How important is the surgeon's experience in the success of orchiopexy? 15 years’ experience of a tertiary center
Orşiopeksi başarısında cerrahın tecrübesi ne kadar önemlidir? Üçüncü basamak bir merkezde 15 yıllık deneyim
Abstract
Objective: Cryptorchidism is one of the most common congenital anomalies in pediatric urology. Orchiopexy operation is performed to prevent testicular damage caused by cryptorchidism. However, orchiopexy is an operation that requires experience. Although re-orchiopexies are technically demanding procedures, often a secondary intervention may be required. Therefore, we examined the causes and outcomes of orchiopexy cases who had secondary intervention in our institute under a single investigator.
Method: Orchiopexy surgeries, performed by pediatric urologists in a tertiary hospital, between 2005 and 2020 were retrospectively reviewed. The cases which were required a secondary orchiopexy are included in the study. Perioperative findings, time of the primary surgery, and success rates were evaluated.
Results: Secondary orchiopexy was applied to 88 cases. Primary surgery was performed in 66 (75%) of these patients in the tertiary hospital by pediatric urologists, and in the remaining 22 (25%) patients in a state hospital by general urologists. It was observed that hernia repair was performed at significantly higher rates in patients whose first operation was performed by a pediatric urologist (79% vs. 32%, p<0.001).
Conclusion: According to the results of our study, inadequate hernia repair may be associated with the need for secondary orchiopexy. Also, we can say that pediatric urologists are more experienced in undescended testis and therefore the results of the first surgery are more satisfactory.
ÖZET
Amaç: Kriptorşidizm, pediatrik ürolojide en sık görülen konjenital anomalilerden biridir. Orşiopeksi operasyonu, kriptorşidizm nedeniyle oluşan testis hasarını önlemek için yapılır. Ancak orşiopeksi tecrübe gerektiren bir operasyondur. Tekrarlayan orşiopeksiler teknik olarak zorlu prosedürler olsa da, sıklıkla ikincil bir müdahale gerekebilir. Bu nedenle kliniğimizde ikincil girişim uygulanan orşiopeksi olgularının nedenlerini ve sonuçlarını tek araştırmacı altında inceledik.
Yöntem: Üçüncü basamak bir hastanede çocuk ürologları tarafından 2005-2020 yılları arasında yapılan orşiopeksi ameliyatları retrospektif olarak incelendi. Sekonder orşiopeksi gerektiren olgular çalışmaya dahil edildi. Perioperatif bulgular, primer cerrahinin zamanı ve başarı oranları değerlendirildi.
Bulgular: 88 olguya sekonder orşiopeksi uygulandı. Bu hastaların 66'sına (%75) üçüncü basamak bir hastanede çocuk ürologları tarafından, geri kalan 22 hastaya (%25) ise bir devlet hastanesinde genel ürologlar tarafından primer cerrahi uygulandı. İlk ameliyatı çocuk üroloji uzmanı tarafından yapılan hastalarda anlamlı olarak daha yüksek oranda fıtık onarımı yapıldığı görüldü (%79'a karşı %32, p<0.001).
Sonuç: Çalışmamızın sonuçlarına göre yetersiz fıtık onarımı sekonder orşiopeksi ihtiyacı ile ilişkili olabilir. Ayrıca çocuk ürologlarının inmemiş testis konusunda daha deneyimli olduğunu ve bu nedenle ilk ameliyatın sonuçlarının daha yüz güldürücü olduğunu söyleyebiliriz.
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