LAPAROSCOPY IN THE MANAGEMENT OF THE IMPALPABLE UNDESCENDED TESTIS IN PEDIATRIC UROLOGY CENTERS IN IRAQ
Keywords:
Laparoscopic orchiopexy, Undescended testis, impalpable testicle, Pediatric urologyAbstract
Introduction: Undescended testis (UDT), or Cryptorchidism, is one of the popular congenital anomalies, with significant involvement for future fertility and testicular tumour. Our study evaluates the effectiveness of laparoscopic management for non-palpable UDT in pediatric patients across three major urology centers in Iraq.
Methods: A retrospective analysis was handled on 42 pediatric patients with non-palpable UDT diagnosed with intra-abdominal cryptorchidism and treated at Al Sader Teaching Hospital, Al Najaf Teaching Hospital, and Baghdad Medical City. Our cases were distributed according to ages into three groups, and they underwent laparoscopic exploration with general anesthesia. Surgical interventions included Single-Staged Procedure and Two-Stage Fowler-Stephens Procedure for normal and small size testicles, and Orchiectomy for atrophied testicles. Pre-operative information, intra-operative findings, postoperative results, and complications were documented and analyzed. Chi-square tests, utilized with the significance limit established at p < 0.05.
Results: We analysed 42 cases (age range: 9 to 72 months; median age: 19 months) the majority of UDT cases (52.4%) occurred in cases age group 13-24 months, with a left-sided slightly predominance (57.1%). during laparoscopic explorations, more than half of the testicles (54.8%) were located near the iliac vessels, and the majority testicles were of normal size (76.2%). The Single-Staged Procedure was the most commonly performed (54.8%), followed by the Two-Stage Fowler-Stephens procedure (38.1%). Furthermore, complication subdivided into early and late. Early complications were observed only in 11.9% of cases, scrotal hematoma accounting the most frequent causes, while late complications, testicular atrophy detected most frequently, were detected in 16.7% of cases. The majority of testicles (65.2%) reached the lower scrotum postoperatively, with a hospital stay of one day in majority of cases.
Conclusion: Laparoscopic management of non-palpable UDT is a safe and helpful procedure in pediatric urology, with the Single-Staged Procedure being highly successful in appropriate cases. Early intervention is essential to achieve best testicular positioning and function result.
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