Best practice for the extent of surgical management is still evolving as we gather data on long-term outcome Keywords: cryptorchidism, Mullerian duct syndrome, male pseudohermaphroditism, undescended testicle

On routine neonatal examination, a newborn term male was noted to have unilateral enlargement of the right lower limb, loose thickened red skin over the palm and widening of all the fingers on the right hand. His body was pinker and warmer on the right side compared with the left and he had a right undescended testicle and hypoplastic scrotum. Radiological examination of the lower limbs demonstrated the enlargement of the soft tissue of the right lower limb compared to the left (Fig. 1). Therefore, the diagnosis was unclear from this constellation of findings and an ophthalmic assessment was requested.

We are presenting a 36 year old male patient who was diagnosed to have a right pararenal mass on CT scan taken for evaluation of his long lasting urinary stone disease and accompanying undescended right testicle. He subsequently underwent a retroperitoneal lymph node dissection for possible testicular tumor or its metastasis in the undescended testicle or retroperitoneal primary tumor, which came out to be non malignant tissue. We confirmed that the highest possible location of the testicle when undescended is at the level of the internal inguinal ring, and paracaval masses associated with undescended testicles do not necessarily represent a testicular tumor in the retained testicle, its metastasis or an extragonadal germ cell tumor (EGT), and further work should be done to illuminate the nature of such cases.

The development of newer imaging modalities and the expanded use of older techniques have substantially improved the care of the pediatric patient. In this article, we review the roles of sonography, voiding cystourethrography, excretory urography, and nuclear medicine studies in the evaluation of the most common pediatric urologic disorders, including urinary tract infection, obstructive and nonobstructive hydronephrosis, and vesicoureteral reflux. Recently developed techniques such as magnetic resonance imaging and color Doppler sonography are also discussed with respect to their use in evaluating upper-urinary-tract obstruction as well as the undescended testicle and testicular torsion. Areas of controversy are identified and rationales for current radiographic evaluation of these disorders are reviewed.

The incidence of undescended testicle in 2850 single-born full-term male neonates was 1.6% and after 6 months of follow-up it was 0.56% Examination of 6270 children aged 1 to 12 years, revealed undescended testicle in 0.43 per cent. It is noted that the incidence of testiculare undescent is lower in Indian children, which may be due to racial, genetic or climatic factors. Spontaneous descent in children beyond the age of one year must be very rare. We did not see any instance of ectopic testis in our series.