title: Laparoscopy for impalpable testis: classification-based management.
abstract: BACKGROUND
  The undescended testis represents one of the most common disorders of childhood. The authors evaluated the safety and efficacy of laparoscopy for the abdominal testis and present a classification of the laparoscopic diagnostic findings to facilitate decision making.
  
  
  METHODS
  Between 2000 and 2005, 95 patients (22 bilateral and 73 unilateral testes, for a total of 117 impalpable testes) with a mean age of 5 years underwent laparoscopy. The testis was managed according to a special classification of the diagnostic findings. Testicular position, size, and viability according to technetium-99m ((99m)Tc) were assessed during the follow-up evaluation.
  
  
  RESULTS
  The laparoscopic findings were classified into six types: type 0 (no testis or vanished testis proximal to the internal ring; 9 patients [7.5%]); type 1 (atrophic intracanalicular testis; 6 patients [5.4%], for whom no further intervention was administered); type 2 (testis at the internal ring with looping vas; 15 patients [14.5%], for whom laparoscopic orchiopexy was performed); type 3 (testis at the internal ring without looping of the vas; 29 patients [24.7%], for whom laparoscopic orchiopexy also was performed; type 4 (high abdominal testes; 49 patients [41.9%], with Staged Fowler-Stephens orchiopexy performed for 47 testes and laparoscopic orchidectomy for 2 testes; and type 5 (persistence of Müllerian duct structures [PMDS] or other abnormalities; 7 testes [6%]). After a mean follow-up period of 3 years, the laparoscopic orchiopexy testes were of good size and viable, but four testes (8.7%) were at the neck of the scrotum. The laparoscopically staged Fowler-Stephens orchiopexy group showed atrophy in two testes (4.3%), and all were in the bottom of the scrotum.
  
  
  CONCLUSIONS
  Classification of the laparoscopic findings facilitates decision making. Laparoscopic orchiopexy is a natural extension of diagnostic laparoscopy for the intraabdominal testis at the internal ring or that seen peeping from it. Laparoscopically staged Fowler-Stephens orchiopexy is the procedure of choice for the high intraabdominal testis not amenable to the one-stage procedure.
authors.affiliation: Department of Urology, Assiut University, Assiut, Egypt.
authors.forename: F
authors.initials: F
authors.lastname: El-Anany
authors.forename: M
authors.initials: M
authors.lastname: Gad El-Moula
authors.forename: A
authors.initials: A
authors.lastname: Abdel Moneim
authors.forename: A
authors.initials: A
authors.lastname: Abdallah
authors.forename: M
authors.initials: M
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Kanayama
authors.forename: A
authors.initials: A
authors.lastname: El-Haggagy
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009919:Orchiectomy / Q000379:methods; D016896:Treatment Outcome