Laparoscopic management and its outcomes in cases with nonpalpable testis

Abstract

Objective: Diagnostic laparoscopy is the gold standard in the algorithm of nonpalpable testis. Testicular tissue is examined and treatment is planned accordingly. In this study we reviewed the place of diagnostic laparoscopy, and evaluated the results and effectiveness of laparoscopy in the diagnosis and management of nonpalpable testis. Material and methods:Children who had diagnostic laparoscopy for nonpalpable testes were included in the study. Physical examination results, ultrasonography (USG) reports, age at surgery, laparoscopic and inguinal exploration findings, surgical procedures, orchiopexy results, early and late-term complications were evaluated. Follow-up visits were performed at 3-month intervals for the first, at 6-month intervals for the 2. year, then at yearly intervals. Testicular size and location was evaluated by during control examination.Results: Overall 58 boys, and 68 testes (26 left: 44.8%; 22 right: 37.9%, and 10 bilateral: 17.2%) were included in the study. Mean age at surgery was 5.5 years (10 months-17 years). Diagnostic value of USG was 15.7%. Diagnostic laparoscopy findings were as follows: Group 1: blind-ended vessels, n=7 (10.2%); Group 2: intraabdominal testes, n=8 (11.7%); Group 3: vas and vessels entering internal ring, n=53 (77.9%). Overall 43 testes underwent orchiopexy, which were normal (n=8) or hypoplastic (n=35). Mean follow-up period was 19 months (1-12 years), and on an average 7 visits were performed (5-14). On follow-up, 5 testes were normal-sized and located in the scrotum, while 4 testes were atrophic and underwent orchiectomy. Two testes were found in the inguinal canal and redo orchiopexy was performed. Control USG revealed reduced testicular blood supply and volume. Conclusion:Laparoscopic surgery is safe and effective in the management of nonpalpable testes. In the majority, routine use of diagnostic laparoscopy in the algorithma does not confer any additional contributions in many patients.

Our experiences of laparoscopy in the non-palpable testes

“…None of the current imaging techniques such as USG, CT or MRI performed to detect the presence or absence of non-palpable testicles have shown 100% reliability [8]. In the study of Erdoğan C et al, they were able to detect the location of only three testicles (15.7%) in USG performed for nineteen testicles [9]. For this reason, some authors have recommended the use of laparoscopy, which can provide diagnosis and treatment, when necessary, as the first choice without resorting to another imaging method [10,11].…”

Laparoscopic management of nonpalpable testis: 5 years’ experience at Dhaka Shishu (Children) Hospital

“…8 Nowadays, laparoscopic procedure is a gold standard in the management of patients with a Nonpalpable testis for localization and to plan subsequent surgical management in many centers. 10 Wide screen behereour institutional experience with laparoscopic management of Nonpalpable testes in children over the last 5years.…”