Skip to main content
SpringerLink
Log in

Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the role of initial laparoscopy and optimized approach in cases of unilateral nonpalpable testis.

Methods

Seventy-four patients with nonpalpable testes were presented. We excluded 9 patients, with palpable testes under anesthesia. Laparoscopy was offered to 65 patients. Contralateral testis hypertrophy with length ≥ 1.8 cm was confirmed in 47 patients. Ultrasound results were available for 35 patients.

Results

Age ranged from 1 to 10 years. Of 65 nonpalpable testes, right side comprised 23 (35.4%) and the left 42 (64.6%). Laparoscopy revealed intra-abdominal testis in 18 patients (27.7%), blind-ending vessels and vas in 8 (12.3%), and vas and vessels traversing the internal ring in 39 (60%). Treatment of intra-abdominal testes included Fowler–Stephens orchiopexy in 7 patients, laparoscopic orchiopexy in 9, and laparoscopic orchiectomy in 2. In 8 patients with blind-ending vas and vessels, laparoscopy was terminated. In 39 patients with vas and vessels traversing the internal ring, scrotal exploration was performed in 36 patients with closed internal ring and inguinal exploration in 3 with open internal ring. Vanished testes were present in 43/47(91.5%) of patients with contralateral testis hypertrophy ≥ 1.8 cm. Ultrasound detected the presence of a testis in only 4/11 (36.3%) of patients, although it could not identify vanished testis.

Conclusions

Initial laparoscopy should be retained as one of the standard treatment for nonpalpable testis. It was the only required modality in 26 patients (40%) and optimized further treatment in 39 patients (60%) by evaluation of the condition of the internal ring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Scorer CG (1964) The descent of the testis. Arch Dis Child 39:605–609

    Article  CAS  Google Scholar 

  2. Acerini CL, Miles HL, Dunger DB, Ong KK, Hughes IA (2009) The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort. Arch Dis Child 94:868–872

    Article  CAS  Google Scholar 

  3. Moore RG, Peters CA, Bauer SB, Mandell J, Retik AB (1994) Laparoscopic evaluation of the nonpalpable tests: a prospective assessment of accuracy. J Urol 151:728–731

    Article  CAS  Google Scholar 

  4. Radmayr C, Oswald J. Scwentner C, Neururer R, Peschel R, Barstsch G (2003) Long-term outcome of laparoscopically managed nonpalpabple testes. J Urol 170:2409–2411

    Article  Google Scholar 

  5. Ismail K, Ashour M, El-Afifi M, Hashish A, El-Dosouky N, Nagm M et al (2009) Laparoscopy in the management of impalpable testis: series of 64 cases. World J Surg 33:1514–1519

    Article  Google Scholar 

  6. Papparella A. Romano M, Novielle C, Cobellis G, Nino F, Monaco D et al (2010) The value of laproscopy in management of nonpalpable testis. J Pediatr Urol 6:550–554

    Article  CAS  Google Scholar 

  7. Park H, Park YH, Park K, Choil H (2011) Diagnostic laparoscopy for the management of impalpable testes. Korean J Urol 52:355–358

    Article  Google Scholar 

  8. Snodgrass WT, Chen K, Harrison C (2004) Initial scrotal incision for unilateral nonpalpable testis. J Urol 172:1742–1745

    Article  Google Scholar 

  9. Snodgrass WT, Yucel S, Ziada A (2007) Scrotal exploration for unilateral nonpalpable testis. J Urol 178:1718–1721

    Article  Google Scholar 

  10. Bae KH, Park JS, Jung HJ, Shin HS (2014) Inguinal approach for the management of unilateral non-palpable testis: is diagnostic laparoscopy necessary? J Pediatr Urol 10:233–236

    Article  CAS  Google Scholar 

  11. Kenemoto K, Hayashi Y, Kojima Y, Tozawa K. Mogami T, Kohri K (2002) The management of nonpalpable testis with combined groin exploration and subsequent transinguinal laparoscopy. J Urol 167:674–676

    Article  Google Scholar 

  12. Hurwitz RS, Kapten JS (2001) How well does contralateral testis hypertyrophy predect the absence of the nonpalpable testis? J Urol 165:588–592

