Role of laparoscopy in management of the impalpable testis

ABSTRACT

The impalpable testis may be a real problem in its diagnosis as well as in its treatment. This study was done for 25 boys having 28 impalpable testes [3 bilateral] through 4 years duration. Their ages ranged from 2-18 years. Preoperative ultrasonography was accurate in 25% only. At laparoscopy; 10 testes were intra abdominal, two of which were atrophied and were excised. Of the remaining 8 testes; the vessels were short in 6; which were managed by 2 stage Fowler-Stephen procedure. The first stage was by proximal clipping and transaction of the vessels. After six months the second stage of testicular descent was done; surgically in 3 testes and laparoscopically assisted in the other 3. In two abdominal testes the vessels were long, these together with 5 peeping inguinal testes were managed by one stage laparoscopic orchiopexy. When no testis was detected abdominally, inguinal exploration was done we found 13 testes; 7 were atrophic and were excised and biopsed, in the 6 viable testes surgical orchiopexy was done. Biopsy was done from the 3 viable testes of those patients above the age of 12, no malignancy was detected. In the excised [9] atrophic testes; no parenchymatous testicular tissue was detected. Follow up for 6 months revealed normal sized testes except in one of the cases managed by surgical 2[nd] stage Fowler-Stephens orchiopexy. From this study it is concluded that, laparoscopy is a very good procedure for accurate diagnosis of the impalpable testis. It is also of great value in treatment of the intraabdominal testis. It is preferred to use it in the 2[nd] stage of Fowler-Stephens operation. Health education about the complication of the undescended testis is very important because most of our patients are older than the proper age for testicular descent