Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis.
OBJECTIVE
We reviewed the histological findings of cord structures excised at inguinal exploration after diagnostic laparoscopy in patients with a nonpalpable testis with the vas deferens and spermatic vessels exiting the internal inguinal ring in the absence of a patent processus vaginalis.


METHODS
A retrospective review of 809 laparoscopic explorations for nonpalpable testes between 1981 and 2003 was conducted. The histological findings of the excised remnants of those patients with a closed processus vaginalis were reviewed.


RESULTS
A total of 110 patients underwent excision of a testicular remnant at inguinal exploration in association with a closed processus vaginalis. Of the specimens 31 (28%) were on the right side and 79 (72%) were on the left side. The incidence of viable germ cell elements was 8 of 110 (7%). The presence of hemosiderin, calcification and fibrosis was identified in all 8 remnants with viable germ cell elements.


CONCLUSIONS
The incidence of viable germ cell elements in the excised remnant when the vas deferens and spermatic vessels are identified exiting a closed internal ring in patients with a nonpalpable testis is 7%. To our knowledge no prior study has evaluated the incidence of viable germ cell elements in remnants associated with a closed internal inguinal ring. Based on these findings, we advocate inguinal exploration and excision of testicular remnants in these patients.
Renzulli
Joseph F
JF
Yale University School of Medicine, New Haven, Connecticut, USA.
Shetty
Rashmi
R
Mangray
Shamlal
S
Anderson
Kevin R
KR
Weiss
Robert M
RM
Caldamone
Anthony A
AA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000002:abnormalities; D013737:Testis / Q000002:abnormalities*; D014649:Vas Deferens / Q000002:abnormalities