The Comparison Of Different Surgical Management For Cryptorchidism

OBJECTIVE To evaluate the clinical effection of different surgicalmanagements for cryptorchid patients, and to explore the optimum selectionof minimally invasive surgery for cryptorchidism.METHODS Between September of2003and May of2011, aretrospective analysis was taken to explore the1720patients (1933testes)who underwent their first surgery for cryptorchidism. Aged from6monthsto17.5years (median3.3years). Under the anesthesia, the1365patients(1536testes) were examined of palpable testis and355patients (397testes)were impalpable. We compared and analyzed the incidences of testis downin scrotum, testicular atrophy and retraction after operation with differentsurgical approaches including by laparoscopic, traditional inguinal andtranscrotal orchidopexy. We are also analyzing the perioperativecomplications in different surgical approaches.RESULTS The explored rates by laparoscopy (144testes) and byinguinal exploration (253testes) were84%(121/144) and88.1%(223/253),respectively. And there was no statistically significant differences (P>0.05)in the explored rates.The surgical effects of1661patients (1869testes) were analyzed, excepting absence or atrophy testis, transverse ectopic testis andFowler-Stephens orchidopexy for the testis. Among inguinal canalicularundescended testis (1014patients,1153testes), that underwent laparoscopic(197testes) and traditional inguinal (956testes) orchidopexy, the rates oftestis was down in scrotum were100%(197/197) and99.4%(950/956), thefollow-up rate were93.9%(185/197) and90.9%(869/956), testicularatrophy after operation were0and2%(2/869), and testicular retraction were0, respectively, and there were no statistically significant differences(P>0.05) between two approaches. Among the external inguinal ring testis(351patients,383testes), that underwent laparoscopic (10testes), traditionalinguinal (307testes) and transcrotal (66testes) orchidopexy, the rates oftestis was down in the scrotum were100%, the follow-up rate were100%(10/10),94.1%(289/307) and97.0%(64/66), and testicular atrophy andretraction after operation were0, respectively. The effection of threeapproaches has no difference. Under the anesthesia, the testes of355patients(397testes) were impalpable preoperatively. Among the intra-abdominaltestis (296patients,333tests), that underwent laparoscopic (110testes) andtraditional inguinal (223testes) orchidopexy, the rates of testis was down inscrotum were90%(99/110) and88.3%(197/223), the follow-up rate were91.8%(101/110) and92.4%(206/223), testicular atrophy after operationwere1.0%(1/101) and1.5%(3/206), and testicular retraction were1.0%(1/101) and1.9%(4/206), respectively. There were no statistically significant differences (P>0.05). The rates of perioperative complicationswere0.5%(7/1486) and0.9%(3/317), respectively, between traditionalinguinal (1486tests) and laparoscopic orchidopexy (317tests). There was nostatistically significant differences (P>0.05). There were no perioperativecomplications in the64patients (66tests) who underwent transcrotalorchidopexy.CONCLUSIONS For the primary cryptorchidism located in or belowexternal inguinal ring under the anesthesia, it is the preferred to undergotranscrotal orchidopexy. If the surgeon proficiency in laparoscopic surgery,laparoscopic orchidopexy is optimum selection for treating intra-abdominaland inguinal canalicular testes. Laparoscopic and transcrotal orchidopexyhave the advantages of minimally invasion.