title: Laparoscopic orchidopexy in boys with prune belly syndrome--outcome and technical considerations.
abstract: OBJECTIVE
  Cryptorchidism is an ubiquitous feature in prune belly syndrome (PBS). Laparoscopic orchidopexy allows dissection of the spermatic cord with minimal morbidity. We discuss the technical difficulties and outcome of three boys with PBS who underwent two-stage laparoscopic Fowler-Stephens orchidopexy (F-SO).
  
  
  METHODS
  Three boys, ages 1, 2, and 4, underwent laparoscopic F-SO. All boys had viable testes that were found within 3 cm of the deep inguinal ring. The testicular vessels were either ligated bilaterally with 4/0 polyglactin or monopolar diathermy was used and the vessels divided. Bilateral second-stage F-SO was performed within 6 months in two boys and limited to one side in the third boy. One boy awaits the contralateral second stage.
  
  
  RESULTS
  All three boys have adequately sized gonads. Based on our experience, the port incisions should be smaller than routine practice to prevent air leak in PBS. Although the intra-abdominal pressure of 12 mm Hg did not vary from our normal practice, a high flow rate is necessary after initial insufflation (6 L/min) to compensate for inevitable gas leaks because the abdominal wall is so thin. Risk of diathermy injury to the thin abdominal wall and the vessels is significant. Laparoscopy enables easy visualization of the ureter, testes, and testicular vessels and permits complete dissection of testicular vessels. It is easier to maintain integrity of spermatic vessels.
  
  
  CONCLUSIONS
  Use of radially expanding trocars, small incisions, and high gas flow rates permit this procedure to be performed safely with good outcome and cosmetic results in this challenging group of boys.
authors.affiliation: Division of Paediatric Urology, Department of Surgery, Royal Liverpool Children's Hospital, Alderhey, Liverpool, United Kingdom. indianajoe@gmail.com
authors.forename: Joe
authors.initials: J
authors.lastname: Philip
authors.forename: Dhanya
authors.initials: D
authors.lastname: Mullassery
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Craigie
authors.forename: Ramaswamy
authors.initials: R
authors.lastname: Manikandan
authors.forename: Simon E
authors.initials: SE
authors.lastname: Kenny
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D056126:Orchiopexy / Q000379:methods*; D011535:Prune Belly Syndrome / Q000601:surgery*; D016896:Treatment Outcome