Citation Information :
Shenoy NS, Sanghvi BV, Shah R, Biswas SK, Parelkar SV. Laparoscopic Diagnosis and Treatment of Nonpalpable Testes in a Tertiary Care Center. World J Lap Surg 2021; 14 (3):157-161.
Background: Cryptorchidism is the commonest genitourinary anomaly in boys. Laparoscopy has been the mainstay for the management of nonpalpable testis.
Aim and objective: This study has been done to assess the role of laparoscopy in diagnosing and treating nonpalpable testes.
Materials and methods: Medical records of 160 patients of laparoscopic testicular exploration, during a 10-year period, were retrospectively analyzed. All 160 boys with 320 testicular units were examined prior to surgery—118 of the 320 testicular units were normally descended (37%), 9 had palpable undescended testicular units (3%), and 193 testicular units (60%) were nonpalpable.
Results: After laparoscopy, 111 of the 193 nonpalpable testicular units were found to be intra-abdominal, 32 were atrophic testes, 22 were peeping testes, 19 were intracanalicular, and 9 were vanishing testes. Of the 111 intra-abdominal testicular units according to the location in relation to the deep inguinal ring, 51 of the testicular units were located within 2 cm from the deep inguinal ring. Among these, 49 cases underwent single-stage laparoscopic orchidopexy and 2 patients required laparoscopic mobilization followed by open orchidopexy due to long loop vas. Sixty testicular units were found greater than 2 cm from the deep inguinal ring and were managed by two-stage Fowler–Stephens laparoscopic orchidopexy.
Conclusion and clinical significance: Laparoscopy is safe and effective in managing nonpalpable testis. Single-stage orchidopexy is the treatment of choice for intra-abdominal testis located within 2 cm from the deep inguinal ring with pliable testicular vessels and two-stage surgery is required for intra-abdominal testis located more than 2 cm from the deep inguinal ring and with nonpliable testicular vessels.
Hutson JM, Clarke MC. Current management of the undescended testicle. Semin Pediatr Surg 2007;16(1):64–70. DOI: 10.1053/j.sempedsurg.2006.10.009.
Berkowitz GS, Lapinski RH, Dolgin SE, et al. Prevalence and natural history of cryptorchidism. Pediatrics 1993;92(1):44–49. PMID: 8100060.
Kolon TF. Cryptorchidism. In: Docimo SG, Canning D, Khoury A, editors. The Kelalis-King-Belman textbook of clinical pediatric urology. 5th ed. London: Informa Healthcare; 2007. p. 1295–1307.
Ismail KA, Ashour MHM, El-Afifi MA, et al. Laparoscopy in the management of impalpable testis (series of 64 cases). Afr J Paediatr Surg 2017;14(4):65–69. DOI: 10.4103/ajps.AJPS_103_08.
Tasian GE, Copp HL. Diagnostic performance of ultrasound in non-palpable cryptorchidism: a systematic review and meta-analysis. Pediatrics 2011;127(1):119–128. DOI: 10.1542/peds.2010-1800.
Elder JS. Ultrasonography is unnecessary in evaluating boys with a nonpalpable testis. Pediatrics 2002;110(4):748–751. DOI: 10.1542/peds.110.4.748.
Cortesi N, Ferrari P, Zambarda E, et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976;8(1):33–34. DOI: 10.1055/s-0028-1098372.
Elder JS. Laparoscopy for the nonpalpable testis. Semin Pediatr Surg 1993;2(3):168–173. PMID: 7914809.
Ferdous KM, Hasan SMD, Kabir KHA, et al. Laparoscopic management of nonpalpable testis: 5 years’ experience at Dhaka Shishu (Children) Hospital. J Pediatr Neonatal Care 2018;8(3):143–146. PMID: 7914809.
Fowler R, Stephens FD. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg 1959;29:92–106. DOI: 10.1111/j.1445-2197.1959.tb03826.x.
Ransley PG, Vordermark JS, Caldamone AA, et al. Preliminary ligation of the gonadal vessels prior to orchidopexy for the intra-abdominal testicle. World J Urol 1984;2:266–268. DOI: 10.1007/BF00326700.
Docimo SG. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol 1995;154(3):1148–1152. PMID: 7637073.
Lindgren BW, Darby EC, Faiella L, et al. Laparoscopic orchidopexy: procedure of choice for the nonpalpable testis? J Urol 1998;159(6):2132–2135. DOI: 10.1016/s0022-5347(01)63294-4.
Denes FT, Saito FJ, Silva FA, et al. Laparoscopic diagnosis and treatment of nonpalpable testis. Int Braz J Urol 2008;34(3):329–334. DOI: 10.1590/s1677-55382008000300010.
Elyas R, Guerra LA, Pike J. Is staging beneficial for Fowler-Stephens orchidopexy? A systematic review. J Urol 2010;183(5):2012–2019. DOI: 10.1016/j.juro.2010.01.035.
Chang B, Palmer LS, Franco I. Laparoscopic orchidopexy: a review of a large clinical series. BJU Int 2002;87(6):490–493. DOI: 10.1046/j.1464-410x.2001.00100.x.
Shehata SM. Laparoscopically assisted gradual controlled traction on the testicular vessels: a new concept in the management of abdominal testis. A preliminary report. Eur J Pediatr Surg 2008;18(6):402–406. DOI: 10.1055/s-2008-1039028.