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High Undescended Testis Treatment with Distal Espermatic Vessel Ligation (Koff-Sethi Technique)

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DOI: 10.4236/ss.2014.56045    2,702 Downloads   3,607 Views  


Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni- or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

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The authors declare no conflicts of interest.

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Molina, C. , Estevanato, A. , Cassini, M. , Andrade, M. and Tucci, S. (2014) High Undescended Testis Treatment with Distal Espermatic Vessel Ligation (Koff-Sethi Technique). Surgical Science, 5, 258-263. doi: 10.4236/ss.2014.56045.


[1] Kollin, C., Karpe, B., Hesser, U., Granholm, T. and Ritzén, E.M. (2007) Surgical Treatment of Unilaterally Undescended Testes: Testicular Growth after Randomization to Orchiopexy at Age 9 Months or 3 Years. The Journal of Urology, 178, 1589-1593.
[2] Canavese, F., Mussa, A., Manenti, M., Cortese, M.G., Ferrero, L., Tuli, G., Macchieraldo, R. and Lala, R. (2009) Sperm Count of Young Men Surgically Treated for Cryptorchidism in the First and Second Year of Life: Fertility Is Better in Children Treated at a Younger Age. European Journal of Pediatric Surgery, 19, 388-391.
[3] Chung, E. and Brock, G.B. (2011) Cryptorchidism and Its Impact on Male Fertility: A State of Art Review of Current Literature. Canadian Urological Association Journal, 5, 210-214.
[4] Trsinar, B. and Muravec, U.R. (2009) Fertility Potential after Unilateral and Bilateral Orchidopexy for Cryptorchidism. World Journal of Urology, 27, 513-519.
[5] Forman, D., Pike, M.C., Davey, G., Dawson, S., Baker, K., Chilvers, C.E.D., Oliver, R.T.D. and Coupland, C.A.C. (1994) Aetiology of Testicular Cancer: Association with Congenital Abnormalities, Age at Puberty, Infertility, and Exercise. BMJ, 308, 1393-1399.
[6] Ludwikowski, B. and Gonzáles, R. (2013) The Controversy Regarding the Need for Hormonal Treatment in Boys with Unilateral Cryptorchidism Goes on: A Review of the Literature. European Journal of Pediatrics, 172, 5-8.
[7] Thorsson, A.V., Christiansen, P. and Ritzén, M. (2007) Efficacy and Safety of Hormonal Treatment of Cryptorchidism: Current State of the Art. Acta Paediatrica, 96, 628-630.
[8] Riedmiller, H., Androulakakis, P., Beurton, D., Kocvara, R. and Gerhatz, E. (2001) EAU Guidelines on Paediatric Urology. European Urology, 40, 589-599.
[9] Hutson, J.M. and Hasthorpe, S. (2009) Testicular Descent and Cryptorchidism: The State of the Art in 2004. Journal of Pediatric Surgery, 40, 297-302.
[10] Ritzen, E.M., Bergh, A., Bierknes, R., Christiansen, P., Cortes, D., Haugen, S.E., Jorgensen, N., Kollin, C., Lindahl, S., Lackgren, G., Main, K.M., Nordenskjold, A., Raipert-De Meyts, E., Soder, O., Taskinen, S., Thorsson, A., Thorup, J., Toppari, J. and Virtanen, H. (2007) Nordic Consensus on Treatment of Undescended Testes. Acta Paediatrica, 96, 638-643.
[11] Murphy, F., Paran, T.S. and Puri, P. (2007) Orchidopexy and Its Impact on Fertility. Pediatric Surgery International, 23, 625-632.
[12] Ritzen, E.M. (2008) Undescended Testes: A Consensus on Management. European Society of Endocrinology, 159, 87-90.
[13] Gapany, C., Frey, P., Cachat, F., Gudinchet, F., Jichlinski, P., Meyrat, B.-J., Ramseyer, P., Theintz, G. and Bumand, B. (2008) Management of Cryptorquidism in Children: Guidelines. Swiss Medical Weekly, 138, 492-498.
[14] Fowler Jr., R. and Stephens, F.D. (1959) The Role of Testicular Vascular Anatomy in the Salvage of High Undescended Testes. Australian and New Zealand Journal of Surgery, 29, 92-106.
[15] Koff, A.S. and Sethi, P.S. (1996) Treatment of High Undescended Testes by Low Spermatic Vessel Ligation: An Alternative to the Fowler-Stephens Technique. The Journal of Urology, 156, 799-803.
[16] Kaya, H., Cengiz, M., Orhan, T., Kendirci, M., Boylu, U. and Gumus, E. (2006) Single Stage Fowler-Stephens Orchidopexy: A Preferred Alternative in the Treatment of Nonpalpable Testes. Pediatric Surgery International, 22, 759-761.
[17] Esposito, C., Vallone, G., Savanelli, A. and Settimi, A. (2009) Long-Term Outcome of Laparoscopic Fowler-Stephens Orchiopexy in Boys with Intra-Abdominal Testis. The Journal of Urology, 181, 1851-1856.
[18] Elyas, R., Guerra, L.A., Pike, J., DeCarli, C., Betolli, M., Bass, J., Chou, S., Sweeney, B., Rubin, S., Barrowman, N., Moher, D. and Leonard, M. (2010) Is Staging Beneficial for Fowler-Stephens Orchiopexy? A Systematic Review. The Journal of Urology, 183, 2012-2018.
[19] Stec, A.A., Stacy, T.T., Adams, M.C., John, C., Pope IV, J.C., Thomas, J.C. and Brock III, J.W. (2009) Orchiopexy for Intra-Abdominal Testes: Factors Predicting Success. The Journal of Urology, 182, 1917-1920.
[20] Daher, P., Nabbout, P., Feghali, J. and Riachy, E. (2009) Is the Fowler-Stephens Procedure Still Indicated for the Treatment of Nonpalpable Intraabdominal Testis? Journal of Pediatric Surgery, 44, 1999-2003.
[21] Dessanti, A., Falchetti, D., Iannuccelli, M., Milianti, S., Altana, C., Tanca, A.R., Ubertazzi, M., Strusi, G.P. and Fusillo, M. (2009) Cryptorchidism with Short Spermatic Vessels: Staged Orchiopexy Preserving Spermatic Vessels. The Journal of Urology, 182, 1163-1168.

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