Laparoscopy in the management of the impalpable undescended testis.
ABSTRACT This study evaluates the role of laparoscopy for managing the intra-abdominal testis.
Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years.
Eleven children required insertion of 'working ports' for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler-Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum. CONCLUSION In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler-Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler-Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.
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ABSTRACT: Laparoscopy and magnetic resonance imaging (MRI) are competitive tools in the diagnosis of non-palpable testis. A prospective evaluation to determine the accuracy of MRI vs laparoscopy in the detection of undescended non-palpable testis was performed in 13 boys with 15 non-palpable testes. The results were compared between MRI, laparoscopy and definitive surgical diagnosis in all patients. MRI have reached a correct diagnosis in 13 out 15 non-palpable testes (86.6%). Three testes were located intra-canalicular, 5 were located just-canalicular, 3 were located intra-abdominal on the sides of urinary bladder. In the other 2/13 cases MRI showed small poorly defined testes with low signal intensity on both T1 and T2-weighted images indicative of fibrotic changes. These 2 testes proved to be atrophic after surgical exploration. MRI failed to detect or localize undescended non-palpable testis in 2 cases. On the other hand, initial laparoscopy revealed 5 testes to be intra-abdominal, and another 5 testes to be just-canalicular. Laparoscopy diagnosed inguinal testis in 3 instances, in which the vas and vessels were seen entering an open internal ring. In another 2 cases, the vas and vessels have entered a closed internal ring, they were diagnosed as vanished or atrophic testes in the inguinal canal. We recommended the use of non-invasive, non-ionizing MRI initially for all children with non-palpable testes to locate normal or atrophic testis, as a positive MRI finding locates the testis reliably, and limit minimally invasive diagnostic laparoscopy to patients with negative MRI findings.
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ABSTRACT: Introduction: To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). Methods: From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient's age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher's exact test for two independent proportions was used for statistical analysis and reported our results. Results: One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. Conclusion: Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings.Frontiers in Pediatrics 01/2014; 2:28.
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ABSTRACT: Cryptorchidism is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. This guideline is intended to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism (typically isolated non-syndromic).The Journal of Urology 05/2014; · 3.75 Impact Factor