Treatment Of Nonpalpable Testis Research Articles

Clinical Efficacy of Laparoscopic Orchiopexy With the Modified Prentiss Maneuver for Non-palpable Testis Near the Internal Ring.

ObjectiveTo compare the clinical efficacy and safety of laparoscopic orchiopexy with the modified Prentiss maneuver (LOMPM) and laparoscopic trans-inguinal orchiopexy (LTIO) for the treatment of non-palpable testis (NPT) <1 cm from the internal ring.MethodsChildren with unilateral NPT who underwent laparoscopic orchiopexy at our center between February 2018 and January 2021 were retrospectively analyzed. According to the surgical method, they were divided into LOMPM and LTIO groups. The operation time, postoperative pain degree, postoperative complications and follow-up results were compared between the two groups.ResultsA total of 98 patients were included in this study, including 41 cases in the LOMPM group and 57 cases in the LTIO group. All patients underwent successful surgery. The LOMPM group was superior to the LTIO group in terms of postoperative testicular position (lower scrotm: 90.2 vs. 71.9%, P = 0.026). There were no significant differences in operation time, postoperative pain score, and complications between the two groups. Preoperative testicular volume, postoperative testicular volume, and testicular growth rate in the LOMPM group were comparable to those in the LTIO group. There were no testicular atrophy, inguinal hernia and hydrocele in both groups after operation.ConclusionsLOMPM was comparable in safety to LTIO, but LOMPM had a good post-operative testicular position, and was suitable for the treatment of NPT near the internal ring.

Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

Aim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes.Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics.Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins.Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.

Diagnostic Laparoscopy in Nonpalpable Testes; Single Center Clinical Results

Amaç: Nonpalpabl testis tanı ve tedavisinde laparoskopi altın standart yöntemdir. Bu çalışmamızda nonpalpabl testis olgularında laparoskopinin tanı ve tedavideki yerini, etkinliğini ve sonuçlarını tartışmayı amaçladık.Materyal ve Metod: Nonpalpabl testis tanısı ile laparoskopi planlanan 56 hasta çalışmaya dahil edildi. Hastaların yaşı, özgeçmişi, fizik muayene bulguları, laboratuar bulguları, ultrasonografi ve manyetik rezorans görüntüleme bulguları incelendi. Tüm hastalara genel anestezi altında tekrar muayene yapıldı. Nonpalpabl testis tanısı teyit edilen hastalara tanısal laparoskopi uygulandı. Laparoskopi bulguları, cerrahi prosedür ve komplikasyonlar değerlendirildi.Bulgular: Çalışmaya dahil edilen 56 hastanın yaş ortalaması 15,3±2,1 yıl idi. Hastaların 28’inde sağ, 22’sinde sol, 6’sında ise her iki testis palpe edilemedi. Sekiz hastada genel anestezi sonrası yapılan muayenede testislerin palpe edilmesi üzerine laparoskopi uygulanmadan orşiopeksi yapıldı. Testisleri palpe edilemeyen 48 hastaya ise tanısal laparoskopi uygulandı. 24 hastada spermatik kordun inguinal kanala girdiği, 15 hastada testislerin intra-abdominal yerleşimli olduğu, 7 hastada kör sonlanan spermatik kord ve 2 hastada ise testis bulunmamakla birlikte müllerien yapılar görüldü. İntra-abdominal testis bulunan hastalardan 9’una laparoskopik orşiopeksi, 6’sına ise laparoskopik orşiektomi uygulandı. Spermatik kordun inguinal kanala girdiği görülen 24 hastaya inguinal eksplorasyon yapıldı. Komplikasyon oranı %4,2 olarak bulundu. Sonuç: Nonpalpabl testis olgularında hem tanı hem de tedavi amacıyla kullanılabilen laparoskopi, düşük komplikasyon oranları ile standart olarak önerilen ve yaygın kabul gören bir yöntemdir.

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

Laparoscopy in the management of impalpable testis (Series of 64 Cases).

