TY - JOUR
T1 - Preservation of müllerian structures with laparoscopic management of intra-abdominal testes in persistent müllerian duct syndrome
AU - Bowen, Diana K.
AU - Matulewicz, Richard S.
AU - Gong, Edward M.
N1 - Publisher Copyright:
© 2015 Journal of Pediatric Urology Company.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Laparoscopic management of remnant uterine structures for patients with persistent müllerian duct syndrome (PMDS) and bilateral intra-abdominal testes include supracervical hysterectomy or splitting of the uterine structure to facilitate orchiopexy. A laparoscopic uterine-sparing approach, however, has not been described in the literature. Methods We present a case of a 10-year-old male with PMDS who underwent laparoscopic two-step Fowler-Stephens orchiopexy (FSO) with uterine preservation. Diagnostic laparoscopy revealed bilateral intra-abdominal testes, a robust right vas deferens but diminutive left vas deferens, and a rudimentary uterine structure posterior to the bladder. At the time of the second-stage FSO, the decision was made to preserve the uterine structure to keep all future fertility options viable. A more extensive dissection was undertaken on the left side to gain adequate length for both testes to reach the scrotum and give the best chance for survival to the right testis with its accompanying robust vas deferens. Conclusion Our case highlights a laparoscopic approach to a challenging problem in pediatric urology. If uterine preservation is preferred, a laparoscopic two-step FSO with uterine preservation is technically feasible and should be a consideration for patients with PMDS and intra-abdominal testes.
AB - Background Laparoscopic management of remnant uterine structures for patients with persistent müllerian duct syndrome (PMDS) and bilateral intra-abdominal testes include supracervical hysterectomy or splitting of the uterine structure to facilitate orchiopexy. A laparoscopic uterine-sparing approach, however, has not been described in the literature. Methods We present a case of a 10-year-old male with PMDS who underwent laparoscopic two-step Fowler-Stephens orchiopexy (FSO) with uterine preservation. Diagnostic laparoscopy revealed bilateral intra-abdominal testes, a robust right vas deferens but diminutive left vas deferens, and a rudimentary uterine structure posterior to the bladder. At the time of the second-stage FSO, the decision was made to preserve the uterine structure to keep all future fertility options viable. A more extensive dissection was undertaken on the left side to gain adequate length for both testes to reach the scrotum and give the best chance for survival to the right testis with its accompanying robust vas deferens. Conclusion Our case highlights a laparoscopic approach to a challenging problem in pediatric urology. If uterine preservation is preferred, a laparoscopic two-step FSO with uterine preservation is technically feasible and should be a consideration for patients with PMDS and intra-abdominal testes.
KW - Laparoscopic orchiopexy
KW - Müllerian remnant
KW - Persistent müllerian duct syndrome
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UR - http://www.scopus.com/inward/citedby.url?scp=84959284845&partnerID=8YFLogxK
U2 - 10.1016/j.jpurol.2015.08.024
DO - 10.1016/j.jpurol.2015.08.024
M3 - Article
C2 - 26619795
AN - SCOPUS:84959284845
SN - 1477-5131
VL - 12
SP - 65
EP - 66
JO - Journal of Pediatric Urology
JF - Journal of Pediatric Urology
IS - 1
ER -