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PAEDIATRIC UROLOGY

V Therapy

Laparoscopy

Intersex ?

2.4 REFERENCES

1. Alaish SM, Stylianos S.

Diagnostic laparoscoy. Curr Opin Pediatr 1998; 10: 323-327

2. Arnbjornsson E, Mikaelsson C, Lindhagen T, Ivarsson SA.

Laparoscopy for non-palpable testis in childhood: is inguinal exploration necessary when vas and vessels are not seen? Eur J Pediatr Surg 1996; 6: 7-9.

3. Balaji КС, Diamond DA.

Laparoscopic diagnosis and management of transverse testicular ectopia. Urology 1995; 46: 879-880.

4. Bourguignon JP, Vanderschueren Lodeweyckx M.

Hormonal treatment of cryptorchidism: lessons from 15 years of worldwide experience. Acta Urol Belg 1995; 63: 77-81.

5. Brown RA, Millar AJ, Jee LD, Cywes C.

The value of laparoscopy for impalpable testes. S Afr J Surg 1997; 35: 70-73.

6. Bukowski TP, Wacksman J, Billmire DA, Lewis AG, Sheldon CA.

Testicular auto-transplantation: a 17-year review of an effective approach to the management of the intra-abdominal testis [see comments]. J Urol 1995; 154: 558-561.

7. Caldamone AA, Amaral JF.

Laparoscopic stage 2 Fowler-Stephens orchiopexy. J Urol 1994; 152: 1253-1256.

  1. Canavese F, Cortes MG, Magro P, Lonati L, Teruzzi E, de Sanctis C, Lala R. Cryptorchidism: medical and surgical treatment in the 1st year of life. Pediatr Surg Int 1998; 14: 2-5.

  2. Cortes D.

Cryptorchidism — aspects of pathogenesis, histology and treatment. Scand J Urol Nephrol Suppl 1998; 196: 1-54.

10. Cortes D, Thorup JM, Lenz K, Beck BL, Neilsen OH.

Laparoscopy in 100 consecutive patients with 128 impalpable testes. Br J Urol 1995; 75: 281-287.

11. Davenport M.

ABC of general paediatric surgery. Inguinal hernia, hydrocele, and the undescended testis. BMJ 1996; 312: 564-567.

  1. Davenport M, Brain C, Vandenberg C, Zappala S, Duffy P, Ransley PG, Grant D. The use of the hCG stimulation test in the endocrine evaluation of cryptorchidism. BrJ Urol 1995; 76: 790-794.

  2. De Вое V, De Backer A, Braeckman J.

Laparoscopy: any indication in the work-up and treatment of undescended testis? Acta Urol Belg 1995; 63: 89-91.

14. DocimoSG.

The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 1995; 154: 1148-1152.

15. DuckettJW.

Pediatric laparoscopy: prudence, please [editorial]. J Urol 1994; 151: 742-743.

16. Esposito C, Garipoli V.

The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intra-abdominal testes [see comments]. J Urol 1997; 158: 1952-1954.

  1. Fahlenkamp D, Winfield HN, Schonberger B, Mueller W, Loening SA. Role of laparoscopic surgery in pediatric urology. Eur Urol 1997; 32: 75-84.

  2. Fedder J, Boesen M.

Effect of a combined GnRH/hCG therapy in boys with undescended testicles: evaluated in relation to testicular localization within the first week after birth. Arch Androl 1998; 40: 181-186.

19. Ferro F, Lais A, Gonzalez Serva L.

Benefits and afterthoughts of laparoscopy for the non-palpable testis. J Urol 1996; 156: 795-798.

20. Gill B, Kogan S.

Cryptorchidism. Current concepts. PediatrClin North Am 1997; 44: 1211-1227.

21. Gordon N.

Undescended testes: screening and early operation. Br J Clin Pract 1995; 49: 318-320.

22. Hadziselimovic F.

Cryptorchidism: the disease and its management. Acta Urol Belg 1995; 63: 83-88.

23. Hadziselimovic F, Herzog B.

Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life. J Urol 1997; 158: 1193-1195.

24. Hamm B.

Sonography of the testis and epididymis. Andrologia 1994; 26: 193-210.

25. Kiely EA.

Scientific basis of testicular descent and management implications for cryptorchidism. Br J Clin Pract 1994; 48: 37-41.

26. King LR.

Orchiopexy for impalpable testis: high spermatic vessel division is a safe maneuver. J Urol 1998; 160: 2457-2460.

27. Lam WW, Tarn PK, Ai VH, Chan KL, Cheng W, Chan FL, Leong L.

Gadolinium-infusion magnetic resonance angiogram: a new, noninvasive, and accurate method of preoperative localization of impalpable undescended testes. J Pediatr Surg 1998; 33:123-126.

