Impalpable Undescended Testis Research Articles

Does the contralateral testicular volume decide the need for diagnostic laparoscopy in cases of unilateral impalpable undescended testis?

BackgroundThis study aimed the evaluation of the value of the calculated volume of a normal testis to predict the status of its contralateral impalpable side and hence decide the importance of laparoscopic exploration.MethodsPatients with unilateral impalpable undescended testis – as confirmed by clinical and sonographic examination- were enrolled in our prospective interventional study between November 2018 and August 2022 at Elshatby University Hospital, Faculty of Medicine, Alexandria University. The volume and three-dimensional diameter of the normal contralateral testis were measured by the pre-operative US using the formula: Volume = L x W x H x π/6, where L is the length, W is the width, H is the height, and was correlated with the intra-operative laparoscopic findings.ResultsSeventy-six patients were included in our study. The age of the studied patients ranged between 6 months and 4 years with a mean of 2.17 ± 1.30 years; most of them were between one and three years old. Forty-six patients (60.5%) have left-sided impalpable testis and 30 patients (39.5%) have right-sided impalpable testis. The calculated volume of the contralateral normal testis was significantly larger in those patients who had both blind ending vas and vessels (0.89 ± 0.16) and in those who had an atrophic testis passing through the deep inguinal ring (DIR) –which was excised through the inguinal region- (0.83 ± 0.20) than in those patients who had their testes intra-abdominal (0.53 ± 0.18) or passing through the DIR to the inguinal region (0.80 ± 0.19). (Kruskal Wallis test; p < 0.001*).ConclusionsThe calculated sonographic volume of a normal testis can predict the status of its contralateral impalpable side significantly with sensitivity & specificity of 75.0% & 88.89% respectively and a cut-off point of ≤ 0.674; hence, helps in parent counselling preoperatively.Trial registrationName of the registry: Clinicaltrials.gov PRS. Trial registration number: NCT05933811. Date of registration: 10-7-2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov.

A novel technique in the management of crossed testicular ectopia in children

BackgroundCrossed testicular ectopia (CTE) is an extremely rare anomaly of urogenital development in which both testes are migrated and descend through a single inguinal canal, one or both testes may be ectopic in the abdomen, the inguinal region or descent to the hemi-scrotum with empty contralateral hemi-scrotum. The etiopathogenic mechanism of CTE is still unknown. CTE was classified into three types based on the associated findings. Most of the cases were found associated with other abnormality such as Persistent Mullerian Duct Syndrome, Inguinal hernia, Hermaphroditism, and other scrotal abnormality. The condition is mostly detected incidentally during repair of inguinal hernia or laparoscopic evaluation of impalpable undescended testis. We present our experience in management of seven cases with CTE including a novel technique named "Arabic eight figure orchiopexy". ConclusionsCTE should be considered in children presented with unilateral inguinal hernia or hydrocele with empty contralateral hemiscrotum. We present a novel technique in management of CTE named "Arabic eight figure orchiopexy".

