Impalpable cryptorchidism--a review of 170 testes

The diagnosis and treatment of cryptorchidism are continuously straightforward except impalpable testis. Preoperative diagnosis and surgical plans of impalpable testis are controversial. In this study, we evaluated our results of treating patients with impalpable testes.

One hundred and fifty patients with 170 impalpable testes are retrospectively reviewed. The preoperative diagnostic modalities, preoperative localization, operative findings and methods and operative results are analyzed. The operated testes are evaluated and followed for at least 6 months after operation.

Preoperative localization could be achieved in 120 testes (70.6%) by image studies (111 by ultrasound, 6 by computed tomography and 3 by magnetic resonance image) and was completely compatible with operative localization. Operative localization for the other 50 testes was done by exploration with laparoscopic assistance in 25. Vanished testis or testicular remnant was noted in 37 testes (21.8%) and the locations of viable testes were prescrotal in 24 (14.1%), canalicular in 86 (50.6%) and abdominal in 23 (13.5%). Preoperative ultrasound could find 96.3% (106/110) of viable testes located in prescrotal and canalicular area, but only 21.7% (5/23) in abdomen. Laparoscopic assistance is very useful of localizing intraabdominal testes and confirming vanished testes. Orchiopexy was done in 126 viable testes (94.7%) by one-stage in 120 testes and two-stage in 6. Post-operative testicular atrophy was noted in 6 testes.

Most of the impalpable viable testes located in prescrotal and canalicular could be detected by ultrasound. Laparoscopic examination can avoid unnecessary exploration. Excluding vanishing and severe atrophic testes, about 90% of impalpable testes can be saved with orchiopexy, mostly by one-stage operation.