Laparoscopic Management of Impalpable Testis in Children, New Classification, Lessons Learned, and Rare Anomalies

Abstract

Cryptorchidism is the most common genitourinary anomaly in male children. About 20% of cryptorchid testicles are impalpable. Laparoscopy has become one of the important diagnostic modalities for the management of impalpable testes. The aim of the present study was in highlighting the lessons and rare anomalies encountered during the management of impalpable testes in children over a period of 10 years in a single pediatric surgery center and to establish a new classification that better describes the anomalies. A retrospective review of 93 laparoscopic explorations for nonpalpable testes between 1998 and 2008 was conducted. Demographic data, intraoperative findings and management, associated anomalies, and postoperative follow-up were collected and analyzed. A new laparoscopic classification is described. Age range was 7 months to 8 years. Twenty bilateral versus 73 unilateral impalpable testes were operated on. Four groups were established with subgroups in each group. Group 1 (vanishing syndrome) had 44 cases, group 2 (peeping testes) had 21 cases, group 3 (intra-abdominal testes) had 38 cases, and group 4 (disorders of sex development) had 10 cases. Associated anomalies included 4 cases of Down syndrome, 7 cases of neurologic impairment, 3 of renal anomalies, 3 of cardiac anomalies, and 1 case of eye anomalies. Follow-up range was 1-6 years. A new laparoscopic classification is presented that better describes the anomalies and help-in planning the treatment of impalpable testes. Impalpable testes with Down syndrome are sometimes associated with bizarre anatomy. Parents should be well informed of all the possible findings, especially in bilateral cases.