Laparoscopic –Assisted Orchidopaxy in Non-Palpable Testes in Adult Population

ABSTRACT:&#x0D; &#x0D; Objectives: To present our experience of managing impalpable undescended testes in post-pubertal patients with intention of testicular preservation using laparoscopic assisted orchidopaxy. &#x0D; &#x0D; Study Design: Descriptive Case series.&#x0D; &#x0D; Place &amp;&#x0D; Duration of&#x0D; Study: Department of Urology, Jinnah Postgraduate Medical Center (JPMC) Karachi, between Jan 2015 to Dec 2020 with minimal 6 months follow-up.&#x0D; &#x0D; Methodology: We included all patients with clinically impalpable testes with aged 12 and above. All patients had ultrasound abdomen performed as initial screening test followed by laparoscopic assessment and definite procedure. Patients with normal or hypo-plastic testes were underwent single staged orchidopaxy, while patients with testicular atrophy were planned for orchiectomy. Intraoperative testicular biopsy and Semen analysis were not routinely performed in our study.&#x0D; &#x0D; Results: Total 36 patients with 41 impalpable testes underwent laparoscopic localization and management. Mean age of patients was 20.75+ 5.98 years. 50% of testes were on the right side, 36.1% on left sided while 3.88% were bilateral. 5 (12.1%) patients had clinical inguinal hernia.. Diagnostic yield of ultrasound was (75.6%) and 100 % in laparoscopy. 33 testis were true intra-abdominal while 4 were inguinal and 4 were vanishing testes Normal looking testes were observed in 24 testes (64.86%) followed by hypoplastic in 11(29.72%) while 2 testes (5.40%) were atrophic. Two intra-operative complications included urinary bladder injury and vas deferens injury in one patient each. Postoperatively testicular ischemic necrosis in one (2.4%) and wound infection in 2 (4.8%) patients were noted. Late follow up revealed one port site hernia (2.4%) and one testicular atrophy (2.4%). Success rate of orchidopaxy in our study was 94.6%.&#x0D; &#x0D; Conclusions: Laparoscopic has been proved as excellent diagnostic and therapeutic tool for the management of intra- abdominal undescended testes in adolescent and post-pubertal patients.&#x0D; &#x0D; &#x0D; Key words: Impalpable testes, Laparoscopic-assisted orchidopaxy, Adolescent, Adult

Crossed testicular ectopia: A report of two cases

The term “crossed testicular ectopia” (CTE) means the deviation from the normal path of descent resulting in unilaterality of both testes. The condition is mostly detected incidentally during repair of inguinal hernia or laparoscopic evaluation of impalpable undescended testis. Preoperative identification of this anomaly is feasible during the clinicoradiological evaluation of the genito-urinary abnormalities. Orchiopexy (transeptal/extraperitoneal transposition/laparoscopy-assisted) is the mode of surgical management. We present here two cases of CTE where laparoscopy-assisted trans-inguinal orchiopexy was done.

Ipsilateral scrotal fullness – a surrogate indicator for testicle location in unilateral impalpable undescended testis

Ipsilateral scrotal fullness – a surrogate indicator for testicle location in unilateral impalpable undescended testis

Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1–16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.

Bilateral orchidopexies: synchronous or metachronous? Survey of BAPS and BAPU members and single-centre comparison

Background/AimApproximately 20% of undescended testes (UDT) are bilateral. It is unclear whether bilateral orchidopexy (BO) should be undertaken synchronously (SBO) or metachronously (MBO). Our aim was to investigate current UK practice and the complications of SBO vs MBO. Materials & methodsFollowing approval of BAPS and BAPU ethics committee, a survey was circulated to UK consultant pediatric surgeons and urologists regarding practice. A departmental retrospective review was additionally carried out for patients undergoing BO between 2005 and 2017. ResultsForty-three consultant surgeons from 20 centres completed the survey. Overall, SBO was preferred by 70% for bilateral palpable UDT versus 30% for bilateral impalpable UDT. When one side was palpable and the other impalpable, 70% preferred SBO. Pediatric urologists were significantly more likely to undertake SBO than pediatric general surgeons. One hundred eighty-eight patients (376 testicular units) were identified who had undergone BO with a median follow up of 9 months. 144/188 (76.6%) underwent SBO, while 44 had MBO. There was no statistical difference in the complication rate between the two groups (7.6% in SBO vs 9.1% in MBO; p = 0.66). ConclusionsThe majority of the responding UK consultants, in particular pediatric urologists, favor SBO. This potentially offers a reduction in cost, more rapid completion of treatment, and is not associated with additional complications by comparison to MBO. We recommend SBO to be standard practice for bilateral UDT whenever possible. Level of EvidenceLevel III, Retrospective Comparative Study.

