title: Importance of scrotum pulling during diagnostic laparoscopy for impalpable testis.
abstract: OBJECTIVE
  To evaluate the significance of a scrotum pulling maneuver during diagnostic laparoscopy for impalpable testis in order to determine whether an initial scrotal or inguinal incision should be carried out.
  
  
  METHODS
  A total of 75 patients undergoing diagnostic laparoscopy were included in the present study. If the vas deferens and spermatic vessels were noted to enter the internal inguinal ring, the affected scrotum was pulled downwards and the movements of the cord structures were observed. If inferior movement of the cord structures at the internal inguinal ring were noted, a scrotal approach was preferred. In the absence of cord structure movement, an inguinal approach was carried out first.
  
  
  RESULTS
  In 59 (76.6%) out of 77 impalpable testes, the spermatic vessels and vas deferens were noted to enter the internal inguinal ring. In 41 of the 59 cases (69.5%), the cord structures were observed to move inferiorly when the scrotum was pulled downwards. In these cases, a scrotal incision was carried out first. In 97% (40/41), a nubbin testis was found and was then excised. In 23% (18/59), the cord structures did not move on pulling the scrotum, and an inguinal approach was initially carried out on these cases. A viable testis was found on the inguinal canal in four cases, and a nubbin testis was excised in 14 cases.
  
  
  CONCLUSIONS
  In patients with impalpable testis undergoing diagnostic laparoscopy, identification of spermatic cord movement along the internal inguinal ring while pulling the scrotum downwards determines the most appropriate surgical approach. This maneuver might also prevent inappropriately placed skin incisions.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jung
authors.forename: Yong Seung
authors.initials: YS
authors.lastname: Lee
authors.forename: Sang Woon
authors.initials: SW
authors.lastname: Kim
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
mesh_terms: D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery*; D003949:Diagnostic Techniques, Surgical; D006061:Gonadal Dysgenesis, 46,XY / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009038:Motion; D011446:Prospective Studies; D012611:Scrotum / Q000601:surgery*; D013085:Spermatic Cord; D013737:Testis / Q000002:abnormalities; D014649:Vas Deferens
keywords: cryptorchidism; laparoscopy; orchiopexy; scrotum; vanishing testes