Abstract
Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes. Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47%) patients presented nonpalpable testes bilaterally, 7 (14%) only at the right side and 20 (39%) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume. Nine (12%) testes were not localized, but their vessels and deferent duct were atrophic. Two (3%) testes were intra-abdominal and atrophic, and 2 (3%) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25%) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29%) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10%) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17%) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54%) cases, reaching a surgical success of 89%. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12%) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89%. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17%) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77% of good results. Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.
Highlights
Cryptorchidism occurs in 0.8 to 1.2% of boys at 1 year old [1,2], and in 20% of them, the testis is nonpalpable [3], and it can be absent, intra-canalicular, or intra-abdominal.The diagnosis and treatment of nonpalpable testes have been controversial, in the last 20 years, since the introduction of laparoscopy, they have undergone major changes
Inguinotomy was performed in a total of 41 (54%) cases, reaching a surgical success of 89%
Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12%) testes, which presented a distance of less than 2 cm from the internal inguinal ring, with a surgical success index of 89%
Summary
The diagnosis and treatment of nonpalpable testes have been controversial, in the last 20 years, since the introduction of laparoscopy, they have undergone major changes. It became one of the choices diagnostic methods, since imaging scans such as ultrasonography, computerized tomography, scintigraphy and magnetic resonance, do not offer a similar accuracy [4,5,6,7]. This work’s objectives were: 1) To analyze the experience of the first 5 years following the introduction of videosurgery for diagnosis and treatment of nonpalpable testes in our service; 2) To access the surgical success of different orchiopexy techniques; 3) To assess the need of exploring the inguinal canal in cases where laparoscopy identifies spermatic vessels and deferent duct penetrating the internal inguinal ring
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