Therapeutic Laparoscopy for Impalpable Testis

Lee, Ahnkie; Yun, Jong Min; Park, Moon Soo; Choi, Hwang

Abstract

Management of impalpable testis is one of the most controversial issues in cryptorchidism. There is wide variation in approach to this subset of patients. In the child with an impalpable testis, laparoscopy is increasingly used as the diagnostic study of choice. We have recently extended its value by using it as a therapeutic tool. Ten laparoscopic surgical procedures were performed in 10 patients with 12 intra-abdominal testes. In 2 adults with a small intra-abdominal testis and normal contralateral testis, laparoscopic orchiectomy was performed. In 3 patients with 5 intra-abdominal testes, the first phase of two-stage Fowler-Stephens orchiopexy was performed. These patients underwent an open surgical procedure three or four months later. In 3 patients, one stage orchiopexy was performed without dividing the spermatic vessels. In 2 Patients these testes could be mobilized after division of the spermatic vessels (laparoscopic one-stage Fowler-stephens orchiopexy). follow-up ranged from 3 months to 35 months (mean 16.8 months). At follow up 9 of 10 testes (90%) are in the scrotum without atrophy, while 1 (10%) is atrophic. Our early results suggest that increased experience will allow laparoscopic surgery to be a valuable option in the treatment of impalpable testis