Nonpalpable Undescended Testes Research Articles

Role of Diffusion Weighted Imaging in Localization of Non-palpable Undescended Testes Taking Laparoscopic Finding as Gold Standard

Objective: To ascertain the accuracy of diffusion-weighted imaging (DWI) in the localization of undescended testes. Material & Methods: This prospective cross-sectional study was conducted in the radiology department of a tertiary care hospital from 01-06-2022 to 15-12-2023. Total of 150 patients were included in the study. Two experienced radiologists independently examined, one observing conventional MRI alone and the other observing DWI-MRI. Following that, all of the patients underwent laparoscopic examination. The data was entered into a proforma. The findings of conventional MRI alone and DWI-MRI were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of DWI in comparison to laparoscopy. Results. The average age was 10.37 +/- 5.663. Conventional MRI imaging localized 50.6 % of the cases in our study, 55% of cases via DWI-MRI and 60% by laparoscopy. Sensitivity, specificity, PPV, NPV, and accuracy of conventional MRI were 72 %, 83 %, 86 %, 66 % and 76 % respectively, while for DWI-MRI was 82 %, 86 %, 93 %, 89 %, and 78 % respectively. Conclusion: The detection of undescended testes is improved by DWI-MRI. DWI-MRI is a recommended imaging tool for improving MRI's preoperative diagnostic accuracy in localization and identification of nonpalpable undescended testes.

Long-term Outcome of Laparoscopic Surgery for Nonpalpable Undescended Testis.

The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 × length × breath × height. A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm3) was smaller than the normal nonoperated side (mean = 2.524 cm3). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm3), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT.

Diffusion‐weighted imaging and conventional magnetic resonance imaging for detection of non-palpable undescended testis

BackgroundMRI is noninvasive imaging tool and does not imply ionizing radiation and applies multiplanes images, but it is sometimes less efficient in locating intraabdominal functioning testicles and it fails to locate most of the atrophied testicles. Our aim in this study was to assess the value of the combined conventional MR imaging and DWI in the detection of non-palpable undescended testes in pediatric patients and correlate the results with the laparoscopic finding.ResultsThis prospective study was carried out from January 2020 to February 2022 on 60 pediatric patients with 68 non-palpable undescended testes referred from Urology department to the radiodiagnosis and medical imaging department at our institute for MR imaging evaluation of clinically diagnosed non-palpable undescended testis, and their age ranged from 6 months to 17 years with mean age of 4.24 ± 4.67 years. The conventional MRI sensitivity was 85.71%, specificity was 100%, NPV was 60%, and PPV was 100% with accuracy of 88.23%. The combined DWI and MRI sensitivity was 92.86%, specificity was 100%, NPV was 75%, and PPV was 100% with accuracy of 94.12%. DWI was able to detect all viable abdominal testes, while only detecting 26 (out of 28) inguinal testes. Combined assessment was able to detect all viable abdominal and inguinal testes.ConclusionsCombined DWI with a high b value and conventional MRI including T1WI, T2WI and fat-suppression T2WI showed considerable diagnostic performance compared to conventional MRI alone improving the preoperative sensitivity and accuracy of detection of non-palpable undescended testes.

Proportion of Testicular Absence and Position of Testis in Unilateral Nonpalpable Undescended Testis in a Tertiary Teaching Hospital in South India

Introduction: Undescended testis is a common surgical problem in children which needs to be treated by one and a half year of age. When testis is non palpable, it could be either absent, and when present intra-abdominal or inguinal. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with nonpalpable undescended testis from January 2016 to June 2021. Results: Mean age of intervention was 43.7 months (range 7 to 153 months). Incidence of absent testis was 30.97%. in 156 children who had ipsilateral undescended testis, 92 had intra-abdominal testis and 43 had inguinal testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy were suggestive of absent ipsilateral testis (p <0.001). Testis is absent in 11.3% only when ipsilateral hemi scrotum is under developed. Conclusion: Proportion of absent testis is 30.97% in children with unilateral undescended testis. Presence of nubbin of testis in ipsilateral scrotum and contralateral testicular hypertrophy are predictive of ipsilateral testicular absence. Keywords: Undescended testis, atrophic testis, Contralateral hypertrophy.

