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. 2024 Jan 2;24(1):1.
doi: 10.1186/s12894-023-01386-4.

Laparoscopic orchidopexy for the treatment of cryptorchidism in adults: a description of the technique and outcomes

Hu Han #  1   2 , Jiaxing Li #  1   2 , Hong-En Lei  1   2 , Hang Yin  3   4 , Long Tian  5   6
Affiliations

Laparoscopic orchidopexy for the treatment of cryptorchidism in adults: a description of the technique and outcomes

Hu Han et al. BMC Urol. .

Abstract

Background: There are few studies on cryptorchidism in adults, and its treatment is still controversial.

Methods: To summarize the surgical strategy and clinical efficacy of laparoscopic orchidopexy for the treatment of cryptorchidism in adults, 37 adult cryptorchidism patients were retrospectively analyzed between September 2017 and February 2022. All 37 patients underwent laparoscopic orchidopexy, of whom 33 underwent inguinal hernia repair without tension. The intraoperative procedures and surgical techniques were recorded in detail. Preoperative examination and regular postoperative review of color Doppler ultrasound, and reproductive hormone, alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels were performed.

Results: All testes descended successfully into the scrotum, including 25 through the inguinal route and 12 through Hesselbach's triangle route. No intraoperative or postoperative complications were observed. The follow-up time was 38.6 (± 19.4) months, and no evidence of testicular malignancy was found during the follow-up period. After analyzing the reproductive hormone levels at 1 year postoperatively in 28 patients with more than 1 year of follow-up, it was found that the patients had a significant increase in testosterone levels and a decrease in follicle-stimulating hormone levels after surgery. None of the patients showed any significant improvement in semen quality after surgery.

Conclusion: Our study suggests that laparoscopic orchidopexy is a safe and feasible surgical procedure for the treatment of cryptorchidism in adults, especially high cryptorchidism, which is difficult to treat. After comprehensive consideration, preserving the testis should be preferred for treating cryptorchidism in adults to maximize the protection of the patient's reproductive hormone secretion function.

Keywords: Cryptorchidism in adults; Laparoscopic orchidopexy; Reproductive hormones; Tension-free hernia repair.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A: Opening the peritoneum with an arched incision above the deep inguinal ring (the black dashed line shows the incisional alignment, and the blue shaded area shows the unclosed internal inguinal canal ring). B: Separating the spermatic cord (black dashed line shows the spermatic cord). C: Fully freeing the medial vas deferens (the green dashed line shows the vas deferens, black dashed line shows the spermatic cord). D: Fully freeing the retroperitoneal spermatic cord (black dashed line shows the spermatic cord). E: Suturing to fix the patch F: Absorbable continuous sutures to close the peritoneum
Fig. 2
Fig. 2
Anatomical landmarks in laparoscopic orchidopexy: The yellow shaded area is the “pain triangle”. The red-shaded area is the “danger triangle”, which contains the external iliac artery and the femoral nerve. The blue-shaded area is the deep inguinal ring (DIR). The red dashed line is the inferior epigastric artery (IEA), the green dashed line is the vas deferens (VD), and the black dashed line is the spermatic cord (SC)
See this image and copyright information in PMC

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