Ces Urol 2011, 15(2):101-107 | DOI: 10.48095/cccu2011018

Impalpable testis, what first: diagnostic laparoscopy or inguinal exploration?

Marcel Drlík, Radim Kočvara

Oddělení dětské urologie, Urologická klinika 1. LF UK a VFN, Praha

Aim:
Management of impalpable testis remains controversial so far. Although laparoscopy has been accepted by many paediatric urologists as a diagnostic approach of choice, the others advocate primary inguinal exploration due to its simplicity. The aim of this study was to evaluate the benefit of diagnostic laparoscopy in the management of impalpable testis.

Material and methods:
We reviewed the findings of diagnostic laparoscopy performed on 57 boys (18 right side, 31 left side, 8 bilateral) with 65 impalpable testis from January 1999 to January 2010. The patients age varied from 4 months to 17 years (mean 47 months). Only impalpable testes, confirmed under general anesthesia, were selected for the study.

Results:
In total of 65 testicular units three groups were created. In 18 cases we found intra-abdominal blind ending internal spermatic vessels and vas (anorchia), cord structures entering the inguinal ring were observed in 22 cases, in 25 cases we found intra-abdominal testis.
In 13 cases intra-abdominal testes were located highly and treated with:two steps Fowler-Stephens operation (6), autotransplantation (2), laparoscopicaly assisted orchiopexy (3) and orchiectomy (2). Remaining 12 cases of intra-abdominal testes were placed close to internal inguinal ring and treated with open orchiopexy through inguinal access.

Conclusion:
Diagnostic laparoscopy is the only reliable method to confirm anorchia or presence of highly located intra-abdominal testis. If all 57 boys underwent open inguinal exploration at first, 31 boys (54%) (18 boys with anorchia and 13 with highly intraabdominaly located testes) should inevitably undergo later laparoscopy and second general anesthesia. Only in 26 boys (46%), the open inguinal exploration could establish final diagnosis. However, hypoplastic testis could be overlooked. Therefore we strongly recommend laparoscopy as an initial diagnostic method of choice. The boys with impalpable testis should be referred to a paediatric urology centre with available laparoscopy equipment and educated staff.

Keywords: diagnostic laparoscopy, impalpable testis, cryptorchism

Received: October 27, 2010; Accepted: November 24, 2010; Published: March 1, 2011