laparoscopic management of the impalpable testicle: could it be the standard procedure?

ABSTRACT

From August 1998 to Jane 2001, we managed 19 patients aged 3 4-28 [mean 21] years with unilateral impalpable testicles [8 right and 11 left]. Inguinal ultrasonography [US] was done to- all patients pre-operatively and one inguinal testicle was detected. Examination under anaesttesia detected another inguinal testicle. Open trans-inguinal ororchidopexy was done for both. The remaining 17 patients were all subjected tolaparoscopy with diagnostic and therapeutic intentions 7 intra-abdominal non-atrophic testicles with long tortuous testicular vessels were managed by laparoscopic one-stage orchidopexy with preservation of testicular vessels. Two intra-abdominal non-atrophic testicles with short direct testicular vessels were managed by laparoscopic two-stage Fowler-Stephens [F-S] procedure at six-month interval. One intra-abdominal atrophic testicle was managed by laparoscopic orchidectomy. One intra-abdominal blind-ending vas deferens needed no further management In 6 patients the vas and vessels were seen entering the internal inguinal ring and inguinal exploration was done at the same setting with the following results; 2 non-atrophic testicles were managed by orchidopexy, 3 atrophic testicles were managed by orchidectomy and one blind-ending vas needed no further management. Among our 19 patients, there were 7 epsilateral hernial sacs, Which were managed by inguinal hernia repair at the same operative setting without recurrences at 6-month follow-up, Laparoscopic localization of testicular position was 100% successful. The success rate of laparoscopic orchidopexy [7 one-stage and 2 two-stage F-S] was 89%, which was defined as scrotal testicular position without atrophy at 6 months follow-up. Apart from one minor self-limited subcutaneous emphysema, laparoscopic procedures were not attended by complications. Our study confirms the safety and efficacy of laparoscopic diagnosis and therapy of impalpable testicles in adults