Predictive Value of the Contralateral Testicular Hypertrophy for Testicular Nubbin in Patients with Unilateral Impalpable Testis / 대한비뇨기과학회지

PURPOSE: Many pediatric urologists perform diagnostic laparoscopy for the evaluation of the patients with impalpable testis. While laparoscopic procedure is very useful for accurate localization of the impalpable testis, it has potentially significant complications especially in the less experienced hands. Previous studies demonstrated that the contralateral testicular hypertrophy (CTH) could be induced by hemicastration in prepubertal animals. The CTH can occur in the cases of the testicular nubbin (TN), which is usually removed by inguinal approach. If we can perfectly predict the TN by confirming the CTH, the diagnostic laparoscopic procedure could be omitted in case of unilateral impalpable testis with the CTH. Therefore, we studied to determine the correlation between CTH and TN in children with unilateral impalpable testis. MATERIALS AND METHODS: From May 1995 to May 1998, 22 boys (1-13y) with unilateral impalpable testis were evaluated at our institution. Preoperative ultrasonography was performed to measure the size of the descended palpable testis. The CTH was defined if the longitudinal diameter of the descended testis was greater than the mean +2 S.D. of the normal testicular size in Korean children. RESULTS: In cases with the CTH, the sensitivity and specificity for prediction of the TN were 82% and 91%, respectively. The positive and negative predictive values for TN using the CTH were 90% and 83%, respectively. CONCLUSIONS: The correlation between CTH and TN in unilateral impalpable testis was significantly high (p=0.015), but there were a few exceptional cases. Therefore, we could not replace the diagnostic laparoscopic procedure using the CTH in the evaluation of the children with unilateral impalpable testis.

Assessment of Surgical Methods for Impalpable Cryptorchid Testis / 대한비뇨기과학회지

Management of the impalpable testis is one of the controversial issues in cryptorchidism. So we studied to evaluate the usefulness of laparoscopy and surgical methods for impalpable testis. From January 1992 to December 1993, a total of 36 patients with impalpable cryptorchid was admitted to Seoul National University Children's Hospital. All the patients were examined by laparoscopy under general anesthesia. According to laparoscopic finding, in 15 patients with high abdominal testis, we performed 5 microscopic testicular autotransplantations and 10 testicular vessels transsections(Fowler-Stephens method). In other cases, We performed 9 standard orchiopexies and 6 orchiectomies. Complication of laparoscopy was not experienced. During mean follow up period of 12 months, success rate was 80% in microscopic testicular autotransplantation, 80% in testicular vessels transsection and 91% in standard orchiopexy. Therefore, we think that laparoscopy can be used safely to assess the accurate location of impalpable testis and that surgical methods including testicular autotransplantation are acceptable to high abdominal testis.

Impalpable Testis: Localization and Management / 대한비뇨기과학회지

Between January 1987 and February 1990, records of 5Z patients with 60 impalpable testes who had surgery were reviewed retrospectively regarding localization and management of the testes. Seven out of 60 testes turned out to be palpable by careful examination under anesthesia. Ultrasonogram detected 8 testes (5 intracanalicular and 3 preperitoneal) out of 25 testes. Laparoscopy provided and in planning the appropriate surgical approach in all 8 testes. Of the 47 testes found at surgery 19 were intraabdominal, 14 intracanalicular, 12 in preperitoneal and 1 located in superficial inguinal area. Also 13 vanished testes were confirmed during surgery examining blind end of spermatic vessels and vasa. Two patients with intersex ( true hermaphroditism and hernia uteri inguinalis) were presented as unilateral impalpable testes. 42 testes were brought down surgically utilizing regular orchiopexy in 26 testes, transabdominal orchiopexy in 8 testes, Fowler-Stephens orchiopexy in 7 testes and staged orchiopexy in 1 testis were done with acceptable results. transabdominal approach is recommended in cases of suspecting intraabdominal testis or intersex.

Clinical Observation on Intrascrotally Impalpable Testis / 대한비뇨기과학회지

A clinical observation was made on 143 cases of Intrascrotally impalpable testis seen in Department of Urology, Han Yang University Hospital during the period from May, 1972 to June, 1983. The following results were obtained. 1. Patient`s ranged in age from 10 months to 42 yrs. age. and only 33 cases (23.1%) visited our hospital under 4 yrs. age. 2. 105 cases(75.3%)had unil. involvement & right side was more frequently affected. Bilaterality was noted 34 cases(23.7%). 3. Among 177 exploration, most popular type was prepubic in 71 testes(40.1%) and also 4 cases of anarchism & vanished testis were noted. 4. Chromosomal study was done on 4 cases and all cases yielded 46XY, cytogenetically normal man. 5. Inguinal hernia sac was found in 151 cases(87.2%). 6. Semen analysis was performed on 7 post-pubertal cases and all 3 cases of bil. intrascrotally impalpable testis revealed azoospermia. 7. Pathologic findings of 13 cases were evaluated on the basis of presence of spermatogonia, spermatogenic activity, atrophy of seminiferous tubules, interstitial fibrosis, thickening of B. M. 8. Orchiopexy was performed on 166 cases(93.7%), orchiectomy on 7 cases(4%) and open & closure on 4 cases(2.3%). 9. 2 cases of wound infection & 1 case of testicular atrophy with necrosis was noted.