Laparoscopic removal of mullerian duct remnants in boys

Marcello Cimador, Marcello Cimador, Michele Libri, Marcello Dòmini, Gabriella Pelusi, Giovanni Ruggeri, Antonio Aquino, Mario Lima

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

Abstract

Abstract: Purpose: Mullerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the mullerian duct to regress due to insufficient production or peripheral action of mullerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described. Materials and Methods: Six males were treated from February 1998 to February 2003. Age at surgery was between 3 and 18 years (mean 8.6). All patients showed severe hypospadias and 2 had mixed gonadal dysgenesis with ambiguous genitalia. Three patients presented with urogenital infections and all had a large MDR. Laparoscopic procedures, which were preceded by cystoscopy, were performed using a 10 mm umbilical trocar for the camera and 3, 5 mm trocars for instruments placed in the suprapubic region and iliac fossa bilaterally. The remnants were ligated with endoscopic loops or an endoscopic GIA stapler and cut. Results: Mean operative time was 2 hours. We noted no complications. In 2 cases there was deferential ectopia and in another of mixed gonadal dysgenesis bilateral gonadectomy was performed because of the risk of degeneration. Feeding started on postoperative day I and the patients were discharged home on day 5. After a followup of 8 months to 4 years all boys were healthy. Conclusions: Multiple approaches are used in traditional surgery, often leading to complications. Laparoscopy improves the view, decreases surgical risk and operative time, avoids large scars and allows more rapid hospital discharge.
Original languageEnglish
Pages (from-to)364-368
Number of pages5
JournalTHE JOURNAL OF UROLOGY
Volume171
Publication statusPublished - 2004

All Science Journal Classification (ASJC) codes

  • Urology

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