title: Examination under anesthesia for management of impalpable undescended testis: a traditional technique revisited.
abstract: BACKGROUND
  Many new tools for management of impalpable testes have emerged during the last few years, yet, not many studies have compared them to the traditional ways of managing this problem. This work aims to reiterate the importance of the physical examination under general anesthesia prior to the surgical procedure in order to decide the best surgical approach for patients with impalpable undescended testis, especially in developing countries where expensive investigations are at premium.
  
  
  METHODS
  The study included boys who were treated consecutively and recorded prospectively from 2000 to 2010. Examination under anesthesia (EUA) was performed during the study period. Those in whom the testes were palpable underwent the standard orchiopexy procedure. In those boys where EUA failed to detect the testes, laparoscopy or extended inguinal exploration was carried out, and the testes were treated accordingly.
  
  
  RESULTS
  On initial clinical evaluation at the outpatient clinic, 545 boys were recorded to have impalpable testes. Undescended testis was unilateral in 529 boys and bilateral in 16 boys. However, on examination under anesthesia only 189 (34.7 %) were impalpable. Among boys in whom the testes were palpable after EUA, 38 had small-size testes, 18 had normal size, and the remaining 300 boys had a sac or cord-like structure.
  
  
  CONCLUSIONS
  Meticulous EUA facilitates the accurate diagnosis and planning of the surgical approach to patients with an impalpable testis and should remain part of the surgeon's skill set. It is an inexpensive initial evaluation tool that may help in saving hospital resources, especially in developing countries.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, College of Medicine, King Faisal University, Riyadh, Kingdom of Saudi Arabia. ossamaz2004@yahoo.com
authors.forename: Ossama M
authors.initials: OM
authors.lastname: Zakaria
authors.forename: Emad
authors.initials: E
authors.lastname: Hokkam
authors.forename: Karam E
authors.initials: KE
authors.lastname: El Kadi
authors.forename: Waleed H
authors.initials: WH
authors.lastname: Al Buali
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Zakaria
authors.forename: Mohamed Y
authors.initials: MY
authors.lastname: Daoud
authors.forename: Sameh A
authors.initials: SA
authors.lastname: Shehata
authors.forename: Abdulrahman S
authors.initials: AS
authors.lastname: Almulhim
authors.forename: Hamed A
authors.initials: HA
authors.lastname: Alwadaani
mesh_terms: D000768:Anesthesia, General; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery; D003906:Developing Countries; D004534:Egypt; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D009919:Orchiectomy; D056126:Orchiopexy / Q000379:methods; D010808:Physical Examination / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome