title: The management of nonpalpable testis with combined groin exploration and subsequent transinguinal laparoscopy.
abstract: OBJECTIVE
  About 20% of all cryptorchid testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of finding a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration for a nonpalpable testis.
  
  
  METHODS
  While 30 patients each had a unilateral nonpalpable and a contralateral descended palpable testis, 3 had a unilateral nonpalpable and a contralateral undescended palpable testis. When we identified neither a normal testis nor a spermatic cord at exploration of the inguinal canal, we subsequently performed laparoscopic observation through the internal inguinal ring.
  
  
  RESULTS
  Of the 30 patients with a unilateral nonpalpable and a contralateral descended testis 8 required transinguinal laparoscopy. However, the procedure was avoided in 22 patients because the testis, its remnant or testicular vessels and vas deferens were detected by inspecting the inguinal region.
  
  
  CONCLUSIONS
  Further extended incision into a Pfannenstiel incision was unnecessary in cases of blind ending vas and vessels in the peritoneum with transinguinal laparoscopy. In addition, laparoscopy was avoided in 22 of the 30 children (73.3%) with a unilateral nonpalpable and a contralateral scrotal testis. Our strategy of initial inguinal exploration followed by transinguinal laparoscopy for nonpalpable testis may become a reasonable alternative.
authors.affiliation: Department of Urology, Nagoya City University Medical School, Nagoya, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kanemoto
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kojima
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tozawa
authors.forename: Tohru
authors.initials: T
authors.lastname: Mogami
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies