Dados do Trabalho

Título

STUDY OF ABDOMINAL TESTICULAR VESSELS DISTRIBUTION IN HUMAN FETUSES - BASIS FOR FOWLER-STEPHENS SURGERY

Introdução e Objetivo

The high abdominal undescended testis is a challenging situation in pediatric urology. Irrespective of the surgical technique, preservation of an adequate arterial supply for the testis is crucial for successful orchiopexy to ensure normal testicular size and texture.  Fowler-Stephens surgery performed in two times is one of the surgical options to treat this condition. The knowledge of testicular vascular anatomy is a key point in this procedure.  The objective of this study is to analyze the histology and the distribution of testicular vessels during the human fetal period.

Método

We studied 19 human male fetuses (38 testis) ranging in age from 13 to 19 weeks post-conception (WPC). The fetuses were well preserved and were evaluated regarding crown-rump length (CRL), Total length (TL) and body weight immediately before dissection. The testis was dissected and embedded in paraffin, from which 5-µm thick sections were obtained and stained with Masson’s trichrome and Anti-CD31 antibody to quantify the vessels. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image Pro and Image J programs, using a grid to determine volumetric densities (Vv). Means were statistically compared using the paired T-test (p<0.05). 

Resultados

The fetuses presented weight between 58g and 551g (mean=222.5g), had CRL between 8cm and 25cm (mean=15.34cm), TL between 11cm and 46.45cm (mean= 23.1cm) and all testis were in abdominal position (Figure A).  We observed that the mean number of vessels volumetric density in the upper portion of the testis was 7.6% (4.6 to 15%) and in the lower portion the mean was 5.02% (2.3 to 9.8%), with a significant difference (p=0.0001) (Figures B, C and D). In the analysis between the upper portion of the right and left testis (p=0.99) and in the analysis of the lower portion of the right and left testis (p=0.83) we did not observe significant differences.

Conclusão

The upper portion of the abdominal testis in human fetuses had a higher concentration of vessels when compared to the lower portion. These results confirm the importance of performing minimal manipulation of the lower end of the testis during the Fowler-Stephens surgery.