Scrotal exploration for unilateral nonpalpable testis.

Area of Science:

• Pediatric Surgery
• Urology
• Andrology

Background:

• Unilateral nonpalpable testis (UNPT) diagnosis often requires surgical exploration.
• Previous approaches involved initial scrotal exploration followed by laparoscopy if a viable testis was not found.
• The decision to proceed to laparoscopy was influenced by the knowledge that it would be performed regardless of initial findings.

Purpose of the Study:

• To evaluate the utility of scrotal exploration as a primary diagnostic tool for UNPT.
• To determine the indications for performing laparoscopy in cases of UNPT.
• To assess the effectiveness of scrotal exploration in managing extra-abdominal testes and nubbins.

Main Methods:

• A series of consecutive patients with UNPT underwent initial scrotal exploration.
• Laparoscopy was selectively performed only when scrotal findings were inconclusive, such as absent nubbins/testes, patent processus vaginalis, or ambiguous nubbin appearance.
• Contralateral descended testicular length was measured.

Main Results:

• Out of 43 patients, 30 (70%) had monorchism and 13 (30%) had an extra-abdominal or intra-abdominal testis.
• Laparoscopy was performed in only 7 (23%) of the 30 monorchism cases.
• A contralateral descended testicular length of ≥1.8 cm strongly predicted monorchism.

Conclusions:

• Scrotal exploration can definitively diagnose and manage extra-abdominal testes and nubbins in UNPT patients.
• Laparoscopy is primarily indicated for identifying intra-abdominal testes, which are found in a minority of cases.
• Selective use of laparoscopy streamlines the diagnostic pathway for UNPT.