Laparoscopic classification and treatment of the impalpable testis

Abstract

Laparoscopic orchiopexy has gained popularity in recent years. However, the decision when to perform one-stage laparoscopic orchiopexy without division of the spermatic vessels versus initial ligation of the spermatic vessels followed later by orchiopexy is not clear. A new laparoscopic classification to facilitate decision-making during laparoscopy, according to the position of the impalpable testis and the relation of the spermatic vessels and vas deferens to the internal ring, with a management protocol based on this classification is presented. Over a 2-year period, a total of 37 boys with 52 impalpable gonads underwent a laparoscopic procedure. Four laparoscopic types of testis were noted: type I: no testis visualized; type II: a testis seen at the internal ring with the vas and vessels looping to the internal ring; type III: testis at the internal ring, with vas and vessels going to the testis directly; and type IV: intra-abdominal testis not related to the internal ring. Of the 52 gonads, 19 (36.5%) were type I, 13 (25%) type II, 6 (11.5%) type III, and 14 (27%) type IV. Thirty-three testes were followed up (mean follow-up 8 months); 3 showed atrophy (11%) and 4 were retracted at the scrotal neck after staged, laparoscopic-assisted orchiopexy (LAO). Laparoscopy is of great value for both diagnosis and management of impalpable testes. A classification based on laparoscopic findings will help in planning further surgical action, and LAO is a safe and effective form of operative management for impalpable testes.