[ role of laparoscopy in the diagnosis and treatment of undescended testis]

ABSTRACT

Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and torsion and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. Many Radiological methods in addition to surgical exploration have been used to localize the non-palpable testis. In these cases, the laparoscopic technique is a usefull method for diagnosis and treatment. Prospective study. From 2005 to 2010, 59 children between 2- 13 years [median age 4 years] were admitted to our department in Assad and Mwassat hospitals with the diagnosis of nonpalpable testis, 7 of them have bilateral cryptorchidism [66 testicles in total]. Laparoscopy was done for all these patients using 30 degree optic through 5 mm sub umbilical port, 2 additional 5 mm ports were used when necessary as working channels. Direct orchiopexy was done for 10 testicles [15.15%] as laparoscopy indicated that the testicle are located in the inguinal canal, orchiectomy was done for atrophic testis via laparoscopy or inguinal approach in 11 cases [16.16%]. In 14 cases [21.21%] the testicles were absent. In the remaining 31 cases [46.96%] the testicular vessels were clipped [first stage-Stephen Fowler], and orchiopexy was postponed for 6 months. During the second stage all testicles were found viable, except for an atrophied one that we excised, and were brought down freely to the scrotum with a peritoneal patch covering the vas. Laparoscopy is now considered to be the gold standard in the diagnosis and management of nonpalpable ectopic testis. The accuracy of radiological means in locating the nonpalpable testis do not reach 100% except for the selective angiography which is an invasive procedure, while laparoscopy is characterized by the possibility of diagnosis and management at the same time. Compared with the surgical exploration, laparoscopy is preferred in managing nonpalpable testis