title: Bimanual digital rectal examination for the evaluation of the nonpalpable testis.
abstract: OBJECTIVE
  In the evaluation and treatment of the nonpalpable testis open surgical exploration and laparoscopy are methods used to differentiate abdominal, infrainguinal (below the internal ring) and atrophic or absent testes. We sought to evaluate the use of bimanual digital rectal examination as an additional tool to localize the nonpalpable testis.
  
  
  METHODS
  Forty-one consecutive patients with 45 nonpalpable testes were evaluated in a prospective fashion. Bimanual digital rectal examination was performed with the patients under general anesthesia just before diagnostic laparoscopy or open inguinal exploration. Palpability, location, length and contralateral testicular length were recorded.
  
  
  RESULTS
  Twenty-five gonads or spermatic cords (56%) were palpable using the bimanual technique. All positive examinations were confirmed laparoscopically or by open exploration, and the majority of gonads were intra-abdominal (17 of 25, 68%). Seventeen normal appearing gonads underwent orchiopexy and 8 were removed secondary to atrophy, dysgenesis or poor position. Twenty testes (44%) were not palpated using this method. Of these gonads 10 normal appearing testes were found at exploration and underwent orchiopexy. Of the 10 remaining gonads 6 atrophic testes were removed, and 4 hemosiderin laden remnants were thought to represent "vanished testes." Overall, 26 gonads or remnants were intra-abdominal, 10 were "peeping" or canalicular and 9 were infrainguinal. The overall specificity was 100%, with a sensitivity of 60%. The positive predictive value was 100%.
  
  
  CONCLUSIONS
  Bimanual digital rectal examination is a valuable tool in the evaluation of the nonpalpable testis, and identified the presence and position of the testis in the majority of our cases. Although sensitivity is low, when the testis is palpated by this method, diagnostic laparoscopy to localize the testis may be avoided.
authors.affiliation: Division of Pediatric Urology, University of Kansas School of Medicine/Children's Mercy Hospital, 5520 College Boulevard, Suite 425, Overland Park, KS 66211, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Gatti
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Cooper
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity