SHEN Jian,BI Yun-li.Laparoscopic management of persistent müllerian duct combined with cystoscope[J].Journal of Clinical Pediatric Surgery,,12():107-109.[doi:10.3969/j.issn.1671— 6353.2013.02.009]
Laparoscopic management of persistent müllerian duct combined with cystoscope
- Keywords:
- Laparoscopy; Cystoscopy; Pseudohermaphroditism/SU; Cryptorchidism/SU
- Abstract:
- Objetive Persistent müllerian duct syndrome(PMDS)is a rare malformation, characterized by the presence of müllerian structures in a virilized male, frequently presents as undescended testis, either intraabdominal or within a hernial sac. We intend to describe the characters and surgical management of the patients with PMDS by laparoscopic procedure in our hospital from February 2003 to July 2011. Methods We indexed all the cases of PMDS operated by laparoscopic procedure in our hospital’s database. These cases were reviewed for the ages at operation, the chief complaint, the symptoms and signs presenting, and the finding and management in the operations. Results 11 patients with PMDS were treated by laparoscopic procedure since 2003 when such procedure was held in our hospital for the first time. The mean age at operation was 49.82±41.20 months( raging from 5 to 145 months). In one case open procedure was taken at last because of the difficulty to handle bleeding during our early experience. In all the 11 patients, 5 were hospitalized as hypospadias, 2 were hospitalized as cryptorchidism, and 5 were hospitalized as abdominal pain and epididymo-orchitis. 6 paitients had cryptorchidism( 4 left side including one transverse testicular ectopia, 2 bilateral including one right side transverse testicular ectopia). 6 patients had hypospadias. 4 patients had both hypospadias and cryptorchidism. 3 patients had absolutely normal appearance of genitalia and presented as abdominal pain with epididymo-orchitis( two cases)or abdominal mass with infection( one case). In 6 cases the vasa deferentia were cut off because of their entrance into the müllerian cyst. Cystoscope was used to assist the laparoscopic procedure as a guide to identify the edge of the müllerian duct remnant and its junction to the urethra in the very last 3 cases. Conclusions The diagnosis is almost exclusively obtained during surgical exploration, at which time the often unanticipated müllerian structures are encountered. Excision of the müllerian structures is recommended in symptomatic cases such as that with repetatus infection or abdominal pain. Laparoscope combined with cystoscope is an effective minimally invasive technique to the management of these patients.
References:
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