Background:The undescended testis represents one of the most common disorders of childhood. Laparoscopy has been widely used both in the diagnosis and treatment of non-palpable testis. In this study, we investigated and evaluated the usefulness of laparoscopy in the diagnosis and treatment of no palpable testis.Patients and Methods:From January 2003 to January 2008, we used laparoscopy in the management of 64 patients with 75 impalpable testes. Their ages varied from 1 to 15 years (median age = 4.6 years). The site and the size of the testes were localised by abdominopelvic ultrasonography in all 64 children for accurate diagnosis. One stage laparoscopic orchiopexy was performed in 26 testes, staged Fowler-Stephens orchiopexy was underwent in 17 testes, while laparoscopic orchidectomy was done in 5 testes. Follow-up by clinical examination and colour Doppler ultrasound was performed in every patient who underwent orchiopexy.Results:There were 11 patients with bilateral non-palpable testes. The overall diagnostic agreement of ultrasound with laparoscopy was seen in only 16 out of 75 testes (21.3%). The results of diagnostic laparoscopy were varied and showed various pathological. Conditions and positioned of the testes, such as 20 low intra-abdominal testes (26.6%), 17 testes were high intra-abdominal (22.7%), and 18 testes (24%) entered the inguinal canal. Associated inguinal hernia was present in 4 patients. After a mean follow-up period of 26 months (6 months – 5 years), all testes were in the bottom of the scrotum except 3 testes were retracted to the neck of the scrotum and atrophy of the testis occurred in 2 patients (2.7%).Conclusion:Laparoscopy has proven to be the only diagnostic modality where the findings provide a clear dependable direction for the definitive management of impalpable testes, so it allows an accurate diagnosis and definitive treatment in the same sitting.

Laparoscopy in the Management of Impalpable Testis: Series of 64 Cases

The undescended testis represents one of the most common disorders of childhood. Laparoscopy has been widely used for the diagnosis and treatment of non-palpable testis. In this study, we investigated and evaluated the usefulness of laparoscopy in the diagnosis and treatment of the non-palpable testis. From January 2003 to January 2008, we used laparoscopy in the management of 64 patients with 75 impalpable testes. The patients' ages varied from 1 to 15 years (median 4.6 years). The sites and sizes of the testes were localized by abdominopelvic ultrasonography (US) in all 64 children. One-stage laparoscopic orchiopexy was performed for 26 testes, staged Fowler Stephens orchiopexy for 17 testes, and laparoscopic orchidectomy for five testes. Follow-up by clinical examination and color Doppler US was performed in every patient who underwent orchiopexy. There were 11 patients with bilateral non-palpable testes. The overall diagnostic agreement of US with laparoscopy was seen for only 16 of 75 testes (21.3%). The results of diagnostic laparoscopy were varied and showed various pathologic conditions and positions of the testes, such as 20 low intraabdominal testes (26.6%), 17 high intraabdominal testes (22.7%), and 18 testes (24%) that had entered the inguinal canal. Associated inguinal hernia was present in four patients. After a mean follow-up period of 26 months (6 months-5 years) all testes were seen to be located in the bottom of the scrotum, with the exception of three testes that had retracted to the neck of the scrotum and two testes that had atrophied (2.7%). Laparoscopy has proven to be the only diagnostic modality where the findings provide a clear, dependable direction for definitive management of impalpable testes. It allows an accurate diagnosis and simultaneous definitive treatment.

Laparoscopic diagnosis and treatment of nonpalpable testis

Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1%) had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

LAPAROSCOPIC ORCHIDOPEXY

Design Case series. Setting: Pediatric surgical department of B V Hospital(QAMC) Bahawalpur and Allied Hospital Faisalabad. Period: From April 2005 to Mar 2007. Material &amp; Methods:Cryptorchidism is most frequent presentation in pediatric population. Laparoscopy has become “Gold Standard” in thediagnosis and therapy of nonpalpable undescended testis. We present our two year experience in the managementof 40 cases at two centers. The age of the patients ranged from 9 months to 12 years. Laparoscopy was done tolocalize the testis prior to surgery. Thirty four patients underwent one stage laparoscopic orchidopexy, 7 patients hadopen orchidopexy and 3 needed two stage Fowler-Stephen orchiodopexy. Laparoscopy is a valuable tool in bothdiagnosis and treatment of nonpalpable testis.

