Laparoscopy in the management of the impalpable undescended testis

St James's University Hospital and the General Infirmary Leeds, UK.
British Journal of Surgery (Impact Factor: 5.54). 08/1998; 85(7):983-5. DOI: 10.1046/j.1365-2168.1998.00748.x
Source: PubMed


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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    • "All of these anatomical landmarks individually or collectively have bearing on the operative management of the Impalpable testes. (Atlas & Stone 1992; Bianchi, 1995; Bogaert et al. 1993;Elder, 1993; EI Gohary, 2006; Froeling et al.1994;Humphrey et al. 1998; Poenaru et al.1994; Perovic& Janic 1994) "

    Advanced Laparoscopy, 09/2011; , ISBN: 978-953-307-674-4
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    • "There are three main locations of impalpable testes: 40% of all impalpable, undescended testes are located intraperitoneally; 15% are vanished testes; and 45% have cord structures entering the internal inguinal ring [5,6]. For the assessment and diagnosis of impalpable, undescended testes, several diagnostic imaging tools, such as computed tomography or magnetic resonance imaging, cannot give us 100% reliable information about testes [12,15,16]. "
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    ABSTRACT: Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes. 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. 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. Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.
    Korean journal of urology 05/2011; 52(5):355-8. DOI:10.4111/kju.2011.52.5.355
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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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