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Purpose: To present our
experience with laparoscopic management of the non-palpable undescended testis. Patients
and Methods: Between Nov. 2010 and Oct. 2012, 47
non-palpable testes in 41 patients were evaluated prospectively by laparoscopy.
The age of the patients at the time of surgery varied from 1 to 9 years with a
mean age of 2.85 years. Testicular viability and location were evaluated by physical
examination and Doppler ultrasonography after 1 and 3 months. Results: Out of 49 testicular units, 47 (95.9%) were
successfully treated by laparoscopic orchiopexy. 45 testicular units (91.8%)
were treated by one-stage laparoscopic orchiopexy, 2 (4.1%) were treated by
two-stage laparoscopic orchiopexy and 2 (4.1%) diagnosed as vanishing testis
with detection of blind end spermatic vessels and vas deferens during
laparoscopy. Physical examination and Doppler study demonstrated that 46 of 47
testes (97.9%) were viable and 45 of 47 (95.7%) were located in the lower
scrotum and 2 of 47 (4.3%) in the upper scrotum at the end of follow-up. Conclusion: The laparoscopy is a reliable technique for
diagnosis and treatment of the non-palpable intra-abdominal testis with high
success and survival rates of the testes.
A 40-years-old female patient with severe right
facial pain with a throbbing component along the mandibular division of the
trigeminal nerve resistant to medical management. Continuous inferior alveolar
nerve block with local anesthetics using an indwelling catheter provided a complete pain resolution for the
patient for 2 weeks, after which the catheter got infected and was removed. A
trial of balloon occlusion of the right internal maxillary artery provided
complete resolution of the throbbing component of the patient’s pain. This was
followed by permanent embolization with multiple coils.
In this article we discuss the effect of posture on impedance during the placement of a spinal cord stimulator. Although, according to several studies, there appears not to be a specific and consistent change in impedance with change in posture, we noticed on multiple occasions that if the impedance remains very high during spinal cord stimulator (SCS) lead placement, asking the patient to sit up from the prone position may drop the impedance down. This could be explained by having air around the lead, from using loss of resistance to air technique in finding the epidural space, which moves up when sitting the patient up, or having the lead immersed in epidural fat. Sitting the patient up from the prone position should be tried if the impedance remains very high before aborting the procedure and taking the lead out.
Some pelvic pain syndromes are very resistant to medical treatment. Several studies have demonstrated that sacral neuromodulation, which has been successfully used for the treatment of bladder dysfunction, incontinence, urinary retention and urinary frequency -, can be successfully used for the treatment of chronic pelvic pain -. Several studies have also demonstrated significant involvement of dorsal column pathways in the transmission of visceral pelvic pain  and the successful use of spinal cord stimulation for the treatment of chronic pelvic pain . We report three cases of severe chronic pelvic pain that failed conservative treatment modalities. Placement of a combined sacral nerve roots stimulator and a low thoracic spinal cord stimulator resulted in a significant pain relief and improvement in daily life activities. We believe that this combination may help patients suffering from chronic pelvic pain resistant to medical management.