Korean J Urol.  2010 Feb;51(2):106-110.

Laparoscopic Orchiopexy for a Nonpalpable Testis

• Kim J
• Min GE
• Kim KS

Abstract

PURPOSE: We evaluated the efficacy and the availability of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied outcomes including the testicular survival rate and associated complications.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 67 children (86 testicular units) who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis between 1996 and 2008. The mean patient age was 2.4 years (median, 1 year; range, 0.5-9 years), and the mean follow-up period was 21.8 months (range, 0.3-138.4 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months.
RESULTS
Of 86 testes, 69 testes were treated with primary laparoscopic orchiopexy (PLO) sparing the internal spermatic vessel, 14 testes were treated with one-stage Fowler-Stephens laparoscopic orchiopexy 1, and 3 testes were treated with two-stage Fowler-Stephens laparoscopic orchiopexy 2. The testicular survival rates were 97.7% (84/86) within 1 month and 93.7% (59/63) beyond 3 months. Of 59 viable testes followed up beyond 3 months, 48 (81.4%) testes were positioned in the lower scrotum and 11 (18.6%) testes in the mid to high scrotum.
CONCLUSIONS
Laparoscopic orchiopexy was successful for a nonpalpable intra-abdominal testis with a high testicular survival rate irrespective of the location from the internal ring. However, atrophy of the testis or upward migration of the testis can occur during follow-up, so we suggest watchful, periodic follow-up evaluating the viability and location of orchiopexed testes that are located in the lower scrotum in the immediate postoperative period or during short-term follow-up.

Keyword

Testis; Laparoscopy

MeSH Terms

Atrophy
Child
Follow-Up Studies
Glycosaminoglycans
Humans
Laparoscopy
Medical Records
Orchiopexy
Postoperative Period
Retrospective Studies
Scrotum
Survival Rate
Testis
Glycosaminoglycans

Reference

1. Scorer CG. The descent of the testis. Arch Dis Child. 1964; 39:605–609. PMID: 14230757.

2. Levitt SB, Kogan SJ, Engel RM, Weiss RM, Martin DC, Ehrlich RM. The impalpable testis: a rational approach to management. J Urol. 1978; 120:515–520. PMID: 30847.

3. Choi K, Park T, Kim KS. Laparoscopic orchiopexy for intra-abdominal testis: complications and technical aspects. Korean J Urol. 2000; 41:420–424.

4. Baker LA, Docimo SG, Surer I, Peters C, Cisek L, Diamond DA, et al. A multi-institutional analysis of laparoscopic orchidopexy. BJU Int. 2001; 87:484–489. PMID: 11298039.

5. Lee A, Yun JM, Park MS, Choi H. Therapeutic laparoscopy for impalpable testis. Korean J Urol. 1997; 38:848–854.

6. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano FP. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy. 1976; 8:33–34. PMID: 16743.

7. Jordan GH, Robey EL, Winslow BH. Laparoendoscopic surgical management of the abdominal/transinguinal undescended testicle. J Endourol. 1992; 6:157–161.

8. Samadi AA, Palmer LS, Franco I. Laparoscopic orchiopexy: report of 203 cases with review of diagnosis, operative technique, and lessons learned. J Endourol. 2003; 17:365–368. PMID: 12965060.

9. Lindgren BW, Darby EC, Faiella L, Brock WA, Reda EF, Levitt SB, et al. Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis? J Urol. 1998; 159:2132–2135. PMID: 9598558.

10. Lintula H, Kokki H, Eskelinen M, Vanamo K. Laparoscopic versus open orchidopexy in children with intra-abdominal testes. J Laparoendosc Adv Surg Tech A. 2008; 18:449–456. PMID: 18503383.

11. Chang M, Franco I. Laparoscopic Fowler-Stephens orchiopexy: the Westchester Medical Center experience. J Endourol. 2008; 22:1315–1319. PMID: 18484895.

12. Elder JS. Two-stage Fowler-Stephens orchiopexy in the management of intra-abdominal testes. J Urol. 1992; 148:1239–1241. PMID: 1357193.