title: Initial scrotal incision for unilateral nonpalpable testis.
abstract: OBJECTIVE
  We investigated use of initial scrotal incision for the management of unilateral nonpalpable testis.
  
  
  METHODS
  Scrotal incision followed by laparoscopy was performed in a consecutive series of 40 boys with unilateral impalpable testis.
  
  
  RESULTS
  Initial scrotal incision revealed 22 scrotal nubbins and 4 extra-abdominal testes among the 40 patients. Of 13 patients with intra-abdominal testis 6 had a looping vas that was dissected to the internal ring via the scrotal incision, and the incision was used for orchiopexy in 12. Laparoscopy detected 1 case of intra-abdominal vanished testis but falsely diagnosed 6 additional cases based upon blind-ending vas and vessels despite a known scrotal nubbin. It also detected 13 intra-abdominal testes but was inconclusive in 14 cases in which vas and vessels exited the internal ring, not including the 4 patients with extra abdominal testes who did not undergo laparoscopy.
  
  
  CONCLUSIONS
  Scrotal incision may be sufficient to diagnose testicular loss when a nubbin is encountered, and can detect an extra abdominal testis not palpated with the patient under anesthesia. The incision is used for orchiopexy in those patients with a testis that can be brought to the scrotum in a single stage. Laparoscopy potentially can be reserved for cases in which no nubbin is found and in all cases when a patent processus vaginalis is encountered.
authors.affiliation: Division of Pediatric Urology, Children's Medical Center and The University of Texas Southwestern Medical Center, Dallas, Texas 75235, USA. warren.snodgrass@childrens.com
authors.forename: Warren
authors.initials: W
authors.lastname: Snodgrass
authors.forename: Kechi
authors.initials: K
authors.lastname: Chen
authors.forename: Clanton
authors.initials: C
authors.lastname: Harrison
mesh_terms: D002648:Child; D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D008297:Male; D012611:Scrotum / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods