title: Laparoscopic evaluation of the nonpalpable tests: a prospective assessment of accuracy.
abstract: To assess diagnostic accuracy, laparoscopy and surgical exploration were prospectively performed in 104 children with 126 nonpalpable testes. Laparoscopic localization of the testis was correct in 90% (114 of 126 testes) and was nondiagnostic in 8% largely due to preperitoneal insufflation. No surgical complications occurred. Using the criteria of blind-ending vas deferens and spermatic vessels as diagnostic of an intra-abdominal vanishing testis, the accuracy of diagnosis was 100% but the inability to identify either vas or vessels was associated with intra-abdominal testes in 2 of 3 cases. Identification of canalicular vas deferens and spermatic vessels was associated with testes in 36 of 75 cases (48%). Bilateral nonpalpable testes were significantly less likely to have an absent testes (5%) than a unilateral nonpalpable testis (59%), suggesting the possibility of different pathophysiological mechanisms in those entities. Diagnosis and surgical management of nonpalpable testes were directly impacted by laparoscopy in 42 of 117 testes (36%) by identifying intra-abdominal vanishing testis, the location of an intra-abdominal testes or the need for retroperitoneal exploration when vas deferens and spermatic vessels were not found. Accurate knowledge of testis location in 97% of the testes facilitated development of an appropriate surgical strategy (that is laparoscopic/laparoscopic assisted versus open procedure).
authors.affiliation: Department of Surgery, Children's Hospital, Boston, Massachusetts.
authors.forename: R G
authors.initials: RG
authors.lastname: Moore
authors.forename: C A
authors.initials: CA
authors.lastname: Peters
authors.forename: S B
authors.initials: SB
authors.lastname: Bauer
authors.forename: J
authors.initials: J
authors.lastname: Mandell
authors.forename: A B
authors.initials: AB
authors.lastname: Retik
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006552:Hernia, Inguinal / Q000150:complications; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013737:Testis / Q000098:blood supply; D014649:Vas Deferens