Gubernaculum-sparing orchiopexy versus gubernaculum excision; A randomized trial on success and atrophy rates

IF 2 3区医学 Q2 PEDIATRICS Journal of Pediatric Urology Pub Date : 2024-10-01 DOI:10.1016/j.jpurol.2024.06.041

Reza Abbasion , Mahdi Mottaghi , Parisa Saeidi Sharifabad , Masoud Mahdavi Rashed , Hassan Mehrad-Majd , Mohammadhadi Mohammadzadeh Rezaei

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Abstract

Introduction and objective

Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy.

Study design

This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman's tests were used where appropriate.

Results

Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6–84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm³ among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p = 0.002).

Conclusion

Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint.

Trial registration

https://irct.ir/trial/58842.

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保留肛门括约肌与肛门括约肌切除术；关于成功率和萎缩率的随机试验

之前的研究表明，腹腔镜睾丸环切术后，额外的血液供应可减少睾丸萎缩。我们评估了在开放式传统睾丸吻合术后保留睾丸粘膜附件（包含来自嵴动脉及其吻合处的血液供应）对萎缩率的影响。这项双盲随机试验于 2022 年 3 月至 2023 年 9 月进行。纳入的睾丸无法触及的男孩，即使在麻醉状态下进行了检查，也要接受诊断性腹腔镜检查，以评估睾丸的位置和大小。睾丸有凹陷，且与腹股沟内环的距离大于 2 厘米。通过随机排列法将参与者分为两组（疏通睾丸（GS）组和切除睾丸（GE）组）。总体成功定义为形态学成功（萎缩<术中大小的20%）和解剖学成功（阴囊或阴囊高位）。手术后三个月和六个月，通过超声波对男孩进行随访。在适当的情况下采用独立 t 检验、重复方差分析和弗里德曼检验。在 92 名男孩（总计 105 个 UDT）中，75 个睾丸（GS 组 36 个，GE 组 39 个）被用于分析。参与者的平均年龄为 25 ± 17 个月（6-84 个月）。所有参与者、GS 组和 GE 组病例术中睾丸的平均大小分别为 460 ± 226 毫米、396 ± 166 毫米和 520 ± 258 毫米。两组患者的睾丸体积在两个随访检查点上都有明显下降，但GE组的下降幅度明显更大（< 0.001）。GS男孩的解剖成功率明显更高（97.2%对82.1%；=0.038）。GS组的总体成功率明显更高（61.1% 对 25.6%; = 0.002）。虽然两组的平均睾丸体积都有所缩小，但我们发现 GS 组的形态学和总体成功率更高。与六个月的检查点相比，手术后三个月的体积缩小幅度最大。.[显示省略]

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来源期刊

Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY

CiteScore

3.70

自引率

15.00%

发文量

330

审稿时长

4-8 weeks

期刊介绍： The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.