Is laparoscopic re-evaluation justified in cryptorchidism with previous negative open exploration?

Nonpalpable testes account for 20% of cryptorchidism. Laparoscopy is now the mainstay in management, but open surgery has been the only option for many patients in the past and even today. We suspected that open exploration may have missed gonads in presumed negative open exploration. As abdominal gonads are even more prone to cancerous degeneration, we proposed laparoscopic re-evaluation to patients with previous inconclusive open exploration for impalpable testis.

All boys presenting to our referral center with past history of inconclusive open exploration for nonpalpable testis or with clinical or lab evidence of functional testicular tissue were consecutively offered laparoscopic re-exploration. Standard diagnostic laparoscopy with same-stage laparoscopic orchiopexy or one stage Fowler procedure was employed as required. The presence, number, and site of detected gonads were recorded.

141 male patients with nonpalpable testis comprising 171 nonpalpable gonads were laparoscopically explored with no adverse events. Sixteen patients (19 gonads) already had a negative open exploration. Seven gonads were discovered in these boys, 5 iliac and 2 retrovesical.

Although a modest number of samples, our results underscore the prevalence of missed diagnosis. Obviously, laparoscopic re-exploration is indicated when a child with previous bilateral inguinal exploration presents with hormonal evidence of functioning gonadal tissue. Further we now recommend laparoscopic re-evaluation in most patients with nonpalpable testis and history of negative open exploration altogether.