Cryptorchidism treatment

Following the early laparoscopic diagnosis of non-palpable testes (59), the laparoscopic orchidopexy of undescended testes has gained in popularity. According to the position of the undescended testis, either a primary laparoscopic orchidopexy or a two-stage Fowler-Stephens technique is performed (60). The staged technique can be carried out either totally by laparoscopy, or the first stage by laparoscopy and the second by open surgery (61). The recommended minimal interval between the two stages is six months. Due to the extent of mobilization which can be performed by laparoscopy, a primary orchidopexy can be performed for undescended testes as high as 3.5 cm above the internal inguinal ring (62). The success rate (scrotal location of the testicle and absence of atrophy) of laparoscopic orchidopexy is reported as being up to 100% in several series of between 3 and 13 patients, with a follow up ranging from three to 18 months (61, 63-65).

Laparoscopy is currently recommended for the treatment of undescended testes (66-71). However, long-term studies are needed to assess the testicular growth after the various procedures (60).

The current guidelines for the laparoscopic treatment of cryptorchidism are summarized in Table 3.4. Table 3.4 Treatment of crytorchidism: guideline recommendations

Hernia repair

The success of open hernioplasty (Lichtenstein) is indicated by the almost total lack of recurrences (72-76). Similar results are demonstrated by the laparoscopic procedure which is based on the same principle (77-86). However, the latter results are still influenced by the learning curve. In all Phase III trials, the laparoscopic approach was found to have no disadvantages; it was associated with less pain and a shorter convalescence time compared with open hernioplasty (87-93). Laparoscopy is superior to open hernioplasty for recurrent or bilateral hernia management. The good socio-economic aspects of laparoscopically managed hernia repair are another advantage (94).

The current guideline recommendations for hernia repair are given in Table 3.5. Table 3.5 Hernia repair: guideline recommendations

Nephrectomy

Among the early attempts to perform urological procedures by laparoscopy, transperitoneal nephrectomy has been a milestone (95). Following this pioneer success, retroperitoneal routes were developed to remove kidneys by laparoscopy (6, 96). Based on those early experiences, the research work continued rapidly to expand, allowing urologists trained in laparoscopy to extend safely the indications for kidney removal by laparoscopy, either by the trans- or retroperitoneal route.

Date: 2016-06-13; view: 6