Laparoscopy as an indispensable tool for management of the inpalpable testis: a 5-year experience

ABSTRACT

Cases of impalpable testis, for whom laparoscopy was planned in a 5-year period, were reviewed. Careful physical examination was routinely done after the induction of anesthesia, before committing to laparoscopy. Testis position and quality, the character of the vas deferens and spermatic vessels, type of management and contribution of laparoscopy were recorded. Testes were classified into five laparoscopic types Type 0, intra-abdominal vanishing testis; type 1, intracanalicular, with the vessels and vas near normal or slightly reduced in size [type Ia] or grossly attenuated or atretic [type Ib]; type II, testis lies at the internal ring with the vessels and vas looping into the internal ring; type III, testis lies at or slightly above the internal ring with the vessels and vas going directly to the testis and type V, intra-abdominal testis not related to or more than 2.5 cm from the internal ring. One hundred and sixty-six patients with 193 impalpable testes at their initial physical evaluation were identified between Marsh 1997 and 2002. In 18 patients, 22 testes were found under anesthesia. Laparoscopy was conducted in 148 patients with 171 impalpable testes. Laparoscopy was informative on testis position in all cases. It allowed avoiding unnecessary exploration of 19.3% and executing the definitive surgical management of 34% of the impalpable testes and performing preliminary procedures for 21% of them in preparation for their definitive management