title: Impalpable testis: laparoscopy or inguinal canal exploration?
abstract: OBJECTIVE
  There is great controversy regarding the best approach to impalpable testis. In this retrospective study we evaluated the accuracy of intraperitoneal laparoscopy, inguinal canal exploration and ultrasound in the diagnosis of impalpable testis.
  
  
  METHODS
  Over a 2-year period (2004-06), 76 patients with a diagnosis of uni- or bilateral clinically impalpable testis were referred to our center. A preoperative ultrasound evaluation was done and all patients underwent intraperitoneal laparoscopy. An inguinal canal incision and exploration was done in all cases except for patients with high intra-abdominal testes (> 2 cm above the internal ring), for whom laparoscopic dissection, mobilization and orchidopexy were necessary.
  
  
  RESULTS
  The mean age of the patients was 15.36 years (range 1-39 years). The undescended testis (UDT) was right-sided in 25% of patients, left-sided in 41% and bilateral in 34%. Intraperitoneal laparoscopy, inguinal canal exploration and ultrasound detected 70.6%, 78.4% and 15.6% of testes, respectively.
  
  
  CONCLUSIONS
  Laparoscopy changed the management protocol of impalpable UDT in only 21% of cases. Inguinal canal exploration alone was sufficient in the majority of our cases. We recommend laparoscopy for those patients with impalpable UDT in whom an initial inguinal canal exploration proves negative.
authors.affiliation: Urology Nephrology Research Center, Shahid Labbafinejad Hospital, Shaheed Beheshti Medical University, Tehran, Iran. fsharifiaghdas@yahoo.com
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.forename: Faramarz M A
authors.initials: FM
authors.lastname: Beigi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*