Ajay Verma¹, Sachit Anand¹, Vinanti Naik¹
1- Department of Pediatric Surgery, AIIMS, New Delhi, India
Abstract Body
Introduction: Persistent Müllerian Duct Syndrome (PMDS) is a rare disorder of male sexual differentiation characterized by the retention of Müllerian structures in 46,XY males. Surgical management poses unique challenges due to the proximity of Müllerian remnants to vas deferens and testicular vessels. We present two cases of PMDS with bilateral undescended testes, successfully managed with laparoscopic hysterectomy and orchidopexy .
Methods: Two boys aged 6 and 8 years presented with bilateral non-palpable testes. Diagnostic laparoscopy confirmed intraabdominal testes alongside a uterus and fallopian tubes. Careful dissection was performed to mobilize the testes and excise the Müllerian structures without compromising the vas deferens and vascular supply . Laparoscopic hysterectomy with bilateral salpingectomy was undertaken, followed by single-stage laparoscopic-assisted orchidopexy .
Results: In both cases, Müllerian remnants were densely adherent to the vasa and epididymis. Sharp dissection with bipolar cautery allowed successful separation. The testes were mobilized on long vascular pedicles and brought down to the scrotum without tension. Postoperative recovery was uneventful. At 6-month follow-up, both testes were well-positioned, with normal size and perfusion on Doppler ultrasonography .
Conclusion: Laparoscopic management of PMDS enables excellent visualization for meticulous dissection, safe removal of Müllerian remnants, and tension-free orchidopexy . Early surgical intervention optimizes testicular outcomes and reduces long-term complications.