The value of laparoscopy for impalpable testes.
Impalpable testes constitute up to 20% of cases of undescended testes and present both a diagnostic and a therapeutic problem. Knowledge of testicular site prior to orchidopexy is useful in planning surgical strategy. Misdirected blind inguinal exploration can be avoided. Many imaging techniques are time-consuming and expensive and can neither confidently locate an impalpable testis nor exclude its absence. Recently laparoscopy has been advocated as a safe and efficient method of identifying presence and site of an impalpable testis. The first stage of a divided-vessel orchidopexy may also be performed simultaneously. Fifty children with 60 impalpable testes--40 unilateral and 10 bilateral--underwent laparoscopic examination prior to groin exploration. In 5 (8%) an inguinal testis was found which had been missed on pre-operative palpation. The testis was absent in 23 (38%), of whom 13 had a limited negative groin exploration because cord structures were seen entering the internal ring. In 30 (50%) an intra-abdominal testis was identified; 14 were relocated into the scrotum with a standard orchidopexy, 16 required a divided-vessel orchidopexy. In 2 (4%) intra-abdominal testicular remnants were removed. There was no operative morbidity. We conclude that laparoscopy is a useful technique in the management of children with impalpable testes. Open perumbilical insertion of the trochar is a safe method of introducing the telescope into the peritoneal cavity. In addition to accurately identifying a testis in 60%, 40% were spared the pain and morbidity of an extensive groin exploration.
Brown
R A
RA
Department of Paediatric Surgery, University of Cape Town.
Millar
A J
AJ
Jee
L D
LD
Cywes
S
S
D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D013737:Testis / Q000601:surgery*