High Cryptorchidism Descendopexy

Sliding testicles and orbiting testicles are a special type of cryptorchidism. The former testicle is located at the height of the outer ring buckle, and it can be lowered to the scrotum by manipulation, but because the spermatic cord is short, the testicle returns to its original position after releasing the hand. The spermatic cord of the testicles is very long, and the testicles can be removed from the scrotum or outside the scrotum due to abnormal testicular muscles or unclosed sheaths. The main treatment is high cryptorchidism. Treating diseases: cryptorchidism Indication 1. The cryptorchidism without mechanical disorders has not been reduced by chorionic gonadotropin therapy. 2, the path of decline in the presence of mechanical disorders, such as cryptorchidism with inguinal hernia. 3. Ectopic testicles. 4, adult cryptorchidism, if the unilateral cryptorchid testis has been highly atrophied, in order to prevent testicular malignant transformation, testicular resection should be performed, otherwise testicular fixation should be performed. 5. The sheath is not closed. Preoperative preparation The position of the testicle should be clarified before surgery. Through the percussion of the supine and standing positions, more than 90% of the cryptorchidism can be found on the scrotum or in the inguinal canal, and the cryptorchidism of the testis can be assisted by the combination of ultrasound, magnetic resonance and CT. Find. Although venography and laparoscopy have a high success rate in confirming the abdominal testis, they can only be applied after other methods fail because of invasive trauma. In order to identify bilateral cryptorchidism and non-testis in the abdominal cavity, a chorionic gonadotropin test should be performed. The method was to measure the basal testosterone concentration on the first day, and then stimulated with -hCG for 3 days. On the fourth day, the plasma testosterone level did not increase by more than 20 ng/100 ml, indicating that there were no testes on both sides. Shave the pubic hair 1 day before surgery and wash the perineal skin. Surgical procedure A dermal incision parallel to the inguinal ligament is made from a transverse finger above the midpoint of the inguinal ligament to lower the pubic tuberosity. 1. After the incision is made according to the above requirements, the subcutaneous tissue is carefully separated until the subcutaneous ring and the external oblique muscle aponeurosis. The aponeurosis of the external oblique muscle was cut open to reveal the inguinal canal. Most cryptorchidism is located in the inguinal canal. If you can't find the testicles, open the inguinal canal. In patients with inguinal hernia, the testicles may be located in the abdominal cavity, and the abdominal pressure is appropriately increased. It can be seen that the testicles enter the inguinal canal with the hernia sac. 2, release the testis and spermatic cord cut off the testicular ligament, cut the testicular sheath, check the testis, epididymis and vas deferens, remove the excess testicular sheath, the testicular sheath is turned over and suture the edge of the sheath. The spermatic sheath is completely stripped from the spermatic cord, so that the spermatic cord is fully freed and released until the testicle can be brought to the pubic symphysis. 3, close the peritoneal sheath like the sheath and the abdominal cavity, the sheath should be closed at the inner ring. Be careful not to damage the vas deferens and spermatic vessels. When combined with inguinal hernia, a hernia repair should be performed. 4, expand the scrotum, build the testicular sac cavity with the index finger through the incision of the deep fascia deep fascia facing the scrotum separation, expand the scrotum cavity, directly to the bottom of the scrotum. 5. Fix the testicles with the medium-sized silk thread. The testis under the white membrane or ligament is sutured in the inner surface of the meat membrane at the bottom of the testicular cavity, so that the testicles are moved into the enlarged scrotal cavity, and the spermatic cord should not be twisted. 6. Close the incision and suture the incision according to the layer. Note that the outer ring can accommodate a small finger, and the suture is too tight to affect the testicular blood supply. Shoemaker testicular fixation 1. Use your fingers to reach the bottom of the scrotum to hold the scrotum, and cut a 2cm incision on the scrotum. Be careful not to damage the meat membrane. A nest that can accommodate the testes is separated between the skin and the meat membrane. 2, the meat membrane of the separation site is cut into a small mouth, the edge is clamped with two tissue clamps, and the testicles are pulled out of the scrotum by a non-invasive vascular clamp through the small hole of the meat membrane. Be careful not to reverse the spermatic vessels, and suture the two needles on both sides of the cut edge of the meat membrane to place the testicles in the subcutaneous fossa. Finally suture the skin incision of the scrotum. complication 1, testicular retraction testicular incompleteness is due to insufficient peritoneal detachment. The testicular retraction is mostly due to the incomplete completion of the spermatic cord in the operation, and the testicle is barely pulled into the scrotum, which is not treated by corresponding traction. If the testicles are retracted above the outer ring, testicular fixation should be performed again after 3 months. 2, testicular ischemia and testicular atrophy testicular atrophy and preoperative testicular size. Mostly caused by intraoperative damage to the spermatic blood vessels, spermatic cord torsion and excessive traction testicular strength. If you use a magnifying glass or surgical microscope and fine instruments during surgery, you can avoid this complication by careful operation. 3, vas deferens often occur in cases that do not touch the testes. Microsurgical vasectomy should be performed immediately or in adulthood. 4, bleeding and infection scrotum progressive increase suggestive of active bleeding, should be surgical exploration. 5, in addition to retaining too much sheath can occur in the long-term hydrocele, when the effusion is small, can not be treated, when the effusion is more, surgery is required.