The use of laparoscopy in the management of nonpalpable undescended testes

The stable incidence of undescended nonpalpable testes and the ever-progressing utilization of laparoscopy has led to the commonplace utilization of laparoscopy in the diagnosis and treatment of these nonpalpable testes. The historical published literature is ambiguous with regard to recommendations regarding the use of laparoscopy in the setting of nonpalpable testes. As a result, this review is timely and necessary in that it is important for the practicing physician and surgeon to review and have available to them the current recommendations for the management of patients with nonpalpable testes. With ongoing advances of minimally invasive surgery in the face of the limitations of both ultrasound and magnetic resonance imaging, the use of laparoscopy in the diagnosis and treatment of nonpalpable testes is now commonplace. Several reports recommend laparoscopy as the gold standard for the evaluation and treatment of nonpalpable testes, allowing for localization of the testis, characterization of the testis and associated structures (vas deferens, testicular vessels) and subsequent treatment options. Because of the superior diagnostic capabilities and the ability to provide therapeutic interventions, laparoscopy should be used in the evaluation and treatment of all patients with nonpalpable testes.

P-236A The usefulness of laparoscopy for diagnosia and treatment of non palpable testis(Urology 2, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-236A The usefulness of laparoscopy for diagnosia and treatment of non palpable testis(Urology 2, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

Single stage Fowler–Stephens orchidopexy: a preferred alternative in the treatment of nonpalpable testes

In this present study we aimed to discuss the surgical efficacy of single stage Fowler-Stephens orchidopexy (FSO) technique, with an emphasis on its practical and logical application that may be kept in mind during a standard orchidopexy procedure. Twenty-two children have undergone a single stage FSO procedure for nonpalpable testes during the last 9 years in our department. Surgical procedure was initiated with a standard inguinal oblique incision keeping in mind that depending on the position and the anatomic features of the testes a FSO method might be needed. While an excellent result was defined as a testis with good scrotal position, size and adequate blood flow on Doppler sonogram, acceptable result was a palpably normal sized testis in a high scrotal position with adequate blood supply and lastly an unacceptable result was the atrophy of the testis with compromised blood supply. During regular follow-up visits although some cases revealed testicular atrophy; long-term examination (12 months) did show that majority of the testes maintained their normal position and tissue consistency (21/24, 87.5%). Due to the necessity of surgical approach either in the evaluation or the treatment of nonpalpable testes in most cases along with the unsatisfactory data of the time consuming and invasive radiological procedures; we believe that a classical orchidopexy approach together with further single stage FSO will be a rational and satisfactory algorithm in the majority of such cases.

Guideline for the Surgical Diagnosis and Treatment of Nonpalpable Testis Based on Experiences with Laparoscopic Procedure

Purpose: We assessed our laparoscopic experiences for the children with nonpalpable testis to evaluated the advantages of performing laparoscopy and we suggest a surgical management guideline for them. Materials and Methods: We retrospectively reviewed the medical records of a total of 83 children(97 testes) who underwent diagnostic laparoscopy for nonpalpable testes. We analyzed the surgical decisions and outcomes according to the laparoscopic findings. Results: On the laparoscopic examination, 48(49.5%) testes were located in the abdominal cavity. We subsequently performed inguinal orchiopexy (28), laparoscopic orchiopexy(8), Fowler-Stephens orchiopexy(10, one or two stage), or orchiectomy(2). The other 40(41.2%) were suspected to be testicular nubbin, and we managed this by excision of the testicular nubbin by the inguinal(29) or scrotal(10) approach, except for one viable testis in the inguinal canal. When blind-ending vessels were observed, we stopped the procedure under the diagnosis of vanishing testis in 9 cases(9.3%). The testicular survival rates were 92.6%(25/27) for inguinal orchiopexy, 100%(8/8) for laparoscopic orchiopexy and 60%(6/10) for Fowler-Stephen orchiopexy. Conclusions: We preferred laparoscopic orchiopexy for treating intraabdominal testis when the location was 2.5cm from the internal ring. When the testicular location was closer to the internal ring, we recommend inguinal orchiopexy as a viable option. In cases with high riding testis or very short internal spermatic vessels, we recommend Fowler-Stephens orchiopexy. For the suspected testicular nubbin, we preferred trans-scrotal excision when the nubbin was identified in the scrotum. Otherwise, we recommend inguinal exploration.

Advantages of Video-Assisted Approach in Detecting Epididymal Anomalies and Treatment of Nonpalpable Testis

In children with a nonpalpable abdominal testis, preoperative localization is very helpful prior to surgical investigation both to reduce the time required and to plan the correct surgical procedure. It is no doubt that laparoscopy is useful in both diagnosis and management of nonpalpable testis. In this study, 15 patients with 17 nonpalpable testes admitted to our clinic in 2 years period were evaluated retrospectively. Ultrasound study was performed in all patients after detailed physical examination. Testicular location, size, and configuration of epididymis were determined by laparoscopy and compared with ultrasound findings. Laparoscopy, in conjunction with ultrasound, permits not only a better localization and anatomy of the testis but is also superior in planning the best choice of management. We believe that the video-assisted inguinal approach is a feasible method in the treatment of nonpalpable testis when compared to pure open surgery.

Laparoscopic Assessment and Treatment of Non-Palpable Testis in an 18-Year-Old Male

Laparoscopy, both diagnostic and therapeutic, has been used in the management of pediatric non-palpable testes. We report a case of left non-palpable testis at the unusual age of 18 years. Laparoscopic exploration revealed an intra-abdominal testis lying between the internal inguinal ring and external iliac vessels. The testis was visually in good condition and, in contrast to the accepted procedure of orchiectomy performed in late adolescent cryptorchidism, we decided to preserve this intra-abdominal testis, which was located too far from the scrotum for a primary orchidopexy. The first stage of the Fowler-Stephens procedure was performed laparoscopically. The second-stage orchidopexy was performed successfully through an inguinal approach 3 months later, after sonographic ascertainment of non-decreased testicular volume. Laparoscopy allows thorough exploration for an intra-abdominal testis, with simultaneous therapeutic options. Our experience highlights the feasibility of laparoscopic assessment and treatment of cryptorchidism in adolescents and young adults.

The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis

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.

Adult nonpalpable testis: is laparoscopy always required?

Laparoscopy is widely used in the diagnosis and treatment of nonpalpable testes. Some nonpalpable testes are vanishing testes. In such cases, unnecessary laparoscopic interventions can be avoided by a careful selection of cases. Between 1996 and 2001, laparoscopic intervention was applied to 107 patients with nonpalpable testes. Of the cases, 23 were bilateral and 84 were unilateral. Patients were between 19 and 27 years of age (average age, 23 years). Diagnostic ultrasonography was performed in 44 of the 84 patients with nonpalpable testes. Dimensions of the scrotal testis were determined by the Prader orchiometer method. The dimensions of the opposite scrotal testis (of the scrotal nubbin) and the abdominal testis were compared with the dimensions of 20 normal, healthy individuals' scrotal testis (control group). Results were evaluated by the Mann-Whitney U test. During laparoscopy, 24 (28.5%) of the patients were found to have a vanishing testis. The vas deferens and the testicular blood vessels ended bluntly at the anterior edge of the interior inguinal ring in one patient, inside the inguinal canal in five patients, and in the scrotum in 18 patients. Among the 84 patients with nonpalpable testes, no testis was found in any of the 18 patients with palpable scrotal nubbins. The opposite scrotal testes were hypertrophic in 17 (70.8%) of 24 patients who had vanishing testis (P < .05), and they were hypertrophic in 22 (36%) of the 60 patients (P > .05) who had laparoscopically identified intraabdominal testes. We conclude that clinical and radiologic diagnosis is sufficient for adult patients with nonpalpable testicles and palpable scrotal nubbins and hypertrophic contralateral scrotal testes. Laparoscopic intervention should be applied to patients who do not have palpable scrotal nubbins.