To determine the sensitivity, specificity, and diagnostic accuracy of diffusion-weighted MRI in localization of non-palpable undescended testes taking laparoscopic findings as the gold standard: A cross-sectional study from Pakistan

BackgroundCryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. MethodsA cross-sectional study was conducted in the radiology department of a tertiary care hospital from September 27, 2018 to September 26, 2019. A total of 416 patients were included. Abdomen-pelvic and scrotal ultrasound were performed. Preoperative abdominal and pelvic DW-MRI was performed with a 1.5-T MRI system using a body coil. All study patients underwent laparoscopic exploration. Intra-abdominal atrophic testes were treated with laparoscopic orchiectomy and orchiectomy samples were taken for histopathologic examination. DW-MRI findings were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW-MRI taking laparoscopy as the gold standard. ResultsThe mean age was 17.08 ± 7.99 years and the mean BMI was 19.36 ± 4.96 kg/m2. In our study, 34.1% of cases were diagnosed as undescended testes localized by DWI-MRI and 51% of cases were diagnosed as undescended testes localized via laparoscopy. Sensitivity, specificity, PPV, NPV and accuracy were 65.1%, 98%, 97.2%, 73% and 81.3% respectively. ConclusionDW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes.

Referral patterns for undescended testis: A 7 year comparative analysis of primary care providers

Cryptorchidism, or undescended testis (UDT), is identified in 1% of boys by one year of age and carries long term risks of infertility and testicular neoplasia. In 2014, the American Urological Association (AUA) released a guideline statement stating that patients with UDT should be referred to a urologist by 6 months of age in order to facilitate timely surgical correction. This study is the follow-up to a 2010 study assessing referral patterns to our university center from primary care providers. In this new study, we aim to identify changes in referral patterns in response to the establishment of the 2014 AUA guidelines and to understand how our referring physicians stay abreast of current knowledge regarding UDT. A 9 question anonymous survey regarding UDT referral patterns was sent to providers who had previously referred a patient to our pediatric urology practice. The results were categorized by specialty and were compared to the similar survey from 2010. Surveys were sent to 500 physicians with 138 (27.6%) responses received. Less than half of respondents reported that they would refer a boy with unilateral or bilateral palpable UDT by 6 months of age (37.0% and 38.4% respectively). This was not significantly different than the 2010 survey (p=0.68 and 0.27 respectively). Two-thirds of physicians would refer a patient with unilateral nonpalpable UDT within the recommended time frame (68.8%); this was also unchanged from 2010 (p=0.87). There was an improvement in respondents who would refer immediately for bilateral nonpalpable testes from 49.8% in 2010 to 53.6% in 2017 (p=0.01). Residency training was most commonly cited as the primary source of knowledge regarding UDT although 89.3% of respondents citing this were >5 years removed from residency training. Delayed referral patterns were reported by the majority of providers for palpable UDT and by greater than one-third of providers for nonpalpable UDT. There was minimal change in referral patterns between 2010 and 2017 despite the release of the AUA cryptorchidism guidelines in 2014. In both 2010 and 2017, residency training was identified as the primary source of knowledge regarding management of UDT. These findings suggest an unmet need for education regarding contemporary management of UDT for the primary care physicians in our community.

Infantile pure yolk sac tumor of testis - A case report

Intra-abdominal testicular tumors are uncommon in prepubertal children. The present study is a rare case of intra-abdominal testicular yolk sac tumor with elevated Alpha feto protein levels whose diagnosis was confirmed by histopathology and immuniohistochemistry. Serum tumor markers and radiological examination also aids towards the diagnosis of nonpalpable undescended testis. Keywords Undescended testis, Tumor markers

Clinical Characteristics, Ultrasonographic Findings, and Treatment of Pediatric Transverse Testicular Ectopia: A 10-Year Retrospective Review

