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Laparoscopic-assisted management of impalpable testis in patients older than 10 years
Ahmed Khan Sangrasi1, Abdul Aziz Laghari, Mujeeb Rehman Abbasi
1Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan. ahmedsangrasi@hotmail.com
Insights
Laparoscopic surgery offers a safe and effective solution for managing undescended testes (cryptorchidism) in older children and adults. This technique successfully treated impalpable testes, including intraabdominal cases, with minimal complications.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Surgery
Background:
- Cryptorchidism, or undescended testis, affects 1% of male births.
- While often treated in childhood, neglected cases present in older individuals, particularly in developing countries.
- Management of impalpable testes in adolescents and adults poses unique surgical challenges.
Purpose of the Study:
- To evaluate the initial experience of managing impalpable testes in older children and adults using laparoscopic assistance.
- To assess the safety and efficacy of laparoscopic techniques for locating and treating undescended testes in this patient population.
Main Methods:
- Diagnostic laparoscopy was performed on 32 patients with 40 impalpable testes.
- Laparoscopic-assisted orchiopexy or orchiectomy was employed for intraabdominal testes.
- Mobilization of testicular vessels and vas deferens allowed for repositioning through a neo-inguinal ring.
Main Results:
- Laparoscopy successfully localized 90% of impalpable testes, with 75% identified as intraabdominal.
- Single-stage laparoscopic-assisted orchiopexy was performed in 40% of cases, while laparoscopic orchiectomy was done in 35%.
- No major complications were reported; associated hernias were repaired concurrently.
Conclusions:
- Laparoscopic-assisted single-stage orchiopexy is a safe and effective treatment for intraabdominal testes in older patients.
- The technique facilitates tension-free scrotal fixation by shortening the spermatic cord.
- Laparoscopy provides a valuable approach for managing complex cases of undescended testis in adolescents and adults.
Objective:
Cryptorchidism affects 1% of male births. The majority of patients with undescended testis are identified and treated in childhood, but a significant proportion of them especially in third-world countries are neglected and present late. Herein, we present our initial experience of managing impalpable testis in older children and adults with laparoscopic assistance.
Patients And Methods:
This study was conducted from 2003 through 2008 at LUMHS Jamshoro. Thirty-two patients with 40 impalpable testes were included in this study. Diagnostic laparoscopy was performed in 32 anesthetized patients. Laparoscopic-assisted orchiopexy or orchiectomy was performed in patients with intraabdominal testis. Testicular vessels and vas deferens were mobilized and after obtaining sufficient length were brought through the posterior wall of the inguinal canal by creating a neo-inguinal ring medial to the epigastric vessels after a small inguinal incision.
Results:
Of 40 impalpable testis, ultrasound localized 16 (40%) of them, and on laparoscopy, 36 (90%) were localized, 30 (75%) as intraabdominal and in 6 (15%) cases vas and vessels were entering into the internal inguinal ring (intracanalicular). The remaining 4 patients were diagnosed as having vanishing testis (anorchia). Laparoscopic orchiectomy was performed in 14 (35%) of these testes, while single-stage laparoscopic-assisted orchiopexy using Prentiss' maneuver was performed in 16 (40%) testis. No major complications occurred. Seven testes were associated with ipsilateral hernias and were simultaneously repaired laparoscopically.
Conclusion:
Laparoscopic-assisted single-stage orchiopexy is a safe and successful procedure for intraabdominal testis in adolescents and older patients. The additional benefit of shortening the usual course of spermatic cord was beneficial to fix the testis in the scrotum without tension.
