Korean J Urol.  2011 May;52(5):355-358.

Diagnostic Laparoscopy for the Management of Impalpable Testes

• Park JH
• Park YH
• Park K
• Choi H

Abstract

PURPOSE
Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes.
MATERIALS AND METHODS
Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end.
RESULTS
The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy.
CONCLUSIONS
Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.

Keyword

Laparoscopy; Testis

MeSH Terms

Cryptorchidism
Follow-Up Studies
Gonadal Dysgenesis, 46,XY
Humans
Inguinal Canal
Laparoscopy
Male
Orchiectomy
Orchiopexy
Testis
Gonadal Dysgenesis, 46,XY
Testis

Figure

• 

  FIG. 1 (A) Laparoscopic findings of a normal vas deferens and spermatic vessels exiting the internal inguinal ring. The vas deferens and vessels clearly meet at the ring. (B) The vas deferens and vessels do not meet, suggesting that they are blind-ending, which is the characteristic finding of an intraperitoneal nonviable testis (including vanishing testis). (C) Intraperitoneal viable testis located above the internal inguinal ring.

Reference

1. Bloom DA. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol. 1991. 145:1030–1033.

2. Chang B, Palmer LS, Franco I. Laparoscopic orchidopexy: a review of a large clinical series. BJU Int. 2001. 87:490–493.

3. Jordan GH. Will laparoscopic orchiopexy replace open surgery for the nonpalpable undescended testis? J Urol. 1997. 158:1956.

4. Kirsch AJ, Escala J, Duckett JW, Smith GH, Zderic SA, Canning DA, et al. Surgical management of the nonpalpable testis: the Children's Hospital of Philadelphia experience. J Urol. 1998. 159:1340–1343.

5. Sweeney DD, Smaldone MC, Docimo SG. Minimally invasive surgery for urologic disease in children. Nat Clin Pract Urol. 2007. 4:26–38.

6. El-Anany F, Gad El-Moula M, Abdel Moneim A, Abdallah A, Takahashi M, Kanayama H, et al. Laparoscopy for impalpable testis: classification-based management. Surg Endosc. 2007. 21:449–454.

7. Turek PJ, Ewalt DH, Snyder HM 3rd, Stampfers D, Blyth B, Huff DS, et al. The absent cryptorchid testis: surgical findings and their implications for diagnosis and etiology. J Urol. 1994. 151:718–720.

8. Swerdlow AJ, Higgins CD, Pike MC. Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ. 1997. 314:1507–1511.

9. Hadziselimović F, Herzog B. Treatment with a luteinizing hormone-releasing hormone analogue after successful orchiopexy markedly improves the chance of fertility later in life. J Urol. 1997. 158:1193–1195.

10. Smolko MJ, Kaplan GW, Brock WA. Location and fate of the nonpalpable testis in children. J Urol. 1983. 129:1204–1206.

11. Esposito C, Garipoli V. The value of 2-step laparoscopic Fowler-Stephens orchiopexy for intra-abdominal testes. J Urol. 1997. 158:1952–1954.

12. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976. 8:33–34.

13. Snodgrass WT, Yucel S, Ziada A. Scrotal exploration for unilateral nonpalpable testis. J Urol. 2007. 178:1718–1721.

14. Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995. 154:1148–1152.

15. Humphrey GM, Najmaldin AS, Thomas DF. Laparoscopy in the management of the impalpable undescended testis. Br J Surg. 1998. 85:983–985.

16. Weiss RM, Carter AR, Rosenfield AT. High resolution real-time ultrasonography in the localization of the undescended testis. J Urol. 1986. 135:936–938.

17. Siemer S, Humke U, Uder M, Hildebrandt U, Karadiakos N, Ziegler M. Diagnosis of nonpalpable testes in childhood: comparison of magnetic resonance imaging and laparoscopy in a prospective study. Eur J Pediatr Surg. 2000. 10:114–118.

18. Ang CW, Forrest J. Diagnostic laparoscopy and management of the impalpable testis--a review of 10 years' practice at a nonpaediatric specialist centre. J Pediatr Urol. 2008. 4:214–217.

19. Snodgrass W, Chen K, Harrison C. Initial scrotal incision for unilateral nonpalpable testis. J Urol. 2004. 172:1742–1745.

20. Esposito C, Vallone G, Settimi A, Gonzalez Sabin MA, Amici G, Cusano T. Laparoscopic orchiopexy without division of the spermatic vessels: can it be considered the procedure of choice in cases of intraabdominal testis? Surg Endosc. 2000. 14:658–660.

21. Elyas R, Guerra LA, Pike J, DeCarli C, Betolli M, Bass J, et al. Is staging beneficial for Fowler-Stephens orchiopexy? A systematic review. J Urol. 2010. 183:2012–2018.