Impalpable Testes: An Experience of 97 Surgically Corrected Cases

Lee, Dong Hyoung; Kim, Kwang Sae

Abstract

PURPOSE: We analyzed our experience of surgically corrected impalpable testes to evaluate our results and to determine the best possible surgical approach for impalpable testes.
MATERIALS AND METHODS
Medical records of 97 boys who had undergone surgery for impalpable testes were reviewed with respect to the age at presentation, localization procedure, surgical approach, testicular location and volume. Minimal follow-up was 6 months.
RESULTS
The average age at presentation was 47.7 months. Surgical locations of testes included preperitoneum in 46 testes, intraabdomen in 18 testes and inguinal canal in 1 testis. Fifty-three testes were absent at exploration. Surgical procedures consisted of 59 orchiopexies, 53 excision of blind-ended spermatic vessel and 6 orchiectomies. The average volume of abdominal testes was reduced to 44.0% of contralateral normally descended testicular volume. Compensatory hypertrophies were seen in 45 contralateral testes among 53 unilateral absent testes. The inguinal exploration was successful in defining the location of all the testes in the last 41 consecutive boys. Laparoscopy did not help to avoid surgical exploration. Of 38 impalpable testes at office examination, 18 testes turned out to be palpable when examined under anesthesia while ultrasonography detected 14 testes with 1 false positive finding. Of 51 regular orchiopexies 49 testes showed excellent or acceptable results. Of 8 Fowler-Stephens orchiopexies 3 testes resulted in atrophies.
CONCLUSIONS
Most pexed impalpable testes showed successful results in terms of testicular position and growth. However, there were more testicular atrophies in cases whose spermatic vessels were ligated. Inguinal exploration with or without intraperitoneal extension was successful in the management of impalpable testes in this series.