Preoperative Laparoscopic Localization of the Nonpalpable Testis: A Critical Analysis of a 10-Year Experience

Tennenbaum, Steven Y.; Lerner, Seth E.; McAleer, Irene M.; Packer, Michael G.; Scherz, Hal C.; Kaplan, George W.

doi:10.1016/s0022-5347(17)35074-7

Cited by 85 publications

(31 citation statements)

References 30 publications

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“…Tubular structures such as the vas have a different embryological origin than the testis and its supporting vasculature, and cases have been described where the testis and vas were found in strikingly different locations, as was the case in patient 3 [24]. Overall, laparoscopy has been successful in 97–99% of cases in identifying the anatomy accurately [23, 25, 26]. The difficulty remains when no testicle or appendage is found.…”

Section: Discussionmentioning

confidence: 99%

Lost and Found Testes: The Importance of the hCG Stimulation Test and Other Testicular Markers to Confirm a Surgical Declaration of Anorchia

McEachern¹,

Houle

Garel

et al. 2004

Horm Res Paediatr

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Background: In patients with impalpable testes,laparoscopy or open surgery is considered conclusive in establishing the absence of testicular tissue. Methods: Retrospective chart review. Results: Over a 22-year period, 4 out of 82 patients with a diagnosis of bilateral anorchia by laparoscopy or laparotomy had persistent testicular tissue suggested by endocrine evaluations. The clue to the presence of testicular tissue was: (1) a pubertal rise in plasma testosterone (2 patients); (2) the presence of possible Müllerian structures and of a detectable plasma anti-Müllerian hormone (1 patient), and (3) the fact that one of the gonads had not been seen at surgery (1 patient who still had a testosterone response to hCG postoperatively). Testes were localized by venography (3 patients) and laparotomy (1 patient). Conclusion: A surgical diagnosis of bilateral anorchia needs to be confirmed by hCG stimulation, gonadotropin levels, or other markers of testicular function.

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Section: Discussionmentioning

confidence: 99%

Lost and Found Testes: The Importance of the hCG Stimulation Test and Other Testicular Markers to Confirm a Surgical Declaration of Anorchia

McEachern¹,

Houle

Garel

et al. 2004

Horm Res Paediatr

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“…Various diagnostic modalities such as computerized tomography, ultrasonography, and magnetic resonance imaging have been used in attempts to localize the non-palpable testis. Failure to detect the testis cannot be accepted as conclusive evidence of its absence [1,7], however, laparoscopy can accurately detect the presence or absence of an intra-abdominal testis [3,4,6]. In reviewing the English and French literature, no useful laparoscopic classi®ca-tion for impalpable testes was found, and all the classi®cations were based on external examination.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic classification and treatment of the impalpable testis

Hay

Soliman

Rahman

et al. 1999

Pediatric Surgery International

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Laparoscopic orchiopexy has gained popularity in recent years. However, the decision when to perform one-stage laparoscopic orchiopexy without division of the spermatic vessels versus initial ligation of the spermatic vessels followed later by orchiopexy is not clear. A new laparoscopic classification to facilitate decision-making during laparoscopy, according to the position of the impalpable testis and the relation of the spermatic vessels and vas deferens to the internal ring, with a management protocol based on this classification is presented. Over a 2-year period, a total of 37 boys with 52 impalpable gonads underwent a laparoscopic procedure. Four laparoscopic types of testis were noted: type I: no testis visualized; type II: a testis seen at the internal ring with the vas and vessels looping to the internal ring; type III: testis at the internal ring, with vas and vessels going to the testis directly; and type IV: intra-abdominal testis not related to the internal ring. Of the 52 gonads, 19 (36.5%) were type I, 13 (25%) type II, 6 (11.5%) type III, and 14 (27%) type IV. Thirty-three testes were followed up (mean follow-up 8 months); 3 showed atrophy (11%) and 4 were retracted at the scrotal neck after staged, laparoscopic-assisted orchiopexy (LAO). Laparoscopy is of great value for both diagnosis and management of impalpable testes. A classification based on laparoscopic findings will help in planning further surgical action, and LAO is a safe and effective form of operative management for impalpable testes.

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“…If gonads or viable germ cells are present in the inguinal canal, the size and the direction of the vas and the spermatic vessels are well represented and the difference between the normal and the abnormal side can be detected laparoscopically [9,10]. Any ectopic testicular tissue or remnant is potentially at risk for malignant degeneration [10][11][12][13][14]. Some authors have reported the complete absence of viable testicular tissue in specimens excised from patients who underwent inguinal exploration [6,15].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of nonpalpable testes: A multicenter study of the Italian Society of Video Surgery in Infancy

Papparella

Parmeggiani

Cobellis³

et al. 2005

Journal of Pediatric Surgery

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Preoperative Laparoscopic Localization of the Nonpalpable Testis: A Critical Analysis of a 10-Year Experience

Cited by 85 publications

References 30 publications

Lost and Found Testes: The Importance of the hCG Stimulation Test and Other Testicular Markers to Confirm a Surgical Declaration of Anorchia

Lost and Found Testes: The Importance of the hCG Stimulation Test and Other Testicular Markers to Confirm a Surgical Declaration of Anorchia

Laparoscopic classification and treatment of the impalpable testis

Laparoscopic management of nonpalpable testes: A multicenter study of the Italian Society of Video Surgery in Infancy

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