Role of Laparoscopy in Diagnosis and Management of Nonpalpable Testes

Abstract

There is still a lot of controversy among urologists with regard to the treatment of nonpalpable (intra-abdominal) testes. This is a prospective randomized comparative study between open and laparoscopic orchidopexy for abdominally located testes. It is an assessment of the usefulness of laparoscopy in the diagnosis and definitive treatment of nonpalpable (abdominally located) testes. Methods: For a span of 5 years, orchidopexy was performed for 64 patients between the ages of 1 to 15 years (mean age of 4.6 years) with nonpalpable (intra-abdominal) testes. In all, 75 testes were involved in the study during which some had laparoscopic and open Fowler-Stephens orchidopexy while others had laparoscopic orchidectomy. One stage Fowler-Stephens orchidopexy was performed laparoscopically for 28 testes; 17 had two stage Fowler-Stephens orchidopexy. Laparoscopic orchidectomy was done for five testes. Postoperative follow-up consisted of clinical and color Doppler utrasonography. This was done for all who underwent orchidopexy. Results: The diagnostic convergence of US and laparoscopy was 16 out of 75 testes (21.3%). Laparoscopically 20 testes were located low intra-abdominally (26.6%), 17 were in the category of high intra-abdominal testes (22.7%). 18 testes had entered the inguinal canal (24%). Four of the patients had associated hernia. Mean follow-up period was 26 months (1 month to 5 years) during which the testes where found in their respective hemiscrotums except for two testes which had atrophied and three which were retracted up the