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Laparoscopic evaluation and management of nonpalpable testis in children
1Department of Pediatric Surgery, Assaf Harofeh Medical Center, The Sackler School of Medicine, Tel-Aviv University, Zerifin, Israel. gadlotan@hotmail.com
Insights
Laparoscopic surgery for nonpalpable testes in children is highly effective. This minimally invasive approach offers superior outcomes compared to open surgery, with lower complication rates and shorter hospital stays.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Undescended testes, or cryptorchidism, affect a significant number of pediatric patients.
- Nonpalpable testes present unique diagnostic and management challenges.
- Laparoscopy has emerged as a valuable tool in evaluating and treating these conditions.
Purpose of the Study:
- To evaluate the outcomes of laparoscopic management for nonpalpable testes in children.
- To assess the efficacy and safety of laparoscopic techniques, including the Fowler-Stephens procedure.
Main Methods:
- Retrospective review of 109 boys aged 12 months to 14 years with nonpalpable testes over a 6-year period.
- Diagnostic laparoscopy to identify testicular location and viability.
- Laparoscopic orchiopexy or orchiectomy as indicated, including the Fowler-Stephens procedure.
Main Results:
- Diagnostic laparoscopy identified intra-abdominal testes in 54.1% of patients.
- Orchiectomy was performed in 45.8% due to atrophic testicles.
- Successful laparoscopic orchiopexy, including single-stage procedures for testes near the inguinal ring, resulted in good outcomes with only 3.4% experiencing post-operative testicular atrophy.
Conclusions:
- Laparoscopic management of nonpalpable testes is the current "state of the art" in pediatric urology.
- This approach demonstrates superior results regarding morbidity, complication rates, and hospital stay compared to open techniques.
Abstract:
We evaluated the outcome of children with nonpalpable testis managed and treated laparoscopically in our department over a 6-year period. One hundred nine boys aged 12 months to 14 years were included in the study; most were between the ages of 12 months and 18 months. Diagnostic laparoscopy and eventual orchiectomy were performed in 50 patients (45.8%) with atrophic testicles. A normal sized intraabdominal testicle was found in 59 patients (54.1%). Seven of the intra-abdominal testicles were bilateral (6.4%), and 12 were located in the vicinity of the inguinal ring (11%). All patients underwent both the first and second stages of the Fowler-Stephens procedure, except for those whose testicles were located in the vicinity of the internal inguinal ring. They underwent an immediate one-stage laparoscopic-assisted orchiopexy without difficulty. Only two patients had atrophic testicles observed in the scrotal area after the complete Fowler-Stephens procedure (3.4%). The good results reported in most series establish the laparoscopic management of the nonpalpable testis as "state of the art," with results superior to those obtained with the open technique regarding morbidity, complication rate, and length of hospital stay.