[Impalpable testis: complete inguinal exploration by laparoscopy].
OBJECTIVE
To prospectively evaluate an inguinal approach to surgery for impalpable testis possibly assisted by laparoscopy during the same operation.


METHODS
From January 1996 to March 2002 each case of unilateral impalpable testis was operated via an inguinal incision and laparoscopy was performed during the same procedure whenever the inguinal canal was devoid of any testicular structures. Sixty boys were included in this study. Anatomical features were evaluated and testes were classified according to their trophicity and their site. We evaluated the number of laparoscopies and the factors justifying this procedure. Orchidopexy was performed via an inguinal approach with extensive retroperitoneal dissection to release spermatic vessels, when necessary. A one-stage Fowler-Stephens operation was performed when the vascular pedicle remained too short despite this dissection. The results of orchidopexy were evaluated by physical examination with a minimum follow-up of 4 months.


RESULTS
In this series of 60 cases, we identified 19 viable testes. Fourteen were situated in the abdomen, 3 in the inguinal canal, and 2 in a perineal ectopic position. The other cases were considered to present testicular atrophy. Laparoscopy was performed in 23 boys (38%) in whom no viable or atrophic testis was demonstrated via the inguinal incision. Sixteen of the 19 viable testes were descended by preserving the spermatic vessels with a good result. Two Fowler-Stephens operations gave a good result. One testis was removed.


CONCLUSIONS
An inguinal incision, possibly completed by laparoscopy, appears to be a simple and reliable method of evaluation and treatment of impalpable testis.
Ravasse
Philippe
P
Service de Chirurgie pédiatrique, CHU Côte de Nacre, 14000 Caen. ravasse-p@chu-caen.fr
Petit
Thierry
T
Delmas
Pierre
P
D001284:Atrophy; D002648:Child; D003456:Cryptorchidism / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D013520:Urologic Surgical Procedures / Q000379:methods
Testicule impalpable: exploration inguinale complétée éventuellement par une laparoscopie.