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Abstract
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.
Figures and Tables
Fig. 1
Findings of the diagnostic laparoscopy in the patients with nonpalpable testis. (A) Intra-abdominal testis: (a) the testicular location is <2.5cm from the internal ring, (b) the testicular location is ≥2.5cm from the internal ring, (c) very high level of testis or an inadequate length of internal spermatic vessels. (B) Suspicious testicular nubbin. (C) Vanishing testis.
Fig. 2
Guideline for the surgical management of nonpalpable testis according to the findings on diagnostic laparoscopy. IR: internal ring, IS: internal spermatic. *Two cases are orchiectomized - teratoma (1 case), very high location and inadequate vessels (1 case).
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