The value of laparoscopy in the management of non-palpable testis.
OBJECTIVE
To retrospectively review the value of laparoscopy in the management of impalpable testis.


METHODS
In 1993-2006, 182 laparoscopies for impalpable testis were performed for a total of 194 testicular units. Five laparoscopic findings were considered: testicular ectopia, intra-abdominal testis, and cord structures that are blind ending, completely absent (agenesis) or entering the internal inguinal ring.


RESULTS
In 62 cases an intra-abdominal testis was found; 18 were classified as high and managed by a laparoscopic Fowler-Stephens procedure. Cord structures entering the inguinal ring were observed in 77 patients and 45 underwent an inguinal exploration: a testis was found in 12 cases and in 33 a remnant was excised. In 35 cases, intra-abdominal blind ending vas and vessels were observed and eight showed testicular agenesis. No major surgical complications were recorded. Follow up ranged from 1 to 3 years.


CONCLUSIONS
Our study confirms the value of laparoscopy in the management of non-palpable testis, providing a definitive diagnosis by the direct view of spermatic bundle and testis. Ninety-three patients were managed by laparoscopy only, and in 44 it was essential for the subsequent surgical approach. When the internal inguinal ring is patent and/or normal spermatic vessels are present an inguinal exploration is mandatory.
Papparella
A
A
Division of Pediatric Surgery, Second University of Naples, Via S. Pansini 5, 80131 Naples, Italy. alfonso.papparella@unina2.it
Romano
M
M
Noviello
C
C
Cobellis
G
G
Nino
F
F
Del Monaco
C
C
Parmeggiani
P
P
D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods; D008297:Male