To evaluate the clinical data, ultrasonic features, treatment, and long-term outcome of transverse testicular ectopia (TTE) in children. Children with TTE were enrolled in the study between November 2009 and August 2019 in Shenzhen Children's Hospital in China. Clinical information, including demographiccharacteristics, clinical manifestations, TTE-associated anomalies, ultrasonographic findings, and surgical procedures, were collected from all patients. Patients were re-evaluated at the end of 4 weeks and 6 months after the operation. A total of 16 cases were enrolled and underwent surgeries, all patients had undescended testis with contralateral inguinal hernia. The ultrasonic findings showed two testicles in 15 cases and no testes in 1 case. Müllerian ducts remnants were found by laparoscopy in 6 cases or by ultrasound in one case. Sixteen cases were treated with laparoscopy orchidopexy or laparoscopy assisted trans-septal orchidopexy-inguinal exploration. After surgery, 16 patients had both testicles in an orthotopic position and with equal size, with normal blood flow. TTE should be suspected in patients with nonpalpable undescended testis and contralateral inguinal hernia. The contralateral processus vaginalis sac occurs in all cases of TTE. Ultrasonography is essential for an early diagnosis of TTE. Laparoscopy-assisted surgery is safe, effective, and minimally invasive therapy for TTE.

Comparison of imaging and laparoscopy in diagnosis of non-palpable undescended testes.

Objective: To assess the accuracy of ultrasound and MRI in comparison with laparoscopy in the detection of non-palpable undescended testes. Patients and Methods: 42 patients with non-palpable undescended testis were submitted to US, MRI and laparoscopy from October 2014 to October 2020 in the urology department of Al-Sader Medical City, Najaf. Laparoscopic findings were compared with US and MRI results. Results: Sensitivity was 60%, 70% and 100% and specificity was 30%, 50% and 100% for US, MRI and laparoscopy, respectively. Conclusion: Laparoscopy is more superior to US and MRI in the detection of non-palpable undescended testis.

Yolk sac tumor in intraabdominal undescended testis in a child with normal serum alpha-fetoprotein: a rare case report

BackgroundIntraabdominal testicular tumors are rare in prepubertal children, and most of the cases reported are intraabdominal testicular teratoma. The present study reports the first case of intraabdominal testicular yolk sac tumor (YST) with normal preoperative serum alpha-fetoprotein levels and diagnosis confirmed on histopathology and immunohistochemistry.Case PresentationA 2-year-old boy presented with bilateral nonpalpable undescended testes (UDT) and abdominal mass. Preoperative serum alpha-fetoprotein was normal. Contrast-enhanced computed tomography (CECT) scan of whole abdomen revealed a heterogeneous mildly enhancing space-occupying lesion in midline and left side of pelvis, left intraabdominal testis and nonvisualization of right testis. During surgery, the mass was found to involve right testis with one turn of torsion of its pedicle. Derotation of testis was performed, and right radical orchiectomy was performed. Left orchiopexy was also performed at the same time. Histopathology and immunohistochemistry confirmed diagnosis of intraabdominal testicular YST. There was no recurrence or distant metastasis at 12-month follow-up after surgery.ConclusionIn a case of nonpalpable UDT and abdominal mass/pain, one should always consider possibility of intraabdominal testicular tumor and should investigate the case with serum tumor markers and ultrasound/CECT abdomen. Further, histology of tumor helps in guiding treatment of condition.

Role of Laparoscopy in Management of Nonpalpable Undescended Testis in Children

Abstract Background Normal testicular descent relies on a complex interplay of numerous factors. Any deviation from the normal process can result in an undescended testis (UDT). UDT is a common abnormality that carries fertility and malignancy implications. Aim of the Work The aim of this study is Evaluation of the role of laparoscopy in diagnosis and management of clinically impalpable testis. Patients and Methods Nineteen male patients were included in this study with twenty two non-palpable testes. All these patients were subjected to diagnostic laparoscopy & the subsequent decision was then based on the laparoscopic finding. There was no age limit for the procedure. The procedure was carried in Ain Shams University teaching hospital and El-mataria teaching hospital. Results The study included nineteen patients with twenty two non-palpable testes. Age at presentation was averaging 18.5 ± 12.5 months. Our study may present convincing evidence that laparoscopy has significant advantage over imaging procedures. Preoperative imaging proved inaccurate in determining testicular position in 10 of the 22 testes (45.5%) this is in agreement with many studies which reported that ultrasonography helped to identify only 45% of non palpable testis. Conclusion This study tried to assess roughly the effectiveness of laparoscopy as a diagnostic tool and treatment of non-palpable undescended testis. This study dealt with a very small number of patients and this issue still needs more researches to study all the benefits and disadvantage and shall need further study on a wide range of patients.

