Page 5 - Journal of WALS

WJOLS

Role of Laparoscopy in Diagnosis and Management of Nonpalpable Testes
Hospital Stay are not considered as absent testes. Approximately 36 to 64% of

Basically, this was a day procedure and patients were discharged children with nonpalpable would actually be monorchid. In our
home except for 10 (15.6%) who stayed overnight and six (9.4%) series three testes were not seen. To have accurate intraoperative
stayed for 48 hours. assessment of the viability of the testes it is suggested that in
future intraoperative Doppler scan of the testes could be done.
Follow-up We believe this, combined with improved technique good patient
For a period of 6 months to 5 years patients had follow-up selection (appropriate age for orchidopexy should be between
during which each patient who underwent orchidopexy had 6 to 12 months) would give better outcomes.
clinical examination and Doppler ultrasound scan. All testes CONCLUSION
which underwent one stage laparoscopic orchidopexy were
located in their respective hemiscrotums and are of good size Laparoscopy has proven to be an effective and accurate method
with Doppler confirming their viability. Two were, however, of diagnosis of nonpalpable (intra-abdominal) testes as it
retracted high up the scrotum. Only two of the testes which had enables accurate determination of anatomical localization as
orchidopexy by a two stage Fowler-Stephens procedure were well as viability. It is also comparatively an effective tool for
found atrophic. The rest were normally placed in the scrotum. definitive management of nonpalpable testes in which case the
simultaneous surgical correction of the anomaly makes it more
DISCUSSION acceptable. This minimal access technique makes open
Since the first reported case of laparoscopy in the diagnosis exploration of the abdomen difficult-to-find testes unnecessary.
and management of nonpalpable testes was reported over 25 REFERENCES
years ago, there are thousands of documented cases now
showing the impact of laparoscopy in the management of 1. Williams EV, Appanna T, Foster ME. Management of
nonpalpable (intra-abdominal) testes. The principles of surgery impalpable testis: A six-year review together with a national
experience. Postgrad Med J 2001;77:320-22.
has been enhanced as exposure, lighting and magnification, 2. Gatti JM, Ostlie DJ. The use of laparoscopy in the management.
which are crucial to the success of pediatric procedures, are Pediatric of nonpalpable undescended testes. Curr Opin
achieved. Besides accurate assessment of testicular position in 2007;19:349-53.
the abdominal cavity as well as their viability, which are essential 3. Barqawi AZ, Blyth B, Jordan GH, et al. Role of laparoscopy in
to good surgical outcomes, are taken care of. 12,13 Moore et al patients with previous negative exploration for impalpable testis.
Urology 2003;61:1234-37.
and Tennenbaum et al in 1994, reported the accuracy of testicular 4. Rosito NC, Koff WJ, Olivera TL, et al. Volumetric and
localization by laparoscopy to be greater than 95%. Radiographic histological findings in intra-abdominal testes before and after
imaging studies according to Hrebinko and Bellinger (1993) division of spermatic vessels. J Urol 2004;171:2430-33.
and Siemer et al (2000) carry unacceptable false-negative and 5. Kucheria R, Sahai A, Sami TA, et al. Laparoscopic management
of cryptorchidism in adults. Eur Urol 2005;48:453-57.
false-positive rates and are more invasive. 14,15 Some authors 6. Chew H, Hutson JM. Incidence of cryptorchidism and ascending
even report that abdominopelvic ultrasonography rarely locates testes in trisomy 21:A 10-year retrospective review. Pediatr
intra-abdominal testes and in only 18% cases correctly identifies Surg Int 2004;20:744-47.
testes located in the inguinal canal. Bakr and Kotb (1998) found 7. Storey DW, Mac Kinnon AK. The laparoscope and the
that magnetic resonance imaging detected only 37% of cases. undescended testis. J Pediatric Sur 1992;27:89-92.
Laparoscopic management of nonpalpable testes has gained 8. Cortesi D, Ferrari P, Zambarda E. Diagnosis of bilateral
cryptorchidism by laparoscopy. Endoscopy 1976;8:33-34
considerable acceptance since it was first described by Jordan et Quoted from BJM Int 87:490-93.
al in 1992. Chang et al (2001) reported 85% success rate for one 9. Scott JES. Laparoscopy as an aid in the diagnosis and management
stage or two stage Fowler-Stephens procedure with 4% failure of impalpable testes. J Pediatr Surg 1982;17:14-16.
rate. This technique is now being used in many centers. Potential 10. Alam S, Radharkirishnan J. Laparoscopy for nonpalpable testes.
J Pediatr Surg 2003;38:1534-36.
major complications include vascular injury, bowel injury and 11. Bargawi AZ, Blyth B, Jordan GH, et al. Role of laparoscopy in
bladder perforation. Fortunately with an open Hasson technique patients with previous negative exploration for impalpable testis.
of trocar placements these complications are rare. Other minor Pediatr Urol 2003;61:1234-37.
complications, such as hematoma, subcutaneous insufflations 12. Tennenbaum SY, Lerner SE, McAleer IM, et al. Preoperative
do not require conversion to open technique. laparoscopic localization of the nonpalpable testes: A critical
analysis of a 10 years experience. J Urol 2000;164:154-55.
In our series, laparoscopy was used as a tool for diagnosis 13. Chang B, Palmer LS, France I. Laparoscopic orchidopexy:
and definitive management of nonpalpable (intra-abdominal) A review of a large clinical series. Br J Urol 2001;87:490-93.
testes in 64 patients over a period of 5 years (2003-2008). 14. Elder JS. Ultrasonography is unnecessary in evaluating boys
Laparoscopic Fowler-Stephens orchidopexy was performed for with a nonpalpable testis. Pediatrics 2002;110:748-51.
43 testes (57.4%) and eight (10.6%) by open orchidopexy. 15. Siemer S, Humke U, Uder M, et al. Diagnosis of impalpable
testes in childhood: Comparison of magnetic resonance imaging
We describe testes as vanishing if the vas and vessels end and laparoscopy in a prospective study. Eur J Pediatr Surg
blindly either in the abdomen or close to the internal ring. These 2000;10:114-18.

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