Role of laparoscopic in diagnosis and treatment of undescended testis in children at Viet Duc Hospital

Abstract Introduction: Evaluating the role of laparoscopic for diagnosis and treatment of undescended testis in children. Material and Methods: Restrospective study, between 6/ 2014 and 6/2017. All the patients are aged from 1 to 16 years with undescended testis underwent laparoscopic surgery for diagnosis and treatment in Deparment of pediatric surgery – Viet Duc hospital enrolled. Results: Of 95 patiens in total had 106 undescended testis diagnosed and treated by laparoscopy. The mean age of patients was 7,5 ± 3,8 years. 44,2% undescended were on the left side, 44,2% were on the right and 11,6% were undescended bilateral. The correct diagnosis by ultrasound accounted in 79,4%. The locations of testis diagnosed by laparoscopic are : intra abdomen in 45,3%, deep inguinal orifice in 16,9%, extra inguinal orifice in 26,4%, no testicle found in 11,4%. The mean time of operation were 67,33± 28,01 pht. Scrotal positions were achieved 74,5%, remove atrophic testis accounted in 7,6%. Stephen- Flowler technique including step I were in 4,7%, step II in 1,9%. The outcome evaluated by testicular positions following 3 months after operation are : good in 79,2%, moderate 13,2%, poor in 7,6%; By classification of Aubert are : good in 81,1%, moderate in 11,3% and poor in 7,6 %. Conclusion: Laparoscopic surgery is not only a highly sensitive diagnostic method to find accurately the location and size of the testes, but also the most effective method to treat impalpable undescended testes.

Inguinal Exploration for the Management of Impalpable Undescended Testes

Introduction: The primary goal of surgical intervention with an impalpable testis is to locate and reposition the gonad. There has been much debate in the management of impalpable undescended testes. Many centres still advocate the role of open inguinal exploration in impalpable testes.Materials and methods: This retrospective study included 35 male patients. The clinical notes were reviewed for details of age at operation, side, location and condition of testes intraoperatively and the type of operation performed. Standard approach of inguinal explorations was performed under general anaesthesia. Follow up in first week and after 3 months was done. Results: 25(71.42%) impalpable testes were in left side, 9(25.71%) were on right side and 1(2.85%) was bilateral. At exploration 17(47.22%) were intracanalicular, nine (25%) were intraabdominal with seven low and two high,49(11.11%) were scrotal and six (16.66%) were absent, seven (41.17%) canalicular testes underwent orchidopexy and 10(58.22%) underwent gonadectomy for atrophied testes. Seven (77.77%) low abdominal testes were brought down to scrotum and two (22.22%) high abdominal were brought down to lower inguinal area as a first stage surgery. All 4(100%) scrotal testes were atrophied and gonadectomy performed. Six patients were diagnosed anorchia, 14 (87.5%) of impalpable testes that underwent orchidopexy were in a follow up with excellent results. One high first stage orchidopexy and another canalicular testes were found to have atrophied who did orchidectomy in follow-up.Conclusion: Inguinal exploration is a safe, reliable and successful surgical procedure for the management of impalpable testes including intraabdominal testes without procedure related complications.

Reliability of hypertrophy of the contralateral testis in prediction of the status of impalpable testis

Background: The hypertrophied testis can predict the status of the impalpable contralateral one. The aim of this study was to assess the accuracy of contralateral testicular hypertrophy for predicting the presence or absence of impalpable undescended testis (UDT) in Egyptian boys. Patients and methods: This study was carried out on 204 patients with unilateral impalpable UDT who presented to the Pediatric Surgery Department, Al-Azhar University Hospitals, from July 2014 to April 2016. Only 40 patients with unilateral impalpable UDT and hypertrophy of the contralateral testes were included in this study. They were subjected to routine laboratory investigations, ultrasonography measurement of the volume of the hypertrophied testis, and diagnostic laparoscopy for the impalpable intra-abdominal testis (IAT). Both ultrasonography and laparoscopic findings were reported. Results: Out of 204 patients with unilateral impalpable UDT, only 40 patients fulfilled the inclusion criteria. Their ages ranged from 1 to 5 years, with a mean of 2.3±1.18 years. Testicular volume ranged from 0.94 to 6.33 cm 3 , with amean of 3.12±1.41 cm 3 . Diagnostic laparoscopy indicated 30 patients with vanishing testis, four patients with low IAT, and three patients with high IAT and three patients with testicular vessels and vas passing internal inguinal ring, where inguinal exploration indicated atrophic testes. Conclusion: Hypertrophied testis can predict the absence of other contralateral impalpable testis when its volume is 1.85 cm 3 . Keywords: hypertrophy, impalpable undescended testis, laparoscopy, reliability