Detection of monorchidism in boys with unilateral undescended testes: clinical benefits and limitations of contralateral testicular size

Contralateral testicular size was recommended as an effective measurement in prediction of monorchidism in some previous studies but a few argued it as invalid. Further investigation was demanded. To investigate the effectiveness of contralateral testicular size in prediction of monorchidism in patients with unilateral non-palpable undescended testes (NPT) aged between 9 and 48 months. Total of 707 patients aged between 9 and 48 months and diagnosed with unilateral undescended testes (UDT) between January 2016 and December 2018at the study department were enrolled. In accordance with physical examinations and surgical findings, patients were divided into three groups: palpable UDT (group A, n=609), non-palpable but viable testes (group B, n=57) and monorchidism (group C, n=41). Contralateral testicular length and volume were evaluated with ultrasonography. Comparison of contralateral testicular size between three groups and calculation of optimal cut-off value and diagnostic performance of it among NPT were performed. The length and volume of contralateral testes of group C were larger than of group A (P<0.01) and group B (P<0.01), whereas these differences between groups were small. Among patients with NPT, a receiver operating characteristic curvewas used to determine the optimal cut-off value. It revealed that both a testicular length of 17.5mm and a volume of 1.05ml provided the highest Youden's index for prediction of monorchidism. The sensitivity and specificity for testicular length were 34.1% and 94.7%, and volume were 34.1% and 93%, respectively. The predictive accuracy for testicular length and volume were 69.4% and 65.7%, respectively. Even though the negative predictive valuewas merely 66.6% (54/81) and 66.2% (53/80), the positive predictive value (PPV) reaches to 82.3% (14/17) and 77.7% (14/18) for testicular length and volume. Several factors including choosing of measurement tools, age range, ethnicity, and selection bias of cohorts may be accounted for the huge differences among cut-off values and predictive accuracy. The diagnostic performance of contralateral testicular size in prediction of monorchidism in patients with NPT was poor. But the PPV was relatively promising. Contralateral testicular hypertrophy can provide information for surgical planning. The overall diagnostic performance of contralateral testicular size in prediction of monorchidism in poatients with UDTaged between 9 and 48 months was poor. But the efficiency of cut-off value predicting absence of viable testes was relatively higher. This value should be objectively applied but only as a reference which would not be a complete replacement of laparoscopy exploration.

