Diagnostic laparoscopy for the management of impalpable testes

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.

Keywords: Laparoscopy; Testis.

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.