Abstract

Introduction: Laparoscopic techniques were introduced as alternatives to many open urologic procedures. In pediatric urology, one of the main applications of laparoscopy is the evaluation and treatment of nonpalpable testis. We are presenting our initial experience with laparoscopy in patients with nonpalpable testis.

Materials and Methods: Laparoscopy was performed under general anesthesia on 10 patients from December 2000 to July 2001. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected. Laparoscopic orchiopexy or orchiectomy was performed in cases with intra-abdominal testis. If the internal spermatic vessels terminated within blind end intraperitoneally, making it impossible to identify the testis, the case was judged to be vanishing testis.

Results: Ten boys, aged from 18 months to 25 years (median 9.8 years) were identified with 17 nonpalpable testes. Of 17 nonpalpable testes, in 11 the vas and vessels entered an open internal ring. The inguinal region was explored in all the 11 testes. Orchiopexy was performed on 10 testes and orchiectomy was performed on one testis. Four of 17 testes were intra-abdominal. Laparoscopic orchiopexy was performed in two testes and laparoscopic orchiectomy was performed in two testes. In one boy with bilateral nonpalpable testes neither vas and vessels nor testes were visualized and this case was diagnosed as vanishing testis.

Conclusion: Diagnostic laparoscopy is a very helpful minimally invasive technique in the diagnosis of nonpalpable testes especially when ultrasonography and/or computed tomography are not informative. In addition, orchiectomy and orchiopexy can be done as laparoscopically in the patients with intraabdominal testes. Therefore, the laparoscopy has an important role in the diagnosis and treatment of nonpalpable testes.