Laparoscopic Approach to Nonpalpable Testis
Treatment plan for nonpalpable testis (NPT) is made according to findings of physical examination and laparoscopic exploration. Preoperative radiological evaluation is not routinely needed. The testis in inguinoscrotal region may not be palpated due to size and consistency of the testis or patient’s condition. Reexamination and confirmation of NPT under general anaesthesia is needed. Surgery should be started to plan at the age of 6 months. Laparoscopic exploration shows intraabdominal testis or findings of testicular agenesis, inguinal or vanishing testis. Depending on the distance between the testis and the internal ring, primary orchiopexy or Fowler-Stephens (FS) procedure could be performed for intraabdominal testis. A testis within 2 cm of the internal ring can be brought down without vessel division. If the testis is high and spermatic vessels need to be divided, gubernaculum sparing two-stage FS orchiopexy may increase the chance of testicular survival.
KeywordsNonpalpable testis Laparoscopy Orchiopexy Fowler-stephens Children
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