Pediatric Laparoscopic Surgery: Four Years Experience in Dhaka Medical College Hospital

Purpose: Laparoscopy is gaining popularity over laparotomy in various surgical conditions. Now a day, an increasing number of diagnostic and therapeutic surgical procedures are being done laparoscopically. The aim of this study was to assess the safety and feasibility of laparoscopy in children.Materials and Methods: This retrospective study was carried out in the Department of Pediatric Surgery of Dhaka Medical College Hospital over a period of 52 (Fifty two) months from June 2009 to August 2013. A total of 123 patients were operated laparoscopically up to 12 years of age for different surgical conditions. Data was collected from the hospital records and analyzed retrospectively.Results: Out of these 123 laparoscopically performed cases, Appendectomy was performed in 39 cases, closure of internal inguinal ring for Inguinal Hernia was done in 36 patients, 20 patients underwent Cholecystctomy, 16 patients had laparoscopic procedures for impalpable Undescended Testis (UDT), 5 patients were operated for Adnexal Mass of which one case was converted into open procedure due to technical difficulties and 1 for Pancreatic Pseudo cyst. Diagnostic Laparoscopy was performed for 2 patients with Biliary Atresia and 4 patients for Ambiguous Genitalia. Median age of the patients was 6.08 years (ranging from 2 months to 12 years of age). The length of post operative hospital stay was 2-3 days. All the laparoscopic procedures for Inguinal Hernia and impalpable UDT were performed as day care surgery. Operative and post operative complications were minimal. Other advantages of the laparoscopic procedures were smaller incisions, incidental diagnosis of other associated pathology, lesser post operative pain, earlier oral feeding, quicker mobilization and a better cosmetic result.Conclusion: With the recent development of laparoscopic surgical techniques and equipments, laparoscopic surgical procedures are becoming popular day by day and can be performed safely for both diagnostic and therapeutic purposes in pediatric surgical patients.J. Paediatr. Surg. Bangladesh 4(1): 11-18, 2013 (January)

Testicular Tumors in Undescended Testes in Children Below 5 y of Age.

To evaluate the presentation, treatment and outcome of testicular tumors in undescended testes (UDT) in boys below 5y of age. Case records of boys below 5y of age, diagnosed to have germ cell tumors (GCT) in the UDT were reviewed. Seven children in the age range of 05-54mo (mean 26mo) were included. While five of these 7 (71%) presented with abdominal mass [one antenatally detected], 2 (29%) were detected to have a GCT during orchiopexy. In three of these five with abdominal mass, the alpha-fetoprotein (αFP) was markedly elevated. Two of these three with elevated αFP were endodermal sinus tumors while the third was embryonal carcinoma. The 4th patient with an abdominal mass was diagnosed to have an immature teratoma (IMT) while the patient with antenatally diagnosed mass had a mature cystic teratoma (MT). Both the patients with incidentally detected mass during the orchiopexy had mature teratoma (MT). All the seven children are alive and disease free at last follow-up. Though rare, boys with impalpable undescended testes may develop germ cell tumors early in childhood. These can be managed with chemotherapy and resection and have a good disease free outcome.

Early experience with laparoscopic surgery in children in Ile-Ife, Nigeria.