Laparoscopic diagnosis and treatment of nonpalpable testis.

Laparoscopy has become one of the important diagnostic modalities of nonpalpable testis and has been developed and applied in the treatment of this disease. In the present study, we investigated the usefulness of laparoscopy in the diagnosis and treatment of nonpalpable testis. Laparoscopy was carried out under general anesthesia on 21 patients (23 testes) from October 1991 to October 1999. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected with an incision in the inguinal region to look for the testis. Patients with intra-abdominal testis underwent laparoscopic orchiopexy or orchiectomy. If the internal spermatic vessels terminated with a blind end intraperitoneally, making it impossible to identify the testis, the case was judged to be vanishing testis and the operation was finalized without any further examination. In eight of 23 testes (35%), the internal spermatic vessels and vas deferens made their way into the internal inguinal ring. The inguinal region was examined in all the eight testes. Orchiopexy was carried out on two testes and orchiectomy was carried out on six testes. An intra-abdominal testis was detected in eight of 23 testes (35%). Laparoscopic orchiopexy was carried out on seven testes. One-stage orchiopexy was carried out on two of the seven testes and two-stage Fowler-Stephens orchiopexy was carried out on five of the seven testes. Orchiectomy was carried out on the remaining testis. Blocking or lack of the internal spermatic vessels and vas deferens was seen in seven of the 23 testes (30%) and this condition was diagnosed as vanishing testis. Laparoscopy for nonpalpable testis is considered to be the most effective technique for diagnosing the presence or absence of the testis and the location of the testis.

Laparoscopic orchidopexy in children.

Cryptorchidism is a common condition in boys. Approximately 20% of undescended testes are nonpalpable and may be located within the abdominal cavity. Given the potential of these gonads for malignant transformation and infertility, it is essential to determine the presence or absence of a nonpalpable testis. Radiologic imaging and open surgical exploration have proved to be unreliable. In the hands of experienced surgeons, laparoscopy has become the method of choice for evaluating the nonpalpable testis. An increasing number of surgeons are applying laparoscopy in the treatment of nonpalpable testes, and early results are encouraging. Both diagnostic and therapeutic laparoscopy necessitate operative skills. The exact advantages of laparoscopy over conventional surgery in orchidectomy and single- or two-stage orchidopexy need to be determined.

Laparoscopic-Guided Second-Stage Fowler–Stephens Procedure for Nonpalpable Testis in Children

ABSTRACT Laparoscopy has become the standard approach in the treatment of nonpalpable testis in children. Usually, in the two-stage operation, the laparoscope is used for locating and dividing the ...

Laparoscopic orchiectomy

Laparoscopy has proved to be the most reliable technique in the diagnosis and treatment of nonpalpable testis found in almost 20% of cryptorchid cases. Possible applications are laparoscopic exploration in order to visualise a vanishing testis, Fowler-Stephens orchidopexy and orchiectomy. In orchiectomy, the use of laparoscopy is indicated in adults with single nonpalpable testis, while it is reasonable to use it in severely compromised cases when there is a bilateral nonpalpable testis. Finally it should be used when severe testicular hypotrophy is found. We performed laparoscopic orchiectomy in 6 men at the Departments of Urology of Sassari and Trieste from 1991 to 1996. The mean time of the operation was 1 hour and 50 mins with 1 day hospitalisation. No complications occurred.