28. Lee PA.

Consequence of cryptorchidism: relationship to etiology and treatment. Curr Probl Pediatr 1995; 25: 232-236.

29. Maddern GJ, Sutherland PD.

Laparoscopic exploration for a presumed intra-abdominal testicle. Endosc Surg Allied Technol 1994; 2: 293.

  1. McAleer IM, Packer MG, Kaplan GW, Scherz HC, Krous HF, Billman GF. Fertility index analysis in cryptorchidism. J Urol 1995; 153: 1255-1258.

  2. Nane I, Ziylan O, Esen T, Kocak T, Ander H, Tellaloglu S.

Primary gonadotropin releasing hormone and adjunctive human chorionic gonadotropin treatment in cryptorchidism: a clinical trial. Urology 1997; 49: 108-111.

32. Nguyen HT, Coakley F, Hricak H.

Cryptorchidism: strategies in detection. Eur Radiol 1999; 9: 336-343.

33. O'Hali W, Anderson P, Giacomantonio M.

Management of impalpable testes: indications for abdominal exploration. J Pediatr Surg 1997; 32: 918-920.

34. Palmer LS, Gill B, Kogan SJ.

Endocrine analysis of childhood monorchism. J Urol 1997; 158: 594-596.

35. Polascik TJ, Chan-Tack KM, Jeffs RD, Gearhart JP.

Reappraisal of the role of human chorionic gonadotropin in the diagnosis and treatment of the non-palpable testis: a 10-year experience. J Urol 1996; 156: 804-806.

36. Puri P, Nixon HH.

Bilateral retractile testes subsequent effects on fertility. J Pediatr Surg 1977; 12: 563.

37. Pyorala S, Huttunen NP, Uhari M.

A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab 1995; 80: 2795-2799.

  1. Rabinowitz R, Hulbert WC Jr. Cryptorchidism. Pediatr Rev 1994; 15: 272-274.

  2. Ritchey ML, Bloom D.

Summary of the urology section. American Academy of Pediatrics. Pediatrics 1995; 96: 138-143.

40. Sarihan H, Sari A, Abes M, Dine H.

Non-palpable undescending testis. Value of magnetic resonance imaging. Minerva Urol Nefrol 1998; 50: 233-236.

41. Rubben H, Goepel M.

Leitlinie zum Kryptorchismus. Urologe A 1998; 37: 666-667.

42. Siemer S, Uder M, Humke U, Bonnet L, Zeigler M.

Diagnostik des nicht tastbaren Hodens im Kindesalter: Laparoskopie oder Kernspintomographie? Urologe A 1998; 37: 648-652.

43. Tzvetkova P, Tzvetkova D, Kanchev L, Yanev V.

HCG stimulation test for diagnosis of androgen deficiency. Arch Androl 1997; 39: 163-171.

44. Vaysse P.

Laparoscopy and impalpable testis a prospective multicentric study (232 cases). GECI. Groupe d'Etude en Coeliochirurgie Infantile. Eur J Pediatr Surg 1994; 4: 329-332.

45. Yu TJ, Lai MK, Chen WF, Wan YL.

Two-stage orchiopexy with laparoscopic clip ligation of the spermatic vessels in prune-belly syndrome. J Pediatr Surg 1995; 30: 870-872.

3. HYPOSPADIAS

3.1 BACKGROUND

Depending on the localization of the external urethral orifice, hypospadias can be subdivided into distal (75%; glandular, coronary, subcoronary), intermediate (13%) and proximal (12%; penoscrotal, scrotal, perineal) forms. Differentiation between functionally necessary and aesthetically feasible operative procedures is important for therapeutic decision-making. As all surgical procedures carry the risk of complications, thorough pre-operative counselling of the parents is crucial.

3.2 DIAGNOSIS

Apart from the description of the local findings (position, shape and width of the orifice, size of the penis, information on the curvature of the penis on erection and inflammation), the diagnostic evaluation includes assessment of associated anomalies:

Severe hypospadias with unilaterally or bilaterally impalpable testis and scrotal transposition require a complete genetic work up. In case of ambiguous genitalia, retrograde genitography should be performed soon after birth to exclude an adrenogenital syndrome (AGS).

A thorough physical examination, urinalysis and usually sonography are performed routinely in all forms of hypospadias. Excretory urogram or voiding cystourethrography (VCUG) are required only when the findings in the investigations mentioned above are inconclusive. Urine trickling and ballooning of the urethra requires exclusion of meatal stenosis by careful inspection.