The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis

Abstract

Objective: Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes.Materials and Methods: Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47%) patients presented nonpalpable testes bilaterally, 7 (14%) only at the right side and 20 (39%) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume.Results: Nine (12%) testes were not localized, but their vessels and deferent duct were atrophic. Two (3%) testes were intra-abdominal and atrophic, and 2 (3%) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25%) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29%) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10%) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17%) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54%) cases, reaching a surgical success of 89%. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12%) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89%. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17%) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77% of good results.Conclusion: Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.

Current management of non-palpable testes: a literature review and clinical results

“…Laparoscopy has become the "gold standard" diagnostic method for non-palpable testis. In addition to being a diagnostic method, it has been an option for treatment this condition (7,19,20,21,22) Figure 1).…”

“…Vessels are preserved by blunt dissection avoiding electrocoagulation. A new internal inguinal ring is created medially to the obliterades ipsilateral umbilical artery, up to the scrotal sac (19); one way to determine if sufficient length of dissection has been achieved is to draw the testis towards the contralateral internal inguinal ring. If the testis does not easily reach the ring, it is simple to further incise the peritoneum lateral to the vessels and provide further mobilization.…”