Management of the impalpable testis: a six year review together with a national experience

Abstract

The management of undescended testes remains variable, and the use of laparoscopy for localisation is controversial. This study reviews the need for laparoscopy and also assesses the current practice among a cohort of surgeons.A retrospective review of all patients undergoing orchidopexy was performed, together with a postal survey of all members of the Welsh Surgical Society.Of the 139 orchidopexies performed, the testis was deemed impalpable in 39 (28%) cases. All patients were treated with groin exploration, and only in two (5%) patients was the testis not located. From the survey, replies were received from 90 (81%) surgeons, of whom 65 (72%) were still performing orchidopexy. Forty eight (74%) surgeons performed orchidopexy between the age of 2 and 3, and only 32 (36%) performed preoperative investigations. The follow up period was variable with the majority of patients seen at six weeks.Laparoscopy for the impalpable testis is not initially warranted. An inguinal exploration is regarded as the definitive investigation. This has the advantage of providing the diagnosis and treatment in the majority of cases. (Postgrad Med J 2001;77:320-322) Keywords:cryptorchidism; impalpable testis; orchidopexy; laparoscopy Cryptorchidism means hidden or obscure testis, and is generally synonymous with an undescended testis. Of newborn boys, between 1% and 3% have an empty scrotum, 1 thus making cryptorchidism one of the most common surgical disorders in childhood. Although its aetiology is unclear, the definitive treatment for true undescended testes is surgical placement into the scrotum, thereby improving fertility and decreasing the malignant potential.The majority of cryptorchid testes are palpable but incompletely descended into the scrotum. As many as a third of these testes will likely be retractile when examined.2 However, the non-palpable gonad constitutes 20% of all cases.3 It may be located anywhere between the upper scrotum and abdomen, or may even be absent. Accurate preoperative localisation of the non-palpable testes has been diYcult, and its need disputed. We conducted a study to answer the question: was groin exploration a correct method for diagnosis and treatment of the impalpable testis, or is laparoscopy indicated? We set out to look at our own experience and also to evaluate the current practice within a cohort of surgeons. Subjects and methodsThe first part of this study was a retrospective review of a single consultant's (MEF) experience of all patients who underwent orchidopexy between June 1991 and August 1997. The surgeon was a general surgeon who had a special interest in paediatric surgery, and worked in a district general hospital. These patients were identified from clinical coding and theatre registers. Orchidopexy for reasons other than undescended testes were excluded. Case notes were reviewed for details of age, side of undescended testis, preoperative palpability, and the type of operation performed.The second part was a survey comprising a single sheet questionnaire (appendi...

Magnetic resonance imaging for detection of non palpable undescended testes: Diagnostic accuracy of diffusion-weighted MRI in comparison with laparoscopic findings

“…The accuracy rates of diagnosis and localization of a nonpalpable testis with MRI (85%) and ultrasound (84%) are nearly equally with no statistically significant differences (13,14). Diagnostic laparoscopy has been established as the most reliable diagnostic technique for localizing nonpalpable testes with nearly 100% sensitivity and specificity (1,(14)(15)(16), However, it is an invasive technique.…”

“…Undescended testis or cryptorchidism, a condition in which one or both testicles are not appropriately positioned in the scrotum at birth (1). It is the most common congenital genitourinary anomaly in boys and has an incidence of 1-3% in term and 15-30% in premature male infants (2,3).…”

Inguinal Exploration for the Management of Impalpable Undescended Testes

“…al. reported that in 37 of impalpable testes, inguinal exploration was suffi cient for deciding and executing treatment 15 . Adam and Allaway reported good results with inguinal exploration followed by intraperitoneal approach for 110 impalpable testes.…”

Hodenhochstand und Infertilität unter besonderer Berücksichtigung der interdisziplinären Leitlinie

“…Beide Methoden sind als gleichwertig zu betrachten. Da in etwa 5% der Fälle die Operation mit dem ge wählten Verfahren nicht erfolgreich been det werden kann, sollte während des Ein griffs auf das jeweils andere Verfahren ge wechselt werden können [35,36]. Bei 9,8% der Jungen wird bei abdominalen Hoden eine Hodenaplasie diagnostiziert [13].…”