Background:Laparoscopy is not yet routinely employed in many Paediatric Surgical Units in Nigeria despite the advantages it offers. This study describes the preliminary experience with laparoscopic procedures in a single centre.Patients and Methods:A retrospective analysis of all children who had laparoscopic surgery between January 2009 and December 2013 at the Paediatric Surgical Unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis.Results:Eleven (44%) diagnostic and 14 (56%) therapeutic procedures were performed on 25 children whose age ranged from 5 months to 15 years (Median: 84 months, Mean: 103 ± 64.1 months), including eight (32%) females and 17 (68%) males. Indications included acute appendicitis in 12 (48%), intra-abdominal masses in six (24%), three (12%) disorders of sexual differentiation, two (8%) ventriculoperitoneal shunt malfunctions and impalpable undescended testes in two (8%) children. The procedures lasted 15-90 minutes (Mean = 54 (±21.6) minutes). Conversion rate was 17% for two patients who had ruptured retrocaecal appendices. No intra operative complications were recorded while three (12%) patients had superficial port site infections post-operatively. All diagnostic (11) and two therapeutic procedures were done as day case surgery. The mean duration of hospital stay was 3.1 (±3.3) days for those who had appendectomies.Conclusion:Laparoscopic surgery in children is safe and feasible in our hospital. We advocate increased use of laparoscopy in paediatric surgical practice in Nigeria and similar developing settings.

Examination Under Anesthesia for Management of Impalpable Undescended Testis: A Traditional Technique Revisited

Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide the best surgical approach for patients with impalpable undescended testis, especially in developing countries where expensive investigations are at premium. The study included boys who were treated consecutively and recorded prospectively from 2000 to 2010. Examination under anesthesia (EUA) was performed during the study period. Those in whom the testes were palpable underwent the standard orchiopexy procedure. In those boys where EUA failed to detect the testes, laparoscopy or extended inguinal exploration was carried out, and the testes were treated accordingly. On initial clinical evaluation at the outpatient clinic, 545 boys were recorded to have impalpable testes. Undescended testis was unilateral in 529 boys and bilateral in 16 boys. However, on examination under anesthesia only 189 (34.7 %) were impalpable. Among boys in whom the testes were palpable after EUA, 38 had small-size testes, 18 had normal size, and the remaining 300 boys had a sac or cord-like structure. Meticulous EUA facilitates the accurate diagnosis and planning of the surgical approach to patients with an impalpable testis and should remain part of the surgeon's skill set. It is an inexpensive initial evaluation tool that may help in saving hospital resources, especially in developing countries.

Laparoscopic management of impalpable undescended testes: 20 years′ experience

BACKGROUND:Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years.MATERIALS AND METHODS:From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler — Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite.RESULTS:None of the testis atrophied after two-stage Fowler — Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy.CONCLUSIONS:Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler — Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler — Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.

Paediatric laparoscopic orchidopexy as a novel mentorship: Training model

Although Laparoscopy is becoming a standard procedure in management of pediatric urology disorders, but its widespread use still limited. This can be attributed mainly to difficulty in acquiring such specialized technique, especially by post graduate practicing urologist. Thus, we herein evaluate the impact of condensed laparoscopic training programme in children hospital with the aim to analyze the feasibility and safety of laparoscopic orchidopexy in training basic laparoscopic skills. The aim of this study was to review experience as a mentor in training laparoscopic skills through condensed training programme based on high volume low risk procedure of pediatric laparoscopic orchidopexy. In order to implement a condensed laparoscopic curriculum in a short period of time while maintaining utmost patient safety, laparoscopic orchidopexy was used as the technique of choice. The course was conducted over a period of 5 days starting from 1 st November 2010 in a tertiary pediatric surgical center under guidance of an expert mentor. A total of 30 testicular units in 27 pediatric patients of different age group diagnosed with impalpable undescended testis underwent laparoscopic intervention. The course was conducted in three stages with the aim to deliver laparoscopic skills to trainee. In stage one out of eight cases operated by mentor with assistance of trainee six were operated on day 1 and two cases were operated on second day. The trainee performed 12 cases of laparoscopy independently with assistance of mentor in stage two which was carried out on day 2, 3 and 4. Finally all 7 cases including two second stage laparoscopic orchidopexy procedures were carried out independently by trainee under observer ship of mentor in stage three during day 4 and 5 of training programme. The feasibility and efficacy of laparoscopic orchidopexy in training laparoscopic skills through condensed training programme was assessed through analysis of mentorship experience.

