Page 3 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1119
ORIGINAL ARTICLE Role of Laparoscopy in Diagnosis and Management of Nonpalpable Testes
Role of Laparoscopy in Diagnosis and

Management of Nonpalpable Testes

Henry Atawurah
Member of World Association of Laparoscopic Surgeons, Corresponding Member of European Association of Urology Active Member of SIU
Urologist, Effia Nkwanta Regional Hospital, Sekondi, Ghana

ABSTRACT
There is still a lot of controversy among urologists with regard to the treatment of nonpalpable (intra-abdominal) testes. This is a
prospective randomized comparative study between open and laparoscopic orchidopexy for abdominally located testes. It is an
assessment of the usefulness of laparoscopy in the diagnosis and definitive treatment of nonpalpable (abdominally located) testes.
Methods: For a span of 5 years, orchidopexy was performed for 64 patients between the ages of 1 to 15 years (mean age of 4.6 years)
with nonpalpable (intra-abdominal) testes. In all, 75 testes were involved in the study during which some had laparoscopic and open
Fowler-Stephens orchidopexy while others had laparoscopic orchidectomy.
One stage Fowler-Stephens orchidopexy was performed laparoscopically for 28 testes; 17 had two stage Fowler-Stephens
orchidopexy. Laparoscopic orchidectomy was done for five testes. Postoperative follow-up consisted of clinical and color Doppler
utrasonography. This was done for all who underwent orchidopexy.
Results: The diagnostic convergence of US and laparoscopy was 16 out of 75 testes (21.3%). Laparoscopically 20 testes were located
low intra-abdominally (26.6%), 17 were in the category of high intra-abdominal testes (22.7%). 18 testes had entered the inguinal canal
(24%). Four of the patients had associated hernia. Mean follow-up period was 26 months (1 month to 5 years) during which the testes
where found in their respective hemiscrotums except for two testes which had atrophied and three which were retracted up the
scrotum.
Conclusion: Laparoscopy can provide accurate diagnosis of nonpalpable testes and thereby enabling a simultaneous, comparable
definitive treatment.
Keywords: Laparoscopy, Nonpalpable (intra-abdominal) testes, Orchidopexy, Hemiscrotum.

INTRODUCTION PATIENTS AND METHODS
Cryptorchidism (undescended testes), according to independent In accordance with our hospital's protocol all patients underwent
investigators (Scorer and Farrington, 1971; Berkowitz et al, 1993; the following:
Thong et al, 1998) is the most common congenital anomaly (1) History taking; (2) Clinical examination of a relaxed patient in
found at birth and affects 3% or more of full term male newborns. the supine position with warm examining hands. Other common
Approximately 80% of undescended testes are clinically sites for testicular ectopia also inspected; (3) Routine laboratory
1-3
palpable and 20% nonpalpable (intra-abdominal). Intra- examinations and (4) Ultrasonography to locate testes. Testes
abdominal testes can be located anywhere between the lower which were not palpable even after attempts to get them down
pole of the kidney (cephalad) and caudally, the internal ring. the inguinal canal were considered nonpalpable (intra-
Rarely, they are found in the perihepatic and perisplenic regions. abdominal). Laparoscopy was performed for these testes (75)
The consequences of cryptorchidism include infertility, in 64 patients. Based on laparoscopic findings, the testes were
neoplasm, testicular torsion, hernia. The aim of surgery is to categorized according to their location and following definitive
avert these consequences and give the testes better endocrine management were carried out:
function. 4-7 The modalities employed in the diagnosis of 1. One stage laparoscopic Fowler-Stephens orchidopexy. Of
cryptorchidism include US, computed tomography, magnetic the patient who underwent this technique, 20 testes were in
resonance imaging, angiography among others. Many of these lower abdomen and six located at the deep inguinal ring
techniques are associated with false-negative and false-positive (in all 26). The testicular vessels of 14 testes were dissected
results. free from the peritoneum for an adequate length and in a
Diagnostic laparoscopy was first introduced by Cortesi tension free fashion brought down to the respective
9
8
et al and first series in children was described by Scott. The hemiscrotums. Twelve testes had to be delivered through a
use of laparoscopy for the management of nonpalpable testes scrotal peritoneal port. All testes were housed in a sub
was first described by Jordan et al in 1992. It has since proven dartus pouch.
to be versatile and is used widely now for the purpose of 2. Two stage Fowler-Stephens orchidopexy. This technique
diagnosis and definitive management of undescended was employed for 17 testes. Second stage was performed 6
testes. 10,11 months after the first.

World Journal of Laparoscopic Surgery, May-August 2011;4(2):73-75 73