الفهرس 
Definition of Cryptorchidism
Consequences, indications for treatment and outcomeOnly 14 pages are availabe for public view
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Abstract
There is a lot of controversy regarding the best
management for IAT. Fowler Stephens orchiopexy still
remains the most popular procedure undertaken by most
surgeons. However, there is still a lack of strong, clear
evidence in favour of either the one stage or two stage FSO.
Testicular atrophy is the main complication of such a
procedure.
One stage laparoscopic FSO holds a comparatively
higher testicular atrophy rate than the two stage operation.
Expected postoperative testicular position is relatively the
same though where both the one stage and two stage
operations can be expected to achieve a scrotal position for
the IAT should it remain viable. A high scrotal position is
still an acceptable position for IAT with short spermatic cord
following one stage laparoscopic FSO. No individual patient
factors were significantly associated with risk of testicular
atrophy or ascent. There is also no increased complication
rate with the one stage laparoscopic FSO.
One stage laparoscopic FSO holds some small added
advantages over two stage operation but this still does not justify it as it holds a higher testicular atrophy rate. Those
advantages include avoiding a repeat anaesthesia, the
potentially difficult dissection associated with a re-operation,
the further waiting period of a 3-6 months for the second
stage and the further cost of a second laparoscopy
An IAT with short spermatic cord can withstand a one
stage laparoscopic FSO and still maintain a normal blood
flow to it. Normal testicular blood flow RI was detected in all
clinically assumed viable testes. It is still to be proven
whether the descent of the IAT after one stage or two stage
laparoscopic FSO will halt the deterioration in fertility of the
IAT.
There is an important yet limited role for ultrasound in
confirming testicular viability or atrophy. If a testis can be
felt clinically in the scrotum at the 6 mo F/P, there is no need
for further radiological investigations to confirm its viability.
Both conventional and Spectral Doppler U/S will not add
more than what is already known by examination. However,
if a testis is not felt clinically in the scrotum at the 6 mo F/P,
a conventional U/S is still important to rule out that it might
have retracted upwards and ascended into the muscular or
subcutaneous track for which it was rerouted from theabdomen. If a testicular nubbin is seen by ultrasound,
Spectral U/S will almost always confirm that there is
significantly dampened or absent blood flow to it, and no
spectral waveform will be able to be drawn.
A well conducted randomised controlled trial is
required to further confirm our results. This can only be
achieved through the involvement of multiple paediatric
surgery centers nationwide. However, a two stage
laparoscopic FSO still shows better results in terms of
testicular viability than the single stage; and should remain
our gold standard in IAT with short spermatic vessels. This is
despite the more added benefits the one stage FSO has.