EFFICACY OF LAPAROSCOPY IN THE MANAGEMENT OF UNILATERAL NONPALPABLE TESTIS

Background:Undescended testis is one of the most common malformations seen in the field of pediatric surgery. The most problematic aspect of undescended testis is the diagnosis and treatment of nonpalpable testis. Laparoscopy has been widely used for the diagnosis and treatment of nonpalpable testis. Objective:To evaluate the role of laparoscopy in the diagnosis and treatment of unilateral nonpalpable undescended testis. Methods:This is a prospective study carried out in the period from December 2012 to December 2017 in the Pediatric Surgery Department of a tertiary hospital in Baghdad. We used laparoscopy in the diagnosis and treatment of 40 patients aged between one and 12 years (median age 4.9 years) with unilateral nonpalpable undescended testis. Boys with a palpable testis at any point were excluded from the study. Surgical procedure was individualized according to the laparoscopic findings either by one stage laparoscopic orchiopexy, two stage Fowler-Stephens procedure or laparoscopic orchiectomy. Results:Laparoscopy was able to diagnose the site of the nonpalpable testes in all the patients. Out of 40 nonpalpable undescended testes, 26 testes (65%) were intra-abdominal (12 testes were low intra-abdominal, 14 testes were high intra-abdominal). In 9 patients, (22.5 %), the vas deferens and spermatic vessels were found entering the internal inguinal ring. In 3 patients, (7.5 %), the testes were vanishing, and the testes were absent in 2 patients (5%). All patients with low intra-abdominal testes (n=12) were subjected to one stage laparoscopic orchiopexy through the normal inguinal ring. Out of 14 patients with high intra-abdominal testes, 7 patients underwent two staged Fowler-Stephens laparoscopic procedures, while three patients were treated by laparoscopic Prentiss maneuver and the remaining 4 patients underwent immediate laparoscopic orchiectomy due to presence of an atrophied testis. Patients with the vas deferens and spermatic vessels entering the internal inguinal ring (n=9) were treated by orchiopexy via conventional inguinal approach. Conclusion:Laparoscopy for unilateral nonpalpable testis has an excellent diagnostic yield combined with high success rate following repair. Keywords:Laparoscopy, nonpalpable undescended testis, Fowler-Stephens procedure Citation:Zain AZ, Mohammed NH, Fadil SZ, Abdul-Hassan BA. Efficacy of laparoscopy in the management of unilateral nonpalpable testis. Iraqi JMS. 2019; 17(3&amp;4): 223-230. doi: 10.22578/IJMS.17.3&amp;4.9

Diagnostic Value of Combined Diffusion Weighted MRI and Conventional MRI in The Diagnosis of Non-Palpable Undescended Testes

Background: Additional MRI assessments, as DWI are useful methods to improve the accuracy and sensitivity of diagnosis of non-palpable testes. Objective: The aim of this work was to assess diagnostic value of combined diffusion weighted MRI and conventional MRI in the diagnosis of non-palpable undescended testes before laparoscopy. Patients and Methods: This was a prospective study during a period of 12 months duration from January 2018 to December 2018 including 30 male patients with 33 non-palpable undescended testes (unilateral in 27 cases and bilateral in three cases). They were prospectively enrolled in this study. Their ages ranged from 6 months to 21 years old (mean age = 4.04 ± 4.004 years, mood=1 years). The research was carried on the Radiology Department, Al Azhar University Hospital and AlAhrar Teaching Hospital. All patients underwent ultrasound then underwent magnetic resonance imaging included different pulse sequences and scanning planes. Results: Conventional MRI showed sensitivity of 79.31%, specificity of 100% and overall accuracy of 81.82%; DWI had higher sensitivity (82.76%) but lower specificity (75%) and similar overall accuracy (81.82%) compared to conventional MRI; combined assessment had the highest sensitivity (86.21%), specificity (100%) and accuracy (87.88%). Conclusion: DWI findings complement the information on the location and viability of undescended testes obtained with conventional MRI before laparoscopy.

Diagnostic Value of Combined Diffusion Weighted MRI and Conventional MRI in The Diagnosis of Non-Palpable Undescended Testes

Background: Additional MRI assessments, as DWI are useful methods to improve the accuracy and sensitivity of diagnosis of non-palpable testes. Objective: The aim of this work was to assess diagnostic value of combined diffusion weighted MRI and conventional MRI in the diagnosis of non-palpable undescended testes before laparoscopy. Patients and Methods: This was a prospective study during a period of 12 months duration from January 2018 to December 2018 including 30 male patients with 33 non-palpable undescended testes (unilateral in 27 cases and bilateral in three cases). They were prospectively enrolled in this study. Their ages ranged from 6 months to 21 years old (mean age = 4.04 ± 4.004 years, mood=1 years). The research was carried on the Radiology Department, Al Azhar University Hospital and AlAhrar Teaching Hospital. All patients underwent ultrasound then underwent magnetic resonance imaging included different pulse sequences and scanning planes. Results: Conventional MRI showed sensitivity of 79.31%, specificity of 100% and overall accuracy of 81.82%; DWI had higher sensitivity (82.76%) but lower specificity (75%) and similar overall accuracy (81.82%) compared to conventional MRI; combined assessment had the highest sensitivity (86.21%), specificity (100%) and accuracy (87.88%). Conclusion: DWI findings complement the information on the location and viability of undescended testes obtained with conventional MRI before laparoscopy.

