Abstract：
OBJECTIVE: Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy.
METHODS: This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis\'s location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman\'s tests were used where appropriate.
RESULTS: Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6-84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p = 0.002).
CONCLUSIONS: Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint.
BACKGROUND: https://irct.ir/trial/58842.
METHODS: This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis\'s location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman\'s tests were used where appropriate.
RESULTS: Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6-84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p = 0.002).
CONCLUSIONS: Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint.
BACKGROUND: https://irct.ir/trial/58842.
摘要：
目的：先前的研究表明，额外的血液供应可以减少腹腔镜睾丸固定术后的睾丸萎缩。我们评估了在开放常规睾丸固定术后保留gubernacular附着（包含来自乳制动脉及其吻合的血液供应）对萎缩率的影响。
方法：这项双盲随机试验于2022年3月至2023年9月实施。包括睾丸无法触及的男孩，即使在麻醉下进行检查，接受诊断性腹腔镜检查以评估睾丸的位置和大小。Nubbin睾丸和与腹股沟内环距离>2厘米的那些。通过置换区组随机化将参与者分为两组（gebernaculumsparing（GS）和切除术（GE））。总体成功定义为实现形态学成功（萎缩<术中大小的20％）和解剖学成功（阴囊或阴囊高位）。在手术后三个月和六个月通过超声对男孩进行随访。独立t检验,重复的方差分析，和弗里德曼的测试在适当的地方使用。
结果：92个男孩（总共105个UDT），75个睾丸（36个GS，GE组39个）用于分析。参与者的平均年龄为25±17个月（范围6-84）。所有参与者的平均睾丸大小为460±226、396±166和520±258mm3，GS,和GE案例，分别。两组在两个随访检查点均显示睾丸体积显著减少，但GE组的下降幅度明显更高(p<0.001).GS男孩的解剖成功率明显更高（97.2％对82.1％；p=0.038）。GS组的总体成功率明显更高（61.1%对25.6%；p=0.002）。
结论：虽然两组的平均睾丸体积均减少，我们发现GS组的形态学和总体成功率较高.与六个月检查点相比，手术后三个月的尺寸减少最大。
背景：https://irct。ir/trial/58842。
方法：这项双盲随机试验于2022年3月至2023年9月实施。包括睾丸无法触及的男孩，即使在麻醉下进行检查，接受诊断性腹腔镜检查以评估睾丸的位置和大小。Nubbin睾丸和与腹股沟内环距离>2厘米的那些。通过置换区组随机化将参与者分为两组（gebernaculumsparing（GS）和切除术（GE））。总体成功定义为实现形态学成功（萎缩<术中大小的20％）和解剖学成功（阴囊或阴囊高位）。在手术后三个月和六个月通过超声对男孩进行随访。独立t检验,重复的方差分析，和弗里德曼的测试在适当的地方使用。
结果：92个男孩（总共105个UDT），75个睾丸（36个GS，GE组39个）用于分析。参与者的平均年龄为25±17个月（范围6-84）。所有参与者的平均睾丸大小为460±226、396±166和520±258mm3，GS,和GE案例，分别。两组在两个随访检查点均显示睾丸体积显著减少，但GE组的下降幅度明显更高(p<0.001).GS男孩的解剖成功率明显更高（97.2％对82.1％；p=0.038）。GS组的总体成功率明显更高（61.1%对25.6%；p=0.002）。
结论：虽然两组的平均睾丸体积均减少，我们发现GS组的形态学和总体成功率较高.与六个月检查点相比，手术后三个月的尺寸减少最大。
背景：https://irct。ir/trial/58842。