Role of ultrasonography in the preoperative assessment of impalpable testes: a single center experience.

Background. Abdominoscrotal sonogram is often used in boys with a nonpalpable testis to determine the presence of the testis. We describe our experience with the use of ultrasonography in boys with a nonpalpable testis. Methods. We retrospectively reviewed the medical records of boys aged less than 14 years, who underwent preoperative ultrasonography for an impalpable undescended testis (IUDT) between 2006 and 2010 in our institution. The results of sonography and laparoscopy were compared. Results. A total of 26 impalpable testes in 22 patients, including 4 with bilateral impalpable testes, were preoperatively assessed by ultrasonography for their localization. Sonography localized only 6 of the 26 (23%) testes, which were laparoscopically explored and followed by orchiopexy. Conclusion. Ultrasound is not reliable in the preoperative assessment of patients with impalpable testes.

Laparoscopic management of 128 undescended testes: Our experience

To describe different laparoscopic procedures in the management of impalpable undescended testes (UDT) and their outcome. Descriptive study. The medical records of all the patients, managed laparoscopically for impalpable UDT between January 2008 to March 2011 at the department of Pediatric surgery, the Children's Hospital and The Institute of Child Health Lahore, Pakistan were reviewed for demography, history and clinical examination, investigations, operative notes, complication and outcome. There were a total of 90 patients (128 testes) with impalpable UDT managed laparoscopically. The mean age of presentation was 4.25 years (SD±3.47). In 38 (42.2%) patients, UDT were bilateral, whereas in 33 (36.7%), these were right sided and in 19 (21%), these were left sided. Laparoscopic findings revealed 65 (50.8%) testes lying higher up in the abdomen, 26 (20.3%) testes at internal ring, vas and vessel going into the deep ring in 22 (17%) cases and 15 (11.7%) atrophied/vanishing testes. Laparoscopic 2-Stage Fowler-Stephen (FS) orchidopexy was performed in 65 testes, laparoscopic orchidopexy was performed in 26 testes, laparoscopy followed by inguinal exploration and orchidopexy in 19 testes (3 testes were atrophied) and orchidectomy was performed in 9 testes. There were three conversions to laparotomy, one for external iliac iatrogenic injury and two for adhesions of the testes with the intestine. During follow-up at 6 months, 2 patients had testicular atrophy and the parents of 5 patients where testes could be brought to the scrotum neck were worried for the location. Laparoscopic management of impalpable UDT is an effective way of managing every kind of impalpable UDT. It is safe and its complications are very few.

Laparoscopic Management of Intra-Abdominal Testis: 5-Year Single-Centre Experience—A Retrospective Descriptive Study

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.

Bilateral Impalpable Testes: A Special Entity of Cryptorchidism

Background: Cryptorchidism is one of the most common genitourinary disorders in young boys. 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%. However, bilateral impalpable testes represent a special category that should be differentiated from anorchidism as well as male pseudohermaphroditism. We investigated whether bilateral impalpable testes with its inherent hormonal and genetic factors has different outcomes in terms of success of orchiopexies compared to unilateral impalpable testes. Methods: We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6 month outcomes, in patients diagnosed with bilateral impalpable undescended testes between 2006 and 2010. Findings were reported after a minimum of 6 months from the last surgical intervention. Results: Nine patients underwent laparoscopy for bilateral impalpable testes, 7 of whom had testes in the region of the internal inguinal ring. The success rate after laparoscopic exploration and open orchiopexy was 60% while the success rate with unilateral impalpable testes was 63.3% in the same study. Conclusion: Although laparoscopy is extremely useful in both the diagnosis and treatment of patients with bilateral impalpable testes, laparoscopy should be preceded by careful cytogenetic and hormonal workup for this particular group of patients. We found that the success rates of laparoscopic management of bilateral and unilateral impalpable testes were similar, as shown by testicular size clinically sassed during serial postoperative outpatient visits.