Page 22 - WJOLS - Laparoscopic Journal

WJOLS
REVIEW ARTICLE Diagnostic and Therapeutic Management of Impalpable Testis in the Era of Laparoscopy

Diagnostic and Therapeutic Management of

Impalpable Testis in the Era of Laparoscopy

Shahid Ahmed Shaikh
General Surgery, Ex-Consultant General Surgeon, Kuldhuffushi Regional Hospital, Haa Daal Atoll, Republic of Maldives

Abstract
Undescended testis is one of the common urogenital abnormality encountered. Annandale was the first person to perform orchidopexy
in 1877. At present single stage, Stephen-Flower’s staged, procedure is being carried out for impalpable intra-abdominal undescended
1
testis with open and laparoscopy techniques with various modifications including testicular autotransplant. Cortesi et al were the first to
2
do diagnostic laparoscopy for cryptorchidism in 1976. Jordan et al described laparoscopic orchidopexy in 1992. Since then laparoscopic
method has been gaining popularity, with advances in the field of laparoscopy. In this study, recent articles of impalpable intra-abdominal
testis were reviewed to see the use of laparoscopy in the diagnosis and management.
Conclusions: Diagnostic laparoscopy has become the gold standard for the diagnosis of impalpable testis. Laparoscopy for surgical
correction is gaining popularity in pediatric as well as adult group with more and more surgeons opting for laparoscopic treatment. It can
also benefit the patient and is logical if both diagnosis and surgical correction are combined at one time. 3
Keywords: Laparoscopy, impalpable, orchidopexy, high, cryptorchidism, impalpable, undescended, testis.

INTRODUCTION
This condition has been first described by Hunter in 1786.
The prevalence of imperfect descent of one or both the
testis in boys at 1 year of age is 1%, in full-term male infants
it is 3%, and in premature male neonates it is 33% at birth.
Spontaneous descent is possible until 6 months of age
4
(Fig. 1). Nonpalpable testis account for approximately 20%
of the undescended testis. 4
The aim of the surgery is to mobilize the testis to its
normal position. There is a need for reposition the testis
early into the scrotum to reduce the risk of infertility but
5-7
the subject is still controversial. The incidence of testicular
cancer in males with undescended testis is 40 times more
8
that those without undescended testis. Ten percent of Fig. 1: Sites of ectopic testis
testicular cancer patients are those with undescended
testis. 9,10
There is still a lot of controversy regarding the method • The use of laparoscopy as a diagnostic tool
to be adopted for the mobilization of the testis (single stage • Know the benefits of using laparoscopy in this surgery
or two stage Flower-Stephen, autotransplant) and the results • The outcome of the surgery with the use of laparoscopy
of the various authors vary accordingly. But as our aim in
this study, was to know about the use of laparoscopy in • The opinion of the surgeon about the use of laparoscopy
this procedure, and its benefits from the articles. We strictly in impalpable testis.
adhered to this protocol by not commenting on the surgical
technique. MATERIALS AND METHODS

AIMS AND OBJECTIVES A systematic review of the literature was conducted using
• Review the recent articles to check the use and efficacy search engine, PubMed, google and highwire. All the recent
of laparoscopy in the diagnosis and management of articles were collected which have done laparoscopic surgery
impalpable testis for impalpable intra-abdominal testis irrespective of the age

World Journal of Laparoscopic Surgery, May-August 2010;3(2):75-79 75