Abstract
Background. Undescended testis is one of the most common urological problems in children, affecting about 1% of boys at age of 1 year. Of these, about 20% have a nonpalpable testis with a very high probability that the testis is absent. This may have a significant impact on the possibility of malignancy in these testes, as well as on the later fertility of these subjects. Methods. We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6-month outcomes, in 91 patients diagnosed with impalpable undescended testes between January 2006 and December 2010. Results. Of the 91 patients, 9 had bilateral and 82 had unilateral impalpable testes. All 100 testes were managed laparoscopically. The largest group of intra-abdominal testes in this series, 42 testes, was entering the internal ring; in these, laparoscopic exploration and standard open orchiopexy resulted in a 66% success rate. The total success rate was 63.3%. Conclusion. Laparoscopy is extremely useful in both the diagnosis and treatment of impalpable testes. Objectively measured mobility of the testis towards the contralateral internal inguinal ring is an excellent intraoperative indicator for type of orchiopexy. Standardization of management may increase the success rate of orchiopexy.
Highlights
About 1-2% of boys at age of 1 year have an undescended testis (UDT); this disorder is unilateral in about 90% of individuals and bilateral in about 10% [1–3]
We describe here our single-institution experience with laparoscopic management of impalpable testes in children over the last 5 years
Three main laparoscopic findings are possible: intraabdominal testis, observed in 40% of patients; intra-abdominal blind-ending cord structures, observed in 15%; cord structures entering the internal inguinal ring, observed in 45% [11]
Summary
About 1-2% of boys at age of 1 year have an undescended testis (UDT); this disorder is unilateral in about 90% of individuals and bilateral in about 10% [1–3]. Almost 20% of undescended testes are nonpalpable [4]. Undescended testes are usually evaluated and managed by imaging methods and surgery, respectively [5]. Laparoscopy was first used in 1976 to locate undescended testes [6]. Surgical treatment of undescended testis has included dividing the spermatic vessels to gain additional length and bringing the testis to the scrotum while maintaining the collateral blood supply [5]. The first stage of this procedure was later modified to include laparoscopic ligation of the spermatic vessels [7]
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