    Article  CAS  Google Scholar 

  13. Hasson HM (1971) A modified instrument and method for laparoscopy.Am. J Obstet Gynecol 110:886–887

    Article  CAS  Google Scholar 

  14. Fowler R Jr, Stephens FD (1959) The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Zeal J Surg 29:92

    Article  CAS  Google Scholar 

  15. Cisek LJ, Peters CA, Atala A, Bauer SB, Diamond DA, Retik AB (1998) Current findings in diagnostic laparoscopic evaluation of the nonpalpable testis. J Urol 160:1145–1149

    Article  CAS  Google Scholar 

  16. Zakaria OM, Hokka E, El Kadi KE, Al Buali WH, Zakaria HM, Daoud MY et al (2013) Examination under anesthesia for management of impalpable undescended testis: A traditional technique revisited. World J Surg 37:1125–1129

    Article  Google Scholar 

  17. Breyer BN, DiSandro M, Baskin LS, Hsieh MH (2009) Obesity does not decrease the accuracy of testicular examination in anesthetized boys with cryptorchidism. J Urol 18:830–834

    Article  Google Scholar 

  18. Tasian GE, Yiee JH, Copp HL (2011) Imaging use and cryptorchidism: determinants of practice Patterns. J Urol 185:1882–1887

    Article  Google Scholar 

  19. Tasian GE, Copp HL (2011) Diagnostic performance of ultrasound in nonpalpable cryptorchidism: a systematic review and meta-analysis. Pediatrics 127:119–128

    Article  Google Scholar 

  20. Kantarci M, Doganay S, Yalcin A et al (2010) Diagnostic performance of diffusion-weighted MRI in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings. AJR Am J Roentgenol 195:W268–W273

    Article  Google Scholar 

  21. Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086

    Article  Google Scholar 

  22. Kolon TF, Herndon A, Baker LA, Baskin LS, Baxter CG, Cheng EY et al (2014) Evaluation and Treatment of Cryptorchidism: AUA Guideline. J urol 192:337–345

    Article  Google Scholar 

  23. Ueda N, Shiroyanagi Y, Suzuki H, Kim WJ, Yamazaki Y, Tanaka Y (2013) The value of finding a closed internal ring on laparoscopy in unilateral nonpalpable testis. J Pediatr Surg 48:542–546

    Article  Google Scholar 

  24. Elder JS (1994) Laparoscopy for impalpable testes: significance of the patent processus vaginalis. J Urol 1523:776–778

    Article  Google Scholar 

  25. Belman AB, Rushton HG (2001) Is the vanished testis always a scrotal event? BJU Int 87:480–483

    Article  CAS  Google Scholar 

  26. Yamazaki Y, Suzuki M, Shiroyanagi Y, Matsunol D, Tanaka Y (2009) Scrotal nubbins associated with blind-ending spermatic vessels and a normal vas deferens on laparoscopy. Int J Urol 16:902–904

    Article  Google Scholar 

  27. Koff S (1991) Does compensatory testicular enlargement predict monorchism? J Urol 146:632–633

    Article  CAS  Google Scholar 

  28. Braga LH, Kim S, Farrokhyar F, Lorenzi AJ (2014) Is there an optimal contralateral testicular cut- off size that predicts monorchism in boys with nonpalpable testicles? J Pediat Urol 14:693–698

    Article  Google Scholar 

  29. Laron Z, Dickerman Z, Ritterman I (1980) Follow-up of boys with unilateral compensatory testicular hypertrophy. Fertil Steril 33:297–301

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Urology Department, School of Medicine, University Hospital, 61111, Minia, Egypt

    Ahmed Zaki Mohamed Anwar, Tarek Khalaf Fathelbab, Amr Mohamed Abdelhamid, Ehab Mohmed Galal, Mostafa Magdi Ali & Ehab Rifat Tawfiek

Authors
  1. Ahmed Zaki Mohamed Anwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tarek Khalaf Fathelbab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amr Mohamed Abdelhamid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ehab Mohmed Galal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mostafa Magdi Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ehab Rifat Tawfiek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tarek Khalaf Fathelbab.

Ethics declarations

Conflict of interest

None of the contributing authors has any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Ethical approval

The study was approved by the Departmental ethics committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anwar, A.Z.M., Fathelbab, T.K., Abdelhamid, A.M. et al. Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience. Int Urol Nephrol 50, 2139–2144 (2018). https://doi.org/10.1007/s11255-018-2006-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-018-2006-7

Keywords

Search

Navigation