Laparoscopic management of non-palpable un-descended testes: our experience

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis &gt;2 cm from deep inguinal ring in 20, near deep ring &lt;2 cm in 20 and at inguinal canal in 6 patients. In the diagnostic laparoscopy, high intra-abdominal testis found in 34, low intra-abdominal testis in 24, blind ending of vas and vessels in 2 patients. The operative procedures performed are diagnostic laparoscopy, laparoscopic orchidopexy, laparoscopic orchidectomy, conversion to open orchidopexy and open orchidectomy. The mean operative time was 53.67±2.37 for unilateral and 102.76±5.38 for bilateral cases. The postoperative complications include surgical emphysema, wound infection and scrotal haematoma. The mean hospital stay was 14.23±2.37 hours for unilateral and 16.27±5.38 hours for bilateral.Conclusions: Laparoscopic orchidopexy appears to be a feasible, minimally invasive, less postoperative pain and trauma, faster convalesce and return to normal activity and an effective technique for the management of low intra-abdominal testes.

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

Role of Laparoscopy in Management of Non-Palpable Undescended Testis in Children

Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic Fowler–Stephens procedures, and staged laparoscopic traction orchiopexy (Shehata technique). Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis. Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intraabdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or Shehata technique. Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in 1/20 testis (5%). Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while Shehata technique has excellent results in management ofintra-abdominal testis with short TV

Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre

Before 2014, there was a lack of recommendations on managing cryptorchidism, or undescended testis (UDT), from a large pediatric urological or surgical organization. We assessed the variability in management of UDT among pediatric urologists and pediatric surgeons at a single tertiary pediatric referral centre before publication of major guidelines. We performed a retrospective review of the electronic records of patients who underwent primary unilateral or bilateral orchidopexy at our centre between January 2012 and January 2014. A total of 488 patients (616 testes) were identified, of whom 405 (83.0%) and 83 (17.0%) were managed by pediatric urologists and pediatric surgeons, respectively. There was no difference in baseline characteristics, including age seen in clinic or at surgery, testis location/palpability and availability of preoperative ultrasonograms, of patients seen by the 2 groups. Pediatric surgeons ordered preoperative ultrasonography more often than pediatric urologists (25.3% v. 3.7%, p < 0.001). With palpable UDTs, although both groups used open approaches, pediatric urologists preferred a scrotal approach (56.9%), and pediatric surgeons approached most testes inguinally (98.8%). With nonpalpable UDTs, laparoscopic approaches were preferred by both groups; however, pediatric urologists used a 2-stage Fowler–Stephens approach more often than pediatric surgeons (48.4% v. 15.8%, p < 0.001). There was wide variation in the management of primary UDT between pediatric urologists and pediatric surgeons before the publication of guidelines. The most prominent difference between the 2 groups was in the ordering of preoperative ultrasonography. Future assessment of change in practice patterns may elucidate whether guidelines are an effective tool for standardization of practice.

The diagnostic value of magnetic resonance imaging in the diagnosis of nonpalpable undescended testis

Objective The aim of this study was to assess the value of MRI to localize undescended nonpalpable testis before laparoscopy operation. Background Conventional MRI sequences when combined with diffusion-weighted imaging sequence is a good tool for tissue characterization as they provide functional and structural information about tissues. It could detect the site and viability of nondescended testes. Patients and methods During a period of 12-month duration from January 2016 to December 2016, 20 male patients ranging in age from 5 months to 25 years (mean = 9.86 ± 6.91 years) were included in this study. All patients selected were referred to the MRI scanning for assessment of nonpalpable undescended testes that are clinically diagnosed before laparoscopy. Results Conventional MRI combined with diffusion-weighted images gives better results as regards the location of undescended testis and also detection of viability of testicular tissue. This technique had the highest sensitivity (100%), specificity (90%), and accuracy (90%). Conclusion Conventional MRI with fat-suppression technique when combined with diffusion-weighted imaging gives the highest accuracy for localization and detection of viability of undescended nonpalpable testis.